Certificate of Need Laws in Massachusetts — What Patients Need to Know
Massachusetts has one of the longest-standing Certificate of Need frameworks in the nation, first enacted in 1971 and most recently amended in 2022. Known locally as the Determination of Need (DoN) process, the state’s program requires healthcare providers to obtain regulatory approval before building new facilities, expanding existing ones, or acquiring major medical equipment. Understanding how this process works is essential for Massachusetts patients who want to know why certain services are—or are not—available in their communities.
MASSACHUSETTS — KEY FACTS
| CON Law Status | ACTIVE CON LAW |
| Programme Scope | active |
| Year Enacted | See agency |
| Services Requiring Approval | hospitals, nursing homes, ambulatory surgery centres, imaging equipment (MRI/CT), dialysis facilities, hospice providers, psychiatric facilities, home health agencies |
| Governing Agency | Massachusetts Health Policy Commission / Department of Public Health |
| Hospitals in State (CMS data) | Data not available |
The Arguments
WHAT SUPPORTERS ARGUE
Defenders of Massachusetts’ Determination of Need process argue that it helps prevent unnecessary duplication of expensive healthcare services, which can drive up costs across the system. They contend that the review process ensures new facilities and expansions meet genuine community health needs rather than simply serving the most profitable markets. Proponents also point to recent reforms adding a health equity analysis requirement as evidence that the program can evolve to address disparities in healthcare access.
WHAT CRITICS ARGUE
Critics argue that Massachusetts’ CON process creates barriers to entry that protect incumbent healthcare providers from competition, potentially keeping prices higher and limiting patient choice. They contend that the lengthy approval process can delay access to new facilities and technologies, particularly in underserved areas that may need them most. Some opponents also raise concerns that the process can be influenced by existing providers who have financial incentives to block new competitors from entering the market.
The Data
WHAT THE DATA SHOWS IN MASSACHUSETTS
No CMS hospital charge data is currently available for Massachusetts facilities in the dataset reviewed. Separately, national reporting by ProPublica has highlighted broader concerns about nursing home oversight, including a case involving former Skyline Healthcare owner Joseph Schwartz, where at least three families won multimillion-dollar wrongful death suits but have been unable to collect any payment—underscoring the challenges of ensuring accountability in regulated healthcare settings.
Recent Developments
Massachusetts amended its CON framework in 2022, incorporating updates to the Determination of Need review process. A notable reform added a health equity analysis requirement, meaning applicants must now demonstrate how proposed projects will affect equitable access to care across different populations. These changes reflect an ongoing policy effort to ensure the regulatory process addresses not only cost and capacity concerns but also disparities in healthcare access.
What This Means For Patients in Massachusetts
For Massachusetts patients, the Determination of Need process means that new hospitals, nursing homes, surgery centers, imaging facilities, dialysis centers, hospice providers, psychiatric facilities, and home health agencies must receive state approval before operating, which can influence where and when new services become available. The recently added health equity analysis requirement is intended to ensure that these regulatory decisions take into account the needs of historically underserved communities.
THE BOTTOM LINE
Massachusetts operates one of the nation’s most comprehensive Certificate of Need programs, and the ongoing debate centers on whether the regulatory framework better serves patients by ensuring planned, equitable healthcare growth or whether it limits competition and access in ways that may not always align with community needs.
Frequently Asked Questions
Does Massachusetts have a Certificate of Need law?
Yes, Massachusetts has maintained a Certificate of Need law since 1971, operating under a process known as Determination of Need (DoN). The law was most recently amended in 2022 and is one of the most comprehensive CON programs in the United States.
What services require CON approval in Massachusetts?
Massachusetts requires CON approval for a broad range of services, including hospitals, nursing homes, ambulatory surgery centers, major imaging equipment such as MRI and CT scanners, dialysis facilities, hospice providers, psychiatric facilities, and home health agencies. This full-scope coverage means most significant healthcare expansions or new facilities in the state must go through the Determination of Need review process.
How do Massachusetts CON laws affect hospital costs?
Proponents argue that the CON process helps control costs by preventing unnecessary duplication of expensive services, while critics contend it can reduce competition and potentially keep prices higher. No CMS hospital charge data is currently available for Massachusetts facilities in the dataset reviewed, making direct cost comparisons difficult to assess at this time.
Can I find out if a facility has CON approval in Massachusetts?
Yes, the Massachusetts Health Policy Commission and the Department of Public Health oversee the Determination of Need process and maintain records of applications and approvals. Patients can visit the state’s official CON page at https://www.mass.gov/con for information about facility approvals and ongoing reviews.