The Michigan SBL

The Michigan SBL became effective October 22, 2020. MCL 333.24501 to MCL 333.24517 of the Michigan Public Health Code. Two of the most relevant characteristics of the Michigan law are

  • Reimbursement rates that vary depending upon the type of provider and the circumstances of the claim but are always tied to percentages of INN rates and Medicare rates.

  • Arbitration is available to obtain a 25% bump up if complicating factors exist

Regarding bifurcation, according to CMS,

Based on the survey response and CMS communications with staff in the Michigan Department of Insurance and Financial Services (DIFS), the Michigan Department of Licensing and Regulatory Affairs (LARA), and the Michigan Department of Health and Human Services, CMS understands that DIFS will enforce sections 2719 (as applied by section 110 of the No Surprises Act), 2746 (other than section 2746(c)), 2799A-1, 2799A-2, 2799A-3, 2799A-4, 2799A-5, and 2799A-9 (other than section 2799A-9(a)(4)) of the PHS Act with respect to health insurance issuers; and LARA will enforce section 2799B-1 of the PHS Act with respect to health care providers.

Letter from CMS to Governor of Michigan, dated December 27, 2021.

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