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

  • Air Ambulance (Helicopter)
  • Bone Marrow Transplants
  • Cardiac Catheterization
  • Computed Tomography (CT) Scanners
  • Heart, Lung, Liver Transplants
  • Hospital Beds
  • Magnetic Resonance Imaging (MRI)
  • Megavoltage Radiation Therapy (MRT)
  • Neonatal Intensive Care Unit (NICU)
  • Nursing Home/Hospital Long-Term Care Unit Beds (NH/HLTC)
  • Open Heart Surgery
  • Positron Emission Tomography (PET) Scanners
  • Psychiatric Beds: Acute Inpatient
  • Surgical Services
  • Urinary Lithotripters