Overview of Mass General Determination of Need Process
Hospitals work with and report to the Massachusetts Department of Public Health (DPH) on the Determination of Need. The Determination of Need law and regulation governs Health Care Facilities as that term is defined in M.G.L. c 111, § 25B. Under Massachusetts law M.G.L. c. 111, §§ 25C and 51, proposals for a Substantial Capital Expenditure, Substantial Change in Services and Original Licensure as well as many Transfers of Ownership and Changes in Site for Health Care Facilities must be reviewed and approved under the DoN Regulatory scheme.
The purpose and objective of the DoN program is to encourage competition with a public health focus; to promote population health; to support the development of innovative health delivery methods and population health strategies within the health care delivery system; and, to ensure that resources will be made reasonably and equitably available to every person within the Commonwealth at the lowest reasonable aggregate cost. To that end, health care organizations must file a Determination of Need (DoN) application with DPH when capital improvement projects are planned for its facilities. New capital improvement projects (new construction and purchases) must be approved by the state’s Public Health Council, and five percent of expenses must go to community health. DPH has developed requirements and has issued guidelines on how these funds are distributed and monitored.
Massachusetts Department of Public Health, Determination of Need (DoN)
- Factor 6 – 5% of “maximum capital expenditure” for new capital investment
- For projects over $500,000 – 25% of funds must be allocated to statewide fund
- Remainder distributed through a process based on CHNA with community engagement
- The applicant can choose a pooled funding option subject to DPH for approval
- Tier 1 and Tier 2 Funds – An allocation committee needs to be in place to allocate funds
- Annual reports required
What is the purpose of this process?
DPH’s Community Health Initiative (CHI) Program ensures that hospitals fulfill the Affordable Care Act’s and state Attorney General’s regulatory requirement to designate and distribute funds to improve local, community-identified health needs. Funds must address social determinants of health (SDOH) and health equity with an upstream (structural/policy) approach to improving community health.
Active Determination of Need
Mass General's current Determination of Need supports more than $62M in community health investments through the MGH Community Health Impact Funds. Learn more about the funds, priorities, and how to apply.