Michigan

Michigan

Michigan is one of eight states to require CONs within all six broad categories—hospital beds, beds outside hospitals, equipment, facilities, services, and emergency medical transport. Unlike most states, Michigan does not allow a CON applicant’s competitors to participate in the application process or otherwise object to pending CON applications. In response to COVID-19, Governor Whitmer directed the Department of Health and Human Services (DHHS) to grant CON applications without strictly complying with CON requirements.

COVID-19 Response

On March 17, 2020, Governor Whitmer issued an executive order authorizing DHHS to grant CON applications without strictly complying with existing statutory requirements. Exec. Order 2020-13 (Mar. 17, 2020). In response, DHHS directed applicants to existing emergency application rules. DHHS, Application for Emergency Certificate of Need. The application is lengthy compared to emergency notice provisions or applications in other states, and Michigan provides no data online documenting how many healthcare facilities or providers used the emergency application process to expand facilities or services in response to COVID-19.

Application Process

In Michigan, CON applications may undergo comparative, substantive or nonsubstantive review. Applications undergoing nonsubstantive review should be decided within 45 days, see Mich. Admin. Code r. 325.9206(4), while the review period for comparative and substantive applications is no longer than 120 days. Mich. Admin. Code r. 325.9207(1); 325.9208(1)(b). Applications can be submitted at any time. The fee ranges from $3,000 to $18,000 depending on the proposed capital expenditure. Mich. Comp. Laws § 333.20161(3)(a), (b). Competitors cannot intervene in the application process.

CON? Number of CONs Moratoria Temporary COVID-19 response:
Hospital Beds Yes 1 – Preexisting regulations
Beds Outside Hospitals Yes 4 – Preexisting regulations
Equipment Yes 8 – Preexisting regulations
Facilities/ Buildings Yes 5 – Preexisting regulations
Services Yes 6 – Preexisting regulations
Emergency Medical Transport Yes 1 – Preexisting regulations

Note: these citations are accurate as of May 2020.

Michigan CONs in Detail

Category

Types of CONs

Mich. Comp. Law

Hospital Beds

Any change in the bed capacity of a health facility, or physical relocation of beds from one licensed site to another. Mich. Comp. Laws

§ 333.22209(1)(b), (c)

1.Hospital beds.

§ 333.22205(1)(a)

Beds Outside Hospitals

Any change in the bed capacity of a health facility, or physical relocation of beds from one licensed site to another.

Mich. Comp. Law

§ 333.22209(1)(b), (c)

1.Beds in psychiatric hospitals or psychiatric units.

§ 333.22205(1)(b)

2.Beds in nursing homes.

§ 333.22205(1)(c)

3.Beds in freestanding surgical outpatient facilities.

§ 333.22205(1)(d)

4.Beds in facilities operated by a health maintenance organization.

§ 333.22205(1)(e)

Equipment

Initiation, replacement or expansion of one of the covered services. Mich. Comp. Law

§ 333.22203(10)(b)

1.Extracorporeal shock wave lithotripsy.

§ 333.22203(10)(b)(i)

2.Megavoltage radiation therapy.

§ 333.22203(10)(b)(ii)

3.Positron emission tomography.

§ 333.22203(10)(b)(iii)

4.Fixed magnetic resonance imager.

5.Mobile magnetic resonance imager.

§ 333.22203(10)(b)(vi)

6.Fixed computerized tomography scanner.

7.Mobile computerized tomography scanner.

§ 333.22203(10)(b)(vii)

8.Other equipment if the expenditure is in excess of $3.375 million, as calculated annually.

§§ 333.22209(1)(d),

333.22203(9); see Capital Expenditure Threshold 202051

Facilities/Buildings

The acquisition or operation a health care facility, or any capital expenditure in excess of $3.375 million on behalf of a health care facility.

Mich. Comp. Laws

§ § 333.22209(1)(a), 333.22203(9)

1.Hospitals.

§ 333.22205(1)(a)

2.Psychiatric hospitals or psychiatric units.

§ 333.22205(1)(b)

3.Nursing homes.

§ 333.22205(1)(c)

4.Freestanding surgical outpatient facilities.

§ 333.22205(1)(d)

5.Health maintenance organizations.

§ 333.22205(1)(e)

Category

Types of CONs

Mich. Comp. Law

Services

1.Neonatal intensive care services.

§ 333.22203(10)(a)(i)

2.Open heart surgery.

§ 333.22203(10)(a)(ii)

3.Extrarenal organ transplantation.

§ 333.22203(10)(a)(iii)

4.Surgical services at a freestanding surgical outpatient facility, or ambulatory surgery center.

§ 333.22203(10)(b)(iv)

5.Cardiac catheterization.

§ 333.22203(10)(b)(v)

6.Any capital expenditure in excess of $3.375 million on behalf of a health care facility.

§§ 333.22209(1)(a),

333.22203(9); see Capital Expenditure Threshold 202052

Emergency Medical Transport

1.Air ambulance services.

§ 333.22203(10)(b)(viii)

Michigan CON Exceptions

No CON Required For:

Mich. Comp. Law

1.Institution conducted by and for adherents of a church which depends on prayer through healing.

§ 333.22205(2)(a)

2.Health care facility or agency located in a correctional institution.

§ 333.22205(2)(b)

3.Veterans’ facility operated by the state or federal government.

§ 333.22205(2)(c)

4.Facility owned and operated by the department of community health.

§ 333.22205(2)(d)

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