MICHIGAN: Response Requested Regarding HB 4486 & SB 314

Two years ago this month, the Legislature passed and Governor Whitmer signed legislation that would overhaul the state’s No Fault insurance system that had been in place since 1972. The primary components of the package were choice, a rate freeze and mandatory cuts in rates for insurance companies, and a fee schedule for services performed on behalf of those injured in a car accident. Additionally, the reform set in place a medical fee schedule that set rates for what hospitals and rehabilitation clinics can charge under the No Fault system. While there are some variations in what the fee schedule pays based on percentage of indigent care, the average payment for a procedure with a code under Medicare will receive 200% of what Medicare normally pays. If there is not a Medicare code, then the provider will be paid 55% of whatever their rate was in January of 2019. As part of the fee schedule, a limit was placed on attendant care at 56 hours per week. 

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The majority of the reforms were put in place last July, but the fee schedule portion takes effect on July 2nd of this year.  The initial intent of this law was to give people an option on what level of coverage they would want for Personal Injury Protection (PIP).  Drivers could continue to choose an unlimited PIP amount as well as $50,000 for those on Medicaid, $250,000, $500,000, or if qualified, no PIP coverage at all.  If a lower level of PIP is chosen, then a person’s health insurance would become the primary payer once their benefit was exhausted. The Legislature also mandated a rate cut for each level of choice and froze that rate for eight years.  For example, unlimited PIP is required to have a rate cut of 10% under the legislation. 

Additionally, the reform set in place a medical fee schedule that set rates for what hospitals and rehabilitation clinics can charge under the No Fault system.  While there are some variations in what the fee schedule pays based on percentage of indigent care, the average payment for a procedure with a code under Medicare will receive 200% of what Medicare normally pays.  If there is not a Medicare code, then the provider will be paid 55% of whatever their rate was in January of 2019.  As part of the fee schedule, a limit was placed on attendant care at 56 hours per week. 

There is a push by some in the post-acute rehabilitation space to try to alter the fee schedule, specifically the 55% provision for services without a Medicare code, which would include home care services. 
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If your home care organization would be affected by this change, please respond to this message no later than Wednesday, May 12. 
 
Fee Schedule Fix — Michigan Brain Injury Provider Council (mbipc.org)