Michigan Compiled Laws
350-1980-5 - Part 5 (550.1501...550.1518)
Section 550.1513 - Provider Class Plan; Examination; Automatic Retention; Placing Plan Into Effect; Preparation of Plan by Commissioner; Notice.

Sec. 513.
(1) Upon receipt of a provider class plan under section 511(1), the commissioner, after considering the information and factors described in section 509(4), within 90 days shall examine the plan and determine if the plan substantially achieves the goals, achieves the objectives, and substantially overcomes the deficiencies enumerated in the findings made by the commissioner. If the commissioner determines that the plan substantially achieves the goals, achieves the objectives, and substantially overcomes the deficiencies enumerated in the findings made by the commissioner, the plan shall be automatically retained and placed into effect as provided in section 506.
(2) If the commissioner determines that the plan does not substantially achieve the goals, does not achieve the objectives, and does not substantially overcome the deficiencies enumerated in the findings made by the commissioner pursuant to section 510(2), the commissioner shall do all of the following:
(a) Prepare a provider class plan that substantially achieves the goals, achieves the objectives, and substantially overcomes the deficiencies enumerated in the findings made pursuant to section 510(2), and transmit that plan to the health care corporation. A provider class plan prepared pursuant to this subdivision shall be retained for the commissioner's records and placed into effect as provided in section 506(4), unless a request for an appeal is made under subdivision (b).
(b) Give written notice to the health care corporation of an opportunity for an appeal pursuant to section 515. The notice shall state that a request for an appeal shall be made by the corporation within 30 days after the receipt of notice under this subdivision.
(3) In making a determination pursuant to subsection (1), or preparing a plan pursuant to subsection (2)(a), the commissioner shall obtain advice and consultation pursuant to section 505(2). The commissioner shall also forward a copy of each notice issued under subsection (2)(b) to each person requesting a copy. The copy shall notify the person of an opportunity for an appeal pursuant to section 515, and that a request for such an appeal is required to be made within 30 days after the receipt of notice given under this subsection.
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.