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.
- 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