Last updated: November 2026.
A Massachusetts determination of need (DoN) is the Department of Public Health (DPH) approval an applicant needs before a health care facility makes a substantial capital expenditure or a substantial change in service. Integral Healthcare Solutions (IHS) drafts DoN application narratives, computation workbooks, notice-of-intent text and a filing calendar. The applicant and its counsel approve the work, and the applicant files; IHS gives no legal advice.
What is a Massachusetts determination of need, and who has to file one?
Under M.G.L. c. 111, section 25C(a), a person or agency of the commonwealth or any political subdivision "shall not make substantial capital expenditures for construction of a health care facility or substantially change the service of the facility unless there is a determination by the department that there is need for the construction or change", except as provided in section 25C½ (page opened 2026-11-06). The DPH program page says proposals for a substantial capital expenditure, a substantial change in services and original licensure, and many transfers of ownership and changes in site, are reviewed under the DoN scheme (page opened 2026-11-06).
How much can a facility spend before a DoN is required?
DPH adjusts the statutory base minimums every year (section 25B½). The table shows its memorandum of November 18, 2025, for October 1, 2025 through September 30, 2026 (memorandum, page opened 2026-11-06). On 2026-11-06 the guidelines page listed no later memorandum (page opened 2026-11-06); confirm current figures with the DoN Program.
| Project type | Statute base (section 25B) | DPH amount, 2025-26 |
|---|---|---|
| Hospitals and comprehensive cancer centers | USD 7,500,000 | USD 27,668,903.99 |
| Other facilities: equipment | USD 400,000 | USD 1,475,927.31 |
| Other facilities: all other expenditures | USD 800,000 | USD 2,951,851.45 |
| Solely outpatient services other than ambulatory surgery | at least USD 25,000,000 | USD 45,128,964.12 |
| Equipment for use outside a health care facility | USD 250,000 (section 25C(d)) | USD 409,845.49 |
The hospital figure excludes major movable equipment not defined as DoN-required; the outpatient-only figure applies to projects not so defined; the figure for other facilities excepts replacing previously approved DoN-required items. DPH consolidates the construction capital expenditures that need its approval and are reasonably foreseeable in one federal fiscal year (October 1 to September 30) with that year's substantial changes in service, excluding conservation projects (105 CMR 100.715(A)).
What else triggers a DoN, including an MRI, CT or PET scanner?
- Hospital: adding, expanding or converting to a DoN-required service or equipment or ambulatory surgery, whether or not a minimum is exceeded (100.100). DPH's January 2017 guideline lists CT, MRI and PET (including PET/CT and PET/MRI) equipment and air ambulance and megavoltage radiation therapy services; listing means case-by-case review, not a moratorium (guideline, page opened 2026-11-06). Maintenance or replacement of existing DoN-required equipment needs no Notice (100.715(B)(1)(a)).
- Other facilities: a service or staff addition entailing annual operating costs above the minimum (statute base USD 350,000, adjusted yearly), bed increases above 12 beds in total, DoN-required items or ambulatory surgery (100.100).
- Original licensure of a hospital or freestanding ambulatory surgery center (100.730(A)(1)). A Notice that includes ambulatory surgery issues only in listed categories tied to a certified accountable care organization or to a center licensed as a clinic on or before January 1, 2017 (100.715(B)(2)).
- Acquiring an existing facility: see the FAQ on buying a hospital or clinic (section 25C(f)).
- Equipment above the threshold for use outside a facility, other than innovative-service or new-technology equipment: notice at least 30 days before contracts under the statute, 60 days under the regulation (section 25C(d); 100.715(B)(3)).
Exempt: projects solely for basic biomedical or applied medical research, on 60 days' notice and unless capacity, revenue or notice conditions fail, and Federally Qualified Community Health Centers (100.726).
What does DPH test?
DPH finds need where the applicant "makes a clear and convincing demonstration" that the project meets each factor in 105 CMR 100.210, unless the regulation says otherwise.
| Factor | What the applicant shows |
|---|---|
| 1. Patient panel need, public health value, operations | Need among its patient panel (patients seen in the last complete 36 months); measurable health value and health equity; care continuity and primary care links; agency consultation before and after the Filing Date; community engagement; price competition. |
| 2. Health priorities | Contribution to state cost, public health and delivery system goals, tied to a DPH Health Priority. |
| 3. Compliance | Good standing with laws, including every earlier Notice and its conditions. |
| 4. Financial feasibility | An independent certified public accountant's analysis, with five-year prospective financial information under AICPA attestation standards; an independent cost analysis if DPH requires one. |
| 5. Relative merit | Superior on balance to alternatives, weighing quality, efficiency and cost. |
| 6. Community health initiatives | A DPH-approved plan funded at 5% of total capital expenditure or more, unless the regulation specifies otherwise; 3% for long-term care that is not a conservation project; 2.5% for a conservation project of a facility other than long-term care; 1% for a long-term care conservation project. |
Conservation projects are exempt from factors 1, 2 and 5, and DPH may issue a Notice where a condition sufficiently remedies a defect (100.210(B)-(C)). The statute also requires DPH to consider the state health resource plan, cost goals, effects on the applicant's patients including health equity and surrounding workforce, and comments from the Center for Health Information and Analysis and the Health Policy Commission (section 25C(g)). Chapter 343 of the Acts of 2024, approved January 8, 2025, rewrote that subsection (section 57); the regulation copy DPH posts is dated 12/28/2018. IHS's reading (November 2026): the statute controls where they differ, so build to both.
How long does a DoN take?
DPH acts within 4 months of the Filing Date, with one delay of up to 2 months after the applicant supplies requested information (section 25C(j)). Periods count calendar days; one ending on a closed day runs to the next open day (100.105).
| When | Step |
|---|---|
| At least 14 days before the Submission Date | Publish the notice of intent on the facility website and in the daily newspaper; copy DPH, parties of record and contracted payers (100.405(C)). |
| Before filing | DPH recommends contacting its Bureau of Community Health and Prevention two months ahead (instructions). |
| Filing Date | Staff deem the application substantially complete; notice within two business days (100.405(H)). Incomplete applications are not accepted. |
| First 30 days, plus 10 after any hearing | Public and party comment, Ten Taxpayer registration, hearing requests; DPH may request an independent cost analysis, which stays the review (100.405(D), 100.435, 100.445). |
| Before action | Except in an emergency, on file at least 30 days; staff report at least 30 days before action; party comments at least 20 days before the meeting (100.510, 100.545). |
| Decision | Within 4 months; a postponement request also stays the period; written notice to parties within 14 days (100.615, 100.625). |
| After the decision | An aggrieved applicant or a person empowered to request a hearing may appeal within 14 days to the Health Facilities Appeals Board, which decides within 60 days or is treated as affirming at 120 days (section 25E). A Notice originally lasts no more than 3 years. |
How does IHS prepare a Massachusetts DoN application?
IHS works as an outside drafting team under your leaders and counsel. It sorts the project against the triggers and minimums, drafts the narrative, workbook, community engagement and community health initiative documents and notice-of-intent text for approval.
You supply the project facts, patient data, financials, counsel, the independent accountant, any contact with DPH or other agencies, and the signing, notice, filing and fee. IHS does not contact DPH or any agency for you and does not predict approval. IHS, founded in 2002, is led by Thomas G. Goddard, JD, PhD, former Chief Operating Officer and General Counsel of URAC.
What should an applicant have ready for a Massachusetts DoN?
Items cite 105 CMR 100.000 (page opened 2026-11-06).
- A project statement with Total Value, computation sheets and capital expenditure estimate (100.405(A)).
- Patient panel data and evidence for factors 1 to 3 and 5, the accountant's analysis, and a plan for any independent cost analysis (100.210, 100.405(D)).
- A community health initiative plan and funding commitment (100.210(A)(6)).
- The affidavit signed by the chief executive officer and board chair, the compliance attestation, and the disclosure of construction contracted to local or minority-, women-, or veteran-owned businesses (100.405(A)-(B)).
- Published notice of intent, simultaneous copies to the Attorney General and oversight agencies, and the fee (100.405(B)-(C)).
A free introductory call with IHS sorts out what to build first.
How does an outside application build compare with the other routes?
An internal build uses your planning and finance staff. DPH publishes the instructions and forms (apply page, page opened 2026-11-06). Massachusetts uses a determination of need, separate from other states' certificate of need laws, so general certificate of need consulting and the state licensing overview do not replace this page.
What does a Massachusetts DoN application cost?
The filing fee is the greater of USD 500 or 0.2% of the project's Total Value, nonrefundable (100.405(B)). A 2017 DPH guideline says a transfer-of-ownership fee shall not exceed USD 2 million (guideline, page opened 2026-11-06). Verify current fees with the DoN Program. Community health initiative funding is a project commitment, not a fee, and the DPH pages reviewed list no price for the accountant's analysis. IHS scopes each engagement after a free introductory call.
What this is not
It is not legal advice: IHS is a consulting firm, not a law firm, and counsel decides whether a project needs a DoN and how to handle an appeal. It is not a filing service or a prediction of the decision.
Frequently asked questions
Does an MRI, CT or PET scanner need a DoN?
DPH lists them as DoN-required equipment. A hospital adding, expanding or converting to one needs a Notice whether or not a minimum is exceeded (guideline, page opened 2026-11-06; 100.100).
How do a capital expenditure and a change in service differ?
A capital expenditure is construction spending, including renovation and equipping, above the minimum. A change in service is defined by service type, such as DoN-required equipment, ambulatory surgery or beds above 12, and some count regardless of cost (section 25B; 100.100).
Does buying a hospital or clinic need a DoN?
Except as section 25C½ provides, it needs written notice received at least 30 days before contracts, and a DoN if notice is defective or DPH finds within 30 days that services or beds will change (section 25C(f)). A transfer of ownership Notice requires the whole license to move to one transferee (100.735(C)).
What is a Ten Taxpayer Group, and can the public oppose a DoN?
Any 10 taxpayers organized as a group can register as a party of record in the 30 days after the Filing Date or 10 days after a hearing, then request a hearing within 30 days of the Filing Date, comment on the staff report and speak at the meeting (page opened 2026-11-06).
What happens if a facility proceeds without a DoN?
A civil penalty of not more than USD 500 for each day, assessed by the superior court, and refusal, modification or revocation of the facility license (section 25G; 100.820).
What is an independent cost analysis?
DPH may require one at the applicant's expense, by an entity it selects from a list of 3 the applicant submits (section 25C(h)), requested within 30 days after the Filing Date (100.405(D)).
Can an applicant amend an application after filing?
Not if the Commissioner finds it substantially alters the project's nature, scope, costs or financing, unless allowed; an impermissible amendment that stops the filing means dismissal and a new application (100.425).
How long is a DoN valid?
DPH stipulates the period, originally no more than 3 years, extendable for cause. (section 25C(l)).