New York State’s (NYS) new requirement for certain Certificate of Need (CON) applications to include a Health Equity Impact Assessment (HEIA) went into effect on June 22nd. Going forward, hospitals and other Article 28 facilities that seek to close, substantially reduce, or move services will need to submit an HEIA as part of their CON applications. The HEIA must describe the potential health equity impacts of a project on underserved populations in the applicant’s service area and identify how it could help or harm their access to and quality of care. The HEIA must be conducted by an independent entity who is not the writer or compiler of other parts of the CON.
New York is now the first state to implement a required equity assessment in its health facility planning and approval process. Therefore, although New York drew on some voluntary precedents from around the country and in several other countries, such as Canada and New Zealand, in designing its requirements, actually implementing this process will be a novelty for both NYS and the affected providers.
So far, all CON applications submitted since the effective date have claimed to be exempt from the HEIA requirements. However, in the coming months, many projects will fall into its scope — from consolidating service lines to moving capacity from inpatient to outpatient settings. If they haven’t already, providers working on such projects and their partners must begin to consider how they will be affected. Below are five important takeaways so far about the HEIA process:
- The scope of an HEIA is both broad and specific. The HEIA template requires considering the impact of a project on at least 12 specific medically underserved groups, based on income, race, gender, sexual orientation, age, disability status, and many other factors. This process is meant to build on the current community needs assessment requirements in CONs, making it more granular and tying it to community engagement. As a result, providers and their assessors will need to think through the possible impacts of their projects on many kinds of different groups, and come up with strategies on how to mitigate them.
- Applicants will have significant flexibility in choosing their independent assessor — for now. In recognition of the diverse types of projects and populations that this will apply to, CON applicants are free to choose their own expert to conduct the HEIA. The only requirements are that the assessor must (a) have experience in “health equity, anti-racism, and community and stakeholder engagement” and (b) be independent from the rest of the CON writing process. The Department of Health has explicitly stated that it does not intend to create a certification or licensure process for HEIA conductors or provide more specific experience requirements, in order to “allow providers to be broad in their thinking” — although it will re-evaluate this position after the first six to twelve months of the process.
- The independence of the HEIA assessor doesn’t mean that providers can’t work on equity issues in parallel. The assessor must not “help compile or write” any other part of the specific CON for which they are conducting the HEIA. However, NYS’s intention doesn’t seem to be to prohibit providers from addressing equity issues during the course of the CON’s development or to wall off the assessor entirely from the CON. Addressing health equity issues that arise in parallel with the development of the CON will be significantly more efficient than waiting to do so until after an HEIA is conducted. As such, entities should consider how their HEIA assessor can provide feedback and information to help guide the development of the CON without violating the conflict of interest policy.
- The HEIA process can potentially help smooth difficulties with community engagement. Many CON projects can arouse significant community opposition, particularly when they potentially reduce access to health services, or appear to do so. The HEIA process offers a positive opportunity to reassure community members and other stakeholders that they now have a formal structure to raise these concerns to an independent entity. Providers should consider how to take advantage of this to help proactively address the vital interests of the community.
- The HEIA increases the incentive to ensure projects maximize flexibility. Conducting and responding to the HEIA will be a significant new part of the process for providers undertaking major service line changes, whether they are expansions into new areas or removal of excess capacity. When designing a strategy for such projects, providers should keep in mind that creating capacity that has multiple uses or flexibility for conversion will be even more important than before. Maintaining flexibility will both enable the facility to address concerns the HEIA may raise about serving a wider range of potential medically-underserved populations, and allow it to have greater capacity to respond to shifting community needs without having to go through another CON process and a new HEIA.
SPG is always available to help clients navigate these issues in the context of your wider strategy. We are now thinking through how we can support clients specifically with HEIA development — please reach out at any time to discuss.