The Delaware Certificate of Public Review program is a review process used to assure that there is a continuing public scrutiny of certain health care developments which could negatively affect the quality of health care or threaten the ability of health care facilities to provide services to the medically indigent.  This public scrutiny is focused on balancing concerns for access, cost, and quality.

A Letter of Intent starts the process for a Certificate of Public Review. Information regarding the process from start-to-finish is contained in the CPR Application Kit along with Monthly Activity Reports. A Certificate of Public Review is required for the following activities:

1. The construction, development or other establishment of a health care facility or the acquisition of a nonprofit health care facility;
2. Any expenditure by or on behalf of a health care facility in excess of $5,800,000, or some greater amount which has designated by the Board following an annual adjustment for inflation using an annual inflation index determined by the United States Department of Labor, Bureau of Labor Statistics, which, under generally accepted accounting principles consistently applied, is a capital expenditure. A capital expenditure for purposes of constructing, developing or otherwise establishing a medical office building shall not be subject to review under this chapter.
   
   When a person makes an acquisition by or on behalf of a health care facility under lease or comparable arrangement, or through donation which would have required review if the acquisition had been by purchase, such acquisition shall be deemed a capital expenditure subject to review.
   
   The Board may exempt from review capital expenditures in excess of $5,000,000, when determined to be necessary for maintaining the physical structure of a facility and not related to direct patient care.  A notice of intent filed pursuant to § 9305 of this title, along with any other information deemed necessary by the Board, shall provide the basis for exempting such capital expenditures from review; 
3. A change in bed capacity of a health care facility which increases the total number of beds (or distributes beds among various categories, or relocates such beds from 1 physical facility or site to another) by more than 10 beds or more than 10 percent of total licensed bed capacity, whichever is less, over a 2-year period; 
4. The acquisition of major medical equipment, whether or not by a health care facility and whether or not the acquisition is through a capital expenditure, an operating expense or a donation. The replacement of major medical equipment with similar equipment shall not be subject to review under this chapter. In the case of major medical equipment acquired by an entity outside of Delaware, the use of that major medical equipment within Delaware, whether or not on a mobile basis, is subject to review under this chapter. Major medical equipment which is acquired for use in a dispensary or first aid station located within a business or industrial establishment maintained solely for the use of employees or in a first aid station, dispensary or infirmary offering services exclusively for use by students and employees of a school or university or by inmates and employees of a prison is not subject to review.