Following Sheppard Mullin's recent webinar on Health Equity Impact Assessments (HEIAs), one thing is clear: providers and investors cannot afford to treat equity requirements as an afterthought in the Certificate of Need (CON) process.
In New York, Public Health Law § 2802-b now requires an HEIA for any CON application that involves a significant change in ownership, services, or location. This includes a formal review of how the project may impact access to care in underserved communities, and requires clear strategies to address any identified equity gaps. The New York State Department of Health (DOH) expects applicants to identify specific equity barriers: transportation, language access, mitigation plans, and a service area that makes sense based on data, not just geography.
New York is not unique in this approach. States such as Illinois, California, and Maine are embedding equity considerations into their approval frameworks. Even in jurisdictions without explicit HEIA mandates, health systems and investors are increasingly required to demonstrate how their proposals address access to care, demographics, and downstream impact. These considerations are becoming more common in compliance reviews and waiver applications.
Key practical considerations highlighted during the firm's program include:
- Integrate HEIA Early: If you are preparing a CON, make sure the HEIA is not the last thing on your checklist. Build it into your timeline early.
- Use Robust Data for Service Area Definition: Define your service area using claims data, census maps, or EHR geography, rather than relying solely on familiar ZIP codes.
- Develop Actionable Plans: If gaps in access are identified, present a concrete strategy to address them. Simple assurances of future monitoring are no longer sufficient.
- Plan Proactively, Even Beyond HEIA Jurisdictions: Even if you are not in a HEIA state, start planning now. Equity reviews are becoming part of the reputational and regulatory risk landscape nationwide.
Providers should approach HEIAs as they would financial diligence or community relations — as core parts of project planning, rather than as compliance obligations. In today's competitive and highly visible environment, a strong HEIA can help move a deal forward, whereas a weak one may cause delays or stall them altogether.
To dive deeper into this topic, check out our recent webinar. You can watch the full recording here.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
