Michigan Administrative Code › Department - Labor and Economic Opportunity › Workers Compensation Agency › Workers' Compensation Health Care Services Rules › Part 1 - GENERAL PROVISIONS › Section R. 418.10101 - Scope

Current through Vol. 24-12, July 15, 2024
Rule 101.
(1)
				  These rules do all of the following:
(a)
				  Establish procedures by which the employer shall furnish, or cause to be
				  furnished, to an employee who receives a personal injury arising out of and in
				  the course of employment, reasonable medical, surgical, and hospital services
				  and medicines, or other attendance or treatment recognized by the laws of the
				  state as legal, when needed. The employer shall also supply to the injured
				  employee dental services, crutches, artificial limbs, eyes, teeth, eyeglasses,
				  hearing apparatus, and other appliances necessary to cure, so far as reasonably
				  possible, and relieve from the effects of the injury.
(b) Establish schedules of maximum fees by a
				  health facility or health care provider for such treatment or attendance,
				  service, device, apparatus, or medicine.
(c) Establish procedures by which a health
				  care provider shall be paid.
(d)
				  Provide for the identification of utilization of health care and health
				  services above the usual range of utilization for such services, based on
				  medically accepted standards, and provide for acquiring by a carrier and by the
				  agency the necessary records, medical bills, and other information concerning
				  any health care or health service under review.
(e) Establish a system for the evaluation by
				  a carrier of the appropriateness in terms of both the level of and the quality
				  of health care and health services provided to injured employees, based upon
				  medically accepted standards.
(f)
				  Authorize carriers to withhold or recover payment from health facilities or
				  health care providers, that have made excessive charges or that have required
				  unjustified treatment, hospitalization, or visits.
(g) Provide for the review by the agency of
				  the records and medical bills of any health facility or health care provider
				  that have been determined by a carrier not to comply with the schedule of
				  charges established by these rules or to require unjustified treatment,
				  hospitalization, or office visits.
(h) Provide for the certification by the
				  agency of the carrier's professional health care review program.
(i) Establish that when a health care
				  facility or health care provider provides health care or health care service
				  that is not usually associated with, is longer in duration than, is more
				  frequent than, or extends over a greater number of days than that health care
				  or service usually does with the diagnosis or condition for which the patient
				  is being treated, the health facility or health care provider may be required
				  by the carrier to explain the necessity in writing.
(j) Provide for the interaction of the agency
				  and the department for the utilization of departmental procedures for the
				  resolution of workers' compensation disputes.
(k) Are intended for the implementation and
				  enforcement of section 315(2) to (9) of the act, MCL 418.315, and provide for
				  the implementation of the agency's review and decision responsibility vested in
				  it by those statutory provisions. The rules and definitions are not intended to
				  supersede or modify the workers' disability compensation act, the
				  administrative rules of practice of the agency, or court decisions interpreting
				  the act or the agency's administrative rules.