Overview of the Determination of Need Process

What is the Determination of Need?

Brigham and Women’s Faulkner Hospital works with and reports to the Massachusetts Department of Public Health (DPH). 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.

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.

The DoN program aims 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. In this way the Department hopes to advance the Commonwealth’s goals for cost containment, improved public health outcomes, and delivery system transformation.

Brigham and Women’s Community Health and Wellness director guides this CHI fund process and provides overall input on the hospital’s community health plan.

Brigham and Women’s Faulkner Hospital’s DoN includes the following components:

• Expansion of medical/surgical inpatient beds
• Establishment of an Observation Unit
• Relocation and expansion of the Endoscopy Unit
• Renovation and expansion of imaging
• Shell space

Massachusetts Department of Public Health, Determination of Need (DoN) (1990; updated 2017)

• 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

Brigham and Women’s Faulkner Hospital's Determination of Need

The Community Health Advisory Committee

The CHI Advisory Committee. The CHI Program sets rules on how and who selects areas for funding based on the total CHI funds of a project. For this DoN process, DPH outlines that a CHI Advisory Committee should be created. The Advisory Committee is composed of members representing cross sections of the four priority area neighborhoods (Jamaica Plain, Hyde Park, Roslindale and West Roxbury). Advisory Committee members select priorities and strategies to fund from the triennial Community Health Needs Assessment (CHNA) and Implementation Plan (CHIP).

The Community Health Initiative Advisory Committee is tasked with the following responsibilities:

• Review engagement with residents and community partners from targeted communities for the CHI
• Determine the priorities and strategies for CHI funding based upon the needs identified in the local needs assessment processes. The Committee will ensure that all health priorities and strategies are aligned with the Department of Public Health’s Health Priorities for the DoN Program
• Provide oversight to an evaluator that is selected to carry out the evaluation of CHI-funded projects
• Complete and submit the Health Priorities and Strategies Selection Form for approval by the Department of Public Health
• Conduct a conflict-of-interest disclosure process to determine which members will comprise the Allocation Committee
• Report to the Department of Public Health on the DoN – CHI.

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