Michigan Compiled Laws
218-1956-35 - Chapter 35 Health Maintenance Organizations (500.3501...500.3580)
Section 500.3528 - Health Maintenance Organization; Credentialing Verification; Accreditation by Nationally Recognized Accredited Body.

Sec. 3528.
(1) A health maintenance organization shall establish written policies and procedures for credentialing verification of all health professionals with whom the health maintenance organization contracts. A health maintenance organization shall apply these standards consistently. This act does not require a health maintenance organization to select a provider as an affiliated provider solely because the provider meets the health maintenance organization's credentialing verification standards. This act does not prevent a health maintenance organization from using separate or additional criteria in selecting the health professionals with whom it contracts.
(2) A health maintenance organization is considered to meet the requirements of this section if the health maintenance organization is accredited by a nationally recognized accredited body approved by the director. As used in this subsection, "nationally recognized accredited body" includes the National Committee for Quality Assurance.
History: Add. 2000, Act 252, Imd. Eff. June 29, 2000 ;-- Am. 2002, Act 621, Imd. Eff. Dec. 23, 2002 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016 Popular Name: Act 218Popular Name: HMO

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Structure Michigan Compiled Laws

Michigan Compiled Laws

Chapter 500 - Insurance Code of 1956

Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)

218-1956-35 - Chapter 35 Health Maintenance Organizations (500.3501...500.3580)

Section 500.3501 - Definitions.

Section 500.3503 - Applicability of Provisions to Health Maintenance Organization.

Section 500.3505 - Health Maintenance Contract; Use of Descriptive Words; Restrictions.

Section 500.3507 - Authorizing and Regulating Health Maintenance Organization; Establishment of System by Director.

Section 500.3508 - Quality Assessment Program; Quality Improvement Program.

Section 500.3509 - Certificate of Authority; Application; Form; Limitation; Change of Service Area.

Section 500.3511 - Governing Body; Election of Enrollee Board Members; Requirements; Meetings.

Section 500.3513 - Health Maintenance Organization Operations; Regulation by Director; Incorporation as Legal Entity.

Section 500.3515 - Additional Health Services; Deductibles; Copayments; "Preventive Health Care Services" Defined; Partial Payment From Government or Private Person.

Section 500.3517 - Healthy Lifestyle Programs; Emergency or Out-of-Area Service; Payment of Expenses or Fees.

Section 500.3519 - Contract and Contract Rates; Fairness; Rate Differential; Basic Health Services to Large Employers Required.

Section 500.3521 - Prepayment Rates; Filing and Approval of Methodology; Schedule.

Section 500.3523 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.

Section 500.3525 - Proposal to Revise Contract or Rate; Approval of Commissioner; Approval With Modifications; Hearing; Disposition; Exception; Notice.

Section 500.3527 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.

Section 500.3528 - Health Maintenance Organization; Credentialing Verification; Accreditation by Nationally Recognized Accredited Body.

Section 500.3529 - Affiliated Provider Contracts; Collection of Payments From Enrollees; Contract Provisions; Waiver of Requirement Under Subsection (2); Contract Format; Evidence of Sufficient Number of Providers.

Section 500.3530 - Availability of Covered Services; Assurance; Establishment and Maintenance of Proximity.

Section 500.3531 - Contracts With Health Care Providers to Become Affiliated Providers; Requirements; Standards; Filing; Duplicative Standards; Notice Procedures; Provider Application Period; Approval or Rejection as Affiliated Provider; Termination...

Section 500.3533 - Prudent Purchaser Contracts; Reimbursement for Unauthorized Services or Services by Nonaffiliated Providers.

Section 500.3535 - Solicitation or Advertising.

Section 500.3537 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.

Section 500.3539 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.

Section 500.3541 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.

Section 500.3542 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.

Section 500.3543 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.

Section 500.3544 - Noninsured Benefit Plan; Processing and Payment of Claims.

Section 500.3545 - Acquisition of Obligations From Another Managed Care Entity.

Section 500.3547 - Health Care Service Operations; Visitation or Examination by Director; Consultation With Enrollees; Authority; Access to Information Relating to Delivery of Services; Submission of Information Regarding Proposed Contract.

Section 500.3548 - Maintenance of Books, Records, Files, and Financial Records; Funds and Assets.

Section 500.3549 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.

Section 500.3551 - Health Maintenance Organization; Net Worth.

Section 500.3553 - Certificate of Authority; Deposit Requirements.

Section 500.3555 - Financial Plan.

Section 500.3557 - Notice of Changes in Operations.

Section 500.3559 - Reinsurance Contract or Plan of Self-Insurance; Purpose; Filing; Approval; Coverage.

Section 500.3561 - Insolvency; Continuation of Benefits.

Section 500.3563 - Insolvency; Offer of Enrollment by Health Insurers Participating in Enrollment Process; Allocation of Group Coverage to Health Maintenance Organizations or Insurers Within Service Area; Nongroup Coverage; Reassignment of Enrollees...

Section 500.3565 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.

Section 500.3567 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.

Section 500.3569 - Assumption of Financial Risk.

Section 500.3571 - State or Federal Health Programs.

Section 500.3573 - Operation of Health Care Delivery System Not Meeting Requirements of Act; Permitted Conduct; Limitations.

Section 500.3580 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.