Application Forms

Submission of Applications

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 Division of Health Care Finance and Policy, Division of Medical Assistance (MassHealth) and the appropriate DPH Regional Health Office listed below.  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 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 person and address/email of each applicable state agency or office listed below prior to submission.

State Agency or Office

Address

Contact Person

Determination of Need

99 Chauncy Street
Boston , MA 02111
Tel. (617) 753-7340

Bernard Plovnick
bernard.plovnick@state.ma.us

Jere Page
jere.page@state.ma.us

Health Policy Commission

2 Boylston Street
Boston , MA 02116

Tel. (617) 979-1400

Karen Tseng
karen.tseng@state.ma.us

Department of Mental Health

25 Staniford Street
Boston , MA 02114
Tel: (617) 626-8121

Lizbeth Kinkead
lizbeth.kinkead@state.ma.us

Center for Health Information and Analysis

2 Boylston Street
Boston , MA 02116
Tel. ( 617) 988-3198

2 Boylston Street
Boston, MA 02116
Tel. (617) 988-3247

Mary Byrnes
(acute care projects)
mary.byrnes@state.ma.us

Patty McCusker
(long term care projects)
patty.mccusker@state.ma.us

MassHealth

1Ashburton Place
Boston , MA 02108
Tel. (617) 573-1623

David Garbarino
(all projects)
david.garbarino@state.ma.us

MassHealth/ Executive Office of Elder Affairs

One Ashburton Place
Boston , MA 02108
Tel. (617) 222-7546

Ron Pawelski
(long term care projects)
ronald.pawelski@state.ma.us

MassHealth/ Providers and Plans

 

100 Hancock Street
Quincy , MA 02171
Tel. (617) 847-6527

100 Hancock Street
Quincy , MA 02171
Tel: (617) 847-6543

Kiki Feldmar
(acute care projects)
kiki.feldmar@state.ma.us

Christopher King (freestanding imaging facilities and ambulatory surgery centers)
christopher.king@state.ma.us

Metro Boston Regional Health Office

5 Randolph Street
Canton , MA 02021
Tel: (781) 828-7700

Cathy O’Connor
cathy.oconnor@state.ma.us

Southeast Regional Health Office

1736 Purchase Street
New Bedford , MA 02740 -6821
Tel: (508) 984-0600

Ron O'Connor
ron.oconnor@state.ma.us

Northeast Regional Health Office

365 East Street
Tewksbury , MA 01876
Tel: (978) 851-7261

Paul Muzhuthett
paul.muzhuthett@state.ma.us

Central Regional Health Office

180 Beaman Street
West Boylston, MA 01593
Tel: (508) 792-7880

Shelly Yarnie
shelly.yarnie@state.ma.us

Western Regional Health Office

23 Service Center
Northampton, MA 01060
Tel: (413) 586-7525

Soloe Dennis
soloe.dennis@state.ma.us


This information is provided by the Determination of Need (DoN) within the Department of Public Health.