History: 2021 MR 18, Eff. Oct. 1, 2021.
R 500.203 Medicare calculation.
Rule 3. When calculating the amount payable to a provider for a service under Medicare
part A or part B, as referenced in section 3157 of the act, MCL 500.3157, the amounts payable to
participating providers under the applicable fee schedule shall be utilized. An amount payable
pursuant to the fee schedule may not exceed the average amount charged by the provider for the
service on January 1, 2019.
History: 2021 MR 18, Eff. Oct. 1, 2021.
R 500.204 Eligibility for enhanced reimbursement.
Rule 4. (1) No less frequently than annually, the department shall issue a bulletin
designating not more than 2 freestanding rehabilitation facilities pursuant to section 3157(4)(b)
of the act, MCL 500.3157. A freestanding rehabilitation clinic that seeks to be recognized by the
department shall submit an application for recognition on a form prescribed by the department.
The department’s designation remains in effect until revoked by the department.
(2) No less frequently than annually, the department shall issue a bulletin that lists which
providers are entitled to enhanced reimbursement under section 3157(4)(a) or section 3157(5) of
the act, MCL 500.3157. To determine whether a provider qualifies for enhanced reimbursement
under section 3157(4)(a) or section 3157(5) of the act, MCL 500.3157, the department shall rely
on data provided by the department of health and human services related to the provider’s
indigent volume factor as of July 1 of the immediately preceding year.
(3) No less frequently than annually, the department shall issue a bulletin that lists which
hospitals are Level I or Level II trauma centers for purposes of enhanced reimbursement under
section 3157(6) of the act, MCL 500.3157. This list must be based on the hospital’s designation
on January 1 of that year.
History: 2021 MR 18, Eff. Oct. 1, 2021.
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
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