Last updated: November 2026. Statute pages opened 2026-11-09 ("Complete Through PA 114 of 2026").
A Michigan certificate of need is the approval Part 222 of the Michigan Public Health Code requires, except as otherwise provided in that part, before a person acquires an existing health facility or begins operating one at a site not currently licensed for that type, changes bed capacity, initiates, replaces or expands a covered clinical service, or makes a covered capital expenditure. Integral Healthcare Solutions (IHS) drafts the narrative, worksheets and review calendar for the applicant to approve and file. This is a compliance services engagement, not legal advice.
What does Michigan require for a certificate of need?
Under MCL 333.22209(1), a person must first obtain a certificate for these actions unless Part 222 provides otherwise:
- Acquire an existing health facility or begin operating one at a site not currently licensed for that facility type.
- Change a health facility's bed capacity.
- Initiate, replace or expand a covered clinical service.
- Make a covered capital expenditure.
A reduction in licensed bed capacity or services at a licensed site does not require a certificate (22209(2)). Counsel should assess bed relocations under 22209(3) and its cross-referenced conditions, including subsection (9).
What counts as a covered clinical service or covered capital expenditure?
MCL 333.22203(9) defines a covered capital expenditure as spending by a person for a health facility on a single project involving acquisition, improvement, expansion, addition, conversion, modernization, new construction or replacement of a clinical service area. The statutory threshold is 2,500,000 dollars or more, adjusted annually, excluding the cost of nonfixed medical equipment. Under MCL 333.22221(g), the department uses an amount determined by the state treasurer from the annual change in the most comprehensive Michigan consumer price index from the Bureau of Labor Statistics, using the preceding July 1–June 30 period. This page does not state the current adjusted threshold.
Section 22203(10) defines covered clinical services, subject to commission modifications under MCL 333.22215. Its categories distinguish initiation or expansion from initiation, replacement or expansion. Counsel should identify the applicable category and commission modifications before IHS maps the evidence.
Who needs a Michigan certificate of need, and what triggers it?
MCL 333.22205(1) covers hospitals licensed under Part 215; psychiatric hospitals or units licensed under the Mental Health Code; nursing homes licensed under Part 217; hospital long-term care units defined in section 20106(6); freestanding surgical outpatient facilities licensed under Part 208; and HMOs with a Michigan license or certificate of authority.
Subsection (2) excludes facilities or agencies in correctional institutions, state- or federally operated veterans facilities, and facilities owned and operated by the department of community health. It also excludes institutions conducted by and for adherents of a church or religious denomination to care for sick people who rely solely on spiritual healing through prayer.
What must a Michigan certificate of need applicant show?
Under MCL 333.22225(1), the applicant must demonstrate unmet need to the department's satisfaction through credible documentation of compliance with applicable review standards. For a project or portion otherwise governed by Part 222 with no applicable standard, credible documentation must demonstrate unmet need through geographic accessibility and efficient, appropriate utilization, considering the project type and existing healthcare system. With or without standards, the department must consider approved projects not yet operating, projects under appeal from its final decision, and projects awaiting its final decision.
Only after that showing, the applicant must demonstrate the additional criteria to the department's reasonable satisfaction: the most efficient and effective available alternative for meeting the need; capital costs producing the least costly total annual operating costs; available capital and operating funds; the least costly available financing; and, for construction, a stipulation to bid capital expenditures among qualified contractors or a proposed alternative achieving substantially the same results. The project must meet applicable commission-approved operating and quality assurance standards, any commission viability criteria, and nonprofit governance requirements. Counsel should assess the qualified advisory-board alternative under 22225(2)(e). MCL 333.22223 requires a statement addressing each criterion, except for applications under section 22210.
The Certificate of Need Commission develops and revises the review standards and reviews each set at least every 3 years (MCL 333.22215(1)(b) and (m)).
How long does Michigan certificate of need review take?
The statute counts from the proposed decision, not from filing. If the proposed decision is other than an approval without conditions or stipulations, the director issues a final decision not later than 60 days after it is submitted to the director, unless the applicant has filed a request for a hearing on that proposed decision. If the proposed decision is an approval, the final decision is due not later than 5 days after submission (MCL 333.22231(6)). The applicant may submit a written hearing request within 15 days after receiving the bureau's proposed denial or notice that the director reversed a proposed approval, to demonstrate that the filed application meets Part 222 approval requirements (MCL 333.22232(1)). The final decision may be appealed within 30 days, only by the applicant and only on the record, to the circuit court for the county of its principal place of business in Michigan or for Ingham County (MCL 333.22231(9)). The time from filing to the proposed decision is not in the statute text; counsel confirms it from the department's rules.
How does IHS prepare a Michigan certificate of need application?
IHS works as an outside drafting team under your leaders and counsel, in four steps.
- Gap assessment. IHS compares your project plan to the showings in MCL 333.22225 and the review standard your counsel identifies, and lists the evidence you lack.
- Evidence mapping and drafting. IHS maps each showing to its data, then drafts the narrative, worksheets, review calendar and attachment checklist for your leaders and counsel to approve.
- Mock review. IHS reads the draft as a reviewer would.
- Readiness support. IHS drafts a post-approval tracker, including any time limit on conditions (MCL 333.22231(2)).
What you supply: the project description and capital cost; need, utilization and financial data; counsel; and the filing, the fee and attendance.
The real limit: the applicant files and attends. IHS does not file with the state, attend or communicate with the department or the commission for you, gives no legal advice, and does not guarantee approval.
IHS, founded in 2002, is led by Thomas G. Goddard, JD, PhD, former Chief Operating Officer and General Counsel of URAC. This program is part of its compliance services practice line.
What should an applicant have ready for a Michigan certificate of need?
Use Part 222 of the Michigan Public Health Code, complete through PA 114 of 2026 (pages opened 2026-11-09), to organize:
- Counsel's trigger and exception assessment: MCL 333.22209.
- The applicable commission review standard and counsel's comparative-review assessment: MCL 333.22215 and MCL 333.22229.
- Need and utilization evidence, including the no-standard branch when applicable: MCL 333.22225(1).
- A written alternatives analysis: MCL 333.22225(2)(a).
- Capital and operating funds, financing alternatives and any construction bidding plan: MCL 333.22225(2)(b).
- Quality, viability and applicable nonprofit governance evidence: MCL 333.22225(2)(c)–(e).
A free introductory call with IHS can identify which materials need drafting.
How does an outside application build compare with the other routes?
The routes are not exclusive. The table lists them without ranking them.
| Route | What it involves |
|---|---|
| Internal build | Planning and finance staff write the narrative and worksheets. |
| Counsel | Advises on need, exceptions, hearings and appeals. IHS gives none of that. |
| Outside drafting support (IHS) | IHS drafts the narrative, worksheets and calendar; the applicant files and attends. |
What does a Michigan certificate of need application cost?
The application fee schedule is in MCL 333.20161(3) (page opened 2026-11-09). Exception: MCL 333.22210(2) prohibits a processing fee for a certificate application to initiate an extended care services program.
| Fee | Amount | Condition |
|---|---|---|
| Base fee | 3,000 dollars | Each application. |
| Added to base | 5,000 dollars | Projected capital expenditure above 500,000 dollars and below 4,000,000 dollars. |
| Added to base | 8,000 dollars | Projected capital expenditure of 4,000,000 dollars or more and below 10,000,000 dollars. |
| Added to base | 12,000 dollars | Projected capital expenditure of 10,000,000 dollars or more. |
| Designated complex project | 3,000 dollars more | Includes comparative review projects and consolidated acquisition or replacement applications. |
| Expedited processing | 1,000 dollars | If required by the department, at the applicant's request. |
| Letter of intent or amendment | 500 dollars | A letter of intent requesting or resulting in a waiver from review, or an amendment request to an approved certificate. |
Fees are payable when the application is submitted and are not refunded if it is denied or a certificate is revoked before its expiration date (MCL 333.20161(5)). If the department exceeds the time in section 22231 for other than good cause, as the commission determines, it returns the fee on the applicant's written request (MCL 333.22231(10)). Verify current fees with the Michigan department that administers Part 222 review. IHS scopes each engagement after a free introductory call.
What this is not
This is not legal advice. IHS is a consulting firm, not a law firm; whether a project needs a certificate, whether an exception applies and any hearing or appeal are for your counsel. It is not a filing service or a guarantee of approval.
Frequently asked questions
What is a certificate of need in Michigan and which projects need one?
Part 222 requires approval before the four actions listed in MCL 333.22209(1), except as otherwise provided in that part. These cover facility acquisition or operation at a site not currently licensed for that type, bed-capacity changes, initiation, replacement or expansion of covered clinical services, and covered capital expenditures.
Does my project need a certificate in Michigan?
Counsel should assess your project against the four actions in MCL 333.22209(1) and applicable Part 222 exceptions. A reduction in licensed bed capacity or services at a licensed site does not require a certificate (22209(2)).
What must a Michigan certificate of need applicant show?
The applicant must demonstrate unmet need under MCL 333.22225(1), including its alternative test for a project or portion without an applicable review standard. Only after that showing do the additional criteria in 22225(2) apply; section 22223 excepts section 22210 applications from its criterion-statement requirement.
How long does Michigan certificate of need review take?
MCL 333.22231(6) sets final-decision deadlines from submission of the proposed decision to the director: not later than 5 days for a proposed approval. For a proposed decision other than approval without conditions or stipulations, it specifies not later than 60 days unless the applicant has filed a hearing request on that proposed decision. These are not filing-to-decision deadlines.
What is the Michigan certificate of need application fee?
MCL 333.20161(3) sets a 3,000-dollar base application fee, with additions shown in the fee table above. Section 22210(2) prohibits a processing fee for an application to initiate an extended care services program. Verify current fees with the Michigan department that administers Part 222 review.
What happens if a project starts without a certificate in Michigan?
If the department determines that a certificate recipient is not in compliance with the certificate's terms, or that a person violates Part 222 or its rules, MCL 333.22247(2) requires one or more listed enforcement actions. Options include certificate revocation or suspension and a civil fine capped at billings for services provided in violation.
Can we reuse an application prepared for another state?
IHS would map the draft to Michigan's requirements before reusing its content. MCL 333.22225(1) governs the need showing, including the route for a project or portion without an applicable review standard.
Should an applicant draft in-house, with counsel or with outside drafting support?
The routes are not exclusive. Counsel advises on need and appeals, your staff can write the narrative, and IHS drafts the narrative, worksheets and calendar for the applicant and counsel to approve. IHS gives no legal advice and does not file.
Related pages
See the Compliance Services overview | State licensing and certificate of need.