On the initiative of Prime Minister Göran Persson of Sweden, the heads of government of the CBSS Member States met in the presence of the President of the European Commission and the Chairman of the European Council on an ad-hoc basis for the first time in Visby, on the Swedish island of Gotland on 3-4 May 1996. Since then, the heads of government have met on a biennial basis.

The final documents from these meetings give overall political guidance to the cooperation among the CBSS Member States. Several concrete initiatives have been launched by the heads of government, i.a. the Agenda 21 for the Baltic Sea region, the Task Force on Organised Crime, the Task Force on Communicable Disease Control and the Northern e-Dimension Action Plan. The CBSS is responsible for the preparation and follow-up of the summit meetings.