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 of Apply to operate an MIH Program

What you need for Apply to operate an MIH Program

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

  • The application is posted as a fillable PDF. You will need to have either Adobe Acrobat or Adobe Reader installed on your computer to complete the application form. 
  • When you open the application, please download and save it to your computer before filling it out. If you fill out the application in your Internet browser without saving, all changes will be lost once the browser window is closed.
  • The application allows applicants to use an electronic signature. Please note that handwritten documents and attachments will not be accepted. If you need assistance setting up your electronic signature, please see the Instructions to create an electronic signature.

Please note: Applicants who also apply to operate an MIH Program with ED Avoidance must submit a separate MIH with ED Avoidance application, with all required attachments, responses, and application fee.

Application Requirements

A complete MIH application includes:

Fees for Apply to operate an MIH Program

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 $30,000 per Certificate of Approval

How to apply Apply to operate an MIH Program

Please fax the complete application form and all required attachments to (617) 887-8751.
 
DPH will notify each applicant by email when the application form and all attachments have been received.

Next steps for Apply to operate an MIH Program

Application Review

  • Once a completed application form and the application fee are received, DPH will review the information and will contact the applicant if clarifications or additional information for the submitted application materials are needed.
  • Upon receiving application approval from DPH, the MIH program must submit payment for the $30,000 MIH Program Registration Fee with the MIH Program Registration Fee Remittance Form.
  • Once the registration fee is received, DPH will issue a Certificate of Approval to operate an MIH Program. Certificates of Approval are valid for 2 years. 

Downloads for Apply to operate an MIH Program

Contact for Apply to operate an MIH Program

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