New legal data released today on LawAtlas.org capture details of state certificate of need laws, the regulatory process states use to determine whether new health care facility capacity should be permitted.

“Increasing visibility and understanding of laws through legal epidemiology and other innovative public health law tools are critical for creating 21st century public health systems that improve the health and well-being of all people” said Washington State Secretary of Health Umair A. Shah, MD, MPH. “Understanding the laws across jurisdictions and being able to measure whether they are creating unintended inequitable circumstances help us improve and create more just systems for all communities.”

The data describe a landscape where more than half of states regulate the certificate of need process, but only about one-third have state health plans in place to guide decision makers on community need.

“Certificate of need laws are crucial in the effort to improve equitable access to health care facilities” said Michael Ellsworth, JD, MPA, Federal Liaison and Senior Policy Counsel at the Washington State Department of Health, who managed the project.

“These data are the first step in much-needed efforts to increase the visibility, transparency, and understanding of these laws to provide policymakers with better tools to modernize certificate of need with a focus toward health equity,” Ellsworth explained.

The data show broad variation in the laws, and limited government guidance on the criteria for the certificate of need process:

• Half of all states — primarily those along the East Coast and Pacific Northwest, and Alaska and Hawaii — have certificate of need laws that specifically include health equity criteria.
• In 25 states, public hearings on the process and its findings are either not required or are optional.
• The timing for a regular review process can range between 45 days in Oklahoma and Mississippi, to up to a full year in New York. In Illinois, for example, the regular process can take up to 120 days and then be extended for an additional 120 days.
• Less than half of all states have criteria in their laws for specific facility types, such as nursing homes, psychiatric hospitals or kidney dialysis centers.

The data were produced by researchers at the Washington State Department of Health in collaboration with the Temple University Center for Public Health Law Research as part of a project funded by the US Centers for Disease Control and Prevention to ChangeLab Solutions to expand the use of policy surveillance and legal epidemiology in public health practice.