Section 333.22227 - Health maintenance organization; purposes for which certificate of need required; capital expenditures; considerations and criteria(1) A health maintenance organization is required to obtain a certificate of need only for 1 or more of the following purposes: (a) The acquisition of, purchase of, new construction of, modernization of, replacement of, or addition to a hospital or other health facility providing inpatient services, if a covered capital expenditure is required.(b) The initiation, replacement, or expansion of a covered clinical service.(2) A covered capital expenditure proposed to be undertaken by a health maintenance organization that is not intended principally to serve the needs of the enrollees of the health maintenance organization, as determined by the department, is subject to this part.(3) In making determinations and conducting reviews for certificates of need for health maintenance organizations, the department shall consider the special needs and circumstances of health maintenance organizations, and shall apply all of the following criteria:(a) The availability of the proposed service from a provider of health care other than the health maintenance organization on a long-term basis, at reasonable terms, and in a cost-effective manner consistent with the health maintenance organization's basic method of operation.(b) The long-term needs of the health maintenance organization, and its current and expected future membership.(c) The long-term impact of the proposed service on health care costs in the health maintenance organization's service area.Add. 1988, Act 332, Eff. 10/1/1988 ;--Am. 1993, Act 88, Imd. Eff. 7/9/1993 .