Apply to operate an MIH Program

Instructions for submitting a Mobile Integrated Health Care (MIH) application to the Department of Public Health (DPH).

Mobile Integrated Health Care Program

The Details

What you need

The MIH application form must be completed by health care entities for proposed services in Massachusetts.

During the application process, please use the guidance information and documentation to help craft your program and application:

Please note, if you wish to apply to operate either a Community EMS or Mobile Integrated Health with Emergency Department Avoidance (MIH with EDA) program, there are separate applications on their respective webpages.

Application Requirements

A complete MIH application includes:

Next Steps

Application Review

Once the Department has completed the review process, you will receive a Conditions letters indicating the program is approved contingent on receiving payment for the $5,000 MIH Program Registration Fee with the MIH Program Registration Remittance Form (PDF) | (DOCX). You will submit the registration payment and form after you receive your Conditions letter.

Once the registration fee and remittance form are received, you will be issued your official Certificate of Approval which will be valid for 2 years.

Fees

Please note: Applicants who also apply to operate an MIH with ED Avoidance Program must submit a separate MIH with ED Avoidance application fee.

Name Fee Unit
MIH Program application fee $1,000 per application
MIH Program registration fee $5,000 per Certificate of Approval

How to apply

  • Application
    • Please mail the complete application form and all required attachments to the address below under payment.
    • DPH will notify each applicant by email when the application form and all attachments have been received.
  • Payment
    • Please mail a check or money order ($1,000 application fee) made out to the “COMMONWEALTH OF MASSACHUSETTS” with a completed MIH Program Application Fee Remittance Form to:
      • Massachusetts Department of Public Health
        Office of Emergency Medical Services
        Mobile Integrated Health Care Program
        67 Forest Street
        Marlborough, MA 0175
    • MIH Program Registration Remittance Form (PDF) | (DOCX)

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