============================================================================== CERTIFICATE OF NEED INTELLIGENCE BRIEF: MASSACHUSETTS The Rojas Report | conlaws.rojasreport.com/states/massachusetts/ ============================================================================== State: Massachusetts (MA) Score: 90/100 Tier: Highly Restrictive Rank: 37 of 51 jurisdictions ------------------------------------------------------------------------------ KEY METRICS ------------------------------------------------------------------------------ 10+ Services regulated by CON 1971 Year CON enacted 38% MGB market share (East MA) $20.6B Mass General Brigham Revenue ------------------------------------------------------------------------------ SUMMARY ------------------------------------------------------------------------------ Massachusetts CON score 85/100 (highly restrictive). 10+ services regulated since 1971. Mass General Brigham controls 38% of the tertiary market in Eastern Massachusetts. ------------------------------------------------------------------------------ SCOPE OF REGULATION ------------------------------------------------------------------------------ * Services Requiring CON Approval ------------------------------------------------------------------------------ APPLICATION PROCESS ------------------------------------------------------------------------------ Massachusetts's Determination of Need law, in place since 1971, is a state- sanctioned shield for incumbent hospital systems. It regulates a wide array of services, allowing giants like Mass General Brigham to cement their market dominance under the guise of public health. The process allows for intervention by 'Ten Taxpayer Groups,' which can register to submit written comments and request public hearings, effectively giving incumbent providers a formal mechanism to obstruct new competition. ------------------------------------------------------------------------------ MARKET CONCENTRATION ------------------------------------------------------------------------------ Massachusetts's Determination of Need law, in place since 1971, is a state- sanctioned shield for incumbent hospital systems. It regulates a wide array of services, allowing giants like Mass General Brigham to cement their market dominance under the guise of public health. Blue Cross Blue Shield of Massachusetts's dominant share of the commercial insurance market. ------------------------------------------------------------------------------ REFORM STATUS ------------------------------------------------------------------------------ Massachusetts (No Full Repeal) The state has made several material reforms, most recently in 2017 and 2024-2025. The 2025 reform broadened the concept of a 'party of record,' but did not dismantle the core CON framework. The system continues to enable incumbents to delay or block new competitors. ------------------------------------------------------------------------------ CASE LAW / DENIALS ------------------------------------------------------------------------------ In 1972, just one year after the CON law was enacted, the Bessie M. Burke Memorial Hospital sought to undertake a major renovation. The Department of Public Health denied the application, arguing that the project was too costly and would still leave the hospital with an outdated facility. The denial was based on the principle of efficient resource allocation. However, the hospital's supporters wielded their political influence. The state legislature intervened, passing a special act that overrode the DPH's decision and authorized the renovation. This case set a precedent, demonstrating that the supposedly objective, needs-based CON process could be subverted by political power, undermining its entire purpose. ============================================================================== Source: The Rojas Report | conlaws.rojasreport.com/states/massachusetts/ Data: Cicero Institute, NASHP, FTC, DOJ, CMS, state health departments Generated: April 2026 ==============================================================================