Michigan’s Certificate of Need

HOW CERTIFICATE OF NEED (CON) WORKS

What and Who Needs CON:

Facilities: hospitals, nursing homes, outpatient surgical centers.
Dozen advanced medical services. Commission can propose changes, subject to veto by Legislature or Governor of covered services. (Ex: Comm. dropped outpatient mental health services as no longer CON-appropriate.)
More detailed requirements than in many states: No longer vague requirements as Michigan had before. Now clear and precise details (“need”) and operations, so applicants know beforehand if project is applicable for approval.
Same requirements regardless of who is applicant: Equal-playing field among all applicants: hospitals, doctors, for-profits, non-profits, etc.

The CON commission:

Composition: 11 members to assure more balanced and expert representation from major sectors concerned about health care. 3-year staggered terms.

Two individuals representing hospitals.
An individual representing physicians licensed under part 170 to engage in the practice of medicine.
An individual representing physicians licensed under part 175 to engage in the practice of osteopathic medicine and surgery.
An individual who is a physician licensed under part 170 or 175 representing a school of medicine or osteopathic medicine.
An individual representing nursing homes.
An individual representing nurses.
An individual representing a company that is self-insured for health coverage.
An individual representing a company that is not self-insured for health coverage.
An individual representing a nonprofit health care corporation operating pursuant to the nonprofit health care corporation reform act, 1980 PA 350, MCL 550.1101 to 550.1704, or a nonprofit mutual disability insurer into which a nonprofit health care corporation has merged as provided in section 5805(1) of the insurance code of 1956, 1956 PA 218, MCL 500.5805.
An individual representing organized labor unions in this state.

Gubernatorial appointment, Senate confirmation.

No more than 5-6 balance between Democratic and Republican Commissioners.

Oversight of CON administration by MDCH: Approve all procedural rules and CON fees, and annually review operations of CON program.

Every 2 years recommend to Legislative Joint CON Committee on appropriate changes/repeal of CON law.

Regular input by Legislature, Governor, & Public to Commission:

Required opportunity for input to Advisory Committees, at each Commission meeting, re Commission’s draft changes (30 day opportunity with public hearing) and Commission’s final proposal (45 days with public hearing).
Annual hearing on Commission’s activities for upcoming year, re Standards to be reviewed.
Legislature (via Joint CON Committee) & Governor: 45 days to veto final proposed Standard.

ADVISORY COMMITTEES:

Appointed by Commission: 2/3rd Experts, 1/3rd Stakeholders; Geographic distribution
Conclude in 6 months and then present recommendations to Commission.

MICHIGAN DEPARTMENT OF COMMUNITY HEALTH:

Decide on Individual Applications: According to Standards and statutory requirements.
Enforce CON: Determine if CON-holders complying with statute, standards & provisions in CON approval. MDCH can require timely changes to operation of individual program, impose fines if appropriate, and as last step revoke CONs for lack of compliance.
Split between function of Commission and MDCH: Similar to split between legislative vs. executive branches of policy-setting vs. administration. In many states, politically-appointed Commission decides on each application and enforcement.

LIST OF STANDARDS REVIEWED BY CON