The bill amends the Social Welfare Act of 1939 to enhance Michigan's medical assistance program through various updates and new provisions. Key changes include requiring the Department of Health and Human Services to seek federal approval for enrolling eligible individuals in contracted health plans, ensuring access to primary care practitioners, and establishing cost-sharing requirements. The bill also emphasizes telemedicine services, fraud detection incentives, and a pharmaceutical benefit that promotes the use of high-value, low-cost prescriptions. Additionally, it outlines the department's responsibilities in managing health plans, including performance bonus incentive plans for long-term care providers and a mandate to disenroll individuals from skilled nursing facilities after 45 days of care.

Moreover, the bill proposes significant changes to claims processing and payment procedures for health professionals and facilities, mandating timely payment procedures and defining "clean claims." It requires claims to be paid within 45 days, with penalties for late payments, and emphasizes electronic claim submissions. An external review process for adverse payment determinations is also introduced, allowing health professionals to contest decisions made by qualified health plans. The bill further amends Medicaid managed care regulations by establishing clear prior authorization processes, requiring timely decisions from Medicaid managed care organizations (MCOs), and ensuring that nursing facilities are compensated at no less than the current Medicaid fee-for-service rate. Overall, these amendments aim to improve the efficiency, transparency, and fairness of the medical assistance program and Medicaid managed care system in Michigan.

Statutes affected:
House Introduced Bill: 400.105