Bill Text: MI HB5343 | 2023-2024 | 102nd Legislature | Introduced
Bill Title: Insurance: insurers; insurance providers to panel a mental health provider within a certain time period of application process; require. Amends 1956 PA 218 (MCL 500.100 - 500.8302) by adding sec. 3406z.
Spectrum: Partisan Bill (Democrat 19-0)
Status: (Introduced) 2023-12-31 - Bill Electronically Reproduced 11/14/2023 [HB5343 Detail]
Download: Michigan-2023-HB5343-Introduced.html
HOUSE BILL NO. 5343
A bill to amend 1956 PA 218, entitled
"The insurance code of 1956,"
(MCL 500.100 to 500.8302) by adding section 3406z.
the people of the state of michigan enact:
Sec. 3406z. (1) Subject to subsection (2), an insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall do all of the following:
(a) Assess and verify the qualifications of a mental health or substance use disorder provider applying to become a participating provider not later than 60 calendar days of receipt of a complete credentialing application and issue a decision in writing to the applicant approving or denying the credentialing application not later than 60 calendar days after receiving the complete credentialing application.
(b) Not later than 10 business days after receipt of an incomplete credentialing application, send a written notification, via United States certified mail, to the applicant requesting any information or supporting documentation that the insurer requires to approve or deny the credentialing application. The notice to the applicant must include a full and detailed description of all the information or supporting documentation required to make the application complete and the name, address, and telephone number of a person who serves as the applicant's point of contact for completing the credentialing application process. Any information required under this section must be reasonably related to the information in the application. As used in this subdivision, "business day" means a day other than a Saturday, a Sunday, or any legal holiday.
(c) Not later than the 60 calendar days described in subdivision (a) or the additional 15 days described in subsection (2), load into the insurer's provider payment system all provider information for an approved mental health or substance use disorder provider, including all information needed to correctly reimburse a newly approved mental health or substance use disorder provider according to the provider's contract. The insurer shall add the approved provider's data to the provider directory upon loading the provider's information into the insurer's provider payment system.
(2) An insurer described in subsection (1) may extend the credentialing period to assess and issue a determination by an additional 15 calendar days if, upon review of a complete application, it is determined that the circumstance presented, including an admission of sanctions by the state licensing board, investigation or felony conviction, or revocation of clinical privileges, requires additional consideration.
(3) An insurer shall reimburse a mental health or substance use disorder provider whose credentialing application has not yet been approved or denied for covered mental health or substance use disorder services for any claims from the provider that the insurer receives with a date of service more than 60 calendar days after the date on which the insurer received a complete credentialing application, or 45 calendar days if the conditions described in subsection (2) are met, if:
(a) The provider has submitted a complete credentialing application and any supporting documentation that the insurer has requested in writing within the time frame established in subsection (2).
(b) The provider has no past or current license sanctions or limitations, as reported by the pertinent state licensing and regulatory agency, or by a similar out-of-state licensing and regulatory entity for a provider licensed in another state.
(c) The provider has professional liability insurance.
(d) The insurer has failed to approve or deny the applicant's complete credentialing application within the time frames established by subsection (1)(a) or (2).
(4) A mental health or substance use disorder provider eligible for reimbursement under subsection (3) who, at the time services were rendered, was not employed by a practice or group that has contracted with the insurer to provide services at specified rates of reimbursement must be paid by the insurer the insurer's standard in-network reimbursement rate for mental health or substance use disorder providers of the same licensure. If the insurer does not have a standard in-network reimbursement rate for the mental health or substance use disorder providers, the reimbursement rate paid must be the median reimbursement rate the insurer pays to mental health or substance use disorder providers of the same licensure.
(5) A mental health or substance use disorder provider eligible for reimbursement under subsection (3) who, at the time services were rendered, was employed by a practice or group that has contracted with the insurer to provide services at specified rates of reimbursement must be paid by the insurer in accordance with the terms of that contract for providers of the same licensure. If providers of the same licensure are already employed by the practice or group that has contracted with the insurer, the reimbursement rate paid must be the median reimbursement rate the insurer pays to mental health or substance use disorder providers of the same licensure.
(6) If an insurer approves the credentialing application of a mental health or substance use disorder provider within the time frames specified in subsection (1)(a) or (2), the insurer shall immediately reimburse the provider for claims submitted after the date of approval at the reimbursement rate specified in the terms and conditions of the contract between the insurer and the provider.
(7) This section applies equally to initial credentialing applications and applications for recredentialing.
(8) As used in this section, "mental health or substance use disorder provider" means any of the following:
(a) A physician licensed under part 170 or part 175 of the public health code, 1978 PA 368, MCL 333.17001 to 333.17097 and 333.17501 to 333.17556, who specializes in psychiatry, addiction medicine, or any subspecialty of psychiatry or addiction medicine.
(b) A psychologist licensed under part 182 of the public health code, 1978 PA 368, MCL 333.18201 to 333.18237.
(c) A licensed bachelor's social worker or licensed master's social worker licensed under part 185 of the public health code, 1978 PA 368, MCL 333.18501 to 333.18518.
(d) A marriage and family therapist licensed under part 169 of the public health code, 1978 PA 368, MCL 333.16901 to 333.16915.
(e) A licensed professional counselor or limited licensed counselor licensed under part 181 of the public health code 1978 PA 368, MCL 333.18101 to 333.18117.
(f) A behavior analyst or assistant behavior analyst licensed under part 182A of the public health code, 1978 PA 368, MCL 333.18251 to 333.18267.
