Nursing homes looking to expand their facilities will need to participate in Medicaid under a broad overhaul of Department of Public Health regulations presented Tuesday.

“By including Medicaid as a requirement for the determination of needs, this ensures that the most vulnerable populations among us also get access to that high-quality care,” Public Health Commissioner Dr. Monica Bharel told the News Service.

Nora Mann, the department’s new director of Determination of Need, said the regulatory mechanism – which goes by the initials D.O.N. – for reviewing major changes by providers was passed in 1971 and is in need of an update.

“Here’s the problem. It’s been outpaced by a rapidly evolving health care market,” Mann told the Public Health Council. She said the regulation is “administratively burdensome,” and “often unclear.”

Mann described a regulatory process that will put greater emphasis on public feedback and allow for collaboration with the Health Policy Commission, an independent government body that reviews the health care market, investigates certain mergers and acquisitions, and can refer matters to the attorney general. Mann told reporters the Public Health Council would not become an enforcement arm of the oversight agency.

The Health Policy Commission has warned of a growing disparity between community hospitals and health care giants, such as Partners Healthcare, whose market clout is seen as a factor in negotiations with health insurers over rates.

The Public Health Council reviews and votes on proposals by providers for major capital expenditures or substantial changes in service, known as determinations of need.

Tuesday opened a public comment period that will end Oct. 7. The final changes to the determination of need process are not expected until winter.