A filing fee is required for an application proposing Substantial Capital Expenditure and/or Substantial Change in Services. The fee is 1/10 of 1% of the proposed capital expenditure, but no less than $250. The filing fee is refunded only if the application has been rejected.
Requests for determination of need are submitted in the form of a DoN Application Kit prepared by the DoN Program. The Kit includes general instructions, An Affidavit of Truthfulness and Proper Submission, an application narrative, and the nine factors applied in determinations of need. Each factor has a list of standards and criteria which must be completed in conjunction with DoN guidelines for the project proposed. The nine review factors based on DoN regulations include: Health Planning Process, Health Care Requirements, Operational Objectives, Standards Compliance, Financial Feasibility ( eight financial schedules), Reasonableness of Expenditures and Costs, Relative Merit, Environmental Impact, and Community Health Service Initiatives (financial contribution based on a percentage of the capital cost or operating cost for prevention and primary services in the service area). Nursing homes are currently exempt from Community Health Service Initiatives.
Processing Applications, Review and Action
The original application and two copies are submitted to the DoN Program Director and, prior to or at the same time of submission, a copy of the application is submitted to the Division of Health Care Finance and Policy, Division of Medical Assistance, and to the appropriate Regional Health Office. Two copies of the application are also submitted to the Department of Mental Health if it concerns mental health and to the Executive Office of Elder Affairs if it involves long term care for the elderly. All applications are subject to completeness review within 30 days of submission. The application is accepted for review if the filing requirements as indicated in the DoN regulations are met. If there are deficiencies, applicants, at the discretion of the Program Director, are a given a reasonable opportunity to correct them. Failure to correct the deficiencies will result in rejection of the application. Applications are designated comparable if they are filed within the same filing period, propose similar or reasonably interchangeable health care services for the same service areas. Comparable applications are reviewed and acted upon at the same time. If an application is amended it loses its comparability status.
Citizens of the Commonwealth of Massachusetts can form a ten taxpayer group(s) as a party of record to comment and request a public hearing on applications for projects proposed in their community. Other parties of record include state agencies concerned about the service under consideration or project costs. Actions on applications are usually by Delegated Review approved by the Commissioner, or by the Public Health Council if there is disagreement among the applicant, Program staff and or the parties of record about the project. To receive approval, applications must meet the nine factors of DoN review and relevant DoN guidelines.
Filing Dates for Applications
Any business day - applications for acute care hospital projects other than innovative services or new technology, emergency applications, unique applications and applications for delegated review (fast track review) including applications for the remodeling, renovation, or replacement of convalescent, nursing and rest home projects.
First business days of February and August - applications for innovative services or new technology.
First business day of May 2006 - applications for construction of new convalescent, nursing and rest home projects subject to licensure by the Department of Public Health.
First business day of January - all other applications.
Disaggregation and Substantial Capital Expenditure Prior to a DoN
This information is provided by the Determination of Need (DoN) within the Department of Public Health.