The US Court of Appeals for the Eighth Circuit ruled Tuesday that Iowa’s Certificate of Need Law, which requires health care providers to obtain a permit before opening a new facility, does not violate the Fourteenth Amendment. The court based its ruling on the Slaughter-House Cases and affirmed the lower court’s ruling.

The case arose out of an outpatient facility, Fox Eye Surgery, LLC, which is suing to be able to perform outpatient surgery. The facility was denied the Certificate of Need, and they claimed that was a violation of the Fourteenth Amendment.

The court pointed to the need for hospitals to have certificates as well. The certificates must be required of all medical facilities to avoid arbitrary rules for when and what types of medical facilities are required to have certificates.

Finally, the court affirmed Iowa’s right to protect the interest of having full-service hospitals by limiting the number of certificates they award to outpatient surgery facilities.