reglab/statecodes huggingface dataset:
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Health Care Services Rules › Part 12 - CARRIER'S PROFESSIONAL HEALTH CARE REVIEW PROGRAM › Section R. 418.101206 - Certification of professional health care review program

Current through Vol. 24-12, July 15, 2024
Rule 1206.
(1) The
				  agency shall certify the carrier's professional health care review
				  program.
(2) A carrier, or the
				  reviewing entity on behalf of the carrier, shall apply to the agency for
				  certification of a carrier's professional health care review program in the
				  manner prescribed by the agency.
(3) A carrier shall receive certification if
				  the carrier or the carrier's review company provides to the agency a
				  description of its professional health care review program and includes all of
				  the information specified in
				  R 418.101204. The agency shall
				  send a copy of the certification of the carrier's review program to the
				  carrier.
(4) The carrier shall
				  submit to the agency for approval a copy of "The Carriers Explanation of
				  Benefits" form utilized to notify providers of payment decisions.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Health Care Services Rules › Part 12 - CARRIER'S PROFESSIONAL HEALTH CARE REVIEW PROGRAM › Section R. 418.101207 - Types of certification

Current through Vol. 24-12, July 15, 2024
Rule 1207.
(1)
				  Certification shall be either unconditional or conditional.
(2) The workers' compensation agency shall
				  issue unconditional certification for a period of 3 years.
(3) The agency may issue conditional
				  certification if it is determined that the carrier or other entity does not
				  fully satisfy the criteria in
				  R 418.101206(3).
				  If the carrier or other entity agrees to undertake corrective action, then
				  conditional certification shall be granted by the agency for a maximum period
				  of 1 year.
(a) If the workers' compensation
				  agency receives multiple written complaints regarding a carrier, or the
				  carrier's review process, and the agency determines the complaints are valid,
				  or that the carrier has not processed payment for medical services in accord
				  with these rules, then the agency may issue conditional
				  certification.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Health Care Services Rules › Part 12 - CARRIER'S PROFESSIONAL HEALTH CARE REVIEW PROGRAM › Section R. 418.101208 - Renewal of certification

Current through Vol. 24-12, July 15, 2024
Rule 1208.
(1) A
				  carrier or other entity shall apply to the workers' compensation agency for
				  renewal of certification in the manner prescribed by the agency, submitting the
				  application within 90 days before the expiration date on the
				  certification.
(2) A carrier or
				  other entity shall receive renewal of certification upon receipt of an updated
				  description of its program as specified in
				  R 418.101206.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Health Care Services Rules › Part 12 - CARRIER'S PROFESSIONAL HEALTH CARE REVIEW PROGRAM › Section R. 418.101209 - Carrier's request for reconsideration of professional review certification

Current through Vol. 24-12, July 15, 2024
Rule 1209.
(1)
				  Within 30 days of the agency's denial of a carrier's request for professional
				  review program certification, the agency shall notify the carrier of the
				  reasons for denial of the certification and shall notify the carrier of its
				  right to request reconsideration of the denial providing additional
				  information.
(2) A carrier shall
				  notify the agency, within 30 days of receipt of the professional review program
				  certification denial, of its disagreement with the action of the agency. The
				  carrier's notice to the agency of disagreement with the agency's denial shall
				  include a detailed statement of the reasons for the disagreement and shall
				  request reconsideration.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Health Care Services Rules › Part 12 - CARRIER'S PROFESSIONAL HEALTH CARE REVIEW PROGRAM › Section R. 418.101210 - Carrier's request for reconsideration of professional review program certification; response

Current through Vol. 24-12, July 15, 2024
Rule 1210.
(1)
				  Within 30 days of receipt of a carrier's request for reconsideration of
				  professional review program certification, the workers' compensation agency
				  shall notify the carrier of the actions taken and shall furnish a detailed
				  statement of the reasons for the action taken.
(2) The agency shall furnish the carrier with
				  an appeal form. The appeal form shall include an explanation of the appeal
				  process.
(3) If a carrier is in
				  disagreement with the action taken by the agency on its request for
				  reconsideration, then a carrier shall deliver or mail its appeal to the
				  agency.
(4) The workers'
				  compensation agency shall hold a hearing within 30 days of the receipt of a
				  carrier's appeal of the agency's decision regarding certification of the
				  carrier's professional review program under section 847 of the act.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Health Care Services Rules › Part 13 - PROCESS FOR RESOLVING DIFFERENCES BETWEEN CARRIER AND PROVIDER REGARDING BILL › Section R. 418.101301 - Carrier's adjustment or rejection of properly submitted bill

Current through Vol. 24-12, July 15, 2024
Rule 1301.
(1) If
				  a carrier adjusts or rejects a bill or a portion of the bill, then the carrier
				  shall notify the provider within 30 days of the receipt of the bill of the
				  reasons for adjusting or rejecting the bill or a portion of the bill and shall
				  notify the provider of its right to provide additional information and to
				  request reconsideration of the carrier's action. The carrier shall set forth
				  the specific reasons for adjusting or rejecting a bill or a portion of the bill
				  and request specific information on a form, "Carrier's Explanation of
				  Benefits," prepared by the agency pursuant to the reimbursement provisions in
				  these rules.
(2) If the provider
				  sends a properly submitted bill to a carrier and the carrier does not respond
				  within 30 days, and if a provider sends a second properly submitted bill and
				  does not receive a response within 60 days from the date the provider supplied
				  the first properly submitted bill, then the provider may file an application
				  with the agency for mediation or hearing. The provider shall send a completed
				  form entitled "Application for Mediation or Hearing" to the agency and shall
				  send a copy of this form to the carrier.
(3) The carrier shall notify the employee and
				  the provider that the rules prohibit a provider from billing an employee for
				  any amount for health care services provided for the treatment of a covered
				  work-related injury or illness if that amount is disputed by the carrier under
				  its utilization review program or if the amount is more than the maximum
				  allowable payment established by these rules. The carrier shall request the
				  employee to notify the carrier if the provider bills the employee.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Health Care Services Rules › Part 13 - PROCESS FOR RESOLVING DIFFERENCES BETWEEN CARRIER AND PROVIDER REGARDING BILL › Section R. 418.101302 - Provider's request for reconsideration of properly submitted bill

Current through Vol. 24-12, July 15, 2024
Rule 1302. A provider may request reconsideration of its
					 adjusted or rejected properly submitted bill by a carrier within 60 days of
					 receipt of a notice of an adjusted or rejected bill or a portion of the bill.
					 The provider's request to the carrier for reconsideration of the adjusted or
					 rejected bill shall include a detailed statement of the reasons for
					 disagreement with the carrier's adjustment or rejection of a bill or a portion
					 of the bill.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Health Care Services Rules › Part 13 - PROCESS FOR RESOLVING DIFFERENCES BETWEEN CARRIER AND PROVIDER REGARDING BILL › Section R. 418.101303 - Provider's request for reconsideration of bill; carrier's response to provider's right to appeal

Current through Vol. 24-12, July 15, 2024
Rule 1303.
(1)
				  Within 30 days of receipt of a provider's request for reconsideration, the
				  carrier shall notify the provider of the actions taken and provide a detailed
				  statement of the reasons. The carrier's notification shall include an
				  explanation of the appeal process provided under these rules, including the
				  fact that any requested administrative appeal hearing shall be conducted by a
				  director's representative, a magistrate, or both.
(2) If a provider disagrees with the action
				  taken by the carrier on the provider's request for reconsideration, then a
				  provider may file an application for mediation or hearing with the agency. A
				  provider shall send its application for mediation or hearing to the agency
				  within 30 days from the date of receipt of a carrier's denial of the provider's
				  request for reconsideration. The provider shall send a copy of the application
				  to the carrier.
(3) If, within 60
				  days of the provider's request for reconsideration, the provider does not
				  receive payment for the adjusted or rejected bill or a portion of the bill, or
				  a written detailed statement of the reasons for the actions taken by the
				  carrier, then the provider may apply for mediation or hearing. The provider
				  shall send the application for mediation or hearing to the agency and shall
				  send a copy to the carrier.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Health Care Services Rules › Part 13 - PROCESS FOR RESOLVING DIFFERENCES BETWEEN CARRIER AND PROVIDER REGARDING BILL › Section R. 418.101304 - Disputes

Current through Vol. 24-12, July 15, 2024
Rule 1304.
(1) If
				  a carrier adjusts or rejects a bill or a portion of a bill under these rules,
				  then a notice given under
				  R 418.101301(1)
				  creates an ongoing dispute for the purpose of section 801 of the act. The time
				  for making payment of a bill under section 801 of the act shall not run unless
				  the bill is properly submitted according to applicable rules and
				  statutes.
(2) Any dispute that
				  concerns any of the following shall be resolved as if an application for
				  mediation or hearing was filed under section 847 of the act:
(a) The medical appropriateness of health
				  care or a health care service.
(b)
				  Utilization of health care or a health care service.
(c) The need for health care or a health care
				  service.
(d) Any dispute over the
				  cost of health care or a health care service.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Health Care Services Rules › Part 13 - PROCESS FOR RESOLVING DIFFERENCES BETWEEN CARRIER AND PROVIDER REGARDING BILL › Section R. 418.101305 - Resolution of disputes

Current through Vol. 24-12, July 15, 2024
Rule 1305.
(1) If
				  a carrier adjusts a fee or rejects a bill under these rules, then a notice
				  given pursuant to
				  R 418.101301 creates a continuing
				  dispute for the purpose of section 801 of the act. The time for making payment
				  of a bill under section 801 of the act shall not run unless the bill is
				  properly submitted according to applicable rules and statutes.
(2) A magistrate, as provided under sections
				  315 and 847 of the act and
				  R
				  408.34 and
				  R
				  408.35, shall resolve any dispute that concerns any of
				  the following:
(a) The medical
				  appropriateness of health care or a health care service.
(b) Utilization of health care or a health
				  care service.
(c) The need for
				  health care or a health care service.
(d) Any dispute over the cost of health care
				  or a health care service.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Health Care Services Rules › Part 14 - DATA ACQUISITION › Section R. 418.101401 - Annual medical payment report

Current through Vol. 24-12, July 15, 2024
Rule 1401.
(1)
				  Payments for medical services received by injured workers shall be reported to
				  the workers' compensation agency on a form prescribed by the agency entitled
				  "Annual Medical Payment Report (WC-406)." The agency shall provide instruction
				  to the carriers and service companies regarding completion of the form. The
				  annual medical payment report shall cover the periods January 1 through
				  December 31 and shall include all of the following information:
(a) The total number of medical payments for
				  health care services for medical cases, wage loss cases, and the carrier's
				  total number of worker's compensation cases in each category during the
				  reporting period.
(b) Medical only
				  cases, defined as those cases where no indemnity was paid, and the total
				  medical payments made by the carrier for those cases.
(c) Wage loss cases, defined as those cases
				  in which wage loss or indemnity was paid, and the total medical payments made
				  by the carrier for those cases. For the purposes of this annual medical payment
				  report, once wage loss benefits are paid, then the case shall always be
				  reported as wage loss.
(d) For the
				  purpose of the Annual Medical Payment Report (WC-406), "medical services" is
				  defined as all reasonable medical, surgical, and hospital services and
				  medicines, or other attendance or treatment recognized by the laws in this
				  state as legal, and furnished by licensed practitioners within the scope of
				  their practice. The report shall not include indemnity payments, travel
				  expenses, payments for independent medical examinations, legal expenses,
				  vocational rehabilitation, or on-site or telephonic case management
				  expenses.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Health Care Services Rules › Part 14 - DATA ACQUISITION › Section R. 418.101402 - Access to workers' compensation case records

Current through Vol. 24-12, July 15, 2024
Rule 1402.
(1) The
				  workers' compensation agency shall have access to necessary workers'
				  compensation health care records, medical bills, and other information
				  concerning health care or health service from workers' compensation carriers or
				  providers.
(2) The agency may
				  review the records and medical bills of any provider determined by a carrier to
				  not be in compliance with the rules or to be requiring unjustified treatment,
				  hospitalization, or office visits. If a carrier requests the agency to perform
				  an on-site review of specific records and medical bills of a provider, then the
				  agency shall arrange a mutually acceptable visit date with the provider, by
				  telephone or in writing, at least 15 working days before the visit. The agency
				  shall confirm the date of the visit in writing not less than 10 working days in
				  advance. The agency shall, by that time, identify for the provider the records,
				  which the agency wishes to review. The records shall remain at the provider's
				  place of business.
(3) The workers'
				  compensation agency shall ensure confidentiality of the individual case records
				  regarding health care services provided to any individual.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Health Care Services Rules › Part 14 - DATA ACQUISITION › Section R. 418.101404 - Access to carrier data for payment of medical claims

Current through Vol. 24-12, July 15, 2024
Rule 1404.
(1) The
				  workers' compensation agency shall have access to payment data from the carrier
				  in the form of the carrier's explanation of benefits and medical bills for the
				  purposes of data analysis.
(2) A
				  carrier shall be notified by the agency when information is to be submitted not
				  less than 60 days before the date required.
(3) The agency shall ensure confidentiality
				  of the billing records provided by the selected carriers.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Health Care Services Rules › Part 15 - PROCEDURE CODE AND REIMBURSEMENT TABLES › Section R. 418.101501 - Tables for health care services and procedures

Current through Vol. 24-12, July 15, 2024
Rule 1501. The agency shall provide separate from these
					 rules a manual, tables, and charts containing all of the following on the
					 agencys website,
www.michigan.gov/wca
:
(a) Procedure codes and relative value units
				  for the medical, surgical, and radiology services.
(b) Reference to the ancillary services
				  identified in the HCPCS Level II codebook as adopted by reference in
				  R 418.10107.
(c) Maximum payment ratios for
				  hospitals.
(d) A copy of the
				  billing forms and instructions for completion.
Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Health Care Services Rules › Part 15 - PROCEDURE CODE AND REIMBURSEMENT TABLES › Section R. 418.101503 - Laboratory procedure codes and maximum allowable payments

Current through Vol. 24-12, July 15, 2024
Rule 1503.
(1) The
				  workers' compensation agency shall determine the maximum allowable payment for
				  the laboratory procedure codes found in the CPT and HCPCS codebooks, as adopted
				  by reference in R418.10107. The rate shall be determined by multiplying the
				  Medicare rate established for this state by 110%.
(2) The pathology procedure codes found in
				  the 80000 series of the CPT code set have assigned relative values and shall be
				  provided on the agencys website at
www.michigan.gov/wca
.
(3) The maximum allowable payments for the
				  laboratory and pathology procedures shall be provided on the agencys website,
www.michigan.gov/wca
.
(4) A provider performing drug testing, drug
				  screening, and drug confirmation testing shall use the appropriate procedure
				  codes G0480-G0483, G0659, or 80305-80307 listed in the HCPCS or CPT codebook,
				  as adopted by reference in R418.10107. A maximum of one service unit per
				  procedure code per date of service shall be billed with these codes.
Michigan Administrative Code › Department - Licensing and Regulatory Affairs › Bureau of Community and Health Systems › Substance Use Disorder Programs › Substance Use Disorder Programs › Part 1 - DEFINITIONS › Section R. 325.1302 - Certified counselor; limited certified counselor; physician who provides counseling

Current through Vol. 24-12, July 15, 2024
Rule 1302.
(1) A
					 certified counselor and a limited certified counselor may provide alcohol and
					 drug counseling to recipients in a substance use disorder services program
					 licensed by the department under part 62 of the public health code, MCL
					 333.6230 to
					 333.6251, but not under any other
					 circumstances unless otherwise provided by law.
(2) A physician who provides counseling may
					 be counted as part of the counseling services requirement if the physician
					 meets the applicable counseling related requirements in these rules.
Michigan Administrative Code › Department - Licensing and Regulatory Affairs › Bureau of Community and Health Systems › Substance Use Disorder Programs › Substance Use Disorder Programs › Part 2 - STATE AGENCY REQUIREMENTS › Subpart A - LICENSING › Section R. 325.1303 - Application; licensing requirement; review process; licensure

Current through Vol. 24-12, July 15, 2024
Rule 1303.
(1)
						As authorized in article 6 and chapter 2A of the mental health code, MCL
						330.1260 to
						330.1287, an application for
						initial licensure or licensure change, including change in ownership, change in
						business name, relocation of the program, addition or deletion of service
						levels, or addition or deletion of a branch site or mobile unit, must be made
						on the most recent applicable form authorized and provided by the
						department.
(2) A person offering
						substance use disorder services shall be licensed under article 6, except as
						provided in subrule (3) of this rule.
(3) A license is not required for an
						individual licensed under article 15 to provide psychological, medical, or
						social services if all of the following are met:
(a) The individual is offering psychological,
						medical, or social services within the scope of his or her individual
						professional license and not under a group or organization offering substance
						use disorder services.
(b) The
						individual is offering psychological or medical services and not providing
						methadone treatment.
Michigan Administrative Code › Department - Licensing and Regulatory Affairs › Bureau of Community and Health Systems › Substance Use Disorder Programs › Substance Use Disorder Programs › Part 2 - STATE AGENCY REQUIREMENTS › Subpart A - LICENSING › Section R. 325.1304 - Application for branch office or mobile unit; requirements; review process; approval

Current through Vol. 24-12, July 15, 2024
Rule 1304.
(1)
						Before operation of a branch location or mobile unit, a licensee shall submit
						an application for review and approval on the most recent applicable form
						authorized and provided by the department.
(2) If an application is incomplete and
						requires additional information, the department shall notify the licensee in
						writing within 45 days after receipt of the application.
(3) The licensee submitting an application
						for a branch location or mobile unit shall have been licensed for a minimum of
						2 years and be in compliance with the public health code, the mental health
						code, and these rules.
(4) An
						application for a branch location must be approved if the branch location
						satisfies all of the following requirements:
(a) The parent organization provides
						outpatient counseling services and is proposing to offer outpatient counseling
						services at the branch office.
(b)
						The branch office is open to recipients no more than 20 hours per
						week.
(c) The branch office has
						applicable policies and procedures required for outpatient counseling
						services.
(d) The branch office is
						located within 75 miles from the parent location.
(e) The total number of branch offices does
						not exceed 3 locations for the parent organization.
(f) The branch office shall post the hours of
						operation of the location in a conspicuous area for public view.
Michigan Administrative Code › Department - Licensing and Regulatory Affairs › Bureau of Community and Health Systems › Substance Use Disorder Programs › Substance Use Disorder Programs › Part 2 - STATE AGENCY REQUIREMENTS › Subpart A - LICENSING › Section R. 325.1305 - License renewal process

Current through Vol. 24-12, July 15, 2024
Rule 1305.
(1)
						Renewal of a license must be completed through an electronic web-based system
						authorized and provided by the department.
(2) A license is renewed and valid only upon
						electronic payment of the applicable renewal fee.
(3) A license must be renewed before August 1
						of each calendar year, unless otherwise specified on the license.
(4) The department may require changes or
						corrections to a license before renewal.
(5) If a license is not renewed within 30
						days after the expiration date, the department may take any enforcement action
						authorized by section
						6243 of the public health code,
						MCL 333.6243.
(6) A license cannot be renewed if the
						location has not offered the covered service within the 12 months immediately
						preceding the renewal period.
Michigan Administrative Code › Department - Licensing and Regulatory Affairs › Bureau of Community and Health Systems › Substance Use Disorder Programs › Substance Use Disorder Programs › Part 2 - STATE AGENCY REQUIREMENTS › Subpart A - LICENSING › Section R. 325.1307 - Licensure survey and complaint investigation process

Current through Vol. 24-12, July 15, 2024
Rule 1307.
(1)
						A prelicensure survey is scheduled and announced.
(2) All other licensure surveys and compliant
						investigations are unannounced.
(3)
						A licensure survey or complaint investigation may be conducted by the
						department during any hours of operation of the program.
(4) A licensure survey or complaint
						investigation may use information not collected from an applicant or licensee
						during its review. If this information is used, an applicant or licensee shall
						be notified of this information.
(5) An applicant or licensee shall grant
						access to the program and cooperate during a licensure survey or complaint
						investigation for the department to determine compliance with applicable
						statutory and regulatory requirements. The department shall consider lack of
						access or cooperation as evidence of noncompliance.
Michigan Administrative Code › Department - Licensing and Regulatory Affairs › Bureau of Community and Health Systems › Substance Use Disorder Programs › Substance Use Disorder Programs › Part 2 - STATE AGENCY REQUIREMENTS › Subpart A - LICENSING › Section R. 325.1309 - Waiver from licensure survey

Current through Vol. 24-12, July 15, 2024
Rule 1309.
(1)
						The department shall provide and make publicly available a procedure for when a
						licensee may be eligible for a waiver from a licensure survey. The procedure
						must include maintaining a list of approved accrediting bodies for
						programs.
(2) On or before October
						1 of each year, the department shall publish a list of programs to receive a
						licensure survey in the next calendar year.
(3) An eligible licensee may request a waiver
						from licensure survey on or before November 1 of each year. A waiver request
						shall be submitted on a form authorized by the department.
(4) On or before January 1 of the survey
						year, the department shall provide in writing an approval or denial of the
						waiver from licensure survey to the licensee.
(5) Denial of a waiver from licensure survey
						is not subject to appeal and will result in a licensure survey during the
						survey year.
(6) An approved waiver
						from licensure survey shall not prohibit the department from conducting an
						onsite licensure survey at any point in the future to protect the health,
						safety, and welfare of individuals receiving care and services.
Michigan Administrative Code › Department - Licensing and Regulatory Affairs › Bureau of Community and Health Systems › Substance Use Disorder Programs › Substance Use Disorder Programs › Part 2 - STATE AGENCY REQUIREMENTS › Subpart B - PROGRAM COMPLAINT AND COMPLAINT INVESTIGATION › Section R. 325.1311 - Program complaint

Current through Vol. 24-12, July 15, 2024
Rule 1311.
(1)
						A program complaint filed with the department shall be limited to allegations
						that the program did not comply with the public health code, mental health
						code, other state laws, or these rules.
(2) A complainant shall provide enough
						information to identify the specific program where the alleged conduct or
						incident took place. This information includes, but is not limited to, the name
						and address of the program.
(3) A
						program complaint may be filed anonymously.
(4) When a program complaint is filed by an
						individual with the department, it must be filed within 12 months of the
						violation. If it is not filed within 12 months of the violation, the department
						may investigate the program complaint if the complainant shows good cause for
						delayed filing of the program complaint, such as lack of knowledge of the
						violation within the 12-month period.
(5) A program complaint shall be submitted
						using the departments hotline or in writing using the United States Postal
						Service, email, the departments online complaint form, facsimile, or other
						method provided for on the departments website,
www.michigan.gov/lara
.
(6) A program complaint must be
						understandable and limited to matters involving an alleged violation of an
						applicable law or rule affecting the complainant, the recipient or, in the case
						of a public interest group, affecting the public or a portion of the
						public.
(7) The department shall
						receive, evaluate, and, if warranted, investigate a filed program complaint.
						The department shall not investigate a program complaint that, as alleged, does
						not violate a law or rule regulated by the department. The department shall
						send a letter of acknowledgement to each complainant upon evaluation of the
						program complaint, except when a program complaint is submitted
						anonymously.
(8) The department
						shall notify the licensee of the nature of the program complaint no earlier
						than the initial visit to the licensee to investigate the program
						complaint.
(9) The department shall
						provide the complainant with the written findings of the program complaint
						investigation, or instructions for how to obtain the written findings, no later
						than 30 days after the conclusion of the program complaint process. The
						department shall inform the complainant of the departments actions if the
						program does not correct areas of noncompliance, when applicable. This subrule
						does not apply when a program complaint is filed anonymously.
Michigan Administrative Code › Department - Licensing and Regulatory Affairs › Bureau of Community and Health Systems › Substance Use Disorder Programs › Substance Use Disorder Programs › Part 2 - STATE AGENCY REQUIREMENTS › Subpart B - PROGRAM COMPLAINT AND COMPLAINT INVESTIGATION › Section R. 325.1313 - Complaint investigation of program complaint

Current through Vol. 24-12, July 15, 2024
Rule 1313.
(1)
						An employee assigned by the department may conduct a complaint investigation of
						a program complaint to ensure compliance with state law or rule.
(2) Complaint investigations pursuant to
						these rules may include, but are not limited to, all of the following:
(a) Observation of the operation of the
						program.
(b) Assessment and copying
						of relevant books, records, recipient records, videos, and other documents
						maintained by a program.
(c)
						Collection of other information, including otherwise privileged or confidential
						information, from any person who may have information bearing on an applicants
						or licensees compliance or ability to comply with the requirements for
						licensure.
Michigan Administrative Code › Department - Licensing and Regulatory Affairs › Bureau of Community and Health Systems › Substance Use Disorder Programs › Substance Use Disorder Programs › Part 2 - STATE AGENCY REQUIREMENTS › Subpart C - ENFORCEMENT AND HEARING › Section R. 325.1315 - Denial of application; revocation of license

Current through Vol. 24-12, July 15, 2024
Rule 1315. An application or license may be denied or
						  revoked for 1 or more of the following reasons:
(a) Violation of the public health code, the
						mental health code, or these rules.
(b) Submission of false information to the
						department that is related and material to the requirements of applying for or
						holding a license.
(c) Denial,
						revocation, suspension, or failure to renew a federal registration to
						distribute or dispense methadone.
(d) Disciplinary action, suspension, or
						revocation of the license issued under article 15 for the medical director of
						the program, or any other health professional who is directly responsible for
						the care of a recipient.
(e)
						Failure of an applicant or licensee to cooperate with the department in
						connection with a licensure survey, complaint investigation, or any other
						investigation or inquiry.
(f)
						Failure to provide information necessary to conduct a thorough assessment of an
						applicant, application, licensee, license, complainants, or complaint
						investigation.
Michigan Administrative Code › Department - Licensing and Regulatory Affairs › Bureau of Community and Health Systems › Substance Use Disorder Programs › Substance Use Disorder Programs › Part 2 - STATE AGENCY REQUIREMENTS › Subpart C - ENFORCEMENT AND HEARING › Section R. 325.1317 - License suspension

Current through Vol. 24-12, July 15, 2024
Rule 1317. A license may be subject to a summary
						  suspension for any violation of the public health code, mental health code, or
						  these rules that may, according to the determination of the department, pose a
						  risk to the public health, safety, or welfare of recipients and where remedial
						  action has not been taken by the provider, pursuant to section 92 (2) of the
						  administrative procedures act of 1969, 1969 PA 306, MCL 24.292
						  (2).
Michigan Administrative Code › Department - Licensing and Regulatory Affairs › Bureau of Community and Health Systems › Substance Use Disorder Programs › Substance Use Disorder Programs › Part 2 - STATE AGENCY REQUIREMENTS › Subpart C - ENFORCEMENT AND HEARING › Section R. 325.1319 - Refusal by department to issue or renew license

Current through Vol. 24-12, July 15, 2024
Rule 1319. A person, representative, director, or
						  officer of a licensee, an agency, a firm, a corporation, an association, or an
						  organization who has had a license revoked or a renewal denied may be refused a
						  license for a period of not less than 3 years after the revocation or renewal
						  denial. The department may accept an application from a person, an applicant,
						  or licensee or anyone connected directly or indirectly with a licensee who has
						  had a license revoked or a renewal denied. The department may reject the
						  application on its face without taking further action after notifying an
						  applicant of the rejection and the reason for the rejection. The rejection is
						  not subject to appeal.
Michigan Administrative Code › Department - Licensing and Regulatory Affairs › Bureau of Community and Health Systems › Substance Use Disorder Programs › Substance Use Disorder Programs › Part 2 - STATE AGENCY REQUIREMENTS › Subpart C - ENFORCEMENT AND HEARING › Section R. 325.1321 - Notification of denial of application

Current through Vol. 24-12, July 15, 2024
Rule 1321. When the department determines that an
						  application shall be denied for any of the reasons specified in R 325.1315, or
						  for any other reason afforded under the public health code, the mental health
						  code, or these rules, an applicant shall be notified in writing of this final
						  agency decision. The denial of an application is not subject to
						  appeal.
Michigan Administrative Code › Department - Licensing and Regulatory Affairs › Bureau of Community and Health Systems › Substance Use Disorder Programs › Substance Use Disorder Programs › Part 2 - STATE AGENCY REQUIREMENTS › Subpart C - ENFORCEMENT AND HEARING › Section R. 325.1323 - Notification of revocation of license or nonrenewal of license; compliance conference; opportunity to appeal

Current through Vol. 24-12, July 15, 2024
Rule 1323.
(1)
						When the department determines that a licensee has committed an act or engaged
						in conduct or practices that warrants the revocation of a license or the denial
						to renew a license, the department shall issue a notice of intent that includes
						all of the following:
(a) The reason or
						reasons for the revocation of a license or the denial to renew a
						license.
(b) The date, time, and
						location for a compliance conference. The compliance conference shall take
						place at least 45 days from the date of the notice of intent.
(c) Guidance to the licensee that a written
						appeal of the notice of intent must be submitted to the department within 30
						days from the date of the notice of intent for the compliance conference to
						occur.
Michigan Administrative Code › Department - Licensing and Regulatory Affairs › Bureau of Community and Health Systems › Substance Use Disorder Programs › Substance Use Disorder Programs › Part 2 - STATE AGENCY REQUIREMENTS › Subpart C - ENFORCEMENT AND HEARING › Section R. 325.1325 - Order of summary suspension

Current through Vol. 24-12, July 15, 2024
Rule 1325.
(1)
						When the department determines that a licensee has committed an act or engaged
						in conduct or practices that justify an order for summary suspension of the
						license because it may pose a risk to the public health, safety, or welfare,
						the department shall notify the licensee, either by personal service or
						certified mail with return receipt requested, of the order to summarily suspend
						the license. The order shall contain the name and license number of the
						licensee, the allegations of risk or harm prompting the summary suspension, and
						the specific date and time the licensee shall cease operations. The order may
						also contain specific actions the licensee must take to address referral of
						recipients, disposition of existing supplies, and recipient records.
(2) Upon issuance of the order for summary
						suspension, the department shall promptly request a formal hearing pursuant to
						section 92(2), MCL 24.292(2) of the administrative procedures act of 1969, 1969
						PA 306, MCL 24.292 (2).
Michigan Administrative Code › Department - Licensing and Regulatory Affairs › Bureau of Community and Health Systems › Substance Use Disorder Programs › Substance Use Disorder Programs › Part 2 - STATE AGENCY REQUIREMENTS › Subpart C - ENFORCEMENT AND HEARING › Section R. 325.1327 - Applicability

Current through Vol. 24-12, July 15, 2024
Rule 1327.
(1)
						The procedures set forth in R 325.1315 to R 325.1325 apply to the hearings and
						penalties related to violations outlined in article 6 of the public health
						code.
(2) Unless otherwise provided
						by article 6 of the public health code, chapter 2a of the mental health code,
						MCL 330.1260 to 330.1287, or these rules, the procedures for a hearing shall
						comply with sections 71 to 92 of the administrative procedures act of 1969,
						1969 PA 306, MCL 24.271 to 24.292, and Part 1 of the Michigan administrative
						hearing system administrative hearing rules,
						R
						792.10101 to
						R
						792.10137.
Michigan Administrative Code › Department - Licensing and Regulatory Affairs › Bureau of Community and Health Systems › Substance Use Disorder Programs › Substance Use Disorder Programs › Part 3 - SUBSTANCE USE DISORDER SERVICES PROGRAM REQUIREMENTS › Subpart A - ADMINISTRATION › Section R. 325.1329 - Ownership; licensee

Current through Vol. 24-12, July 15, 2024
Rule 1329.
(1)
						An applicant or licensee shall disclose ownership of a program to the
						department on the license application. An applicant or licensee is the
						individual or entity applying to the department to establish, conduct, or
						maintain a substance use disorder services program.
(2) An applicant or licensee shall be the
						legal authority and responsible for the management of the program, the
						provision of all services, and its fiscal operations.
(3) An applicant or licensee shall establish
						policies and procedures for the management, operation, and evaluation of the
						program.
(4) Acceptance of a
						license means the licensee shall comply with the public health code, mental
						health code, and these rules.
Michigan Administrative Code › Department - Licensing and Regulatory Affairs › Bureau of Community and Health Systems › Substance Use Disorder Programs › Substance Use Disorder Programs › Part 3 - SUBSTANCE USE DISORDER SERVICES PROGRAM REQUIREMENTS › Subpart A - ADMINISTRATION › Section R. 325.1331 - Policies and procedures

Current through Vol. 24-12, July 15, 2024
Rule 1331.
(1)
						An applicant or licensee shall have policies and procedures for the services
						offered. A licensee shall review and update the policies and procedures
						triennially or as necessary, whichever is sooner. Reviews must be documented
						through date and signature on the policy and procedure or by meeting minutes
						that list the specific policies and procedures reviewed.
(2) Policies and procedures must include all
						of the following:
(a)
						Confidentiality.
(b) Recipient
						rights.
(c) Referrals, including
						access to medication-assisted treatment. The policy and procedure must
						facilitate access to medication-assisted treatment if desired by the
						recipient.
(d) Admissions. This
						policy and procedure must include a consent for treatment that outlines the
						benefits and risks of each treatment and rehabilitative service offered by the
						program, other FDA-approved treatments not offered by the program, and the risk
						of no treatment consistent with current clinical standards supported by
						national guidelines for evidence-based practices.
(e) Discharge, including aftercare. This
						policy and procedure may not allow discharge of a recipient due to a return to
						use as long as the recipient reengages in treatment and complies with program
						policies and treatment protocol prospectively.
(f) Naloxone access. This policy and
						procedure must include protocol to offer a naloxone kit to, at a minimum, all
						recipients with a history of opioid use or who are otherwise determined to be
						at risk for overdose.
(g)
						Follow-up.
(h) Intake.
(i) Telehealth, telemedicine, or other
						communication modalities. This policy and procedure must conform with
						applicable state and federal regulations on the use of electronic information
						and telecommunication technologies to support or promote longdistance clinical
						health care, patient and professional health-related education, public health,
						or health administration.
Michigan Administrative Code › Department - Licensing and Regulatory Affairs › Bureau of Community and Health Systems › Substance Use Disorder Programs › Substance Use Disorder Programs › Part 3 - SUBSTANCE USE DISORDER SERVICES PROGRAM REQUIREMENTS › Subpart A - ADMINISTRATION › Section R. 325.1333 - Complaint filed with program; policy and procedure for initiation, investigation, and resolution

Current through Vol. 24-12, July 15, 2024
Rule 1333.
(1)
						An applicant or licensee shall adopt written policies and procedures for the
						initiation, investigation, and resolution of complaints filed with the program.
						These policies and procedures shall be provided by the applicant or licensee to
						each recipient at the time of admission to the program and upon request.
						Program complaint policies and procedures shall contain, at a minimum, all of
						the following:
(a) A statement that a
						recipient, or the recipients legal guardian or designated representative when
						that person has standing, may file a complaint to the program, the department,
						or both; and, a statement that the person need not cite a specific violation of
						law or rule.
(b) A complainants
						contact information, unless the complainant wants to remain
						anonymous.
(c) A process for filing
						a complaint with the program about potential violations of law or rule,
						including a process to assist the complainant with writing a complaint when an
						oral complaint is not resolved to the complainants satisfaction.
(d) A process to document when oral
						complaints are resolved and when investigation activities are
						discontinued.
(e) If a standard
						complaint form is used, a copy of the form must be provided to each person at
						the time of admission or treatment and upon request.
(f) The name, title, location, and contact
						information of the individual who is responsible for receiving complaints and
						conducting complaint investigations for the program, as well as the process for
						communicating with that individual.
(g) A requirement that all program complaint
						investigations be started within 72 hours of receipt of a complaint or
						discovery of the allegation or allegations, whichever occurs first.
(h) A requirement that all program complaint
						investigations be completed within 15 days of receipt of the complaint or
						discovery of the allegation or allegations, whichever occurs first.
(i) A requirement that the program shall
						deliver to the complainant within 30 days of receipt of the program complaint
						or discovery of the allegation or allegations, whichever occurs first, the
						written results of the investigation or a written status report indicating when
						the written results of the investigation may be expected. The written results
						shall inform the complainant that the complainant may file a program complaint
						with the department and include the departments contact information. This
						subdivision does not apply to a complaint that is filed anonymously.
Michigan Administrative Code › Department - Licensing and Regulatory Affairs › Bureau of Community and Health Systems › Substance Use Disorder Programs › Substance Use Disorder Programs › Part 3 - SUBSTANCE USE DISORDER SERVICES PROGRAM REQUIREMENTS › Subpart A - ADMINISTRATION › Section R. 325.1335 - Program assessment and evaluation

Current through Vol. 24-12, July 15, 2024
Rule 1335.
(1)
						An applicant or licensee shall develop written goals and objectives to assess
						the needs and evaluate the effectiveness of the program and services
						offered.
(2) An assessment must
						identify the staffing needs, supplies, and other necessary components to ensure
						the effectiveness of the delivery of services.
(3) A licensee shall review and document the
						evaluation of the program and services offered. The evaluation must be
						completed annually or when there is a change in services or the needs
						assessment of the recipients, whichever is sooner.
(4) A licensee shall make the reports
						available to the department upon request and during any licensure survey or
						complaint investigation.
Michigan Administrative Code › Department - Licensing and Regulatory Affairs › Bureau of Community and Health Systems › Substance Use Disorder Programs › Substance Use Disorder Programs › Part 3 - SUBSTANCE USE DISORDER SERVICES PROGRAM REQUIREMENTS › Subpart A - ADMINISTRATION › Section R. 325.1337 - Data reporting; informal advisory group

Current through Vol. 24-12, July 15, 2024
Rule 1337.
(1)
						The department may collect information and aggregated data from licensees,
						including, but not limited to, any of the following:
(a) Availability of services.
(b) Hours of operation.
(c) Demographic data.
(d) Morbidity and mortality data.
(e) Volume of care provided to recipients
						from all payor sources.