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.  

Michigan’s 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).⁴⁷ In response, DHHS directed⁴⁸ applicants to existing emergency application rules. DHHS, Application for Emergency Certificate of Need.⁴⁹  

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.   

Types of CONs in Michigan  

	CON?	CON applies with expenditure above:	Temporary  COVID-19 response:
Hospital Beds	Yes	Any amount	Preexisting regulation implemented
Beds Outside Hospitals	Yes	Any amount	Preexisting regulation implemented
Equipment	Yes	$0 – $3.375 million+	Preexisting regulation implemented
Facilities/Buildings	Yes	$3.375 million+	Preexisting regulation implemented
Services	Yes	Any amount	Preexisting regulation implemented
Emergency Medical Transport	Yes	Any amount	Preexisting regulation implemented

Michigan CONs in Detail 

Category	Types of CONs	Mich. Comp. Laws
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)	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)	Beds in psychiatric hospitals or psychiatric units.	§ 333.22205(1)(b)
	Beds in nursing homes.	§ 333.22205(1)(c)
	Beds in freestanding surgical outpatient facilities.	§ 333.22205(1)(d)
	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)	Extracorporeal shock wave lithotripsy.	§ 333.22203(10)(b)(i)
	Megavoltage radiation therapy.	§ 333.22203(10)(b)(ii)
	Positron emission tomography.	§ 333.22203(10)(b)(iii)
	Fixed magnetic resonance imager. Mobile magnetic resonance imager.	§ 333.22203(10)(b)(vi)
	Fixed computerized tomography scanner. Mobile computerized tomography scanner.	§ 333.22203(10)(b)(vii)
	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 202050
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)	Hospitals.	§ 333.22205(1)(a)
	Psychiatric hospitals or psychiatric units.	§ 333.22205(1)(b)
	Nursing homes.	§ 333.22205(1)(c)
	Freestanding surgical outpatient facilities.	§ 333.22205(1)(d)
	Health maintenance organizations.	§ 333.22205(1)(e)
Category	Types of CONs	Mich. Comp. Laws
Services  The initiation, replacement, or expansion of a covered clinical service. Mich. Comp. Laws §§ 333.22209(1)(c), 333.22203(10)	Neonatal intensive care services.	§ 333.22203(10)(a)(i)
	Open heart surgery.	§ 333.22203(10)(a)(ii)
	Extrarenal organ transplantation.	§ 333.22203(10)(a)(iii)
	Surgical services at a freestanding surgical outpatient facility, or ambulatory surgery center.	§ 333.22203(10)(b)(iv)
	Cardiac catheterization.	§ 333.22203(10)(b)(v)
	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 202051
Emergency Medical Transport	Air ambulance services.	§ 333.22203(10)(b)(viii)

No CON Required For:	Mich. Comp. Law
Institution conducted by and for adherents of a church which depends on prayer through healing.	§ 333.22205(2)(a)
Health care facility or agency located in a correctional institution.	§ 333.22205(2)(b)
Veterans’ facility operated by the state or federal government.	§§ 333.22205(2)(c), 333.22209(4)-(5)
Facility owned and operated by the department of community health.	§ 333.22205(2)(d)
Specified reductions and relocations of bed capacity.	§ 333.22209(2)-(3), (7)-(9)