reglab/housing_qa huggingface dataset:
MI Comp L § 550.1504 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704)|350-1980-5 - Part 5 (550.1501...550.1518)|Section 550.1504 - Reimbursement Arrangements; Goals; Definitions; Supplemental Efforts.

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 of providers throughout this state to assure the availability of certificate-covered health care services to each subscriber.  (b) Providers will meet and abide by reasonable standards of health care quality.  (c) Providers will be subject to reimbursement arrangements that will assure a rate of change in the total corporation payment per member to each provider class that is not higher than the compound rate of inflation and real economic growth.  (2) As used in this section:  (a) "Gross national product in constant dollars" means that term as defined and annually published by the United States department of commerce, bureau of economic analysis.  (b) "Implicit price deflator for gross national product" means that term as defined and annually published by the United States department of commerce, bureau of economic analysis.  (c) "Inflation" or "I" means the arithmetic average of the percentage changes in the implicit price deflator for gross national product over the 2 calendar years immediately preceding the year in which the commissioner's determination is being made.  (d) "Compound rate of inflation and real economic growth" means the ratio of the quantity "100 plus inflation", multiplied by the quantity "100 plus real economic growth", to 100; minus 100; or as expressed in the following formula:   ( (100 + I) x (100 + REG) )   ( 100 ) -100   ( )  (e) "Rate of change in the total corporation payment per member to each provider class" means the arithmetic average of the percentage changes in the corporation payment per member for that provider class over the 2 years immediately preceding the commissioner's determination.  (f) "Real economic growth" or "REG" means the arithmetic average of the percentage changes in the per capita gross national product in constant dollars over the 4 calendar years immediately preceding the year in which the commissioner's determination is being made.  (3) Nothing in this section shall preclude efforts by a health care corporation supplemental to the goals prescribed in subsection (1). History: 1980, Act 350, Eff. Apr. 3, 1981 Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350
MI Comp L § 550.1505 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704)|350-1980-5 - Part 5 (550.1501...550.1518)|Section 550.1505 - Provider Class Plan; Development, Modification, Implementation, or Review; Procedures to Obtain Advice and Consultation.

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 class, in any combination, in the development of the provider class plan. A health care corporation may negotiate with 1 or more organizations or associations that represent providers in the relevant provider class in the development and modification of the provider class plan and objectives and methods for implementing that plan.  (2) The commissioner shall establish and implement procedures whereby any person, including a subscriber, may offer advice and consultation on the development, modification, implementation, or review of a provider class plan.  (3) A health care corporation shall establish and implement procedures to obtain advice and consultation from subscribers in the development and modification of the provider class plan and objectives for implementing that plan. History: 1980, Act 350, Eff. Apr. 3, 1981 Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350
MI Comp L § 550.1506 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704)|350-1980-5 - Part 5 (550.1501...550.1518)|Section 550.1506 - Provider Class Plan; Transmitting to Commissioner; Examination; Determination; Notice; Placing Plan Into Effect; Retention of Plan for Commissioner's Records.

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 appropriate provider class. The initial provider class plan for each class, which shall include provider contracts and reimbursement arrangements under which the corporation and a provider class are operating on the effective date of this act, shall be transmitted to the commissioner within 45 days after the effective date of this act, except where a provider class plan reimburses on a prospective basis, in which case the plan shall be transmitted within 1 year and 45 days after the effective date of this act.  (2) Upon receipt of a provider class plan, the commissioner shall examine the plan and shall determine only if the plan contains a reimbursement arrangement and objectives for each goal provided in section 504, and, for those providers with which a health care corporation contracts, provisions that are included in that contract. For purposes of making the determination required by this subsection only, the commissioner shall liberally construe the items contained in a provider class plan.  (3) If the commissioner determines that the plan does not contain a reimbursement arrangement, objectives for each goal provided in section 504, and, for those providers with which a health care corporation contracts, contract provisions, the commissioner, within 15 days after receipt of the plan, shall notify the corporation by certified or registered mail, along with a written statement of the items omitted.  (4) If the commissioner does not notify the health care corporation pursuant to subsection (3), the provider class plan shall be automatically placed into effect, and shall be retained for the commissioner's records. Provider class plans approved by the commissioner or an independent hearing officer under this part shall be considered retained for the commissioner's records under this subsection. History: 1980, Act 350, Eff. Apr. 3, 1981 Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350
MI Comp L § 550.1507 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704)|350-1980-5 - Part 5 (550.1501...550.1518)|Section 550.1507 - Provider Class Plan; Inclusion and Transmittal of Items Omitted.

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 505, and shall transmit the items omitted, as provided in section 506(1). History: 1980, Act 350, Eff. Apr. 3, 1981 Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350
MI Comp L § 550.1508 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704)|350-1980-5 - Part 5 (550.1501...550.1518)|Section 550.1508 - Provider Class Plan; Modifications.

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 health care corporation and is not a plan prepared pursuant to section 511(1) or 515(4). However, the modification shall not take effect until after the modification has been filed with the commissioner.  (b) In all other cases, if the modification has been filed with and is agreed to by the commissioner.  (2) A modification made under subsection (1) shall not extend the time periods provided in section 509(1). In developing plan modifications, a health care corporation shall obtain advice and consultation from providers in the relevant provider class and from subscribers pursuant to section 505. Before agreeing to plan modifications under subsection (1)(b), the commissioner shall obtain advice and consultation pursuant to section 505(2).  History: 1980, Act 350, Eff. Apr. 3, 1981 Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350
MI Comp L § 550.1510 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704)|350-1980-5 - Part 5 (550.1501...550.1518)|Section 550.1510 - Additional Determinations by Commissioner.

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 goals of the corporation as provided in section 504.  (b) That although the provider class plan does not substantially achieve 1 or more of the goals of the corporation, a change in the provider class plan is not required because there has been competent, material, and substantial information obtained or submitted to support a determination that the failure to achieve 1 or more of the goals was reasonable due to factors listed in section 509(4).  (c) That a provider class plan does not substantially achieve 1 or more of the goals of the corporation as provided in section 504.  (2) The commissioner shall notify the health care corporation, and each person who has requested a copy of such notice, of a determination under subsection (1) by certified or registered mail. Determinations made pursuant to subsection (1)(b) or (c) shall include a concise written statement of specific findings supporting that determination.  (3) An existing provider contract or reimbursement arrangement shall remain in effect until a new provider class plan has been retained and placed into effect as provided in section 506(4). A provider class plan shall not be subject to further review until the expiration of the time period provided in section 509(1).  (4) A provider class plan with respect to which a determination was made under subsection (1)(a) or (b) shall not be subject to further review until the expiration of 2 years following the determination. History: 1980, Act 350, Eff. Apr. 3, 1981 Compiler's Notes: Near the end of subsection (1), “determined” evidently should read “determine.”Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350
MI Comp L § 550.1511 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704)|350-1980-5 - Part 5 (550.1501...550.1518)|Section 550.1511 - Provider Class Plan; Transmittal to Commissioner; Preparation by Commissioner.

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, and substantially overcomes the deficiencies enumerated in the findings made by the commissioner pursuant to section 510(2). In developing a provider class plan under this subsection, the corporation shall obtain advice and consultation from providers in the provider class and subscribers, using procedures established pursuant to section 505.  (2) If, after the expiration of 6 months or a period determined by the commissioner pursuant to section 512, the health care corporation has failed to act pursuant to subsection (1), the commissioner shall prepare a provider class plan pursuant to section 513(2)(a), for that provider class. History: 1980, Act 350, Eff. Apr. 3, 1981 Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350
MI Comp L § 550.1512 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704)|350-1980-5 - Part 5 (550.1501...550.1518)|Section 550.1512 - Extension of 6-Month Period Provided in MCL 550.511(1); Determination.

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 class plan that substantially achieves the goals, achieves the objectives, and substantially overcomes the deficiencies enumerated in the findings. In making a determination under this section, the commissioner shall consider the number of provider class plans, the extent of the changes to each plan, and the stage of development of each plan being prepared by the health care corporation pursuant to section 511(1).  History: 1980, Act 350, Eff. Apr. 3, 1981 Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350
MI Comp L § 550.1513 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704)|350-1980-5 - Part 5 (550.1501...550.1518)|Section 550.1513 - Provider Class Plan; Examination; Automatic Retention; Placing Plan Into Effect; Preparation of Plan by Commissioner; Notice.

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 achieves the goals, achieves the objectives, and substantially overcomes the deficiencies enumerated in the findings made by the commissioner. If the commissioner determines that the plan substantially achieves the goals, achieves the objectives, and substantially overcomes the deficiencies enumerated in the findings made by the commissioner, the plan shall be automatically retained and placed into effect as provided in section 506.  (2) If the commissioner determines that the plan does not substantially achieve the goals, does not achieve the objectives, and does not substantially overcome the deficiencies enumerated in the findings made by the commissioner pursuant to section 510(2), the commissioner shall do all of the following:  (a) Prepare a provider class plan that substantially achieves the goals, achieves the objectives, and substantially overcomes the deficiencies enumerated in the findings made pursuant to section 510(2), and transmit that plan to the health care corporation. A provider class plan prepared pursuant to this subdivision shall be retained for the commissioner's records and placed into effect as provided in section 506(4), unless a request for an appeal is made under subdivision (b).  (b) Give written notice to the health care corporation of an opportunity for an appeal pursuant to section 515. The notice shall state that a request for an appeal shall be made by the corporation within 30 days after the receipt of notice under this subdivision.  (3) In making a determination pursuant to subsection (1), or preparing a plan pursuant to subsection (2)(a), the commissioner shall obtain advice and consultation pursuant to section 505(2). The commissioner shall also forward a copy of each notice issued under subsection (2)(b) to each person requesting a copy. The copy shall notify the person of an opportunity for an appeal pursuant to section 515, and that a request for such an appeal is required to be made within 30 days after the receipt of notice given under this subsection. History: 1980, Act 350, Eff. Apr. 3, 1981 Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350
MI Comp L § 550.1514 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704)|350-1980-5 - Part 5 (550.1501...550.1518)|Section 550.1514 - Appeal; Selection and Qualifications of Hearing Officer; Consolidation; Annual Report.

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 resident of this state.  (c) Is not engaged in the provision of health care services.  (d) Is not an officer or employee of a health care provider, health care corporation, or an employee of this state. For purposes of this subdivision, an employee of an educational institution shall not be considered to be employed by this state.  (2) The hearing officer shall be selected at random by the commissioner from the list described in subsection (1), on a per appeal basis. If the individual selected is performing judicial duties, another individual shall be selected.  (3) The hearing officer shall have the power to consolidate appeals related to a provider class.  (4) The commissioner shall prepare and file with the appropriate standing committees of the legislature an annual report regarding the operation of the appeals procedure prescribed in this part, including data regarding the identity of individuals available to serve as independent hearing officers whose names are on the administrator's list; the number of appeals heard; the nature of the controversy involved; the disposition of the appeal; and whether a judicial appeal was subsequently taken, and the disposition of that appeal. History: 1980, Act 350, Eff. Apr. 3, 1981 Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350
MI Comp L § 550.1516 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704)|350-1980-5 - Part 5 (550.1501...550.1518)|Section 550.1516 - Provider Class Plan; Standards.

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 which encourage cost-effective behavior by providers in accordance with the provisions of this act, and in accordance with all of the following:  (i) There shall be a reasonable basis for believing that the programs will be effective.  (ii) The programs applicable to a provider class shall be reviewed to avoid duplication or inconsistency, to the extent practicable.  (c) There shall be a fair and reasonable appeals process established and maintained by the health care corporation for aggrieved providers.  (d) There shall be a reasonable period for implementation of changes.  (e) There shall be reasonably prompt payment by the health care corporation to providers who render covered health care services.  (2) In addition to the standards prescribed in subsection (1), the following standards shall apply to hospitals:  (a) To the extent practicable, reimbursement control shall be expressed in the aggregate to individual hospitals.  (b) No portion of the health care corporation's fair share of hospitals' reasonable financial requirements shall be borne by other health care purchasers. However, this subdivision shall not preclude reimbursement arrangements which include financial incentives and disincentives.  (c) The health care corporation's programs and policies shall not unreasonably interfere with the hospital's ability and responsibility to manage its operations. History: 1980, Act 350, Eff. Apr. 3, 1981 Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350
MI Comp L § 550.1517 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704)|350-1980-5 - Part 5 (550.1501...550.1518)|Section 550.1517 - Annual Report.

550.1517 Annual report. Sec. 517.  A health care corporation shall transmit an annual report for each provider class to the commissioner regarding the level of achievement of the goals provided in section 504. The report shall include data necessary to a determination of the corporation's compliance or noncompliance with the goals, as prescribed in section 504, and compliance with objectives contained in the provider class plan. The report shall be in accordance with forms and instructions prescribed by the commissioner and shall include information as necessary to evaluate the considerations of section 509(4). The report may include other information the corporation deems relevant. History: 1980, Act 350, Eff. Apr. 3, 1981 Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350
MI Comp L § 550.1518 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704)|350-1980-5 - Part 5 (550.1501...550.1518)|Section 550.1518 - Considerations and Standards; Applicability; Appeal.

550.1518 Considerations and standards; applicability; appeal. Sec. 518.  The considerations set forth in section 509(4) and the standards set forth in section 516 shall only apply for purposes of this act and may be appealed only as specifically provided in this act. An appeal from a final determination of an independent hearing officer shall be conducted pursuant to chapter 6 of the administrative procedures act, except that the appeal shall be taken within 30 days after the final determination, upon leave granted, in the court of appeals. History: 1980, Act 350, Eff. Apr. 3, 1981 Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350
MI Comp L § 550.1601 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704)|350-1980-6 - Part 6 (550.1601...550.1620)|Section 550.1601 - Regulation and Supervision of Health Care Corporation; Delegation of Authority.

550.1601 Regulation and supervision of health care corporation; delegation of authority. Sec. 601.  (1) A health care corporation shall be subject to regulation and supervision by the commissioner as provided in this act.  (2) A designee of the commissioner shall not be authorized to act on behalf of the commissioner under this act unless prior written notice of the delegation of authority has been given to a health care corporation subject to that delegated authority. History: 1980, Act 350, Eff. Apr. 3, 1981 Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350