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Care Coordination/Care Management in Michigan

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          In order to enhance the quality of care provided to its residents, the state of Michigan has created incentives to reward Medicaid beneficiaries who practice positive health behaviors.  The law also includes several pay for performance initiatives for Medicaid contracting health maintenance organization.1  Michigan has several laws that promote patient management of care. State law has established an Office of Health and Medical Affairs to promote informed decision making, by publishing data regarding health policy, health status and health needs.2  Michigan law requires the Commissioner of the Insurance Department to produce a consumer’s guide to health insurance organizations that includes information such as, national accreditation or status of accreditation and quality of care for each insurance company.3 State law also mandates health facilities or health care centers to post information on patients’ rights and responsibilities in a public place informing patients of their right to refuse treatments and to receive information on their condition, recovery, and treatment.4  Physicians are also required to provide patients information regarding their treatment, and in certain cases, on alternate treatment options if the patients are found to have advanced illnesses.5   The Department of Community Health must come up with a standardized written summary of the information that physicians are required to provide to patients with advanced illnesses.6  In addition, Michigan law provides patients the opportunity to designate a patient advocate to make health care decisions on behalf of the patient.7

            The state also has specific informed consent laws for treatment purposes.  For example, Michigan requires physicians to obtain a patient’s informed consent before administering an HIV test.   The informed consent must contain specific information outlined by the Department of Community Health, and must be noted in the patient’s medical record.8  Physicians must also comply with strict informed consent laws before performing an abortion,9 and performing genetic tests.10  The state also authorizes minors to provide informed consent to substance abuse treatment, even without parental consent.11

            In an effort to coordinate care, Michigan has passed the Prudent Purchaser Act, which allows health care organizations and providers to enter into agreements in order to control costs, utilization, and quality.12  In addition, the state has enhanced its efforts to manage chronic conditions, such as diabetes.  Michigan requires all health care corporations in the state to develop a diabetes prevention program to be used by providers to discuss prevention and treatment options with patients.13

 

Footnotes

  • 1. M.C.L.A. §400.105b
  • 2. M.C.L.A. §325.2017
  • 3. M.C.L.A. § 500.3580
  • 4. M.C.L.A. § 333.20201
  • 5. M.C.L.A. § 333.5654
  • 6. M.C.L.A. § 333.5655
  • 7. M.C.L.A. §700.5506
  • 8. M.C.L.A. § 333.5133
  • 9. M.C.L.A. §333.17015
  • 10. M.C.L.A. §333.17020
  • 11. M.C.L.A. § 333.6121
  • 12. M.C.L.A. §550.53
  • 13. M.C.L.A. §550.1416b

 

Care Coordination/Care Management in Michigan

Subtopic Statute/Regulation Description
Licensure laws requiring or recommending care coordination or care management activities (Cross reference with private insurance/Medicaid/Medicare data requirements) Mich. Comp. Laws Ann. § 550.1504 - Reimbursement arrangements; goals; definitions; supplemental efforts Health care corporations in Michigan must pursue goals pertaining to access, cost, and quality of health care while entering into reimbursement...
Mich. Admin. Code r. 325.6830 - Periodic examination of health care services; financial examinations The Department of Community Health may examine the quality of health care services being provided by an insurer or health plan.  In conducting...
Mich. Comp. Laws Ann. § 400.105b - Various actions required by the department of community health The Department of Community Health must create incentives to reward Medicaid beneficiaries who practice specific positive behaviors, such as...
Mich. Comp. Laws Ann. § 550.1102 - Legislative intent and policy Michigan enacted the Nonprofit Health Care Corporation Reform Act in order to promote access to health care of “reasonable cost and quality....
Mich. Comp. Laws Ann. § 550.1416b - Establishment of program to prevent onset of clinical diabetes required; report; coverages; “diabetes” defined Health care corporations must create a diabetes prevention program. The program must “emphasize best practice guidelines” for providers...
Patient authorization requirements (to provide health information to another individual) Mich. Comp. Laws Ann. § 700.5510 - Revocation of patient advocate designation Revocation of patient advocate designation   Michigan permits the revocation of patient advocate designations in the following circumstances:...
Mich. Comp. Laws Ann. § 333.17020 - Genetic test; informed consent A provider must receive written, informed consent from the patient before ordering a presymptomatic or genetic test.  The information provided...
Mich. Comp. Laws Ann. § 333.5133 - Information that physicians who order HIV tests and health facilities that perform HIV tests must provide Information; pretest information; informed consent to HIV test; documentation; distribution of information; HIV test performed on anonymous basis;...
Mich. Comp. Laws Ann. § 333.5654 - Recommended medical treatment for advanced illness; duty of physician to inform orally; limitation or modification of disclosed information If a physician determines that their patient has a “reduced life expectancy due to an advanced illness” and recommends treatment, the...
Mich. Comp. Laws Ann. § 333.5655 - Recommended medical treatment for advanced illness; duty of physician to inform orally and in writing; requirements If a physician determines that their patient has a “reduced life expectancy due to an advanced illness” and recommends treatment, the...
Mich. Comp. Laws Ann. § 333.5656 - Updated standardized written summary; development; publication; contents; availability to physicians The Department of Community Health (“department”) must create a “standardized, written summary” of the information physicians...
Mich. Comp. Laws Ann. § 700.5509 - Authority and responsibilities of patient advocate; suspension Michigan defines the “authority, rights, responsibilities, and limitations” of patient advocates as follows: Patient advocates must...
Treatment planning when using interdisciplinary team (including assessments, plan of care, discharge/transfer planning Mich. Admin. Code r. 325.135 - Performance improvement Performance improvement   The trauma registry will be phased in and ultimately administered by regional trauma advisory committees.  The...
Mich. Comp. Laws Ann. § 333.5133 - Information that physicians who order HIV tests and health facilities that perform HIV tests must provide Information; pretest information; informed consent to HIV test; documentation; distribution of information; HIV test performed on anonymous basis;...
Payment reform initiatives Mich. Comp. Laws Ann. § 325.2017 - Additional duties of office Additional duties of office   The Office of Health and Medical Affairs must, among other duties, (1) collect and publish information that will...
Mich. Comp. Laws Ann. § 550.1102 - Legislative intent and policy Michigan enacted the Nonprofit Health Care Corporation Reform Act in order to promote access to health care of “reasonable cost and quality....
Informed consent requirements (If the information is going beyond the patient and provider Mich. Comp. Laws Ann. § 330.1717 - Electroconvulsive therapy or other procedure; consent Michigan prohibits the administration of “electroconvulsive therapy or a procedure intended to produce convulsions or coma” without...
Mich. Comp. Laws Ann. § 333.17013 - Alternative methods of treatment of breast cancer; duty of physician to inform patient; standardized written summary or brochure; form; civil action A physician administering primary treatment for breast cancer must provide their patient with information, both orally and in writing, about...
Mich. Comp. Laws Ann. § 333.17015 - Guidelines and regulations regarding abortion Informed consent; definitions; duties of physician or assistant; location; disclosure of information; view of ultrasound; medical emergency...
Mich. Comp. Laws Ann. § 333.17020 - Genetic test; informed consent A provider must receive written, informed consent from the patient before ordering a presymptomatic or genetic test.  The information provided...
Mich. Comp. Laws Ann. § 333.17520 - Genetic test; informed consent Genetic test; informed consent   Physicians must obtain a patient’s written, informed consent before performing a presymptomatic or...
Mich. Comp. Laws Ann. § 333.2611 - Coordination of activities; establishment of policy; interests to be considered; establishment, purpose, and powers of nonprofit corporation The State Department of Public Health must have a policy concerning research and evaluation using health statistics.  The policy should take...
Mich. Comp. Laws Ann. § 333.5133 - Information that physicians who order HIV tests and health facilities that perform HIV tests must provide Information; pretest information; informed consent to HIV test; documentation; distribution of information; HIV test performed on anonymous basis;...
Mich. Comp. Laws Ann. § 333.5654 - Recommended medical treatment for advanced illness; duty of physician to inform orally; limitation or modification of disclosed information If a physician determines that their patient has a “reduced life expectancy due to an advanced illness” and recommends treatment, the...
Mich. Comp. Laws Ann. § 333.5655 - Recommended medical treatment for advanced illness; duty of physician to inform orally and in writing; requirements If a physician determines that their patient has a “reduced life expectancy due to an advanced illness” and recommends treatment, the...
Mich. Comp. Laws Ann. § 333.5656 - Updated standardized written summary; development; publication; contents; availability to physicians The Department of Community Health (“department”) must create a “standardized, written summary” of the information physicians...
Mich. Comp. Laws Ann. § 333.5657 - Availability of form to patient, patient surrogate, or patient advocate; compliance with MCL 333.5656; placement of signed form in patient's medical record; signed form as bar to civil or administrative action A physician complies with their informed consent duties by providing a “standardized, written summary” regarding a patient’s...
Information sharing across providers (including communication with other providers, across state lines, patient transfer) Mich. Comp. Laws Ann. § 331.532 - Release or publication of proceedings, reports, findings, and conclusions of review entity; purposes; release of department of corrections' records regarding prisoners to legislative corrections ombudsman A review entity may release or publish records, reports, findings, and conclusions for the purpose of: (1) advancing health care research and...
Care Coordination/Care Management Mich. Comp. Laws Ann. § 333.20201 - Policy describing rights and responsibilities of patients or residents A health facility or health care center must post a policy describing the rights and responsibilities of patients in a public place.  The policy...
Mich. Comp. Laws Ann. § 700.5506 - Designation of patient advocate; "community mental health services program or hospital" defined Designation of patient advocate; “community mental health services program or hospital” defined   A patient, who is over the age of...
Mich. Comp. Laws Ann. § 700.5507 - Patient advocate designation; statement; acceptance Patient advocate designation; statement; acceptance   A patient designation should include statements about the patient’s desire on...
Mich. Comp. Laws Ann. § 700.5508 - Determination of advocate's authority to act A patient advocate may only make decisions on behalf of the patient when a physician or psychologist determines that the patient is “unable to...
Discharge instructions/Required follow-up. Mich. Comp. Laws Ann. § 333.21773 - Guidelines and regulations regarding the involuntary transfer or discharge of patients by nursing homes As a general rule, Michigan prohibits nursing homes from involuntarily discharging or transferring patients, but Michigan does provide certain...
New coordinated systems of care (ACOs, Patient Centered Medical Homes/Health homes) (Cross reference with Quality Measurement) Mich. Comp. Laws Ann. § 500.3580 - Consumer guide to health maintenance organizations; publication; contents; data; writing, presentation, promotion, and distribution of guide; access through internet The Commissioner of the Insurance Department must prepare and publish a consumer’s guide to health insurance organizations.  The consumer...
Mich. Comp. Laws Ann. § 550.53 - Prudent purchaser agreements The Michigan Prudent Purchaser Act allows organizations and health care providers of specific services to enter into prudent purchaser agreements for...
Click on the individual state law in the table above to see our summary of the individual law.


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