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Quality Measurement and Reporting in Michigan

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Under Michigan law, insurers or health plans are required to perform health care evaluations annually in order to determine areas of  quality improvement in patient care.1 Additionally, insurers or health plans are required to have a quality assurance program that monitors, reviews, and evaluates the quality of health care services provided. 2 Health maintenance organizations are also required to have a quality improvement program that reviews, designs, measures, and improves health care outcomes. 3

 

Footnotes

  • 1. MI ADC R. 325.6615
  • 2. MI ADC R. 325.6601
  • 3. M.C.L.A. § 500.3508

 

Quality Measurement and Reporting in Michigan

Subtopic Statute/Regulation Description
Performance measurement for health care providers or insurance plans 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. Admin. Code r. 325.164 - Quality assurance A health care provider who submits reports to the Department of Community Health regarding childhood immunizations must allow the Department to...
Mich. Admin. Code r. 325.6615 - Health care evaluations Each insurer or health plan must ensure that health care evaluations are done to promote the efficient use of available health resources.  The...
Quality reporting requirements – providers and health plans Mich. Admin. Code r. 325.21204 - Utilization review; quality control All nursing homes must conduct utilization reviews and quality control programs as required by federal laws regulating skilled nursing and...
Quality assurance programs for hospitals or public programs Mich. Admin. Code r. 325.6601 - Quality assurance program; conduct; contents Each insurer or health plan must have a quality assurance program in place that is approved by the Department of Community Health.  The quality...
Quality assessment for health plans 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. § 500.3508 - Quality assessment program; quality improvement program Quality assessment program; quality improvement program   All health maintenance organizations must establish a quality assessment program that...
External review for insurance and/or peer review purposes (Cross reference to Private Insurance Data and Medical Peer Review) 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...
Click on the individual state law in the table above to see our summary of the individual law.


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