michigan’s certificate of need program michigan department of community health
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Michigan’s Certificate of Need Program
Michigan DepartmentMichigan Department
of Community Healthof Community Health
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Federal Certificate of Need Background
Dist. of Columbia and New York developed CON in 1964.
Federally mandated CON programs were established as a national health care cost containment strategy. The 1974 National Health Planning and Resources Development Act mandated that states have CON programs to be eligible for certain public health funds.
In 1986, the federal mandate for CON was not renewed.
CON regulations are structured, in principle, to improve access to quality health care services while containing costs. Health care organizations are required to demonstrate need before investing in a regulated facility, service or equipment.
Since the repeal of the federal mandate, 37 states have retained some form of a CON program.
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Certificate of Need ProgramsRange of Services Reviewed Under State CON Programs
Source: 2002 National Directory of Health Planning, Policy and Regulatory Agencies, American Health Planning Association.
Non-CON States Less than 10 weighted services 10-19 weighted services More than 20 weighted services
State Rank/State Services Rank/State Services Rank/State Services
Arizona 24 Arkansas 7 9 North Carolina 25 1 Maine 24
California 25 Oklahoma 6 10 Mississippi 18 2 Connecticut 26
Colorado 26 Iowa 9 11 D.C. 23 3 Georgia 25
Idaho 27 Virginia 20 12 Tennessee 20 4 Alaska 27
Indiana 28 Florida 11 13 Alabama 20 5 West Virginia 26
Kansas 29 Montana 7 14 Maryland 17 6 Vermont 25
Minnesota 30 Massachusetts 16 15 Rhode Island 19 7 Missouri 21
N. Mexico 31 Delaware 8 16 New York 25 8 South Carolina 19
N. Dakota 32 Wisconsin 4 17 Hawaii 25
Pennsylvania 33 Nevada 7 18 Michigan 18
S. Dakota 34 Nebraska 2 19 Kentucky 18
Texas 35 Oregon 2 20 Washington 15
Utah 36 Ohio 1 21 Illinois 19
Wyoming 37 Louisiana 2 22 New Jersey 12
Note: Ranking/groupings based on weighted services. 23 New Hampshire 14
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Michigan CON Legislation
Public Act 368 of 1978 mandated the Michigan CON program.
The CON Reform Act of 1988 was passed to create a systematic way to develop standards and reduce the number of services requiring a CON. The act also created the CON Commission. The commission, whose membership is appointed by the Governor, is responsible for developing and approving CON review standards.
Public Act 619 of 2002 modified several sections the Public Health Code pertaining to CON including, but not limited to,:
No CON required for non-clinical capital expenditure projects Redefined “rural county” Expanded exceptions to CON under MCL 333.22209 Expanded the CON Commission Requires review of standards every three years and changes method for
developing standards
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The following projects must obtain a CON [M.C.L. 333.22209(1)]: Acquire an existing health facility or begin operation of a health
facility at a site that is not currently licensed for that type Make a change in the bed capacity of a health facility Initiate, replace, or expand a covered clinical service Make a covered capital expenditure
Capital expenditure projects (i.e., construction, renovation) must obtain a CON if the projects exceeds [M.C.L. 333.22203]:
$2,622,500 for clinical service areas, as of January 2004
Note: Thresholds are indexed annually by the department based on the Consumer Price Index.
Michigan CON ProgramRequirements and Standards
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Michigan CON ProgramRequirements and Standards continued…
Air ambulances (helicopters) Cardiac catheterization, including
diagnostic, therapeutic, angioplasty, PCI, and electrophysiology
Computed tomography (CT) scanners
Hospital beds – general acute care Magnetic resonance imaging (MRI) Megavoltage radiation therapy
(MRT) Neonatal intensive care units (NICU) Nursing home/hospital long-term
care beds
Open heart surgery Positron emission tomography
(PET) Psychiatric beds – acute inpatient Surgical services – hospital and
free-standing Transplantation services – bone
marrow, including peripheral stem cell, heart, heart-lung, lung, liver, and pancreas
Urinary lithotripters
Covered Items, Clinical Services and Equipment:
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Michigan CON ProgramApplication Review Process
Contact from Applicant(phone, meeting, letter)
CON Review Section (CRS)
Application to CRS
Request for additionalinformation
Additional informationreview
Application deemedcomplete
Request info. to CRS& local rev. agency
Application forms sent toapplicant within 15 days
CRS receives LOI
LOI pkg. sent toapplicant
30 days
No Application to localreview agency
Recommendations to CRSin advance of decision date
30 days (non-substantive)
90 days (substantive/comparative)
continued
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Michigan CON ProgramApplication Review Process continued…
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Michigan CON ProgramApplication Review Process continued…
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Michigan CON ProgramApplication Review Process continued…
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Designated Application DatesNon-substantive review – any workdaySubstantive review – 1st workday of monthComparative review – 1st workday ofFeb., June, or Oct.
Non-substantive Review
Proposed decision
Final decision
45 days
5 daysDenial
Proposed decision
Substantive Individual Review
Final decision
Approval
5 days
120 days
15 days
Comparative grouping
Single proposeddecision
Potential Comparative
Not comparative Comparative
30 days
120 daysFinal decision
Hearing
Request for hearing
Waive mandatoryhearing date
Reconsideration
Approval
Final decision Final decision
90 daysRequest for
hearing
15 days
90 days unless waived
Continued
Michigan CON ProgramApplication Review Process continued…
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MDCH and the Office of the Attorney General provide input (administrative feasibility and legality) regarding any
proposed standards.
Commission approves, disapproves, or revises proposed standards.
Commission, standard advisory committee, MDCH or private consultant develops draft standards. MDCH also provides staff assistance.
Proposed standards are disapproved by Commission.
Commission meets to approve, disapprove, or revise proposed FINAL review standards.
Sent to joint legislative committee for 30-day comment period.
Commission holds public hearing.
Standards may be returned for further work.
Review standards become effective and sent to the Office of Regulatory Reform to be published.
Standards are disapproved by Commission. Standards are approved by Commission. Approved standards sent to joint legislative committee and Governor for 45-day review period.
Standards are approved by the joint legislative committee and the Governor.
Standards are disapproved by the joint legislative committee and the Governor.
Standards do not become effective or returned to the Commission for further work.
Proposed standards may be returned to MDCH, standard advisory committee, or
private consultant for further work.
Proposed standards are approved by Commission.
Michigan CON CommissionStandards Development Process
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Michigan CON ProgramSurveillance Tools
Tools: Annual Hospital Statistical Questionnaire
Hospitals, freestanding surgical facilities, freestanding MRT facilities, and freestanding CT facilities
Annual PET scanner survey MRI electronic database Michigan Inpatient Data Base (MIDB)
General Measures: Measures for Select Services: Infrastructure (i.e., equipment) Wait times Procedures Staffing Weighted volumes Certifications
Michigan CON Authority: Act 368, P.A. 1978 – “ A health facility or agency shall provide the department with data and statistics required to enable the department to carry out functions required by federal and state law, including rules and regulations.”
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Michigan CON ProgramWeb Site: www.michigan.gov/con
Highlights
Listserv
Standards
Laws
Rules
Forms
Notices
FQA
Contact Info
Updates
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Question & Answers
Contact Information:
Certificate of Need Program
Lewis Cass Building
320 S. Walnut Street, 3rd Floor
Lansing, Michigan 48913
Phone: 517/241-3344
Web Site: www.michigan.gov/con
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