Mich. Admin. Code R. 500.205 - Charge description master; average amount charged; average charge; submissions to department in connection with an appeal under R 500.65

Rule 5.

(1) Upon the department's request, a provider that appeals a determination to the department under R 500.65, shall make the following submissions to the department, in a form and manner prescribed by the department, as applicable:

(a) If a provider has a charge description master that was in effect on January 1, 2019, the provider shall submit to the department the provider's charge description master that was in effect on January 1, 2019.

(b) If a provider offered or rendered services on January 1, 2019, and does not have a charge description master that was in effect on January 1, 2019, or has a charge description master that was in effect on January 1, 2019 that does not list all of the provider's services offered or rendered on January 1, 2019, the provider shall submit to the department the provider's average amount charged for any service offered or rendered on January 1, 2019, that is not included in a charge description master submitted to the department under subdivision (a) of this subrule.

(c) If a provider does not meet the criteria under subdivision (a) or (b) of this subrule, the department shall consult the FAIR Health benchmarking database to determine the average amount charged in the applicable geozip for the service or services at issue based on FAIR Health's most recently published data that includes dates of service on January 1, 2019, as adjusted in accordance with subrule (6) of this rule.

(2) A provider that submits information under subrules (1)(a) or (b) must also submit an attestation that the information provided is accurate.

(3) A provider must retain its charge description master in effect on January 1, 2019 and documentation containing the average amount charged for services on January 1, 2019, as applicable, until the provider permanently ceases to render services to injured persons for accidental bodily injuries covered by personal protection insurance under chapter 31 of the act, MCL 500.3101 to 500.3179.

(4) Upon request by the department, a provider submitting its charge description master in effect on January 1, 2019 or average amount charged for services on January 1, 2019 shall also submit to the department any documents, materials, and information the department considers necessary to assess the submission's accuracy and to resolve the provider's appeal under R 500.65.

(5) Any proprietary information or sensitive personally identifiable information regarding a patient that is submitted to the department under this rule must be afforded the same level of protection by the department as the information described under section 3157b of the act, MCL 500.3157b.

(6) An average amount charged for each service on January 1, 2019, or amount listed on a charge description master in effect on January 1, 2019, must be adjusted annually by the percentage change in the medical care component of the consumer price index for the year preceding the adjustment. Beginning in 2021, and annually thereafter, the department shall issue a bulletin no later than March 1 of each year setting forth the applicable percentage change in the medical care component of the consumer price index for the year preceding the adjustment. This percentage change applies to services rendered between July 2 of that year and July 1 of the following year.

Notes

Mich. Admin. Code R. 500.205

2021 MR 18, Eff. 10/1/2021