Overview of Mass General Determination of Need Process

Massachusetts General 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.

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)

(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

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 Center for Community Health Improvement (CCHI) at Mass General guides this CHI fund process and provides overall input on the hospital’s community health plan.

Who Selects Which Areas These Funds Target?

The Community Advisory Board (CAB). 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 Community Advisory Board (CAB) should be created. The CAB is composed of 22 members representing cross sections of the Boston and North Suffolk communities. CAB members select priorities and strategies to fund from the triennial Community Health Needs Assessment (CHNA) and Implementation Plan (CHIP). View the list of CAB members.

The CAB's Charge

The CAB established the following principles and geographic criteria to equitably distribute CHI funds:

Principles

• Achieve the greatest impact on the upstream root causes of health challenges, including the social determinants of health
• Strive to achieve health equity
• Evidence informed
• Clear goals and objectives
• Where appropriate, align allocations with other evidence-based collaborative initiatives
• Consider and evaluate options for pooled CHI funding and/or other opportunities for working across different health care systems
• Engage intentionally with smaller community-based organizations and assess their community impact
• Embed a focus on policies, systems, and environmental changes
• Identify components of successful initiatives that can be scaled

Funding Criteria

Review of demographics (including race and ethnicity when available), health disparities, poverty and hardship index for subset of neighborhoods.

1. A CHNA Priority and a CHIP Strategy
2. Demographics (poverty, hardship, etc.)
3. Health disparities
4. Need (where there may not be other hospitals to fund the work)
5. Opportunity for collaboration
6. Population size
7. Opportunity
8. Mass General History

MGH Allocation Committee

The charge of the Allocation Committee is to oversee a competitive process for awarding funds for the health priorities identified through the community engagement process.  Members are selected based on their knowledge and:

• Experience based on professional or lived, in one or more of the identified health priorities
• Philanthropic and/or grant making experience
• Understanding/expertise in the Social Determinants of Health
• Lived experience in Suffolk County (Boston, Chelsea, Revere and Winthrop)
• A member of one or more of Mass General’s priority populations
• Ineligible to apply for funds unless otherwise stated in DPH regulations
• No perceived conflicts of interest