Code of Massachusetts Regulations 113 CMR - HEALTH FACILITIES APPEALS BOARD
Overview of 113 CMR – Health Facilities Appeals Board
The Health Facilities Appeals Board (HFAB) in Massachusetts resolves disputes involving health care facilities, including hospitals, nursing homes, and clinics. Its jurisdiction generally covers:
Appeals of licensing or certificate-of-need (CON) decisions by state agencies
Disputes over facility closures, service reductions, or expansions
Enforcement of health care regulations and facility standards
Mediating disagreements between state agencies and health facilities
The Board’s purpose is to ensure fair, transparent resolution of disputes, balancing patient safety, regulatory compliance, and facility operations.
Case 1: Hospital appealing denial of certificate-of-need (CON)
Scenario: A hospital applies for a certificate-of-need to expand its cardiac surgery unit. The Department of Public Health (DPH) denies the application citing insufficient community need.
Application of rules:
Under 113 CMR, the hospital may appeal DPH’s decision to HFAB.
The Board reviews whether the denial followed statutory procedures, considered correct evidence, and complied with regulatory criteria.
Outcome:
HFAB may uphold the denial, agreeing the expansion isn’t justified.
Alternatively, HFAB may remand the case back to DPH for reconsideration if procedures were flawed or evidence was misapplied.
The decision ensures facilities cannot bypass community need requirements.
Case 2: Nursing home contesting license suspension
Scenario: A nursing home receives a temporary license suspension for failing to meet staffing requirements.
Application of rules:
The nursing home can file an appeal to HFAB for review.
HFAB examines: staffing records, state survey findings, and mitigation efforts by the facility.
Outcome:
HFAB could reinstate the license, possibly with conditions, if the facility demonstrates rapid corrective actions.
Alternatively, the Board may uphold the suspension to protect resident safety.
This case balances regulatory enforcement with the facility’s ability to remedy deficiencies.
Case 3: Appeal over service reduction
Scenario: A hospital proposes to reduce pediatric inpatient beds due to low utilization, but DPH objects, citing community access concerns.
Application of rules:
HFAB reviews the facility’s rationale: utilization data, community needs assessments, and financial sustainability.
The Board evaluates whether the reduction threatens public access to care.
Outcome:
HFAB could approve a partial reduction or impose requirements to ensure essential access.
Alternatively, HFAB may deny the reduction if the Board finds that patient access would be compromised.
This ensures reductions are evidence-based, not arbitrary.
Case 4: Dispute over merger or acquisition of health facilities
Scenario: Two hospitals merge, but community stakeholders argue that the merger violates public interest by reducing competition.
Application of rules:
The merger must meet CON and regulatory standards.
HFAB reviews documentation, public input, and impact on service availability, costs, and quality.
Outcome:
HFAB may approve the merger, possibly with conditions such as maintaining certain service lines.
HFAB could reject the merger if it significantly harms community access or increases monopolistic risk.
Case 5: Appeal regarding facility closure
Scenario: A small rural hospital announces closure due to financial insolvency. State regulators contest closure without sufficient transition planning for patients.
Application of rules:
The hospital appeals to HFAB for authorization to close.
HFAB evaluates the hospital’s plan: patient transfers, continuity of care, and emergency coverage.
Outcome:
HFAB may authorize closure, but require a detailed transition plan.
The Board could delay closure until safeguards are in place to protect patients, balancing financial realities with public safety.
Case 6: Alleged violation of facility standards
Scenario: A clinic is cited for not meeting infection control standards. The Department issues a corrective action plan and threatens penalties.
Application of rules:
The clinic appeals to HFAB, claiming that the alleged violations were overstated or that mitigation steps were sufficient.
HFAB reviews inspection reports, compliance measures, and staff training records.
Outcome:
HFAB may reduce or modify penalties, recognizing partial compliance.
Alternatively, HFAB may uphold the penalties, reinforcing regulatory standards.
This ensures fair adjudication of compliance disputes.
Case 7: Emergency relocation of services
Scenario: A hospital must temporarily relocate its emergency department due to construction. Regulators question whether patient access is sufficiently maintained.
Application of rules:
HFAB reviews relocation plans, emergency transport arrangements, and staffing coverage.
The Board ensures compliance with health facility safety standards during temporary relocation.
Outcome:
HFAB may approve temporary relocation with conditions to ensure continuity of care.
This protects patient safety while allowing necessary facility updates.
Summary of Lessons from These Cases
HFAB provides impartial appeal mechanisms for facilities contesting regulatory decisions.
Patient safety and community access are central considerations in all decisions.
Evidence-based reviews: Board evaluates data, financial records, and corrective plans.
Flexible outcomes: HFAB can uphold, modify, or remand agency decisions.
Transparency and procedural fairness are key, ensuring facilities understand and can respond to regulatory actions.
HFAB decisions balance enforcement with operational realities, ensuring public interest without unnecessarily penalizing facilities.
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