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 4834 – Michigan
Introduced: 2023 Status: In Process
Health facilities: certificate of need; cone-beam tomography equipment; eliminate from definition of a covered clinical service under certain circumstances.
HB 4862 – Michigan
Introduced: 2021 Status: Inactive / Dead
Health facilities: certificate of need; certain PET scanners; exempt from certificate of need regulations. Amends 1978 PA 368 (MCL 333.1101 – 333.25211) by adding sec. 22224b.
HB 4874 – Michigan
Introduced: 2019 Status: Inactive / Dead
House Bill 4874 would amend the Michigan Antitrust Reform Act to prohibit employee noncompete agreements under certain circumstances.
HB 4890 – Michigan
Introduced: 2023 Status: In Process
Health: pharmaceuticals; insulin production program; establish.
HB 4893 – Michigan
Introduced: 2023 Status: In Process
A bill to provide for the establishment of a universal and unified health care system and to reform the current payment system for health care coverage in this state; to create certain boards and committees …
HB 4348 – Michigan
Introduced: 2021 Status: Enacted
AN ACT to license and regulate pharmacy benefit managers; to require reporting of certain data; to provide for the powers and duties of certain state governmental officers and entities; to provide remedies; to require the …
HB 4351 – Michigan
Introduced: 2021 Status: Enacted
House Bill 4351 would amend the Third Party Administrator Act. The bill would require that a contract between a carrier or pharmacy benefit manager and a pharmacy not prohibit the pharmacy from disclosing the current …
HB 4352 – Michigan
Introduced: 2021 Status: Enacted
House Bill 4352 would amend the Public Health Code. Currently under the code, if a pharmacist who sells drugs at retail is asked, he or she must provide the current selling price of a drug …
HB 4459 – Michigan
Introduced: 2019 Status: Enacted
Health; other; charges by nonparticipating providers; regulate. Amends 1978 PA 368 (MCL 333.1101 – 333.25211) by adding art. 18: Surprise Billing Protections. For a covered emergency service provided by a nonparticipating provider at a participating …
HB 4460 – Michigan
Introduced: 2019 Status: Enacted
Health; other; charges by nonparticipating providers; regulate. Amends 1978 PA 368 (MCL 333.1101 – 333.25211) by adding sec. 24505 to art. 18. Requires that for a nonemergency service provided by a nonparticipating provider with advanced …
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