Michigan’s Certificate of Need Program

1
Michigans Certificate of Need Program

• Michigan Department
• of Community Health

2
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.

3
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.
4
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

5
Michigan CON ProgramRequirements and Standards

• 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.

6
Michigan CON ProgramRequirements and Standards
continued
Covered Items, Clinical Services and Equipment

• 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

• 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

7
Michigan CON ProgramApplication Review Process
8
Michigan CON ProgramApplication Review Process
continued
9
Michigan CON ProgramApplication Review Process
continued
10
Michigan CON ProgramApplication Review Process
continued
11
Michigan CON ProgramApplication Review Process
continued
Continued
12
Michigan CON CommissionStandards Development
Process
MDCH and the Office of the Attorney General
provide input (administrative feasibility and
legality) regarding any proposed standards.
13
Michigan CON ProgramSurveillance Tools
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.

• 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

14
Michigan CON ProgramWeb Site www.michigan.gov/co
n

• Highlights
• Listserv
• Standards
• Laws
• Rules
• Forms
• Notices
• FQA
• Contact Info
• Updates

15
Question Answers
Contact Information Certificate of Need
Program Lewis Cass Building 320 S. Walnut
Street, 3rd Floor Lansing, Michigan
48913 Phone [phone] Web Site
www.michigan.gov/con