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Mich. Comp. Laws Ann. § 400.111a - Regulations and guidelines regarding the director of the department of community health

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Policy and procedures for implementation and enforcement of state and federal laws; consultation; guidelines; forms and instructions; “prudent buyer” defined; criteria for selection of providers; notice of change in policy, procedure, form, or instruction; power of director; informal conference; imposition of specific conditions and controls; notice; hearings; examination of claims; imposition of claims review process; books and records of provider; confidentiality; immunity from liability; prohibited payments or recovery for payments; making payments and collecting overpayments; development of specifications; estimated cost and charge information; notice to provider of incorrect payment


The director of the Department of Community Health must consult with other health care providers and a medical care advisory council to establish policies to enforce federal and state Medicaid laws. The director must select certain providers to participate in care management and to oversee certain recipients who abuse the medical services program. The Director may also enroll providers into the Medicaid program, enforce the Medicaid requirements, and develop forms for Medicaid claims and applications.


Before reimbursing a provider’s Medicaid claim, the director of Community Health must review the claim to ensure the provider’s compliance with Medicaid regulations. If the director suspects that the provider has overbilled for services, the director must send notice to the provider of a claims dispute. The notice must identify the practices in dispute, request the medical records relevant to the dispute, set a date for a conference between the provider and the department, and declare that the provider will face penalties, such as rejected claims, if they cannot demonstrate the properness of the disputed claims.


The director may photocopy “the records of a medically indigent individual” for the purpose of administrating the Medicaid program. The department must keep these records confidential.

Current as of June 2015