A filing fee is required for an application proposing Substantial Capital Expenditure and/or Substantial Change in Services. The fee is 2/10 of 1% (.002) 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 (Updated 3/19/2015) 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, Reasonableness of Expenditures and Costs, Relative Merit, Environmental Impact, and Community Health Initiatives. Nursing homes are currently exempt from Community Health Initiatives.
- DoN Application Kit (Updated 3/19/2015)
- Research Project Notice of Assurance Form
- Form 4 - Capital Cost Estimate
Processing Applications, Review and Action
Applicants for Determination of Need are required to submit one original hard copy as well as a digital copy (searchable PDF file format) of an application to the Determination of Need Program. At the time of submission, one digital copy of the application shall also be submitted to the Health Policy Commission, Center for Health Information and Analysis, Division of Medical Assistance (MassHealth) and the appropriate DPH Regional Health Office. Also, a digital copy of an application pertaining to services to the elderly shall be submitted to the Executive Office of Elder Affairs and one pertaining to inpatient psychiatric services in an acute care hospital shall be submitted to the Department of Mental Health. Although a digital copy is strongly preferred, an applicant may substitute a hard copy of the application for the digital copy. To assure delivery of the required copies, an applicant is strongly advised to confirm the current contact information of each applicable state agency or office prior to submission.
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. 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.
Ten citizens of the Commonwealth of Massachusetts can petition to become a ten taxpayer group with the right to comment or request a public hearing on a DoN application as well as to be copied on all written communications related to the application as a party of record. Other parties of record include state agencies concerned about the service under consideration or project costs. Action on an application is by vote of the Public Health Council or, under certain circumstances, approved by the Commissioner through the delegated review process. To be approved, an application must meet the nine factors of DoN review and relevant DoN guidelines.
Filing Dates for Applications
- First business days of February and August – Applications for establishment of innovative services or new technology.
- Any business day – All other applications
Disaggregation and Substantial Capital Expenditure Prior to a DoN
A health care provider is prohibited from disaggregating components of a capital project into smaller projects for the purpose of appearing to spend less than the expenditure minimum. Moreover, the scope of a DoN application may not include any capital expenditure associated with construction undertaken or capital purchases made prior to DoN approval. A prospective applicant is strongly encouraged to seek the guidance of DoN staff prior to undertaking a capital project or purchase that may be subject to DoN regulation to avoid the possibility of incurring significant penalties, including fines, for noncompliance with the DoN process. See Memorandum - 8/15/2011 .