Michigan No-Fault Insurance Reform Act Limits Reimbursement Rates

Kerr Russell
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Kerr Russell

The reimbursement rates under the Michigan No-Fault medical fee schedule 1) limit the amount payable by Medicare to a health provider for treatment or services, 2) limit the reimbursement rate for care providers whose treatment or services are not covered by Medicare, and 3) limit No-Fault coverage for in-home family provided care.

Several House and Senate Bills have been proposed to modify the limitations imposed by the Michigan No-Fault Auto Insurance Reform Act. One possible change includes adjusting the fee schedule in instances where Medicare does not provide coverage to the lesser of either the amount payable under the Michigan No-Fault rehabilitation clinic fee schedule or the provider’s average charge for such treatment as of January 2019. Another reform proposes to fix reimbursement rates for facilities or providers whose treatment is not covered by Medicare. Providers would not be eligible for payment or reimbursement for more than the average amount charged for the treatment in the relevant geographic region. Finally, lawmakers also propose to simply delay both the effective date of the fee schedule and the limit on coverage for in-home family-provided care until July 22, 2022.

As of now, none of the Bills have been passed and the fee schedule that became effective on July 1, 2021 remains intact. It is up to the Michigan Legislature to decide on one of the following Bills to solidify the new changes in the Michigan No-Fault statute and set the standard for how we will proceed with these issues in the future. In the meantime, the Michigan Senate and House have approved a $25 million post-acute auto injury provider relief fund that will be used to distribute funds to care providers affected by the reimbursement rate reductions caused by the Michigan No-Fault medical fee schedule.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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