MI HB5931

Director of the Department of Community Health may establish policies and procedures for provider participation, conditions, and requirements in the medical assistance program, subject to consultation with affected providers and the medical care advisory council.

Director must develop forms and instructions compatible with those required by other third-party payers and regulatory agencies, covering performance standards, participation conditions, claims review methods, and administrative procedures.

Director may give notice of policy changes to providers via departmental bulletin, updating insert to departmental manual, U.S. mail, or electronic mail at least 30 days before the effective date.

Director has authority to impose pre-payment conditions and controls on provider claims that exceed average program amounts, with required informal conference opportunity and notice procedures before claim rejection.

Director may recover overpayments from providers, examine claims for medical necessity compliance, request access to provider records, and collect or make payments directly to providers' employers under specified conditions.