Massachusetts Certificate of Need Laws

The process allows for intervention by 'Ten Taxpayer Groups,' which can register to submit written comments and request public hearings, effectively giving incumbent systems a formal mechanism to obstruct new competition.

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Health denied the application, arguing that the project was too costly and would still leave the hospital with an outdated facility.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.

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.