Michigan Compiled Laws
350-1980-5 - Part 5 (550.1501...550.1518)
Section 550.1504 - Reimbursement Arrangements; Goals; Definitions; Supplemental Efforts.

Sec. 504.
(1) A health care corporation shall, with respect to providers, contract with or enter into a reimbursement arrangement to assure subscribers reasonable access to, and reasonable cost and quality of, health care services, in accordance with the following goals:
(a) There will be an appropriate number of providers throughout this state to assure the availability of certificate-covered health care services to each subscriber.
(b) Providers will meet and abide by reasonable standards of health care quality.
(c) Providers will be subject to reimbursement arrangements that will assure a rate of change in the total corporation payment per member to each provider class that is not higher than the compound rate of inflation and real economic growth.
(2) As used in this section:
(a) "Gross national product in constant dollars" means that term as defined and annually published by the United States department of commerce, bureau of economic analysis.
(b) "Implicit price deflator for gross national product" means that term as defined and annually published by the United States department of commerce, bureau of economic analysis.
(c) "Inflation" or "I" means the arithmetic average of the percentage changes in the implicit price deflator for gross national product over the 2 calendar years immediately preceding the year in which the commissioner's determination is being made.
(d) "Compound rate of inflation and real economic growth" means the ratio of the quantity "100 plus inflation", multiplied by the quantity "100 plus real economic growth", to 100; minus 100; or as expressed in the following formula:

(f) "Real economic growth" or "REG" means the arithmetic average of the percentage changes in the per capita gross national product in constant dollars over the 4 calendar years immediately preceding the year in which the commissioner's determination is being made.
(3) Nothing in this section shall preclude efforts by a health care corporation supplemental to the goals prescribed in subsection (1).
History: 1980, Act 350, Eff. Apr. 3, 1981 Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350

Structure Michigan Compiled Laws

Michigan Compiled Laws

Chapter 550 - General Insurance Laws

Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704)

350-1980-5 - Part 5 (550.1501...550.1518)

Section 550.1501 - Contracts With Health Care Facilities.

Section 550.1501a - Special Participating Contracts With Health Care Providers for Provision of Primary Health Care Benefits to Children Enrolled in Michigan Caring Program.

Section 550.1501b - Conduct on Behalf of or Information Provided to Subscriber by Health Care Provider; Prohibition or Discouragement by Health Care Corporation.

Section 550.1501c - Provider Network.

Section 550.1502 - Contracts for Reimbursement With Professional Health Care Providers; Private Provider-Patient Relationship; Methods of Diagnosis or Treatment Not to Be Restricted; Refusal to Reimburse for Overutilized Services; List of Providers;...

Section 550.1502a - Prudent Purchaser Agreements; Group Contracts; Option; Group Contracts Under Which Financial or Other Advantage Realized; Additional Option; Applicability of Subsection (5); Individual Contracts; Rates; Contracts Subject to MCL 55...

Section 550.1503 - Uniform Reporting by Health Care Providers.

Section 550.1504 - Reimbursement Arrangements; Goals; Definitions; Supplemental Efforts.

Section 550.1505 - Provider Class Plan; Development, Modification, Implementation, or Review; Procedures to Obtain Advice and Consultation.

Section 550.1506 - Provider Class Plan; Transmitting to Commissioner; Examination; Determination; Notice; Placing Plan Into Effect; Retention of Plan for Commissioner's Records.

Section 550.1507 - Provider Class Plan; Inclusion and Transmittal of Items Omitted.

Section 550.1508 - Provider Class Plan; Modifications.

Section 550.1509 - Achievement of Goals and Objectives; Determinations by Commissioner.

Section 550.1510 - Additional Determinations by Commissioner.

Section 550.1511 - Provider Class Plan; Transmittal to Commissioner; Preparation by Commissioner.

Section 550.1512 - Extension of 6-Month Period Provided in MCL 550.511(1); Determination.

Section 550.1513 - Provider Class Plan; Examination; Automatic Retention; Placing Plan Into Effect; Preparation of Plan by Commissioner; Notice.

Section 550.1514 - Appeal; Selection and Qualifications of Hearing Officer; Consolidation; Annual Report.

Section 550.1515 - Appeal; Parties; Request; Time; Relief; Transmittal of Provider Class Plan to Hearing Officer; Determinations.

Section 550.1516 - Provider Class Plan; Standards.

Section 550.1517 - Annual Report.

Section 550.1518 - Considerations and Standards; Applicability; Appeal.