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Resource Use (Cost/Utilization) Measurement and Reporting in Michigan

Under Michigan law, insurers or health plans must perform health care evaluations once a year to promote the efficient use of resources.1 In addition, health benefit plans that provide insurance to public employers are required to provide the employers with a utilization and cost report electronically.  However, any information that the insurer releases, must be de-identified and in compliance with HIPAA regulations.2

 

Footnotes

  • 1. MI ADC R. 325.6615
  • 2. M.C.L.A. §124.85

 

Resource Use (Cost/Utilization) Measurement and Reporting in Michigan

Subtopic Statute/Regulation Description
Required utilization/cost reporting 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...
Mich. Comp. Laws Ann. § 124.85 - Public employer with 100 or more employees; claims utilization and cost information; compilation; "relevant period" defined; disclosure; availability; protected health information not included; date of compilation Medical benefit plans operating within Michigan must electronically provide cost and utilization information to all public employers that have,...
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...