HB 5235 Summary

• Amends the Prudent Purchaser Act to add requirements for physical therapy coverage under prudent purchaser agreements, limiting reimbursement to services provided by licensed physical therapists or assistants under supervision and pursuant to a prescription from specified licensed health professionals.

• Requires organizations to establish written standards for provider agreements addressing quality maintenance, cost control, appropriate utilization, and access to health care services, filed with the commissioner before initial provider panel formation.

• Mandates organizations offer comparable agreements to at least one qualified health care provider within reasonable distance and provide all eligible providers a 60-day application period initially and at least every 4 years thereafter.

• Requires written notification within 90 days (or 30 days after credentialing, whichever is later) of provider applications, with stated reasons for rejection citing applicable standards, and notification of termination reasons upon request.

• Establishes that the act does not require coverage for optometry or chiropractic services beyond those defined in Michigan law as of specified dates (May 20, 1992 for optometry; January 1, 2009 for chiropractic).