Health Equity Impact Assessment Requirements Reviewed by PHHPC
(Dec. 9, 2025) At a meeting of the Public Health and Health Planning Council (PHHPC) on Dec. 4th, representatives of the Department of Health's (DOH) Office of Health Equity and Human Rights reported that they are exploring possible exemptions from the health equity impact assessment (HEIA) requirements applicable to certain health care facility projects. Although they did not provide specific information on the nature or timing of potential changes, DOH staff reported to the PHHPC on the quantity and cost of independent HEIAs conducted to date and the feedback they have received from stakeholders. The PHHPC also received updates from the Office of Aging and Long-Term Care (OALTC) and the Nursing Home Certificate of Need (CON) Ad Hoc Committee (Ad Hoc Committee).
HEIA Updates
DOH staff indicated that, since the HEIA requirements took effect in June 2023, they have received 92 independent HEIAs – 60 for hospital projects, 20 for nursing home projects, 11 for diagnostic and treatment centers, and one for a midwifery birthing center. The independent HEIA consultants charged an average of $26,700 for an assessment, with a median cost of $20,000. LeadingAge NY learned in a separate meeting with DOH staff that the majority of the nursing home projects that have been subject to an HEIA were limited review projects (16 out of 20 total projects) – typically involving minor construction or service adjustments. The required independent HEIA increased the cost of these minor projects, on average, by 20%.
LeadingAge NY submitted comments to DOH and the PHHPC on the HEIA requirements, recommending several types of exemptions. The association recommended, for example, that service additions that enable residents to be served on-site (e.g., dialysis and transfusions), rather than traveling to an external provider, should be exempt, as they improve access to care and quality of life for the residents. Similarly, projects that add, relocate, or preserve adult day health care (ADHC) capacity fill a community need and enhance health equity for Medicaid beneficiaries with complex medical conditions and functional limitations. Likewise, projects that decertify services, beds, or ADHC slots are generally born of financial necessity. The association pointed out that not-for-profit nursing homes are struggling with inadequate Medicaid rates and negative margins, and that reductions and reconfigurations are generally necessary to preserve access overall. Several PHHPC members echoed the association's concerns that the HEIAs are unnecessary in relation to service additions. The DOH staff indicated that they would be considering this input.
Based on its analysis of the HEIA data and stakeholder input, the Department is exploring exemptions for certain types of projects and the thresholds that trigger the HEIA requirements for expansion and relocation projects. According to the DOH staff, consumer stakeholders have advocated for the development and enforcement of accountability measures for health care facilities pursuing changes in services, capacity, or location. Some stakeholders have requested that the Department oversee and enforce mitigation plans developed by health care facilities as part of their HEIAs.
LeadingAge NY will continue to advocate for rationalization of these requirements to optimize access for people with long-term care needs and to minimize excess costs.
OALTC and Ad Hoc Committee Updates
Valerie Deetz, Deputy Director of the OALTC, provided an update on the activities of the Office. She focused on the work of the Center for Hospice and Palliative Care and indicated that the Palliative Care Education and Training Council would be reinvigorated next year. In relation to home and community-based services, she announced that 492 individuals had transitioned from nursing homes to the community this year through various waivers and the Money Follows the Person Program. Ms. Deetz reported that the Department has made $18 million in Vital Access Provider Assurance Program (VAPAP) grants to long-term care providers, although the timeframe for those awards was unclear. She also reported that $45.2 million in Statewide Transformation IV grants had been made to long-term care providers.
Scott LaRue, the Chair of the Ad Hoc Committee, reported to the full Council on the Committee's last meeting, the second of four anticipated meetings. Members of the Council discussed the "chilling presentation" by the Attorney General's Medicaid Fraud Control Unit at the last meeting, describing the diversion of funds to related entities and negative effects on staffing and quality. Dr. Boufford recommended that the Committee include a recommendation to incorporate Prevention Agenda goals into nursing home CON applications. Mr. LaRue noted that the Committee will present its recommendations at its fourth meeting and that the recommendations will cover all issues within its jurisdiction.
LeadingAge NY will continue to monitor these activities and weigh in to support the interests of members. Meeting materials are available here, and a recording is available here.
Contact: Karen Lipson, klipson@leadingageny.org