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Mich. Comp. Laws Ann. § 400.111b - Requirements as condition of participation by provider

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As a condition of participation to provide Medicaid services, a provider must meet the following requirements:

  1. Comply with all state licensing requirements
  2. Have appropriate certification
  3. Provider must enroll in an agreement to provide Medicaid services
  4. Services rendered to a medically indigent patient must be of the same scope and quality as would be provided to the general public
  5. Maintain records necessary to document extent of services, cost, supplies and equipment for any treatment or service provided to all indigent individuals or those who utilize the state’s Medicaid program and to verify medically necessity.
  6. The records must be made available upon request to state authorities, who need the records to carry out their duties. 
  7. The records must be maintained for 7 years after the date of service.  The provider must ensure that all health care provider contractors also retain copies of bills for 7 years. 
  8. The provider must submit all claims on forms prescribed the Department of Community Health within 12 months of the services rendered.
  9. The provider must charge a medically indigent person the same amount to be charged to a member of the general public. 
  10. A provider may be required to submit estimates of cost and charges to the Department.
  11. Payment of a claim by the Department is deemed payment in full to the provider.  Other than copayment, the provider cannot seek payment from the medically indigent individual or his or her family for services that were reimbursed by Medicaid or services deemed to be medically unnecessary. 
  12. A provider may collect fees from the medically indigent person for services performed that were not covered, if the individual knew they would not be covered. 
  13.  A provider who is overpaid in  reimbursements must contact the Department and if the provider does notify or should have notified the Department of this, must return the excess amount.  If a provider consistently fails to return excess reimbursement, it will constitute conversion. 
  14. A provider must certify that the claim being submitted is true and accurate, and is responsible for any agent who submits the claim on his or her behalf. 
  15. Provider must file with the Department a statement identifying those with an ownership interest in the facility and all corporations, partnerships or other associations that the provider has an interest in.
  16. Identify all other health care providers involved in a claim with their provider identification numbers.
  17. All services must meet medical necessity, appropriateness and quality of care.
  18. If a provider nursing home seeks to withdraw from Medicaid, it must provide written notice to the Department.
  19. Providers must retain or dispose of records in accordance with the previous sections.  They must ensure that patient identifying information is not present or destroy records where identifying information is included.

Current as of June 2015