HOUSE BILL NO. 4330

March 12, 2019, Introduced by Reps. Vaupel, Cynthia Johnson, Sabo, Brixie, LaFave, Garrett and Calley and referred to the Committee on Health Policy.

A bill to amend 1939 PA 280, entitled

"The social welfare act,"

(MCL 400.1 to 400.119b) by adding section 111o.

the people of the state of michigan enact:

Sec. 111o. (1) The department shall work with contracted health plans to do all of the following:

(a) Establish and revise, as necessary, a uniform credentialing process for providers of medical assistance required in this section. In complying with this subsection, the department shall consult with medical services providers that are required to accept credentialing under this section.

(b) Ensure that the uniform credentialing process establishes a streamlined uniform credentialing requirement for an individual who provides medical services through a contracted health plan.

(c) By 6 months after the effective date of the amendatory act that added this section and annually after that date, submit a report to the legislature that describes its activities under this section, including establishment of and any revisions to the uniform credentialing process.

(2) A managed care provider that provides, either directly or through a contract, medical services to medical assistance recipients of this state must comply with the uniform credentialing process. On and after the date the uniform credentialing process is certified by the director of the department as being in full force and effect, the department must ensure that all of the forms and processes it uses that relate to providing medical services comply with the uniform credentialing process. Until 3 years after the effective date of the amendatory act that added this section, this subsection does not apply to a managed care provider contracting with a health plan in a region that is served by fewer than 2 health plans.

(3) Primary or secondary credential verification remains the responsibility of each individual health plan. This section does not prohibit a managed care plan from approving or denying a medical services provider's participation in the managed care plan, or from collecting additional information from a medical services provider necessary to meet federal or state law, a requirement of a managed care contract with the department, or plan-specific metrics.

(4) As used in this section, "uniform credentialing process" means the uniform medical service provider credentialing process established, maintained, and revised as required in subsection (1)(a) that meets state and federally recognized standards.

Enacting section 1. This amendatory act takes effect 90 days after the date it is enacted into law.