Overview
Michigan is one of the few states that bans Most Favored Nation (MFN) clauses in healthcare contracts between providers and health care corporations. The ban resulted from a landmark antitrust enforcement case against Blue Cross Blue Shield of Michigan that settled in 2013. In provider consolidation, the state has a strong certificate of need (CON) law that requires review of impact on health Access, pricing, or competition.
Although the Michigan Data Collaborative, a nonprofit healthcare data organization at the University of Michigan, built a Multi-Payer Claims Database that began collecting data in 2010, the state has not implemented an all-payer claims database (APCD). The Michigan Data Collaborative surveys around forty percent of the Michigan population and includes Medicare, Medicaid, and the state’s three largest commercial payers, representing eighty percent of the market in Michigan. In 2015, the state proposed an APCD mandate with the Michigan Health Care Transparency Act, but it failed to pass and has not seen further action since then.
In the 2020 legislative session, the state enacted legislation to protect consumers against surprise billing in emergency situations. When patients receive care at an in-network hospital but see an out-of-network provider, their insurance company will pay the doctor according to a payment formula that is either 150% of what would be charged to Medicaid or the average regional amount in the patient’s health benefit plan.
In telehealth, while Michigan law requires coverage parity for telemedicine services, the insurer, not the provider, decides which services may be “appropriately provided” via telemedicine.
See below for an overview of existing Michigan state mandates. Click on citation tab for detailed information of specific statutes (click link to download statute text).
State Action
Latest Legislative Session: 1/11/2023 - 12/31/2023 (2023-2024 term). *Current session bill updates are ongoing. Check back weekly for updates.
HB 4015 – Michigan
Introduced: 2023 Status: In Process
health insurers; limit amount on co-pay for prescription insulin
HB 4023 – Michigan
Introduced: 2019 Status: Inactive / Dead
Health occupations; health professionals; pilot program allowing certain military medical personnel to practice under the supervision of a licensed physician or podiatrist; create. Amends sec. 16215 of 1978 PA 368 (MCL 333.16215) & adds sec. …
HB 4042 – Michigan
Introduced: 2019 Status: Inactive / Dead
Health occupations; nurses; nurse licensure compact; enact. Amends sec. 17201 of 1978 PA 368 (MCL 333.17201) & adds secs. 16190, 17225 & 17225a. The Nurse Licensure Compact is enacted into law and entered into by …
HB 4043 – Michigan
Introduced: 2019 Status: Inactive / Dead
Consumer protection; unfair trade practices; sale of certain prescription discount cards; prohibit. Amends secs. 2 & 3 of 1976 PA 331 (MCL 445.902 & 445.903). Prohibits selling, marketing, promoting, advertising, or otherwise distributing any card …
HB 4131 – Michigan
Introduced: 2023 Status: In Process
Insurance: health insurers; coverage for health care services provided through telemedicine; modify.
Mich. Comp. Laws § 550.1405. Payment of benefits; interest; claim form; exception: The Nonprofit Health Care Corporation Reform Act – Michigan
Introduced: Status: Enacted
A health care corporation, in consultation with the department of social services, shall develop a single billing form to be used for the billing of each of the following: hospital services, physician services, and pharmaceutical …
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Mich. Comp. Laws § 550.1410b. Premium for group conversion certificate after January 1, 2014; determination; rating factors: The Nonprofit Health Care Corporation Reform Act – Michigan
Introduced: Status: Enacted
Notwithstanding section 410a(8), for a certificate delivered, issued for delivery, or renewed in this state on or after January 1, 2014, the premium for a group conversion certificate under section 410a shall be determined only …
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Mich. Comp. Laws § 550.1414b. Offer of wellness coverage by health care corporation: The Nonprofit Health Care Corporation Reform Act – Michigan
Introduced: Status: Enacted
Wellness coverage may provide for an appropriate rebate or reduction in premiums or for reduced copayments, coinsurance, or deductibles, or a combination of these incentives, for participation in any health behavior wellness, maintenance, or improvement …
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Mich. Comp. Laws § 550.1416b. Coverage for obstetrical and gynecological services by physician or nurse midwife: The Nonprofit Health Care Corporation Reform Act – Michigan
Introduced: Status: Enacted
A group or nongroup certificate that provides coverage for obstetrical and gynecological services shall include coverage for obstetrical and gynecological services whether performed by a physician or a nurse midwife acting within the scope of …
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Mich. Comp. Laws § 550.1418. Emergency health services; medical coverage required; “stabilization” defined: The Nonprofit Health Care Corporation Reform Act – Michigan
Introduced: Status: Enacted
A health care corporation shall not require a physician to transfer a patient before the physician determines that the patient has reached the point of stabilization. A health care corporation shall not deny payment for …
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Ford Motor Company v. Blue Cross Blue Shield of Michigan and Blue Cross Blue Shield – Michigan
District Court: Eastern District of Michigan Status: Pending
On May 31, 2023, Ford filed suit against Blue Cross Blue Shield of Michigan (BCBS MI) and the Blue Cross Blue Shield Association (BCBSA) in …
United States and State of Michigan v. W.A. Foote Memorial Hospital, D/B/A Allegiance Health – Michigan
District Court: Eastern District of Michigan Status: Decided
On June 25, 2015, the Antitrust Division of the Justice Department and the Michigan Attorney General’s Office filed a civil complaint against four Michigan hospitals, …
United States and the State of Michigan v. Blue Cross Blue Shield of Michigan – Michigan
District Court: Eastern District of Michigan Status: Decided
In October 2010, the U.S. Department of Justice and the Michigan Attorney General filed suit against Blue Cross Blue Shield of Michigan alleging the insurer …
Aetna Inc. v. Blue Cross Blue Shield of Michigan – Michigan
District Court: E.D. Michigan Status: Decided
Aetna’s antitrust suit against Blue Shield of Michigan followed DOJ’s investigation into Blue Shield’s use of most-favored nations clauses in insurer-provider contracts, alleging that Blue …
In re: Suboxone Antitrust Litigation (State of Wisconsin, et al. v. Indivior Inc, et al.) – Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Utah, Virginia, Washington, West Virginia, Wisconsin
District Court: E.D. Pennsylvania Status: Pending
In September 2016, 35 state attorneys general and the District of Columbia brought a multi-district case against pharmaceutical manufacturer Indivior, MonoSol RX et al., alleging …
Additional Resources
STATE BUDGET
Michigan’s fiscal year begins on October 1st and ends on September 30th of the following calendar year. While there is no specific legal time requirement for passage of the budget bills, this task is accomplished prior to the beginning of the new fiscal year. Appropriations bills are usually considered and passed in April by the first house, in early June by the second house, and usually final action is completed in July.
KEY RESOURCES