reglab/statecodes huggingface dataset:
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704) › 350-1980-4 - Part 4 (550.1400...550.1439) › Section 550.1436 - Michigan Caring Programs for Children; Creation; Contribution Requirements; Rating Methodologies; Supersedure of Inconsistent Provisions.

550.1436 Michigan caring programs for children; creation; contribution requirements; rating methodologies; supersedure of inconsistent provisions.
Sec. 436.
There may be created within each health care corporation a Michigan caring program for children. The program shall provide primary health care coverage for children as set forth in section 438 and shall be administered by the health care corporation. Each program shall be described in a certificate that sets forth the benefits provided. A certificate and the contribution to be charged shall be subject to the commissioner's approval. Contribution requirements shall be established in accordance with rating methodologies approved by the commissioner which, over time, shall not result in either gain or loss to the corporation. The rating methodology for a program shall not include any factors otherwise includable pursuant to other sections of this act that are intended to provide for subsidies, surcharges, or administrative costs. Any other provisions of this act that would otherwise apply to a program but which are inconsistent with the provisions of this section and sections 437 to 439 are superseded.
History:
Add. 1991, Act 60, Imd. Eff. June 27, 1991
Popular Name:
Blue Cross-Blue Shield
Popular Name:
Act 350
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704) › 350-1980-4 - Part 4 (550.1400...550.1439) › Section 550.1437 - Eligibility of Child for Enrollment in Program.

550.1437 Eligibility of child for enrollment in program.
Sec. 437.
A child is eligible for enrollment in the program if the child meets all of the following:
(a) Is less than 19 years of age.
(b) Is unmarried.
(c) Resides in a household with income 185% or less of the federal poverty level.
(d) Is ineligible to receive health care through title XIX of the social security act, chapter 531, 49 Stat. 620, 42 U.S.C. 1396 to 1396d, 1396f to 1369g, and 1396i to 1396s.
(e) Is enrolled in the program with all other eligible siblings who have no other health care coverage available.
(f) Is a resident of this state.
(g) Has no other health care coverage available.
History:
Add. 1991, Act 60, Imd. Eff. June 27, 1991
Popular Name:
Blue Cross-Blue Shield
Popular Name:
Act 350
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704) › 350-1980-4 - Part 4 (550.1400...550.1439) › Section 550.1438 - Limitation of Benefits; Provision of Other Health Care Benefits.

550.1438 Limitation of benefits; provision of other health care benefits.
Sec. 438.
(1) Notwithstanding any other provision of this act, a health care corporation may limit the benefits it will furnish to an eligible child enrolled in the program to the following primary health care benefits:
(a) Doctor office visits for a sick child.
(b) Medically necessary outpatient diagnostic tests.
(c) Emergency medical and accident care in a doctor's office or hospital's emergency room.
(d) Medically necessary outpatient surgery and anesthesia.
(e) Preventive care, including, but not limited to, immunizations and well-child visits to a doctor's office.
(f) Outpatient substance abuse care.
(2) With the commissioner's approval, a health care corporation may provide other health care benefits in addition to the primary health care benefits set forth in subsection (1).
History:
Add. 1991, Act 60, Imd. Eff. June 27, 1991
Popular Name:
Blue Cross-Blue Shield
Popular Name:
Act 350
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704) › 350-1980-4 - Part 4 (550.1400...550.1439) › Section 550.1439 - Fees Prohibited; Exception; Funding; Enrollment of Children.

550.1439 Fees prohibited; exception; funding; enrollment of children.
Sec. 439.
The program shall not charge any fee to an enrolled eligible child or the child's parents or legal guardians except that if prescription drug benefits are offered a co-pay not to exceed $3.00 may be charged. The program shall be funded by private donations and private and public grants. The health care corporation may provide free of charge administrative services to the program as approved by its board of directors and subject to the commissioner's approval. A child shall be enrolled as follows:
(a) Dependent on funding on a first-come, first-served basis unless a named child is part of a group of 10 or more children who are fully sponsored by private donations.
(b) Without regard to health status.
History:
Add. 1991, Act 60, Imd. Eff. June 27, 1991
Popular Name:
Blue Cross-Blue Shield
Popular Name:
Act 350
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704) › 350-1980-4A - Part 4a Medicare Supplement Certificates (550.1451...550.1499a) › Section 550.1451-550.1499a - Repealed. 2002, Act 559, Imd. Eff. Sept. 27, 2002;—2006, Act 462, Imd. Eff. Dec. 20, 2006.

550.1451-550.1499a Repealed. 2002, Act 559, Imd. Eff. Sept. 27, 2002;—2006, Act 462, Imd. Eff. Dec. 20, 2006.
Popular Name:
Blue Cross-Blue Shield
Popular Name:
Act 350
2023 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 550.1501 - Contracts With Health Care Facilities.

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 reducing access to Michigan licensed health facilities.
(2) Contracts entered into under this section with health care facilities licensed in Michigan are subject to the provisions of sections 504 to 518.
History:
1980, Act 350, Eff. Apr. 3, 1981 ;-- Am. 2003, Act 60, Imd. Eff. July 15, 2003
Popular Name:
Blue Cross-Blue Shield
Popular Name:
Act 350
2023 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 550.1501a - Special Participating Contracts With Health Care Providers for Provision of Primary Health Care Benefits to Children Enrolled in Michigan Caring Program.

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 under section 436. Special participating contracts entered into under this section are not subject to sections 502 to 518.
History:
Add. 1991, Act 73, Imd. Eff. July 11, 1991
Popular Name:
Blue Cross-Blue Shield
Popular Name:
Act 350
2023 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 550.1501b - Conduct on Behalf of or Information Provided to Subscriber by Health Care Provider; Prohibition or Discouragement by Health Care Corporation.

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 404 or from discussing with a subscriber or provider any of the following:
(a) Health care treatments and services.
(b) Quality assurance plans required by law, if applicable.
(c) The financial relationships between the health care corporation and the health care provider including all of the following as applicable:
(i) Whether a fee-for-service arrangement exists, under which the provider is paid a specified amount for each covered service rendered to the participant.
(ii) Whether a capitation arrangement exists, under which a fixed amount is paid to the provider for all covered services that are or may be rendered to each covered individual or family.
(iii) Whether payments to providers are made based on standards relating to cost, quality, or patient satisfaction.
History:
Add. 1997, Act 68, Imd. Eff. July 15, 1997
Popular Name:
Blue Cross-Blue Shield
Popular Name:
Act 350
2023 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 550.1501c - Provider Network.

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 Shield
Popular Name:
Act 350
2023 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 550.1503 - Uniform Reporting by Health Care Providers.

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 Shield
Popular Name:
Act 350
2023 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 Shield
Popular Name:
Act 350
2023 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 Shield
Popular Name:
Act 350
2023 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 Shield
Popular Name:
Act 350
2023 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 Shield
Popular Name:
Act 350
2023 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 Shield
Popular Name:
Act 350
2023 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 Shield
Popular Name:
Act 350
2023 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 Shield
Popular Name:
Act 350
2023 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 Shield
Popular Name:
Act 350
2023 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 Shield
Popular Name:
Act 350
2023 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 Shield
Popular Name:
Act 350
2023 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 Shield
Popular Name:
Act 350
2023 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 Shield
Popular Name:
Act 350
2023 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 Shield
Popular Name:
Act 350
2023 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 Shield
Popular Name:
Act 350
2023 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 550.1602 - Statement of Condition; Statistical, Financial, and Other Reports.

550.1602 Statement of condition; statistical, financial, and other reports.
Sec. 602.
(1) Not later than March 1 each year, subject to a 30-day extension that may be granted by the commissioner, a health care corporation shall file in the office of the commissioner a sworn statement verified by at least 2 of the principal officers of the corporation showing its condition as of the preceding December 31. The statement shall be in a form and contain those matters that the commissioner prescribes for a health care corporation, including those matters contained in section 204a. The statement shall include the number of members and the number of subscribers' certificates issued by the corporation and outstanding.
(2) The commissioner, by order, may require a health care corporation to submit statistical, financial, and other reports for the purpose of monitoring compliance with this act.
History:
1980, Act 350, Eff. Apr. 3, 1981 ;-- Am. 2003, Act 59, Eff. July 23, 2003
Popular Name:
Blue Cross-Blue Shield
Popular Name:
Act 350
2023 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 550.1603a - Health Care Corporation Subject to MCL 500.224 and 500.225; Costs and Expenses.

550.1603a Health care corporation subject to MCL 500.224 and 500.225; costs and expenses.
Sec. 603a.
A health care corporation is subject to sections 224(4) through (13) and 225 of the insurance code of 1956, Act No. 218 of the Public Acts of 1956, being sections 500.224 and 500.225 of the Michigan Compiled Laws, instead of the costs and expenses that may be imposed by the commissioner pursuant to section 603.
History:
Add. 1994, Act 169, Imd. Eff. June 17, 1994
Popular Name:
Blue Cross-Blue Shield
Popular Name:
Act 350
2023 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 550.1604 - Confidentiality; Violation as Misdemeanor; Penalty.

550.1604 Confidentiality; violation as misdemeanor; penalty.
Sec. 604.
(1) The commissioner shall ensure that confidentiality of records containing personal data which may be associated with identifiable individuals. Except as is necessary to comply with a court order, or for the purposes of claim adjudication or when required by law, the commissioner shall not disclose records containing personal data which may be associated with an identifiable individual without the prior informed consent of the individual to whom the data pertain. The individual's consent shall be in writing. If an individual has authorized the release of personal data to a specific person, that person shall not release the data to a third person unless the individual executes in writing another informed consent authorizing that additional release.
(2) The commissioner shall ensure the confidentiality of data which discloses reimbursement levels for specific procedures or services of specific providers and data which, if disclosed, can be used to calculate those reimbursement levels. This subsection shall apply only if the data are not already generally known to providers and if the disclosure of the data would be harmful to the achievement of the goals set forth in section 504. Only that portion of a record dealing with data described in this subsection shall be exempt from disclosure. A person, whose request for a hearing has been granted by the commissioner, may examine the data and shall be subject to the same confidentiality requirements as the commissioner under this subsection.
(3) The commissioner shall ensure the confidentiality of any trade secrets of the corporation, except for information required to be disclosed under Act No. 442 of the Public Acts of 1976, as amended, being sections 15.231 to 15.246 of the Michigan Compiled Laws.
(4) Subject to the provisions of subsections (1) to (3), information which a health care corporation provides to or files with the commissioner shall be governed by Act No. 442 of the Public Acts of 1976, as amended, being sections 15.231 to 15.246 of the Michigan Compiled Laws.
(5) A person who violates the confidentiality provisions of this section is guilty of a misdemeanor, punishable by a fine of not more than $1,000.00 for each violation.
History:
1980, Act 350, Eff. Apr. 3, 1981
Popular Name:
Blue Cross-Blue Shield
Popular Name:
Act 350
2023 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 550.1605 - Certificate of Authority; Suspension or Limitation; Circumstances; Order; Hearing; Notice.

550.1605 Certificate of authority; suspension or limitation; circumstances; order; hearing; notice.
Sec. 605.
(1) Upon due notice and an opportunity for an evidentiary hearing pursuant to the administrative procedures act, the commissioner may suspend or limit the certificate of authority of a health care corporation if the commissioner determines that any of the following circumstances exist:
(a) The health care corporation does not meet the requirements of this act respecting the adequacy of its reserves.
(b) The health care corporation is using methods or practices in the conduct of its business which render further transactions hazardous or injurious to subscribers of the corporation or the public.
(c) The health care corporation refuses or fails to comply with this act or with a lawful order of the commissioner.
(2) If the commissioner finds that the public health, safety, or welfare requires emergency action and incorporates this finding into an order, a summary suspension or limitation of a certificate of authority may be ordered. The suspension or limitation shall be effective on the date specified in the order or upon service of a certified copy of the order on the health care corporation, whichever is later, and shall be effective during the proceedings. The corporation shall have the right to an administrative hearing within 5 days to show why the summary suspension or limitation should be terminated.
(3) An order of limitation may restrict the solicitation of certificates, the renewal of business in force, and the solicitation, offer, or acceptance of contracts, and may impose other conditions to continued authorization as are reasonably necessary to protect the subscribers of the corporation or the public. The commissioner shall terminate an order of limitation when the circumstance giving rise to the order ceases to exist.
(4) Upon suspension or limitation of a corporation's certificate of authority, if the commissioner considers it necessary or desirable for the protection of the subscribers of the corporation or the public, the commissioner may publish notice of the suspension or limitation in 1 or more newspapers of general circulation in the state.
(5) An emergency order by the commissioner which suspends or limits a corporation's certificate of authority shall be for a period not to exceed 1 year and, after opportunity of hearing, the commissioner for good cause may extend the period of suspension or limitation for additional periods not to exceed 1 year.
History:
1980, Act 350, Eff. Apr. 3, 1981
Popular Name:
Blue Cross-Blue Shield
Popular Name:
Act 350
2023 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 550.1606 - Authority of Commissioner Regarding Officers and Directors; Authority as to Dissolution, Taking Over, or Liquidation of Corporations; Insolvency Defined.

550.1606 Authority of commissioner regarding officers and directors; authority as to dissolution, taking over, or liquidation of corporations; insolvency defined.
Sec. 606.
(1) The commissioner shall have the same authority regarding the officers and directors of a health care corporation as the commissioner has with respect to the officers and directors of insurers under sections 249 and 250 of the insurance code of 1956, 1956 PA 218, MCL 500.249 and 500.250.
(2) The commissioner shall have the same authority with respect to the dissolution, taking over, or liquidation of corporations formed or doing business under this act as is provided in chapter 81 of the insurance code of 1956, 1956 PA 218, MCL 500.8101 to 500.8159. For purposes of this subsection, a health care corporation shall be considered to be insolvent if its liabilities exceed its assets, unless otherwise defined in chapter 81 of the insurance code of 1956, 1956 PA 218, MCL 500.8101 to 500.8159.
History:
1980, Act 350, Eff. Apr. 3, 1981 ;-- Am. 2003, Act 59, Eff. July 23, 2003
Popular Name:
Blue Cross-Blue Shield
Popular Name:
Act 350
2023 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 550.1611 - Legislative Intent.

550.1611 Legislative intent.
Sec. 611.
It is the intent of the legislature to promote uniformity of rates among subscribers to the greatest extent practicable.
History:
1980, Act 350, Eff. Apr. 3, 1981
Popular Name:
Blue Cross-Blue Shield
Popular Name:
Act 350
2023 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 550.1612 - Notice of Rate Filing; Contents of Request for Hearing; Advertisements; Limitation on Fee for Copy of Rate Filing; Waiver or Reduction of Fee; Calculation of Costs.

550.1612 Notice of rate filing; contents of request for hearing; advertisements; limitation on fee for copy of rate filing; waiver or reduction of fee; calculation of costs.
Sec. 612.
(1) Upon receipt of a rate filing under section 610, the commissioner immediately shall notify each person who has requested in writing notice of those filings within the previous 2 years, specifying the nature and extent of the proposed rate revision and identifying the location, time, and place where the copy of the rate filing described in section 610(7) shall be open to public inspection and copying. The notice shall also state that if the person has standing, the person shall have, upon making a written request for a hearing within 60 days after receiving notice of the rate filing, an opportunity for an evidentiary hearing under section 613 to determine whether the proposed rates meet the requirements of this act. The request shall identify the issues which the requesting party asserts are involved, what portion of the rate filing is requested to be heard, and how the party has standing. The corporation shall place advertisements giving notice, containing the information specified above, in at least 1 newspaper which serves each geographic area in which significant numbers of subscribers reside.
(2) The commissioner may charge a fee for providing, pursuant to subsection (1), a copy of the rate filing described in section 610(7). The commissioner may charge a fee for providing a copy of the entire filing to a person whose request for a hearing has been granted by the commissioner pursuant to section 613. The fee shall be limited to actual mailing costs and to the actual incremental cost of duplication, including labor and the cost of deletion and separation of information as provided in section 14 of Act No. 442 of the Public Acts of 1976, being section 15.244 of the Michigan Compiled Laws. Copies of the filing may be provided free of charge or at a reduced charge if the commissioner determines that a waiver or reduction of the fee is in the public interest because the furnishing of a copy of the filing will primarily benefit the general public. In calculating the costs under this subsection, the commissioner shall not attribute more than the hourly wage of the lowest paid, full-time clerical employee of the insurance bureau to the cost of labor incurred in duplication and mailing and to the cost of separation and deletion. The commissioner shall use the most economical means available to provide copies of a rate filing.
History:
1980, Act 350, Eff. Apr. 3, 1981
Popular Name:
Blue Cross-Blue Shield
Popular Name:
Act 350