Health Equity Impact Assessment

Presentation to the Greater New York Hospital Association Membership

July 20, 2023
Office of Health Equity and Human Rights
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Background
• Legislation S1451A/A191 in the 2019-2020 Legislative Session:
– A Health Equity Impact Assessment must be filed with an [Certificate of
Need] application for construction or substantial reduction of a hospital
or health related service.
– Governor signed S1451A/A191 on December 22, 2021.
• Another legislation S7885/A8834 in the following 2020-2021 Legislative
Session:
– Clarified types of changes that will require a Health Equity Impact
Assessment.
– Pushed effective date to June 22, 2023.
• Regulations passed by PHHPC on June 29th, 2023.
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Landscape
• 2008: World Health Organization's Commission on Social Determinants of Health called for
"health equity impact assessments" of all economic agreements, market regulation and public
policies.
• Health Impact Assessments (HIAs) are a framework to help decisionmakers consider potential
health consequences for proposed projects.
• These assessments have been performed by subject matter experts all over the world, including
in the U.S., in a variety of fields (including housing, transportation, and infrastructure).
• A push for centering equity in these assessments has resulted in a new sub-field of Health
Equity Impact Assessments (HEIAs).
• Although there is no legislative requirement for HEIAs for health care facilities anywhere else in
the country, the Department looked to organizations and groups that have created equity-
focused templates, including health departments in California, North Carolina, Ohio, Oregon,
Washington, Canada, New Zealand, and Wales.
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Legislation
• HEIA is to understand the health equity impacts of a specific facility project.
• HEIA is a focused assessment on impacts to medically underserved groups:
– Low-income people; – Persons living with a prevalent infectious disease or
– Racial and ethnic minorities; condition;
– Immigrants; – Persons living in rural areas;
– Women; – People who are eligible for or receive public health benefits;
– Lesbian, gay, bisexual, transgender, – People who do not have third-party health coverage or have
or other-than-cisgender people; inadequate third-party health coverage; and
– People with disabilities; – Other people who are unable to obtain health care.
– Older adults;
• HEIA must be conducted by an independent entity.
• There must be no conflict of interest between the independent entity and facility.
• There needs to be meaningful engagement of community and stakeholders.
• Specifies scope and contents of HEIA.
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Purpose
• Standardize practice of assessing whether, and if so how, a facility's project will:
– Improve access to services and health care
– Improve health equity
– Reduce health disparities

• Vision: To create cultural change where dedicated efforts to understand health

equity impacts will be the norm or standard practice in the health care service
delivery industry, and have health equity considerations meaningfully impact the
planning and execution of health care facility projects.
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Facilities Subject to the HEIA Requirement

• Article 28 facilities:
– General Hospitals
– Residential Health Care Facilities (Nursing Homes)
– Diagnostic and Treatment Centers (D&TCs), including Ambulatory
Surgery Centers
– Midwifery Birth Centers

• Not subject to HEIA: D&TCs whose patient population is 50% or more

Medicaid eligible or uninsured (combined).
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Who Will Conduct the HEIA?

Independent Entity means an individual or organization with:
Mandatory expertise and experience (all) Preferred expertise and experience
(one or both)
• Health equity • Health care access
• Anti-racism • Delivery of health care services
• Community and stakeholder engagement

The Independent Entity cannot be someone who:

• Helps compile or writes any part of the CON application being submitted for this specific project,
other than the HEIA;
• Has a financial interest in the outcome of this specific project’s Certificate of Need application
(i.e. individual is a member of the facility’s Board of Directors or advisory board); or
• Has accepted or will accept a financial gift or incentive from the Applicant above fair market
value for the cost of performing the HEIA.
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HEIA Conflict-of-Interest Form

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HEIA Requirement Criteria

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HEIA Template: Overview

Section A. Executive summaries of:
Executive Summary • CON Project (250 words or less)
• HEIA Findings (500 words or less)

Section B. Step 1. Step 2. Step 3. Step 4. Step 5.

Assessment Scoping Potential Mitigation Monitoring Dissemination
(28 questions) Impacts

11 questions 11 questions 4 questions 2 questions 0 questions

Section C. • Signature of facility leadership attesting to having reviewed the HEIA;

Attestation and • Mitigation plan for potential negative impacts (1000 words or less)
Mitigation
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HEIA Template: Structure

Five-step approach to conducting a health equity impact
assessment:
1. Scoping: Using data, identify populations affected.
2. Potential Impacts: Identify positive and negative health impacts
of planned policy, program or initiative.
3. Mitigation: Identify evidence-based ways to reduce potential
negative impacts and amplify positive impacts.
4. Monitoring: Determine mitigation strategies for affected
populations and identify ways to measure success for each
mitigation strategy identified.
5. Dissemination: Identify ways to share results and
recommendations to address equity.
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HEIA Submission Requirements

• Starting June 22, 2023, Certificate of Need applications are not
to be considered complete without the HEIA program documents:
– HEIA Requirement Criteria
– HEIA Template
– HEIA Data Tables
– HEIA Conflict-of-Interest
– Redacted CON Application
• Facilities must submit a full HEIA and a redacted version of the
CON application that is then posted online for public review
– The facility must publicly post the CON application and the HEIA on its
website within one week of acknowledgement by the Department.
– The Department will also publicly post the CON application and the HEIA on
its website within one week of filing with the Department.
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Priorities
• Recruit and build HEIA Unit
• Develop webinars to support implementation
• Monitor program implementation and continue stakeholder
engagement
• Monitor S3609B/A3113A (Webb/Clark)
• Would enhance scope of the HEIAs to require consideration of impact on
availability and provision of reproductive and maternal health services in
the service area if the CON project is implemented.
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Questions
1. What happens if the HEIA has negative findings?
2. What if the Independent Entity is found to be unqualified after submission
to DOH?
3. What if a construction project exceeds the Limited Review cost threshold
but there is no net change in service or care? Are the thresholds still the
same for triggering an HEIA?
4. How does the facility find an Independent Entity? Is there a pre-approved
list of Independent Entities? What do they need to be considered
“qualified”? MPHs? Certificates?
5. Will the HEIA requirement delay CONs? (both filing and reviewing/getting
a decision)
6. Are State grant projects exempt?
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Contact

HEIA Main Webpage:

https://www.health.ny.gov/community/health_equity/impact_assessment.htm

HEIA Program Documents:

https://www.health.ny.gov/facilities/cons/health_equity/

HEIA Program Contact:

HEIA@health.ny.gov