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Medicaid/CHIP Data Requirements in Michigan

Michigan law requires Medicaid providers to maintain records documenting the extent of services, cost, supplies and equipment provided for the treatment on beneficiaries for at least 7 years after providing treatment.1 A provider that fails to maintain records, submits a claim with misleading information or misrepresents services, fails to comply with professionally accepted medical standards, or charges Medicaid a higher rate than the general public may face denial, suspension, probation, or termination from participation in Medicaid by the Director of the Department of Community Health.2  Michigan rewards the positive health behaviors of its Medicaid population as well as health maintenance organizations contracted to provide Medicaid services that meet specified targets for patient adherence or chronic disease management.3   

 

Footnotes

  • 1. M.C.L.A. § 400.111b
  • 2. M.C.L.A. § 400.111e
  • 3. M.C.L.A. §400.105b

 

Medicaid/CHIP Data Requirements in Michigan

Subtopic Statute/Regulation Description
Quality reporting by Medicaid providers (cross post to care coordination/care management (chronic disease management; sharing information across providers; enrollee participation) 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...
Medicaid medical records maintenance by providers (including retention period, storage, and other recordkeeping requirements) Mich. Comp. Laws Ann. § 400.111a - Regulations and guidelines regarding the director of the department of community health Policy and procedures for implementation and enforcement of state and federal laws; consultation; guidelines; forms and instructions; “prudent...
Mich. Comp. Laws Ann. § 400.111e - Grounds for action by director The Director of the Department of Community Health may take the actions specified in M.C.L.A. §400.111d for the following: If the provider...
Confidentiality of Medicaid data (including penalties for violating confidentiality) Mich. Comp. Laws Ann. § 400.111a - Regulations and guidelines regarding the director of the department of community health Policy and procedures for implementation and enforcement of state and federal laws; consultation; guidelines; forms and instructions; “prudent...
Mich. Comp. Laws Ann. § 400.111b - Requirements as condition of participation by provider As a condition of participation to provide Medicaid services, a provider must meet the following requirements: Comply with all state licensing...