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SENATE BILL NO. 894
A bill to amend 1980 PA 350, entitled
"The nonprofit health care corporation reform act,"
(MCL 550.1101 to 550.1704) by adding section 414c.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 414c. (1) Subject to subsection (2), a health care 1
corporation shall do all of the following: 2
(a) Assess and verify the qualifications of a health care 3
provider applying to become a participating provider not later than 4
60 calendar days after receipt of a complete credentialing 5
March 26, 2026, Introduced by Senator CHERRY and referred to Committee on Health Policy.
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application and issue a decision in writing to the applicant 1
approving or denying the credentialing application not later than 2
60 calendar days after receiving the complete credentialing 3
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 health care 8
corporation requires to approve or deny the credentialing 9
application. The notice to the applicant must include a full and 10
detailed description of all the information or supporting 11
documentation required to make the application complete and the 12
name, address, and telephone number of a person who serves as the 13
applicant's point of contact for completing the credentialing 14
application process. Any information required under this section 15
must be reasonably related to the information in the application. 16
As used in this subdivision, "business day" means a day other than 17
a Saturday, a Sunday, or any 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 health care corporation's provider payment 21
system all provider information for an approved health care 22
provider, including all information needed to correctly reimburse a 23
newly approved health care provider according to the provider's 24
contract. The health care corporation shall add the approved 25
provider's data to the provider directory on loading the provider's 26
information into the health care corporation's provider payment 27
system. 28
(2) A health care corporation may extend the credentialing 29
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period to assess and issue a determination by an additional 15 1
calendar days if, on review of a complete application, it is 2
determined that the circumstance presented, including an admission 3
of sanctions by the state licensing board, investigation or felony 4
conviction, or revocation of clinical privileges, requires 5
additional consideration. 6
(3) A health care corporation shall reimburse a health care 7
provider whose credentialing application has not yet been approved 8
or denied for covered services for any claims from the provider 9
that the health care corporation receives with a date of service 10
more than 60 calendar days after the date on which the health care 11
corporation received a complete credentialing application, or 45 12
calendar days if the conditions described in subsection (2) are 13
met, if: 14
(a) The provider has submitted a complete credentialing 15
application and any supporting documentation that the health care 16
corporation has requested in writing within the time frame 17
established in subsection (2). 18
(b) The provider has no past or current license sanctions or 19
limitations, as reported by the pertinent state licensing and 20
regulatory agency, or by a similar out-of-state licensing and 21
regulatory entity for a provider licensed in another state. 22
(c) The provider has professional liability insurance. 23
(d) The health care corporation has failed to approve or deny 24
the applicant's complete credentialing application within the time 25
frames established by subsection (1)(a) or (2). 26
(4) A health care provider eligible for reimbursement under 27
subsection (3) who, at the time services were rendered, was not 28
employed by a practice or group that has contracted with the health 29
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care corporation to provide services at specified rates of 1
reimbursement must be paid by the health care corporation at the 2
health care corporation's standard in-network reimbursement rate 3
for health care providers of the same licensure. If the health care 4
corporation does not have a standard in-network reimbursement rate 5
for the mental health or substance use disorder providers, the 6
reimbursement rate paid must be the median reimbursement rate the 7
health care corporation pays to health care providers of the same 8
licensure. 9
(5) A health care provider eligible for reimbursement under 10
subsection (3) who, at the time services were rendered, was 11
employed by a practice or group that has contracted with the health 12
care corporation to provide services at specified rates of 13
reimbursement must be paid by the health care corporation in 14
accordance with the terms of that contract for providers of the 15
same licensure. If providers of the same licensure are already 16
employed by the practice or group that has contracted with the 17
health care corporation, the reimbursement rate paid must be the 18
median reimbursement rate the health care corporation pays to 19
health care providers of the same licensure. 20
(6) If a health care corporation approves the credentialing 21
application of a health care provider within the time frames 22
specified in subsection (1)(a) or (2), the health care corporation 23
shall immediately reimburse the provider for claims submitted after 24
the date of approval at the reimbursement rate specified in the 25
terms and conditions of the contract between the health care 26
corporation and the provider. 27
(7) This section applies equally to initial credentialing 28
applications and applications for recredentialing. 29
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(8) As used in this section, "health care provider" means any 1
of the following: 2
(a) A physician licensed under part 170 or 175 of the public 3
health code, 1978 PA 368, MCL 333.17001 to 333.17097 and 333.17501 4
to 333.17556. 5
(b) A psychologist licensed under part 182 of the public 6
health code, 1978 PA 368, MCL 333.18201 to 333.18237. 7
(c) A licensed bachelor's social worker or licensed master's 8
social worker licensed under part 185 of the public health code, 9
1978 PA 368, MCL 333.18501 to 333.18518. 10
(d) A marriage and family therapist licensed under part 169 of 11
the public health code, 1978 PA 368, MCL 333.16901 to 333.16915. 12
(e) A behavior analyst or assistant behavior analyst licensed 13
under part 182A of the public health code, 1978 PA 368, MCL 14
333.18251 to 333.18267. 15