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SENATE BILL NO. 893
A bill to amend 1956 PA 218, entitled
"The insurance code of 1956,"
(MCL 500.100 to 500.8302) by adding section 3406mm.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 3406mm. (1) Subject to subsection (2), an insurer that 1
delivers, issues for delivery, or renews in this state a health 2
insurance policy shall do all of the following: 3
(a) Assess and verify the qualifications of a health care 4
provider applying to become a participating provider not later than 5
March 26, 2026, Introduced by Senator CHERRY and referred to Committee on Health Policy.
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60 calendar days of receipt of a complete credentialing application 1
and issue a decision in writing to the applicant approving or 2
denying the credentialing application not later than 60 calendar 3
days after receiving the complete credentialing application. 4
(b) Not later than 10 business days after receipt of an 5
incomplete credentialing application, send a written notification, 6
via United States certified mail, to the applicant requesting any 7
information or supporting documentation that the insurer requires 8
to approve or deny the credentialing application. The notice to the 9
applicant must include a full and detailed description of all the 10
information or supporting documentation required to make the 11
application complete and the name, address, and telephone number of 12
a person who serves as the applicant's point of contact for 13
completing the credentialing application process. Any information 14
required under this section must be reasonably related to the 15
information in the application. As used in this subdivision, 16
"business day" means a day other than a Saturday, a Sunday, or any 17
legal holiday. 18
(c) Not later than the 60 calendar days described in 19
subdivision (a) or the additional 15 days described in subsection 20
(2), load into the insurer's provider payment system all provider 21
information for an approved health care provider, including all 22
information needed to correctly reimburse a newly approved health 23
care provider according to the provider's contract. The insurer 24
shall add the approved provider's data to the provider directory 25
upon loading the provider's information into the insurer's provider 26
payment system. 27
(2) An insurer described in subsection (1) may extend the 28
credentialing period to assess and issue a determination by an 29
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additional 15 calendar days if, upon review of a complete 1
application, it is determined that the circumstance presented, 2
including an admission of sanctions by the state licensing board, 3
investigation or felony conviction, or revocation of clinical 4
privileges, requires additional consideration. 5
(3) An insurer shall reimburse a health care provider whose 6
credentialing application has not yet been approved or denied for 7
covered services for any claims from the provider that the insurer 8
receives with a date of service more than 60 calendar days after 9
the date on which the insurer received a complete credentialing 10
application, or 45 calendar days if the conditions described in 11
subsection (2) are met, if: 12
(a) The provider has submitted a complete credentialing 13
application and any supporting documentation that the insurer has 14
requested in writing within the time frame established in 15
subsection (2). 16
(b) The provider has no past or current license sanctions or 17
limitations, as reported by the pertinent state licensing and 18
regulatory agency, or by a similar out-of-state licensing and 19
regulatory entity for a provider licensed in another state. 20
(c) The provider has professional liability insurance. 21
(d) The insurer has failed to approve or deny the applicant's 22
complete credentialing application within the time frames 23
established by subsection (1)(a) or (2). 24
(4) A health care provider eligible for reimbursement under 25
subsection (3) who, at the time services were rendered, was not 26
employed by a practice or group that has contracted with the 27
insurer to provide services at specified rates of reimbursement 28
must be paid by the insurer the insurer's standard in-network 29
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reimbursement rate for health care providers of the same licensure. 1
If the insurer does not have a standard in-network reimbursement 2
rate for the health care providers, the reimbursement rate paid 3
must be the median reimbursement rate the insurer pays to health 4
care providers of the same licensure. 5
(5) A health care provider eligible for reimbursement under 6
subsection (3) who, at the time services were rendered, was 7
employed by a practice or group that has contracted with the 8
insurer to provide services at specified rates of reimbursement 9
must be paid by the insurer in accordance with the terms of that 10
contract for providers of the same licensure. If providers of the 11
same licensure are already employed by the practice or group that 12
has contracted with the insurer, the reimbursement rate paid must 13
be the median reimbursement rate the insurer pays to health care 14
providers of the same licensure. 15
(6) If an insurer approves the credentialing application of a 16
health care provider within the time frames specified in subsection 17
(1)(a) or (2), the insurer shall immediately reimburse the provider 18
for claims submitted after the date of approval at the 19
reimbursement rate specified in the terms and conditions of the 20
contract between the insurer and the provider. 21
(7) This section applies equally to initial credentialing 22
applications and applications for recredentialing. 23
(8) As used in this section, "health care provider" means any 24
of the following: 25
(a) A physician licensed under part 170 or part 175 of the 26
public health code, 1978 PA 368, MCL 333.17001 to 333.17097 and 27
333.17501 to 333.17556. 28
(b) A psychologist licensed under part 182 of the public 29
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health code, 1978 PA 368, MCL 333.18201 to 333.18237. 1
(c) A licensed bachelor's social worker or licensed master's 2
social worker licensed under part 185 of the public health code, 3
1978 PA 368, MCL 333.18501 to 333.18518. 4
(d) A marriage and family therapist licensed under part 169 of 5
the public health code, 1978 PA 368, MCL 333.16901 to 333.16915. 6
(e) A behavior analyst or assistant behavior analyst licensed 7
under part 182A of the public health code, 1978 PA 368, MCL 8
333.18251 to 333.18267. 9