Certificate of Public Review
The primary goal of the Delaware Health Resources Board (HRB) Certificate of Public Review (CPR) process is to control health costs. This formal review process ensures 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. The Delaware Health Care Commission administers and staffs the public review process, which regulated through the Delaware Code 16 Del. Code 9301.
Construction, development or other acquisition of a health care facility
Construction, development or other acquisition of a health care facility, or the acquisition of a nonprofit healthcare facility, requires a Certificate of Public Review.
Major capital expenditures
Major capital expenditures 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 which requires a Certificate of Public Review.
A capital expenditure for purposes of constructing, developing or otherwise establishing a medical office building 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.4
Bed capacity change
A proposed change in bed capacity, which increases the total number of beds (or distributes beds among various categories, or relocates such beds from one 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 two-year period, requires a Certificate of Public Review.
Acquisition of major medical equipment
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.
Certificate of Public Review Guiding Principles
The following general principles are intended to assist potential Certificate of Public Review (CPR) applicants in understanding the Board’s expectations and also to assist the Board itself in conducting CPR reviews, particularly in matters where specific guidelines are lacking.
- The essential challenge faced by the Board is striking an appropriate balance in its consideration of access, cost and quality of care issues. Evidence that this challenge has been seriously embraced by the applicant should permeate every CPR application.
- The problem of medical indigency is extremely complex. The Delaware Health Care Commission continues to provide leadership in this area. CPR applicants are expected to contribute to the care of the medically indigent.
- Historically, health care delivery has too often been episodic and disjointed. Projects which support a managed, coordinated approach to serving the health care needs of the person/population are to be encouraged.
- Given Delaware’s small size and close proximity to major metropolitan referral centers, particularly in Philadelphia and Baltimore, every health care service need not be available within its borders. Potential CPR applicants are expected to take into account the availability of out-of-state resources.
- Historically, our cost-based reimbursement system has provided little incentive for financial restraint; over-utilization has been encouraged. Revenue centers, not cost centers, were generally emphasized. Projects which reflect or promote incentives for over-utilization (including self-referral) are to be discouraged.
- Strengthening market forces is a central theme in the health care reform strategy adopted by the Delaware Health Care Commission, a theme which is embraced by the Board. Projects resulting from or anticipated to enhance meaningful markets are to be encouraged. In the past, “competition” has often been on the basis of amenities for physicians (the medical arms race) and patients (the plushest waiting room). In meaningful markets there must be a sensitivity to elements of both cost and quality.
- Prevention activities such as early detection and the promotion of healthy lifestyles are essential to any effective health care system. The potential for a project to bring about progress in these areas will be viewed as a very positive attribute.
Certificate of Public Review Process
Letter of Intent
The Certificate of Public Review process starts with a letter of intent submitted to the Delaware Health Resources Board (HRB). The HRB reviews the application and may hold a public hearing before rendering a decision.
The Health Resources Board considers factors such as the proposal’s relationship to the state’s health plan, the population’s need for the project and the potential impact on cost and quality of care.
Procedures
- Applicant files Notice of Intent, found within the CPR Application Kit.
- Applicant files application. When application is determined to be complete, there is notification of the beginning of the review (Public Notice, etc.).
- At the first meeting of the Delaware Health Resources Board after an application is determined complete, there is an overview presentation by the applicant and an opportunity for questions. At this meeting the application is assigned as a staff review or a Review Committee is appointed.
- If a public hearing is requested, this is conducted by Review Committee.
- Review Committee meets with the applicant and deliberates as necessary to formulate a recommendation to the Board.
- Review Committee report is submitted to the Board. The Board makes the decision. From the date of notification referred to in step 2 above, generally the maximum review period is 90 days. There are exceptions, such as a public hearing is requested or it is mutually acceptable to the Board and the applicant.
Certificate of Public Review Application Fees
Certificate of Public Review applications must be accompanied by an application filing fee. Pursuant to Chapter 93 Health Planning and Resources Management, §9305, application fees shall be determined from the following table:
| Capital Expenditures | Application Fee |
|---|---|
| Less than $ 500,000 | $100 |
| $500,000 to $999,999 | $750 |
| $1,000,000 to $4,999,999 | $3,000 |
| $5,000,000 to $9,999,999 | $7,500 |
| $10,000,000 and over | $10,000 |
Filing fees shall be due 30 days after the date of notification of the beginning of review as covered under 9305 subdivision (4). This due date may be extended up to 10 additional days at the discretion of the Bureau. Applications for which filing fees have not been paid within this time frame shall be considered to be withdrawn.
Make checks payable to: Treasurer, State of Delaware and remit to:
Delaware Health Care Commission
1901 North Dupont Highway
New Castle, DE 19720
Health Resources Board Members
| Member Name | Member Designation |
|---|---|
| Cheri Doyle | Board Chairman (Public at Large) |
| Leighann Hinkle | Board Vice Chairman |
| JoAnn Seppelt | Provider |
| Leighann Hinkle | State Employee Health Care Coverage |
| Vacant | Labor Representative |
| Steven Biener | Public at Large |
| Vincent Lobo, Jr. DO | Medical Practitioner |
| Trinidad Navarro | Delaware Health Care Commission |
| Nicole Carrington | Public at Large |
| Yassmine Zerrad | Department of Health and Social Services |
| John Hundley | Health Care Administration |
| Cheryl Heiks | Long-term Care Administration |
| Vacant | Public at Large |
| Timothy Gibbs | Public at Large |
| Pamela Price | Health Insurance Industry Representative |
| Charles “Chip” Walters Jr. | Health Care Coverage for Employers with more than 200 Employees |
Health Resources Board Bylaws
Health Resources Board 2026 Meetings
| DATE | TIME | PLACE |
|---|---|---|
| January 22, 2026 | 2:00-4:00 p.m. | See public meeting calendar for details. |
| February 26, 2026 | 2:00-4:00 p.m. | See public meeting calendar for details. |
| March 23, 2026 | 2:00-4:00 p.m. | See public meeting calendar for details. |
| April 23, 2026 | 2:00-4:00 p.m. | See public meeting calendar for details. |
| May 28, 2026 | 2:00-4:00 p.m. | See public meeting calendar for details. |
| June 25, 2026 | 2:00-4:00 p.m. | See public meeting calendar for details. |
| July 23, 2026 | 2:00-4:00 p.m. | See public meeting calendar for details. |
| August 25, 2026 | 2:00-4:00 p.m. | See public meeting calendar for details. |
| September 15, 2026 | 2:00-4:00 p.m. | See public meeting calendar for details. |
| October 20, 2026 | 2:00-4:00 p.m. | See public meeting calendar for details. |
| November 17, 2026 | 2:00-4:00 p.m. | See public meeting calendar for details. |
| December 15, 2026 | 2:00-4:00 p.m. | See public meeting calendar for details. |
Certificate of Review Notice of Filed Intents
Coming soon!
Current Board Meeting Presentations
2026
January
February
March
April
June
July
August
September
October
Certificate of Review Monthly Activity Reports
The information below is a listing of Delaware Certificate of Public Review activities. For years prior to 2020, please reach out to the HRB.
Archived Years
Application Decisions
| Application | Project | Amount | Year | Status |
|---|---|---|---|---|
| Encompass Health | Inpatient Rehab Facility | $66 Million | 2026 | Approved |
| ChristianaCare | PET/CT scanners | $8 Million | 2026 | Approved |
| ChristianaCare Onix | Inpatient Rehab Facility | $75 Million | 2026 | Approved |
| University of Pennsylvania Health | MRI and CT scanner | $17 Million | 2026 | Approved |
| Nemours | MRI scanner | $7.3 Million | 2026 | Approved |
| ChristianaCare | MRI scanners | $13.5 Million | 2026 | Approved |
| TidalHealth | Ambulatory Surgery Center | $15 Million | 2026 | Approved |
| Nemours | Fetal Care Center | $9.6 Million | 2026 | Approved |
| ChristianaCare | Ambulatory Surgery Center | $9.3 Million | 2026 | Approved |
| Cardiology Physician LLC | Cardiac PET/CT, Dover, Smyrna, Lewes, Oceanview locations | $1.5 Million | 2025 | Approved |
| Nemours | Advanced Delivery Unit | $58.5 Million | 2025 | Approved |
| Sussex Pain Relief Center | Convert to freestanding surgery center | $1.5 Million | 2024 | Approved |
| ChristianaCare | Middletown Health Center Expansion | $96.760 Million | 2024 | Approved |
| ChristianaCare | Radiation Therapy Medical Equipment Varian Ethos | $6.7 Million | 2024 | Approved |
| Nephrology Associates-Milford | Convert vascular access center to freestanding ambulatory center | $450,000 | 2024 | Approved |
| Nephrology Associates-Newark | Convert vascular access center to freestanding ambulatory center | $605,000 | 2024 | Approved |
| Nemours | Outpatient Services Clinic & Infusion Center | $27.250 Million | 2024 | Approved |
| Cedar Tree Surgical Center | Perform General Anesthesia | $150,000 | 2024 | Approved |
| Nemours | Inpatient Unit Hematology Oncology Transplantation Cellular Therapy | $25.7 Million | 2024 | Approved |
| ChristianaCare | Magnetic Resonance Guided Focused Ultrasound | $2.15 Million | 2023 | Approved |
| Advanced Surgical Platforms | Convert to Freestanding Surgery Center | $4.150 Million | 2023 | Approved |
| Bayhealth | Sussex campus, 40 medical/surgical beds and 6 intensive care beds | $3.5 Million | 2023 | Approved |
| Division of Services for Aging and Adults with Physical Disabilities | Replacement Hospital for Delaware Hospital for the Chronically ill | $50,000,000 | 2023 | Approved |
| Molecular Imaging Services Inc. | Cardiac PET | $700,000 | 2023 | Approved |
| Beebe | Hybrid Freestanding Emergency Department | $30 Million | 2022 | Approved |
| Nemours | Dental, Ophthalmology and Surgical Specialty Clinic | $15.3 Million | 2022 | Approved |
| Delaware Surgical Arts | One operating room | $450,000 | 2022 | Approved |
| Nemours | Construction of NICU | $17.5 Million | 2022 | Approved |
| Encompass Health Rehabilitation Hospital | 10 bed expansion | $9.8 Million | 2022 | Approved |
| Post Acute Medical | 40 bed inpatient rehabilitation facility | $33 Million | 2022 | Approved |
| Outpatient Procedure Center | Convert office based surgery facility to a freestanding surgery center | $156,000 | 2022 | Approved |
| Select Specialty Hospital | Relocation of long term acute care hospital from St. Francis Hospital to ChristianaCare Wilmington Hospital | $9.9 Million | 2021 | Approved |
| ChristianaCare | Center for Spine Surgery Joint Venture partnership ChristianaCare and Neurosurgical Group | $5.2 Million | 2021 | Approved |
| Bayhealth | Sussex Hospital additional medical surgical beds | $10-$14 Million | 2020 | Approved |
| Bayhealth | Freestanding Emergency Department | $10.2 Million | 2020 | Approved |
| Nemours A.I. duPont Hospital | Cardiac Cath Lab | $6.1 Million | 2020 | Approved |
| Beebe Healthcare 12 room fit out | Specialty Surgical Hospital | $3 Million | 2020 | Approved |
| Cadia Pike Creek | 52 skilled nursing bed expansion | $12 Million | 2020 | Approved |
| Post Acute Medical | 34 bed inpatient rehab facility | $17 Million | 2020 | Approved |
| Comprehensive Care Capital | Acquisition of Churchman Village, Parkview Nursing and Harbor Healthcare | $67 Million | 2020 | Approved |
| Exceptional Care for Children | 22 bed Bridge Unit | $10,000,000 | 2019 | Approved |
| Peninsula Regional Health System | Affiliation with Nanticoke Health System | $0.00 | 2019 | Approved |
| Beebe Healthcare | Freestanding Emergency Department | $20-23 Mill | 2019 | Denied |
| MeadowWood Behavioral Health | 20 bed expansion | $5 Mill | 2019 | Approved |
| Beebe Healthcare | Freestanding Emergency Department | $22 Mill | 2018 | Approved |
| Beebe Healthcare | Specialty Surgical Hospital | $16.5 Mill | 2018 | Approved |
| Beebe Healthcare | Oncology Center | $19 Mill | 2018 | Approved |
| MeadowWood Behavioral Health | 7 bed expansion | $200,000 | 2018 | Approved |
| Dover Behavioral Health | 16 bed expansion | $4, 409,685 | 2018 | Approved |
| Christiana Care Health Care Center | Renovation and Consolidation | $7.5 Mill | 2018 | Approved |
| Christiana Care PMRI Facility | Renovation and Consolidation | $8.2 Mill | 2018 | Approved |
| The Birth Center-Women’s Holistic Healthcare | Relocation of birth center to Newark, DE | $40,000 | 2018 | Approved |
| Nationwide Healthcare LLC | 150 bed skilled nursing facility | $6 Mill | 2017 | Approved |
| Christiana Care | Interventional Structural Heart Lab | $3.5 Mill | 2017 | Approved |
| Christiana Care | 6 Bed Expansion Inpatient Psychiatric Unit | $8.3 Mill | 2017 | Approved |
| First State Surgery Center | Expansion of Surgery Center | $1 Mill | 2017 | Approved |
| Cataract and Laser Center | Relocation of Surgery Center | $30,000 | 2017 | Approved |
| Bayhealth Medical Center | Replacement Hospital Milford DE | $268 Mill | 2016 | Approved |
| Christiana Care | Women and Children’s Transformation Center | $250 Mill | 2016 | Approved |
| Nemours Alfred I duPont Hospital | Purchase PET Scanner | $5.5 Mill | 2016 | Approved |
| Post Acute Medical LLC | 34 bed inpatient rehabilitation center | $14 Mill | 2015 | Approved |
| Sun Behavioral Health | 90 bed inpatient behavioral health facility | $18 Mill | 2015 | Approved |
| First State Orthopaedics | Free Standing Surgery Center | $4 Mill | 2015 | Denied |
| Genesis HealthCare | Purchase Franciscan Care Center | $7.5 Mill | 2014 | Approved |
| The Weston Group | Acquisition of Masonic Group | $4.5 Mill | 2013 | Approved |
| Bayhealth Kent General | 32 hospital Bed Expansion | $12 Mill | 2013 | Approved |
| Capitol Nursing | 30 Bed expansion | $3 Mill | 2013 | Denied |
| Center at Eden Hill | SNF | $17 – $24 Mil | 2013 | Approved |
| Genesis HealthCare | Acquisition of Lifecare at Lofland | $11,059,700 | 2012 | Approved |
| Delaware Veterans Home | Open 30 beds in existing wing | $0 | 2011 | Approved |
| Nanticoke Health | Cauterization Lab | $1.8 Mill | 2011 | Approved |
| Dover Behavioral Health | 16-bed expansion | $3,500,000 | 2011 | Approved |
| MeadowWood Behavioral Health | 30-bed expansion | $5,000,000 | 2011 | Approved |
| Bayhealth Medical Center | Freestanding Emergency Department | $5,000,000 | 2011 | Approved |
| Nemours/AI Dupont | New Addition with medical/surgical intensive care rooms | $275,000,000 | 2011 | Approved |
| HealthSouth | Middletown Rehab. Hospital | $21,000,000 | 2011 | Approved |
| Molecular Imaging Services, Inc. | Implement a Cardiac PET program with PET scanner | $490,000 | 2010 | Approved |
| ACTS-PUMH | Affiliation Agreement | $0 | 2010 | Approved |
| Christiana Care | Freestanding Emergency Department | $34,000,000 | 2010 | Approved |
| Rockford Center | 24- inpatient bed expansion | $3,000,000 | 2010 | Approved |
| Exceptional Care for Children | 11 bed expansion | $1,200,000 | 2010 | Approved |
| Parkview Nursing | Expansion renovation of facility | $6,200,000 | 2009 | Approved |
| Onix Silverside | 120 bed nursing center | $12,000,000 | 2009 | Approved |
| Nanticoke Health Services | Lease of Mobile Pet Scanner | $122,500 | 2008 | Approved |
| Christiana Care | Wilmington expansion | $205,000,000 | 2008 | Approved |
| Harrison House of Georgetown | Facility Expansion | $0 | 2007 | Approved |
| UHS of Dover, LLC | Convert St. Jones Center from a freestanding center to a hospital | $7,650,000 | 2007 | Approved |
| Christiana Care | Acquisition of a PET/CT scanner | $2,600,000 | 2007 | Approved |
| Newark LTC Operations | Acquisition of operations Churchman Village | $13,000,000 | 2006 | Approved |
| UHS of Dover | Acquisition of St. Jones Center of Behavioral Health | $7,650,000 | 2006 | Approved |
| Helen F Graham Center at Christiana Campus | Cyberknife accelerator | $6,300,000 | 2006 | Approved |
| A.I Dupont Hospital | Construct an addition which allows renovation to CICU/NICU | $15,000,000 | 2006 | Approved |
| Specialty Surgery Center of Seaford | Establish freestanding multi-specialty surgical center | $2,000,000 | 2006 | Approved |
| Bayhealth | Cardiac catheterization | $3,250 | 2006 | Approved |
| Dover Surgicenter | Ambulatory surgery center | $5,500,000 | 2005 | Approved |
| Orthopedic Specialist | Freestanding outpatient surgery | $1,400 | 2005 | Approved |
| Veterans Home | 120 bed facility | $26,714 | 2005 | Approved |
| Rockland Surgery Center | Freestanding surgery center | $1,400,000 | 2005 | Approved |
| Beebe Medical Center | Major expansion | $30,200,000 | 2005 | Approved |
| Delaware Surgery Center | Freestanding multispecialty surgery center | $1,500,000 | 2005 | Approved |
