reglab/statecodes huggingface dataset:
2023 Michigan Compiled Laws › Chapter 400 - Social Services › Act 280 of 1939 - The Social Welfare Act (400.1 - 400.122) › 280-1939-COUNTY-DEPARTMENT-OF-SOCIAL-SERVICES - County Department of Social Services (400.45...400.122) › Section 400.106b - Suspension of Medical Assistance; Conditions; Inmate Residing in Public Institution; Redetermination of Eligibility; Reinstatement; Limitation; Applicability; Defintions.

400.106b Suspension of medical assistance; conditions; inmate residing in public institution; redetermination of eligibility; reinstatement; limitation; applicability; defintions.
Sec. 106b.
(1) The state medicaid plan shall require the department of community health to suspend rather than terminate an individual's medical assistance when either of the following applies:
(a) The individual becomes an inmate residing in a public institution but otherwise remains eligible for medical assistance.
(b) An inmate was not eligible for medical assistance when he or she entered the public institution but is subsequently determined to be eligible for medical assistance while in the public institution.
(2) The department of community health shall redetermine the medical assistance eligibility of the individual.
(3) Upon notification that an individual described in subsection (1) is no longer an inmate residing in a public institution, the department of community health shall reinstate the individual's medical assistance if the individual is otherwise eligible for medical assistance.
(4) This section does not extend medical assistance eligibility to an otherwise ineligible individual or extend medical assistance to an individual if matching federal funds are not available to pay for the medical assistance.
(5) This section applies to the department of community health, a state agency to which the department of community health has delegated these functions as provided under section 105c, or a private or nonprofit entity with which the department of community health has contracted to perform these functions as provided under section 105c.
(6) As used in this section:
(a) "Public institution" means 1 of the following:
(i) An inpatient program operated by the department of community health for treatment of individuals with serious emotional disturbance or serious mental illness.
(ii) A local correctional facility as that term is defined in section 2 of the local corrections officers training act, 2003 PA 125, MCL 791.532.
(iii) A correctional facility as that term is defined in section 15 of the corrections code of 1953, 1953 PA 232, MCL 791.215.
(iv) A youth correctional facility operated by the department of corrections or a private vendor under section 20g of the corrections code of 1953, 1953 PA 232, MCL 791.220g.
(b) "Serious emotional disturbance" and "serious mental illness" mean those terms as defined in section 100d of the mental health code, 1974 PA 258, MCL 330.1100d.
History:
Add. 2014, Act 452, Imd. Eff. Jan. 2, 2015
Popular Name:
Act 280
2023 Michigan Compiled Laws › Chapter 400 - Social Services › Act 280 of 1939 - The Social Welfare Act (400.1 - 400.122) › 280-1939-COUNTY-DEPARTMENT-OF-SOCIAL-SERVICES - County Department of Social Services (400.45...400.122) › Section 400.107 - Medically Indigent; Financial Eligibility; Income.

400.107 Medically indigent; financial eligibility; income.
Sec. 107.
(1) In establishing financial eligibility for the medically indigent, income shall be disregarded in accordance with standards established for the related categorical assistance program. For medical assistance only, income shall include the amount of contribution that an estranged spouse or parent for a minor child is making to the applicant according to the standards of the department of community health, or according to a court determination, if there is a court determination. Nothing in this section eliminates the responsibility of support established in section 76 for cash assistance received under this act.
(2) The department of community health shall apply a modified adjusted gross income methodology in determining if an individual's annual income level is below 133% of the federal poverty guidelines.
History:
Add. 1966, Act 321, Eff. Oct. 1, 1966 ;-- Am. 1967, Act 289, Imd. Eff. Aug. 1, 1967 ;-- Am. 2006, Act 144, Imd. Eff. May 22, 2006 ;-- Am. 2013, Act 107, Eff. Mar. 14, 2014
Compiler's Notes:
Enacting section 1 of Act 107 of 2013 provides:"Enacting section 1. This amendatory act does not do either of the following:"(a) Authorize the establishment or operation of a state-created American health benefit exchange in this state related to the patient protection and affordable care act, Public Law 111-148, as amended by the federal health care and education reconciliation act of 2010, Public Law 111-152."(b) Convey any additional statutory, administrative, rule-making, or other power to this state or an agency of this state that did not exist before the effective date of the amendatory act that added section 105d to the social welfare act, 1939 PA 280, MCL 400.105d, that would authorize, establish, or operate a state-created American health benefit exchange."
Popular Name:
Act 280
2023 Michigan Compiled Laws › Chapter 400 - Social Services › Act 280 of 1939 - The Social Welfare Act (400.1 - 400.122) › 280-1939-COUNTY-DEPARTMENT-OF-SOCIAL-SERVICES - County Department of Social Services (400.45...400.122) › Section 400.108 - Medical or Dental Services to Which Medically Indigent Entitled; Certification; Services to Eligible Children.

400.108 Medical or dental services to which medically indigent entitled; certification; services to eligible children.
Sec. 108.
A medically indigent person as defined under section 106(1)(a) is entitled to all the services enumerated in section 109. A medically indigent person as defined under section 106(1)(b) is entitled to medical services enumerated in section 109(1)(a), (c), and (e). He or she is entitled to the services enumerated in section 109(1)(b), (d), and (f) to the extent of appropriations made available by the legislature for the fiscal year. Medical services shall be rendered upon certification by the attending licensed physician and dental services shall be rendered upon certification of the attending licensed dentist that a service is required for the treatment of an individual. The services of a medical institution shall be rendered only after referral by a licensed physician or dentist and certification by him or her that the services of the medical institution are required for the medical or dental treatment of the individual, except that referral is not necessary in case of an emergency. Periodic recertification that medical treatment that extends over a period of time is required in accordance with regulations of the department of community health is a condition of continuing eligibility to receive medical assistance. To comply with federal statutes governing medicaid, the department of community health shall provide early and periodic screening, diagnostic and treatment services to eligible children as it considers necessary.
History:
Add. 1966, Act 321, Eff. Oct. 1, 1966 ;-- Am. 1967, Act 289, Imd. Eff. Aug. 1, 1967 ;-- Am. 1972, Act 367, Imd. Eff. Jan. 9, 1973 ;-- Am. 2013, Act 107, Eff. Mar. 14, 2014
Compiler's Notes:
Enacting section 1 of Act 107 of 2013 provides:"Enacting section 1. This amendatory act does not do either of the following:"(a) Authorize the establishment or operation of a state-created American health benefit exchange in this state related to the patient protection and affordable care act, Public Law 111-148, as amended by the federal health care and education reconciliation act of 2010, Public Law 111-152."(b) Convey any additional statutory, administrative, rule-making, or other power to this state or an agency of this state that did not exist before the effective date of the amendatory act that added section 105d to the social welfare act, 1939 PA 280, MCL 400.105d, that would authorize, establish, or operate a state-created American health benefit exchange."
Popular Name:
Act 280
2023 Michigan Compiled Laws › Chapter 400 - Social Services › Act 280 of 1939 - The Social Welfare Act (400.1 - 400.122) › 280-1939-COUNTY-DEPARTMENT-OF-SOCIAL-SERVICES - County Department of Social Services (400.45...400.122) › Section 400.109b - Modification of Formula for Indigent Care Volume Price Adjustor.

400.109b Modification of formula for indigent care volume price adjustor.
Sec. 109b.
Beginning October 1, 1988, the formula for the indigent care volume price adjustor shall be modified in such a manner as to distribute, in addition to the $30,000,000.00 appropriated for indigent care in fiscal year 1987-88, not less than $24,000,000.00 annually to hospitals that provide a large proportion of their services to indigent persons.
History:
Add. 1987, Act 266, Imd. Eff. Dec. 28, 1987
Popular Name:
Act 280
2023 Michigan Compiled Laws › Chapter 400 - Social Services › Act 280 of 1939 - The Social Welfare Act (400.1 - 400.122) › 280-1939-COUNTY-DEPARTMENT-OF-SOCIAL-SERVICES - County Department of Social Services (400.45...400.122) › Section 400.109d - Services Relating to Performing Abortions; Prohibitions.

400.109d Services relating to performing abortions; prohibitions.
Sec. 109d.
(1) The legislature finds that the use of medicaid funds for elective abortions has been clearly rejected by the people of Michigan through Act No. 59 of the Public Acts of 1987, initiated by the citizens under the rights of the people reserved in the Michigan constitution, approved by a majority of this legislature, affirmed by the citizens at large through a statewide referendum, and sustained by the Michigan supreme court.
(2) In light of evidence that abortion providers, in conjunction with third party payors, may have devised and implemented plans for reimbursing services in violation of the intent of Act No. 59 of the Public Acts of 1987, the legislature finds the enactment of section 109e a necessary clarification of, and enforcement mechanism for, Act No. 59 of the Public Acts of 1987.
(3) The legislature finds that any practice of separating or unbundling services directly related to the performance of an abortion for the purposes of seeking medicaid reimbursement, with those funds thereby subsidizing in whole or in part the cost of performing an abortion, is an inappropriate use of taxpayer funds in light of Act No. 59 of the Public Acts of 1987.
(4) Recognizing that certain services related to performing an abortion can also be part of legitimate and routine obstetric care, section 109e should not be construed to affect diagnostic testing or other nonabortion procedures. Only physicians who actually perform abortions, and particularly those who perform abortions but do not provide prenatal care or obstetric services, should view themselves as potentially affected by section 109e. Unacceptable requests for reimbursement include those services which would not have been performed, but for the preparation and performance of a planned or requested abortion.
History:
Add. 1996, Act 124, Eff. Mar. 31, 1997
Popular Name:
Act 280
2023 Michigan Compiled Laws › Chapter 400 - Social Services › Act 280 of 1939 - The Social Welfare Act (400.1 - 400.122) › 280-1939-COUNTY-DEPARTMENT-OF-SOCIAL-SERVICES - County Department of Social Services (400.45...400.122) › Section 400.109e - Definitions; Reimbursement for Performance of Abortion; Prohibition; Violation; Penalty; Enforcement; Scope of Section.

400.109e Definitions; reimbursement for performance of abortion; prohibition; violation; penalty; enforcement; scope of section.
Sec. 109e.
(1) As used in this section:
(a) "Abortion" means the intentional use of an instrument, drug, or other substance or device to terminate a woman's pregnancy for a purpose other than to increase the probability of a live birth, to preserve the life or health of the child after live birth, or to remove a dead fetus. Abortion does not include the use or prescription of a drug or device intended as a contraceptive.
(b) "Health care professional" means an individual licensed or registered under article 15 of the public health code, Act No. 368 of the Public Acts of 1978, being sections 333.16101 to 333.18838 of the Michigan Compiled Laws.
(c) "Health facility or agency" means a health facility or agency licensed under article 17 of Act No. 368 of the Public Acts of 1978, being sections 333.20101 to 333.22260 of the Michigan Compiled Laws.
(2) A health care professional or a health facility or agency shall not seek or accept reimbursement for the performance of an abortion knowing that public funds will be or have been used in whole or in part for the reimbursement in violation of section 109a of Act No. 280 of the Public Acts of 1939, being section 400.109a of the Michigan Compiled Laws, as added by Act No. 59 of the Public Acts of 1987.
(3) A person who violates this section is liable for a civil fine of up to $10,000.00 per violation. The department of community health shall investigate an alleged violation of this section and the attorney general, in cooperation with the department of community health, may bring an action to enforce this section.
(4) Nothing in this section restricts the right of a health care professional to discuss abortion or abortion services with a patient who is pregnant.
(5) This section does not create a right to an abortion.
(6) Notwithstanding any other provision of this section, a person shall not perform an abortion that is prohibited by law.
History:
Add. 1996, Act 124, Eff. Mar. 31, 1997
Popular Name:
Act 280
2023 Michigan Compiled Laws › Chapter 400 - Social Services › Act 280 of 1939 - The Social Welfare Act (400.1 - 400.122) › 280-1939-COUNTY-DEPARTMENT-OF-SOCIAL-SERVICES - County Department of Social Services (400.45...400.122) › Section 400.109f - Medicaid-Covered Specialty Services and Supports; Management and Delivery; Specialty Prepaid Health Plans.

400.109f Medicaid-covered specialty services and supports; management and delivery; specialty prepaid health plans.
Sec. 109f.
(1) The department shall support the use of Medicaid funds for specialty services and supports for eligible Medicaid beneficiaries with a serious mental illness, developmental disability, serious emotional disturbance, or substance use disorder. Medicaid-covered specialty services and supports shall be managed and delivered by specialty prepaid health plans chosen by the department. The specialty services and supports shall be carved out from the basic Medicaid health care benefits package.
(2) Specialty prepaid health plans are Medicaid managed care organizations as described in section 1903(m)(1)(A) of title XIX, 42 USC 1396b, and are responsible for providing defined inpatient services, outpatient hospital services, physician services, other specified Medicaid state plan services, and additional services approved by the Centers for Medicare and Medicaid Services under section 1915(b)(3) of title XIX, 42 USC 1396n.
History:
Add. 2000, Act 410, Imd. Eff. Jan. 8, 2001 ;-- Am. 2005, Act 84, Imd. Eff. July 19, 2005 ;-- Am. 2017, Act 224, Eff. Mar. 20, 2018 ;-- Am. 2023, Act 99, Imd. Eff. July 19, 2023
Popular Name:
Act 280
2023 Michigan Compiled Laws › Chapter 400 - Social Services › Act 280 of 1939 - The Social Welfare Act (400.1 - 400.122) › 280-1939-COUNTY-DEPARTMENT-OF-SOCIAL-SERVICES - County Department of Social Services (400.45...400.122) › Section 400.109g - Specialty Services Panel; Creation; Purpose; Membership; Qualifications; Terms; Vacancy; Conflict of Interest; Advisory Capacity; Meetings.

400.109g Specialty services panel; creation; purpose; membership; qualifications; terms; vacancy; conflict of interest; advisory capacity; meetings.
Sec. 109g.
(1) The governor shall create a specialty services panel within the department of community health to review and make determinations regarding applications for participation submitted by community mental health services programs or other managing entities.
(2) The specialty services panel shall consist of the following members, appointed by the governor:
(a) The director of the department of community health or his or her representative.
(b) Two members who represent the department of community health, excluding an individual appointed under subdivision (a).
(c) The director of the department of management and budget or his or her representative.
(d) Four members who represent primary consumers or family members.
(e) Five members who represent other stakeholders, including, but not limited to, 1 representative each from the statewide advocacy organizations representing adults with serious mental illness, children with serious emotional disturbance, individuals with substance abuse disorders, and individuals with developmental disabilities. At least 1 member appointed under this subdivision shall be a county commissioner.
(3) No member appointed under subsection (2)(d) or (e) shall provide direct services or represent providers who provide services for reimbursement under this act to an individual who qualifies for specialty services.
(4) Members of the specialty services panel shall serve for terms of 4 years or until a successor is appointed, whichever is later, except that, of the members first appointed, 4 shall serve for 1 year, 5 shall serve for 2 years, and 4 shall serve for 3 years.
(5) If a vacancy occurs on the specialty services panel, the governor shall make an appointment for the unexpired term in the same manner as the original appointment.
(6) A member of the specialty services panel shall make known any matter in which that member has a potential conflict of interest.
(7) The specialty services panel shall remain in existence to serve in an advisory capacity to the director of the department of community health regarding performance and quality relating to medicaid specialty services and supports. The panel shall meet no less than 2 times a year. The panel shall have access to all aggregate quality management information gathered by the department of community health relating to the managing entities.
History:
Add. 2000, Act 409, Imd. Eff. Jan. 8, 2001
Compiler's Notes:
For abolishment of the specialty services panel and transfer of its powers and duties to the department of community health, see E.R.O. No. 2007-13, compiled at MCL 333.26326.
Popular Name:
Act 280
2023 Michigan Compiled Laws › Chapter 400 - Social Services › Act 280 of 1939 - The Social Welfare Act (400.1 - 400.122) › 280-1939-COUNTY-DEPARTMENT-OF-SOCIAL-SERVICES - County Department of Social Services (400.45...400.122) › Section 400.109j - Designation of Single Point of Entry Agencies; Limitation.

400.109j Designation of single point of entry agencies; limitation.
Sec. 109j.
The department of community health shall not designate more than the initial 4 agencies designated under section 109i(9) to serve as single point of entry agencies or agencies similar to single point of entry agencies unless the conditions of section 109i(16) are met and the legislature repeals this section.
History:
Add. 2006, Act 634, Imd. Eff. Jan. 4, 2007
Popular Name:
Act 280
2023 Michigan Compiled Laws › Chapter 400 - Social Services › Act 280 of 1939 - The Social Welfare Act (400.1 - 400.122) › 280-1939-COUNTY-DEPARTMENT-OF-SOCIAL-SERVICES - County Department of Social Services (400.45...400.122) › Section 400.109k - Compliance of Certain Community Mental Health Services Programs With MCL 330.1204 and 330.1205.

400.109k Compliance of certain community mental health services programs with MCL 330.1204 and 330.1205.
Sec. 109k.
Effective October 1, 2013, a community mental health services program established by a single charter county that has situated totally within that county a city having a population of at least 500,000 shall comply with sections 204(4) and 205 of the mental health code, 1974 PA 258, MCL 330.1204 and 330.1205, before contracting with the department of community health as a specialty prepaid health plan to provide specialty services and supports.
History:
Add. 2012, Act 375, Eff. Mar. 28, 2013
2023 Michigan Compiled Laws › Chapter 400 - Social Services › Act 280 of 1939 - The Social Welfare Act (400.1 - 400.122) › 280-1939-COUNTY-DEPARTMENT-OF-SOCIAL-SERVICES - County Department of Social Services (400.45...400.122) › Section 400.109l - Process for Maximum Allowable Cost Pricing Reconsiderations; Use by Department of Community Health and Contracted Health Plans; Completion; Notification to Pharmacy.

400.109l Process for maximum allowable cost pricing reconsiderations; use by department of community health and contracted health plans; completion; notification to pharmacy.
Sec. 109l.
The department of community health and contracted health plans shall utilize a process for maximum allowable cost pricing reconsiderations that must be available and provided to providers and pharmacists. This process must include identification of 3 national drug codes, if there are 3 or more available, and all available national drug codes, if there are fewer than 3, for the drug in question that are actually available and deliverable by a Michigan licensed wholesaler or a Michigan licensed manufacturer and would fall into the department of community health's or contracted health plans' maximum allowable cost pricing. The process must be completed in 10 business days, with all notification to the pharmacy in either written or electronic form. The department of community health and contracted health plans cannot be held accountable for failing to provide information for which they do not have access.
History:
Add. 2014, Act 167, Eff. Mar. 31, 2015
2023 Michigan Compiled Laws › Chapter 400 - Social Services › Act 280 of 1939 - The Social Welfare Act (400.1 - 400.122) › 280-1939-COUNTY-DEPARTMENT-OF-SOCIAL-SERVICES - County Department of Social Services (400.45...400.122) › Section 400.109m - Individual as Victim of Human Trafficking Violation; Medical Assistance Benefits; "Human Trafficking Violation" Defined.

400.109m Individual as victim of human trafficking violation; medical assistance benefits; "human trafficking violation" defined.
Sec. 109m.
(1) If an individual is a victim of a human trafficking violation, he or she may receive medical assistance benefits for medical and psychological treatment resulting from his or her status as a victim of that human trafficking violation.
(2) As used in this section, "human trafficking violation" means a violation of chapter LXVIIA of the Michigan penal code, 1931 PA 328, MCL 750.462a to 750.462h.
History:
Add. 2014, Act 341, Eff. Jan. 14, 2015
Popular Name:
Act 280
2023 Michigan Compiled Laws › Chapter 400 - Social Services › Act 280 of 1939 - The Social Welfare Act (400.1 - 400.122) › 280-1939-COUNTY-DEPARTMENT-OF-SOCIAL-SERVICES - County Department of Social Services (400.45...400.122) › Section 400.109n - Behavioral Health Treatment Services: Autism Spectrum Disorder; Re-Evaluation and Eligibility Requirements.

400.109n Behavioral health treatment services: autism spectrum disorder; re-evaluation and eligibility requirements.
Sec. 109n.
(1) If the initial evaluation was completed by a qualified licensed practitioner, a child with a confirmed diagnosis of autism spectrum disorder is not required to have a re-evaluation to determine continued eligibility for behavioral health treatment unless a re-evaluation is medically necessary.
(2) As used in this section, "qualified licensed practitioner" means 1 of the following:
(a) A physician with a specialty in psychiatry or neurology.
(b) A physician with a subspecialty in developmental pediatrics, development-behavioral pediatrics, or a related discipline.
(c) A physician with a specialty in pediatrics or other appropriate specialty with training, experience, or expertise in autism spectrum disorder or behavioral health.
(d) A psychologist with a specialty in clinical child psychology, behavioral and cognitive psychology, or clinical neuropsychology, or other appropriate specialty with training, experience, or expertise in autism spectrum disorder or behavioral health.
(e) A clinical social worker with at least 1 year of experience working within his or her scope of practice who is qualified and experienced in diagnosing autism spectrum disorder.
(f) An advanced practice registered nurse with training, experience, or expertise in autism spectrum disorder or behavioral health.
(g) A physician’s assistant with training, experience, or expertise in autism spectrum disorder or behavioral health.
History:
Add. 2021, Act 111, Eff. Mar. 30, 2022
2023 Michigan Compiled Laws › Chapter 400 - Social Services › Act 280 of 1939 - The Social Welfare Act (400.1 - 400.122) › 280-1939-COUNTY-DEPARTMENT-OF-SOCIAL-SERVICES - County Department of Social Services (400.45...400.122) › Section 400.110 - Medical Services for Residents Absent From State.

400.110 Medical services for residents absent from state.
Sec. 110.
Services under this act may be provided to a resident of this state who is temporarily absent from the state. Out of state physicians and institutions in which service is received shall be licensed or approved by the appropriate standard-setting authority in the other state.
History:
Add. 1966, Act 321, Eff. Oct. 1, 1966 ;-- Am. 1967, Act 289, Imd. Eff. Aug. 1, 1967
Popular Name:
Act 280
2023 Michigan Compiled Laws › Chapter 400 - Social Services › Act 280 of 1939 - The Social Welfare Act (400.1 - 400.122) › 280-1939-COUNTY-DEPARTMENT-OF-SOCIAL-SERVICES - County Department of Social Services (400.45...400.122) › Section 400.110a - Funding; Rural Hospital Access Pool; Limitations; Definitions.

400.110a Funding; rural hospital access pool; limitations; definitions.
Sec. 110a.
(1) Beginning in the fiscal year that ends September 30, 2019, and annually after that, the department shall allocate not less than $26,000,000.00 of its general fund appropriation to a rural hospital access pool to assist sole community hospitals, critical access hospitals, and rural hospitals with providing services to low-income residents.
(2) All of the following apply to a payment from the rural hospital access pool:
(a) $7,978,300.00 shall be proportionately divided annually among sole community hospitals and rural hospitals that provide obstetrical care to Medicaid beneficiaries, based on the proportion of Medicaid deliveries performed during the second immediately preceding fiscal year.
(b) The balance remaining in the rural hospital access pool after distribution made under subdivision (a) shall be annually allocated as follows:
(i) Payments shall first be allocated to reimburse sole community hospitals, critical access hospitals, and rural hospitals for unreimbursed and incurred costs for services delivered to fee for service inpatient and outpatient Medicaid beneficiaries as reported during the second immediately preceding fiscal year cost reporting period.
(ii) Money remaining in the rural hospital access pool after all distributions are made under subparagraph (i) shall be allocated based on each sole community hospital's, critical access hospital's, and rural hospital's proportion of Medicaid managed care outpatient payments for services performed during the second immediately preceding fiscal year.
(c) Notwithstanding subdivisions (a) and (b), no hospital shall receive more than 10% of the total funding available under the rural hospital access pool in any 1 fiscal year.
(3) The department must implement this section in a manner that complies with all federal requirements necessary to ensure the maximum amount of federal matching funds is obtained.
(4) As used in this section:
(a) "Critical access hospital" means a hospital designated and certified as a critical access hospital under 42 CFR 485.606.
(b) "Medicaid" means the medical assistance administered by the department under this act.
(c) "Rural hospital" means a hospital that meets both of the following:
(i) Has 50 or fewer staffed beds.
(ii) Is located within a county with a population of not more than 165,000 and within a city, village, or township with a population of not more than 15,000 based on the 2010 federal decennial census.
(d) "Sole community hospital" means a hospital classified as a sole community hospital under 42 CFR 412.92.
History:
Add. 2018, Act 220, Eff. Sept. 24, 2018
Popular Name:
Act 280
2023 Michigan Compiled Laws › Chapter 400 - Social Services › Act 280 of 1939 - The Social Welfare Act (400.1 - 400.122) › 280-1939-COUNTY-DEPARTMENT-OF-SOCIAL-SERVICES - County Department of Social Services (400.45...400.122) › Section 400.111 - Responsibility for Proper Handling of Medical Case; Actions Authorized to Meet Medical Needs of Recipient.

400.111 Responsibility for proper handling of medical case; actions authorized to meet medical needs of recipient.
Sec. 111.
(1) The state department is responsible for the proper handling of each medical case. The state department may transfer a recipient to some other medical institution for treatment better adapted to the recipient's needs, or take any other action to insure meeting the medical needs of the recipient.
(2) When the director has issued an order under section 111f or taken an action authorized by section 111d(1)(b) or (c) with respect to a residential health care facility, that is a hospital, nursing home, or other institution reimbursed for residential or patient care by the medical assistance program established pursuant to this act, the director shall discharge the responsibility under subsection (1) by doing 1 or more of the following:
(a) Arranging for a transfer authorized by subsection (1) and for payment for care rendered until the date of transfer.
(b) Requesting the director of the department of public health to take appropriate action under Act No. 368 of the Public Acts of 1978, as amended, being sections 333.1101 to 333.25211 of the Michigan Compiled Laws.
(c) Filing a petition with the circuit court to place the residential health care facility under the control of a receiver.
(d) Arranging, with the agreement of the affected provider, for the deposit of payments for care rendered a recipient by the residential health care facility in an escrow account.
(e) Using other appropriate means, which shall include assuring that payment is made for care rendered a recipient, that conform with state and federal law, regulation, and policy.
History:
Add. 1966, Act 321, Eff. Oct. 1, 1966 ;-- Am. 1980, Act 321, Imd. Eff. Dec. 12, 1980
Popular Name:
Act 280
Admin Rule:
R 330.11001 et seq. of the Michigan Administrative Code.
2023 Michigan Compiled Laws › Chapter 400 - Social Services › Act 280 of 1939 - The Social Welfare Act (400.1 - 400.122) › 280-1939-COUNTY-DEPARTMENT-OF-SOCIAL-SERVICES - County Department of Social Services (400.45...400.122) › Section 400.111d - Participation as Provider Subject to Denial, Suspension, Termination, or Probation; Actions of Director; Claims Precluded; Exceptions; Consultations; Hearing.

400.111d Participation as provider subject to denial, suspension, termination, or probation; actions of director; claims precluded; exceptions; consultations; hearing.
Sec. 111d.
(1) Participation as a provider in the program is subject to denial, suspension, termination, or probation on the grounds specified by section 111e. The director may take 1 or more of the following actions:
(a) Refuse to enroll an applicant.
(b) Suspend a provider indefinitely or for a term certain.
(c) Terminate the agreement with and the participation of a provider.
(d) Place a provider on probation. At the director's discretion, the probation may have conditions reasonably related to the grounds for probation.
(e) Impose specific limits, conditions, or controls on a provider's provision of services to medically indigent individuals, including specific reviews, documentation, or prior approval of a treatment plan which shall be accomplished before the designated services are rendered.
(f) Selectively suspend a provider's participation at 1 or more practice locations where that provider has no direct, indirect, or close family ownership interest in the practice.
(2) Suspension or termination of a provider shall preclude that provider from submitting a claim, either personally or by a sole proprietorship, clinic, group, partnership, corporation, association, or other entity to the program for any services, supplies, or equipment provided under the program, except for services, supplies, or equipment actually provided and received by a medically indigent individual before the effective date of the suspension or termination.
(3) In reaching a decision whether to exercise authority conferred by this section whenever questions of medical necessity or appropriateness of treatment are involved, the director shall consult, in order to formulate an appropriate action or to evaluate the professional performance of a provider, with peer review advisory committees, professionals, or experts who are individuals of the same licensed profession as the provider subject to the action, as selected by the director.
(4) The affected provider shall be entitled to a hearing held in conformity with chapter 4 and chapter 6 of the administrative procedures act of 1969, Act No. 306 of the Public Acts of 1969, as amended, being sections 24.271 to 24.287 and 24.301 to 24.306 of the Michigan Compiled Laws, on an action proposed to be taken pursuant to this section.
History:
Add. 1980, Act 321, Imd. Eff. Dec. 12, 1980 ;-- Am. 1982, Act 461, Imd. Eff. Dec. 30, 1982 ;-- Am. 1986, Act 227, Eff. Nov. 1, 1986
Popular Name:
Act 280
2023 Michigan Compiled Laws › Chapter 400 - Social Services › Act 280 of 1939 - The Social Welfare Act (400.1 - 400.122) › 280-1939-COUNTY-DEPARTMENT-OF-SOCIAL-SERVICES - County Department of Social Services (400.45...400.122) › Section 400.111g - Prosecution Not Collaterally Estopped or Barred by Decision or Order; Hearing; Decision.

400.111g Prosecution not collaterally estopped or barred by decision or order; hearing; decision.
Sec. 111g.
(1) Notwithstanding any provision in this act, a decision or order of the state department, the director, or any other person rendering a decision in an administrative hearing under this act shall not operate to collaterally estop or bar the prosecution of a person for a violation of this act or a violation of any other statute or common law.
(2) Except as otherwise provided in this act, if a hearing is commenced to determine the validity of any action taken by the state department under this act, the decision in the hearing once concluded shall be rendered promptly but not more than 30 days after the date of conclusion of the hearing.
History:
Add. 1982, Act 461, Imd. Eff. Dec. 30, 1982
Popular Name:
Act 280
2023 Michigan Compiled Laws › Chapter 400 - Social Services › Act 280 of 1939 - The Social Welfare Act (400.1 - 400.122) › 280-1939-COUNTY-DEPARTMENT-OF-SOCIAL-SERVICES - County Department of Social Services (400.45...400.122) › Section 400.111h - Applicability of MCL 400.111a to 400.111g.

400.111h Applicability of MCL 400.111a to 400.111g.
Sec. 111h.
Sections 111a to 111g shall not apply to a provider of medical services under this act if that provider is required by federal or state law, regulation, or directive to accept medicaid recipients.
History:
Add. 1986, Act 227, Eff. Nov. 1, 1986
Popular Name:
Act 280
2023 Michigan Compiled Laws › Chapter 400 - Social Services › Act 280 of 1939 - The Social Welfare Act (400.1 - 400.122) › 280-1939-COUNTY-DEPARTMENT-OF-SOCIAL-SERVICES - County Department of Social Services (400.45...400.122) › Section 400.111k - Lead Screening on Children Enrolled in Medicaid.

400.111k Lead screening on children enrolled in medicaid.
Sec. 111k.
(1) Beginning October 1, 2007, the department of community health shall ensure that, as a condition of participation and funding, all health professionals, facilities, or health maintenance organizations receiving medicaid payments under this act are in substantial compliance with federal standards for lead screening for children enrolled in medicaid.
(2) The department of community health shall determine the statewide average of lead screening being performed on children who are enrolled in medicaid on October 1, 2007 and shall determine whether the rate of children who are enrolled in medicaid receiving a lead screening is substantially in compliance with the federal standards for lead screening for children enrolled in medicaid. If the rate of children who are enrolled in medicaid receiving a lead screening is below 80%, the director of the department of community health shall present to the senate and house health policy committees a written report detailing why the rate is not in substantial compliance with the federally required standards for lead screening and the department of community health's recommendations for improving the rate. If the statewide lead screening testing rate does not equal or exceed 80% for medicaid-enrolled children by October 1, 2007, the department of community health may, with funds appropriated for medicaid managed care or medicaid fee for services, contract with community agencies to provide the percentage of lead screening tests needed to reach an 80% lead screening testing rate. A contracting organization that meets or surpasses contract performance requirements is entitled to share in financial bonuses awarded under the performance bonus program and receive not less than 10% of the beneficiaries who do not voluntarily select a specific health plan at the time of managed care enrollment in addition to any other auto assignments to which the contracting organization is entitled.
(3) As used in this section, "medicaid" means the program of medical assistance administered by the state under section 105.
History:
Add. 2004, Act 55, Imd. Eff. Apr. 12, 2004
Popular Name:
Act 280
2023 Michigan Compiled Laws › Chapter 400 - Social Services › Act 280 of 1939 - The Social Welfare Act (400.1 - 400.122) › 280-1939-COUNTY-DEPARTMENT-OF-SOCIAL-SERVICES - County Department of Social Services (400.45...400.122) › Section 400.111l - Children Participants in Wic Program; Lead Testing Required.

400.111l Children participants in WIC program; lead testing required.
Sec. 111l.
Beginning October 1, 2006, the department and the department of community health shall require that all children participants in the special supplemental food program for women, infants, and children (WIC program) receive lead testing. Federal funds provided for administration of the special supplemental food program for women, infants, and children (WIC program) shall not be used to implement or administer the provisions of this section.
History:
Add. 2006, Act 286, Imd. Eff. July 19, 2006
Popular Name:
Act 280
2023 Michigan Compiled Laws › Chapter 400 - Social Services › Act 280 of 1939 - The Social Welfare Act (400.1 - 400.122) › 280-1939-COUNTY-DEPARTMENT-OF-SOCIAL-SERVICES - County Department of Social Services (400.45...400.122) › Section 400.111n - Effective Date of Policy Changes Affecting Medicaid Cost Reports.

400.111n Effective date of policy changes affecting Medicaid cost reports.
Sec. 111n.
Except as otherwise provided in this section, if the department issues a new interpretation of existing Medicaid provider policy directly affecting nursing facility Medicaid cost reports, that change in policy must have a prospective effective date. A policy may have a retrospective effective date as part of a state plan amendment approval or waiver approval, or if required by state law, federal law, or judicial ruling.
History:
Add. 2019, Act 178, Imd. Eff. Dec. 20, 2019
Popular Name:
Act 280
2023 Michigan Compiled Laws › Chapter 400 - Social Services › Act 280 of 1939 - The Social Welfare Act (400.1 - 400.122) › 280-1939-COUNTY-DEPARTMENT-OF-SOCIAL-SERVICES - County Department of Social Services (400.45...400.122) › Section 400.112 - Medical Services; Contract With Private Agencies as Fiscal Agents.

400.112 Medical services; contract with private agencies as fiscal agents.
Sec. 112.
The state department may contract with any private agency, including a corporation or association, to act as fiscal agent in dealing with vendors providing medical service authorized in this act.
History:
Add. 1966, Act 321, Eff. Oct. 1, 1966
Popular Name:
Act 280
Admin Rule:
R 330.11001 et seq. of the Michigan Administrative Code.
2023 Michigan Compiled Laws › Chapter 400 - Social Services › Act 280 of 1939 - The Social Welfare Act (400.1 - 400.122) › 280-1939-COUNTY-DEPARTMENT-OF-SOCIAL-SERVICES - County Department of Social Services (400.45...400.122) › Section 400.112a - Liability for Medicaid Services; Referral to Department of Treasury as State Debt; Claims Against Tax Refund as Secondary to Claims for Child Support; “Medicaid” Defined.

400.112a Liability for medicaid services; referral to department of treasury as state debt; claims against tax refund as secondary to claims for child support; “medicaid” defined.
Sec. 112a.
(1) An individual is liable to the state for the amount expended by the department under medicaid for medical services for the individual's child if all of the following apply:
(a) The individual is required by court or administrative order to provide dependent health care coverage for the child.
(b) The child is eligible for medicaid.
(c) The individual received payment from a third party for the costs of medical services for the child.
(d) The individual failed to reimburse the provider of the medical services either directly or through the custodial parent or guardian of the child.
(e) The department expended funds under medicaid for the medical services provided for the child.
(2) After notice and an opportunity for an administrative hearing under chapter 4 of the administrative procedures act of 1969, Act No. 306 of the Public Acts of 1969, being sections 24.271 to 24.287 of the Michigan Compiled Laws, the department shall refer the matter to the department of treasury for collection as a state debt through the offset of state tax refunds, and may use the services of the department of treasury to levy the salary, wages, or other employment income, of an individual who has a liability to the state pursuant to subsection (1).
(3) Claims against an individual's income or state tax refund under this section are secondary to claims for current and past due child support.
(4) As used in this section, "medicaid" means the program of medical assistance established pursuant to section 105.
History:
Add. 1994, Act 429, Imd. Eff. Jan. 6, 1995
Popular Name:
Act 280
2023 Michigan Compiled Laws › Chapter 400 - Social Services › Act 280 of 1939 - The Social Welfare Act (400.1 - 400.122) › 280-1939-COUNTY-DEPARTMENT-OF-SOCIAL-SERVICES - County Department of Social Services (400.45...400.122) › Section 400.112b - Definitions.

400.112b Definitions.
Sec. 112b.
As used in this section and sections 112c to 112e:
(a) "Asset disregard" means, with regard to the state's medical assistance program, disregarding any assets or resources in an amount equal to the insurance benefit payments that are made to or on behalf of an individual who is a beneficiary under a qualified long-term care insurance partnership policy.
(b) "Long-term care insurance policy" means a policy described in chapter 39 of the insurance code of 1956, 1956 PA 218, MCL 500.3901 to 500.3955.
(c) "Long-term care partnership program" means a qualified state long-term care insurance partnership as defined in section 1917(b) of the social security act, 42 USC 1396p.
(d) "Long-term care partnership program policy" means a qualified long-term care insurance policy that the commissioner of the office of financial and insurance services certifies as meeting the requirements of section 1917(b) of the social security act, 42 USC 1396p, section 6021 of the federal deficit reduction act of 2005, Public Law 109-171, and any applicable federal regulations or guidelines.
(e) "Medicaid" means the program of medical assistance established by the department of community health under section 105.
History:
Add. 1995, Act 85, Imd. Eff. June 20, 1995 ;-- Am. 2006, Act 674, Imd. Eff. Jan. 10, 2007
Popular Name:
Act 280
2023 Michigan Compiled Laws › Chapter 400 - Social Services › Act 280 of 1939 - The Social Welfare Act (400.1 - 400.122) › 280-1939-COUNTY-DEPARTMENT-OF-SOCIAL-SERVICES - County Department of Social Services (400.45...400.122) › Section 400.112d - Repealed. 2006, Act 674, Imd. Eff. Jan. 10, 2007.

400.112d Repealed. 2006, Act 674, Imd. Eff. Jan. 10, 2007.
Compiler's Notes:
The repealed section pertained to requirements relating to a partnership policy.
Popular Name:
Act 280
2023 Michigan Compiled Laws › Chapter 400 - Social Services › Act 280 of 1939 - The Social Welfare Act (400.1 - 400.122) › 280-1939-COUNTY-DEPARTMENT-OF-SOCIAL-SERVICES - County Department of Social Services (400.45...400.122) › Section 400.112e - Rules.

400.112e Rules.
Sec. 112e.
The department of community health, in consultation with the department of human services and the office of financial services, may promulgate rules pursuant to the administrative procedures act of 1969, 1969 PA 306, MCL 24.201 to 24.328, as necessary to implement the partnership program in accordance with the requirements of section 1917(b) of the social security act, 42 USC 1396p, section 6021 of the federal deficit reduction act of 2005, Public Law 109-171, and applicable federal regulations or guidelines.
History:
Add. 1995, Act 85, Imd. Eff. June 20, 1995 ;-- Am. 2006, Act 674, Imd. Eff. Jan. 10, 2007
Popular Name:
Act 280
2023 Michigan Compiled Laws › Chapter 400 - Social Services › Act 280 of 1939 - The Social Welfare Act (400.1 - 400.122) › 280-1939-COUNTY-DEPARTMENT-OF-SOCIAL-SERVICES - County Department of Social Services (400.45...400.122) › Section 400.112e[1] - Payments Not Required; Amounts Constituting Payment in Full.

400.112e[1] Payments not required; amounts constituting payment in full.
Sec. 112e.
(1) Notwithstanding any other provision of law and through September 30, 1998, the department is not required to pay deductible, coinsurance, or copayment medicare cost-sharing for a service to the extent that the payment, when combined with a payment made under title XVIII for the service, would exceed the payment amount otherwise required under the state plan for the service to be provided to an eligible recipient who is not a medicare beneficiary.
(2) Except for a state plan-approved medical services copayment, the amounts paid by title XVIII and under the state plan for a service, if any, shall constitute payment in full for the service through September 30, 1998.
History:
Add. 1997, Act 173, Imd. Eff. Dec. 30, 1997
Compiler's Notes:
Section 112e, as added by Act 173 of 1997, was compiled as MCL 400.112e[1] to distinguish it from another section 112e, deriving from Act 85 of 1995 and pertaining to rules to implement the partnership program.
Popular Name:
Act 280
2023 Michigan Compiled Laws › Chapter 400 - Social Services › Act 280 of 1939 - The Social Welfare Act (400.1 - 400.122) › 280-1939-COUNTY-DEPARTMENT-OF-SOCIAL-SERVICES - County Department of Social Services (400.45...400.122) › Section 400.112h - "Estate" and "Property" Defined.

400.112h "Estate" and "property" defined.
Sec. 112h.
For the purposes of sections 112g to 112j:
(a) "Estate" means all property and other assets included within an individual's estate that is subject to probate administration under article III of the estates and protected individuals code, 1998 PA 386, MCL 700.3101 to 700.3988, except assets otherwise subject to claims under section 3805(3) of the estates and protected individuals code, 1998 PA 386, MCL 700.3805, are not part of the estate.
(b) "Property" means that term as defined in section 1106 of the estates and protected individuals code, 1998 PA 386, MCL 700.1106.
History:
Add. 2007, Act 74, Imd. Eff. Sept. 30, 2007
Popular Name:
Act 280