550.1501 Contracts with health care facilities. Sec. 501. (1) A health care corporation subject to this act may enter into contracts with health care facilities in Michigan or health facilities in any other jurisdiction. It is the intent of the legislature that contracts with health facilities outside of Michigan expand access to health care without […]
550.1501a Special participating contracts with health care providers for provision of primary health care benefits to children enrolled in Michigan caring program. Sec. 501a. A health care corporation may enter into special participating contracts with health care providers for the provision of primary health care benefits to children enrolled in a Michigan caring program created […]
550.1501b Conduct on behalf of or information provided to subscriber by health care provider; prohibition or discouragement by health care corporation. Sec. 501b. A health care corporation shall not prohibit or discourage a health care provider from advocating on behalf of a subscriber for appropriate medical treatment options pursuant to the grievance procedure in section […]
550.1501c Provider network. Sec. 501c. Beginning January 1, 2014, a health care corporation shall establish and maintain a provider network that, at a minimum, satisfies any network adequacy requirements imposed by the commissioner pursuant to federal law. History: Add. 2013, Act 4, Imd. Eff. Mar. 18, 2013 Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350
550.1502 Contracts for reimbursement with professional health care providers; private provider-patient relationship; methods of diagnosis or treatment not to be restricted; refusal to reimburse for overutilized services; list of providers; recommendation of provider as misdemeanor; symbol of participation; health maintenance organization not impeded; contracts subject to MCL 550.1504 to 550.1518; participation of freestanding surgical outpatient […]
550.1502a Prudent purchaser agreements; group contracts; option; group contracts under which financial or other advantage realized; additional option; applicability of subsection (5); individual contracts; rates; contracts subject to MCL 550.1504 to 550.1518; discrimination against class of health care providers; provisions inapplicable to certain contracts or renewals; optometry, chiropractic, and physical therapist or physical therapist assistant […]
550.1503 Uniform reporting by health care providers. Sec. 503. In the course of developing and establishing provider class plans under this part, a health care corporation shall address the issue of uniform reporting by health care providers. History: 1980, Act 350, Eff. Apr. 3, 1981 Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350
550.1504 Reimbursement arrangements; goals; definitions; supplemental efforts. Sec. 504. (1) A health care corporation shall, with respect to providers, contract with or enter into a reimbursement arrangement to assure subscribers reasonable access to, and reasonable cost and quality of, health care services, in accordance with the following goals: (a) There will be an appropriate number […]
550.1505 Provider class plan; development, modification, implementation, or review; procedures to obtain advice and consultation. Sec. 505. (1) A health care corporation shall establish and implement procedures to obtain advice and consultation from a provider class, either through individual providers of that class or through 1 or more organizations or associations that represent the provider […]
550.1506 Provider class plan; transmitting to commissioner; examination; determination; notice; placing plan into effect; retention of plan for commissioner’s records. Sec. 506. (1) A health care corporation shall transmit a copy of each provider class plan to the commissioner 45 days before the earliest effective date of a provider contract or reimbursement arrangement for the […]
550.1507 Provider class plan; inclusion and transmittal of items omitted. Sec. 507. Within 15 days after receipt of the notification as provided in section 506(3), the health care corporation shall include the items omitted from the provider class plan, after taking into consideration any advice and consultation received from providers and subscribers pursuant to section […]
550.1508 Provider class plan; modifications. Sec. 508. (1) Except during the 6-month period provided in section 509(2), a provider class plan retained by the commissioner as provided in section 506(4) may be modified by the health care corporation after the retention, under either of the following circumstances: (a) If the plan was prepared by the […]
550.1509 Achievement of goals and objectives; determinations by commissioner. Sec. 509. (1) The commissioner may determine if the health care corporation has substantially achieved the goals of a corporation as provided in section 504 and achieved the objectives contained in the provider class plan, at the following times: (a) For a provider contract or a […]
550.1510 Additional determinations by commissioner. Sec. 510. (1) After considering the information and factors described in section 509(4), the goals of a health care corporation as provided in section 504, and the objectives contained in the provider class plan, the commissioner shall determined 1 of the following: (a) That the provider class plan achieves the […]
550.1511 Provider class plan; transmittal to commissioner; preparation by commissioner. Sec. 511. (1) Upon receipt of notice under section 510(2), the health care corporation, within 6 months or a period determined by the commissioner pursuant to section 512, shall transmit to the commissioner a provider class plan that substantially achieves the goals, achieves the objectives, […]
550.1512 Extension of 6-month period provided in MCL 550.511(1); determination. Sec. 512. The commissioner may extend the 6-month period provided in section 511(1) once, for not more than 90 days, if the commissioner determines that a health care corporation requires additional time to assess the findings made by the commissioner or to prepare a provider […]
550.1513 Provider class plan; examination; automatic retention; placing plan into effect; preparation of plan by commissioner; notice. Sec. 513. (1) Upon receipt of a provider class plan under section 511(1), the commissioner, after considering the information and factors described in section 509(4), within 90 days shall examine the plan and determine if the plan substantially […]
550.1514 Appeal; selection and qualifications of hearing officer; consolidation; annual report. Sec. 514. (1) All appeals under this part shall be held before an independent hearing officer. The state court administrator shall compile and maintain a list of individuals possessing all of the following qualifications: (a) Is a retired circuit court judge. (b) Is a […]
550.1515 Appeal; parties; request; time; relief; transmittal of provider class plan to hearing officer; determinations. Sec. 515. (1) An appeal may be brought from any action or determination of the commissioner under section 509(1), 510(1), or 513(1) or (2), by a subscriber, the health care corporation, the attorney general, an employer, an organization or association […]
550.1516 Provider class plan; standards. Sec. 516. (1) All provider class plans retained by the commissioner under section 513 or approved by the hearing officer shall maintain the following standards for all providers: (a) Responsible cost controls shall exist that balance quality, accessibility, and cost. (b) The health care corporation shall promote programs and policies […]
