Auto Insurance Reform FAQ

1. Can companies charge the MCCA Deficit Recoupment, even when PIP coverage has been rejected?
   
   Yes. Insurers can charge for the deficit recoupment, but they must still meet the rollback requirements.
2. Section 3104(20) was amended to require that if a company “passes on any portion of the premium payable under this section to an insured” the passed-on amount must equal the portion attributable to the car, including any excesses or deficiencies. What is the intent of this amendment?
   
   Companies will no longer be allowed to file MCCA rates that are more than those charged by MCCA.
3. Will insurance score filings need to be resubmitted for approval?
   
   Companies will be required to demonstrate compliance with MCL 500.2111(4) if the insurance score is based solely or in part on a credit score as defined in MCL 500.2151(e).
4. Will DIFS be mandating geographical territorial definitions since postal zones are now prohibited?
   
   No. Companies will be required to file their territorial definitions demonstrating they comply with the statute.
5. Do the prohibited rating factors outlined in Sec. 2111(4) only apply to PIP medical coverage or all auto coverages?
   
   The rating factor prohibitions apply to automobile insurance not just PIP.
6. Does the 8-year rate reduction only apply to the PIP premium?
   
   Yes. The statute requires compliance with the premium reduction requirements for PIP for policies issued or renewed before July 2, 2028.

The following questions were posted on 10/11/19.

1. What is the appropriate MCCA premium charge for motorcycles?
   
   Update:
   
   The appropriate premium charge for motorcycle insurers remains the full MCCA premium charged for unlimited coverage. Motorcycle insurance companies are assessed by the MCCA just like auto insurance companies. While motorcycle policies do not include Personal Injury Protection (PIP) benefits, motorcyclists may be entitled to PIP medical benefits if they are injured in an accident involving a motor vehicle. Therefore, motorcycle insurers are required to pay an assessment to the MCCA for all motorcycles they insure, which is typically passed on to the motorcycle policyholder.
2. Do multi-policy discounts offered for the purchase automobile insurance coupled with other insurance products(home, tenant, condo, etc.) violate the prohibition on the establishment of rates or rating classifications based on home ownership?
   
   DIFS will ensure that a multi-policy discount is not used as a surrogate for home ownership by requiring companies to file rules and rates governing multi-policy discounts. If discounts are offered on home insurance policies, the discount cannot be limited to homeowners only and the amount cannot vary by product (home, tenant, condo, etc.).

The following questions were posted on 12/06/19.

ZIP Codes

1. Can postal codes be grouped together and rated on a territorial basis? If not, how are companies allowed to group geographical locations together (county, city, etc.)?

   Territories may not be based on postal zones (i.e. zip codes). This includes grouping a set of zip codes together and making one or more territories. Companies may set their territories on a method that is not based on zip code or a group of zip codes.

The following questions were posted on 04/02/20.

1. Do the mandated PIP premium reductions apply to commercial automobile policies?
   
   No.  As the mandated PIP premium reductions are included in Chapter 21,  they are not applicable to commercial automobile policies.
    

2. If my company is a member of a rating organization that promulgates loss costs (e.g. ISO), do I still have to demonstrate compliance with the mandated PIP premium reductions?
   
   Yes.  Companies that are adopting loss costs for private passenger automobile insurance are required to demonstrate compliance with the PIP premium reductions in MCL 500.2111f using the company’s average premiums.  Note that as to companies adopting loss costs for commercial automobile insurance, the PIP premium reductions do not apply.

1. Section 3107c(8) requires insurers to offer a rider that will provide coverage for attendant care in excess of the $50,000, $250,000 or $500,000 PIP limit.
    
   1. Are there any regulatory requirements for this rider?
      
      This rider must be offered to any driver that chooses the $50,000, $250,000, or $500,000 PIP limits.
   2. Should the premium for the rider be included in the rate reduction?
      
      The rate reduction requirements under Section 2111f apply to specific levels of PIP coverage. Though the rider must be offered for certain PIP options; the rider itself is not PIP coverage and is not included in the rate reduction.
   3. Does the rider or policy pay first?
      
      The rider pays claims in excess of the coverage limit chosen. The PIP coverage pays first.
   4. What is the required limit on the attendant care rider that companies will have to offer per Sec. 3107c(8)?
      
      The statute does not place a required limit on the attendant care rider that companies will be required to offer.
2. Is there a default coverage for PIP medical expenses?
   
   Section 3107c(3) states that if the applicant or named insured has not made an effective PIP selection, there is a rebuttable presumption that the amount of the premium paid accurately reflects the level of PIP coverage applicable to a policy.
   However, if the applicant or named insured has not made a selection and there is no rebuttable presumption, unlimited PIP coverage applies to the policy.
3. When does Section 3009 requiring a change in Bodily Injury limits become effective? Does it go in effect for new policies written and existing policies renewing after July 1, 2020, or does it go in effect for all policies on that date?
   
   The new BI limits did not automatically apply on July 2, 2020. They become effective for policies that are issued or renewed after July 1, 2020.
4. Must insurers offer all levels of PIP coverage, including unlimited?
   
   Yes, insurers are required to offer all levels of PIP coverage, including unlimited.
   
   Additionally, insurers are required to offer a rider that will provide coverage for attendant care in excess of an insured’s PIP limit. This rider must be offered to anyone choosing a policy with a PIP limit ($50,000, $250,000, or $500,000 options).
5. Section 3107d allows a person to opt out of medical PIP coverage under certain circumstances. It further provides a 30-day period for a named insured to obtain medical PIP coverage if the named insured is no longer covered by qualified health coverage. The statute stipulates that a person injured in a motor vehicle accident during the 30-day period will be covered by the Michigan Assigned Claims Plan. Will an injured person be covered by the Michigan Assigned Claims Plan if they are injured in an accident occurring after the 30-day period?
   
   No. A person that opts out of medical PIP coverage under Section 3107d will not be covered under the Michigan Assigned Claims Plan for an accident occurring after the 30-day period.
6. Sec. 3107d(6) says if the insured loses their qualifying health coverage during the term of the policy, the insured must contact the insurer within 30 days to purchase PIP coverage. If the insured secures PIP coverage within the 30 days, but there is a gap between the effective date of health insurance benefits and new PIP benefits, who is responsible for the PIP losses?
   
   Insureds who lose qualified health coverage have a 30-day period to notify their insurer and secure PIP coverage. If an accident occurs during this 30-day period before the driver has secured PIP coverage, the driver would be eligible for benefits under the Michigan Assigned Claims Plan. However, if the accident occurs outside the 30-day period and the driver has not yet secured PIP coverage, the driver is not entitled to claim PIP benefits from any policy or Michigan Assigned Claims Plan.
7. How do the changes to Chapter 31 affect Transportation Network Companies (TNCs), TNC drivers, and TNC passengers?
   
   TNCs and TNC Drivers
   
   The new law states that an applicant or named insured that is a transportation network company shall only select PIP coverages of $250,000, $500,000 or unlimited.
   There are no requirements regarding what level of PIP coverage a TNC driver must carry.
   
   The onus to maintain insurance on a TNC vehicle ultimately lies with the TNC. A company could require their drivers to maintain a certain level of coverage, but the company is held responsible up to their chosen level of PIP coverage if the driver does not maintain that coverage.
   
   Insurers can continue to exclude driving for a TNC from personal auto coverage (MCL 500.3017). TNCs are required to make potential drivers aware of common insurance exclusions and receive their written acknowledgement of these exclusions (MCL 257.2125).
   
   Passengers
   
   If a passenger is covered under an auto insurance policy with PIP benefits, they are covered under that policy.
   
   If a passenger is covered under an auto policy but has opted out of PIP under 3107d or chosen the 3109a(2) exclusion, they are not eligible for PIP reimbursement from the TNC’s policy.
   
   A passenger who is not required to maintain auto insurance can claim benefits under the TNC policy but is subject to whatever PIP choice the TNC has elected, which cannot be a coverage of less than $250,000 per person per accident.
8. Under the new law, because some motor vehicle owner/registrants may have opted out of PIP or chosen a reduced limit, will motorcyclists be limited to recovering for their injuries from that policy?
   
   Under the new law, a motorcyclist involved in an accident with a motor vehicle would continue to seek PIP from the insurer of the motor vehicle but would be subject to any PIP choice limits on the policy. If no PIP coverage is available in the order of priority, a motorcyclist is eligible for up to $250,000 in PIP benefits from the Michigan Assigned Claims Plan.
9. Is PIP now mandated for motorcycles?
   
   No. Motorcycle riders are not entitled to purchase PIP benefits for their motorcycle policy, but they may purchase first-party medical benefits in increments of $5,000-- up to the limit of coverage offered by the insurer. A motorcycle operator must carry at least $20,000 of medical benefits if they ride without a helmet.
10. Are insurers still allowed to offer historic/normal coordination of benefits and/or deductibles with related discounts?
    
    Yes. Insurers may continue to offer coordinated benefits and deductibles if actuarially supported.

The following question was posted on 10/11/19.

1. Do the order of priority changes in Section 3114 have immediate effect?
   
   Yes; however, filings must be submitted prior to changing claims practices. See memo from DIFS issued July 20, 2021.

The following question was posted on 12/03/19.

1. What coverage and premium is reduced when someone elects the $250,000 limit with exclusions for certain individuals?
   
   An excluded person will not receive PIP medical coverage and the PIP medical premium must be reduced by 100%. PIP coverages that are separate from PIP medical coverage such as work loss, replacement services, and some funeral and burial expenses as described in MCL 500.3107 are still included in the policy. Companies can only charge the portion of MCCA premium that is from a deficiency, if applicable.

The following question was posted on 12/06/19.

Premium Reductions

1. What coverage and premium is reduced when someone selects a PIP option of $50,000, $250,000 or $500,000?

   All PIP limits apply to PIP medical. The full PIP premium must be reduced by the amount required in MCL 500.2111f(2). Companies can only charge the portion of MCCA premium that is from a deficiency, if applicable.

2. What coverage and premium is reduced when someone elects to not have PIP coverage?

   A policy that does not include PIP coverage under the opt-out in MCL 500.3107d, will not receive PIP medical coverage and the PIP medical premium must be reduced by 100%. PIP coverages that are separate from PIP medical coverage such as work loss, replacement services, and funeral and burial expenses as described in MCL 500.3107 are still included in the policy. Companies can only charge the portion of MCCA premium that is from a deficiency, if applicable.

The following question was posted on 09/25/20.

1. Do accident-only indemnity plans, fixed indemnity plans, and hospital indemnity plans constitute Qualified Health Coverage (QHC)?

   No. Accident-only indemnity plans, fixed indemnity plans, and hospital indemnity plans are not considered Qualified Health Coverage (QHC).

   QHC as defined in MCL 500.3107d(7)(b)(i) is coverage that:

   • Does not exclude or limit coverage for motor vehicle accidents; and
   • Has an annual deductible of $6,000 or less per covered individual.

The following question was posted on 10/19/20.

1. How do the changes in 3135(3)(e) affect the limited property damage liability (Mini-Tort) coverage that insurers offer?

   Public Acts 21 and 22 of 2019 increased the maximum amount of damages available for a mini-tort claim to $3,000.00 for accidents occurring after July 1, 2020.

   To comply with this change, limited property damage liability coverage must pay up to $3,000.00 on a mini-tort claim for any accident occurring after July 1, 2020. This coverage amount will apply regardless of the date a policy was issued or any conflicting policy language.

The following question was updated on 3/19/24.

1. Does Veterans Affairs (VA) coverage, TRICARE, or CHAMPVA constitute Qualified Health Coverage (QHC)?

   The U.S. Department of Veterans Affairs has determined that VA coverage is not Qualified Health Coverage (QHC) under Michigan’s auto insurance law, so consumers may not use VA coverage to exclude or opt out of PIP medical coverage.

   DIFS has confirmed with the U.S. Department of Defense that TRICARE and CHAMPVA coverage constitute QHC as defined in section 3107d(7)(b)(i). Therefore, customers may rely on TRICARE or CHAMPVA coverage to be eligible for the PIP medical options described in sections 3107c(1)(a), 3107d, and 3109a.

   Please see Bulletin 2023-17-INS for more information.

The following question was posted on 1/19/21.

1. Can Qualified Health Coverage (QHC) documentation be required prior to providing a customer with an auto insurance quote?
   
   No. MCL 500.2116 requires an insurance producer to provide each eligible person seeking automobile insurance a premium quotation for the forms or types of insurance coverages that are offered by the insurers. QHC documentation is not a consideration in what constitutes an “eligible person” as defined in MCL 500.2103.

The following question was posted on 4/8/21.

1. Why must insureds submit proof of Medicare Parts A & B at every renewal?
   
   Insurers should not conclude that an individual meets the criteria for their Personal Injury Protection (PIP) medical coverage choice without collecting documentation regarding Medicare or, if applicable, Qualified Health Coverage or Medicaid (See Bulletin 2023-17-INS). While many people have Medicare benefits for life, some do not. Reasons somebody may lose Medicare coverage may include failing to pay plan premiums, no longer qualifying due to loss of a qualifying disability, or engaging in Medicare fraud. Selecting $250,000 with exclusions, $50,000 in PIP medical coverage, or the PIP medical opt out (Options 4, 5, and 6) can depend on household members having Medicare Parts A & B. Collecting documentation regarding Medicare at every renewal ensures that an insurer can verify and document eligibility for coverages that require Medicare Parts A & B and ensures your customers have coverage if they are injured in an accident.

The following question was posted on 5/14/21.

1. What happens if an insured selects PIP coverage of $250,000 with exclusions (Option 4), but does not provide proof of Qualified Health Coverage (QHC)?
   
   When applying for new coverage or renewing existing coverage, if an insured has chosen limited PIP medical coverage of $250,000, with some or all persons excluded from PIP medical (Option 4), they must provide a completed PIP selection form and proof of QHC for all excluded household members. If proof of QHC is not provided, the policy must be issued with limits of $250,000 for all persons without proof of QHC and with no PIP medical coverage for any or all persons that do provide proof of QHC. The insured will be charged the appropriate premium for those not excluded from PIP medical on the policy.

The following question was updated on 10/27/22.

1. Will the Qualified Health Coverage (QHC) maximum deductible be adjusted this year?
    

   No. For the period of July 1, 2024 through June 30, 2025, the maximum deductible for determining whether health or accident coverage is QHC remains $6,579.

   MCL 500.3107d(7)(b)(i)(B) requires the Director to annually adjust the QHC maximum deductible by the percentage change in the medical component of the Consumer Price Index for the preceding calendar year if the adjustment, or the total of the adjustment and previous unadded adjustments, is $500 or more. The Director has performed the requisite calculation and has determined that the $500.00 threshold for adjusting the deductible has not been met.

   Please see Bulletin 2024-12-INS for more information.

1. When are insurers required to obtain a signed BI selection form?
   
   Section 3009(6) states that insurers are required to do all of the following at new business or renewal:
    
   • Provide the applicant/named insured the liability options available.
   • Provide the applicant/named insured a price for each option.
   • Offer the applicant/named insured the options and BI Selection form.
   
   New Business – At the time of application, if the applicant does not provide a signed and completed BI selection form, the insurer shall issue the policy with $250,000/$500,000 limits.
   
   First Renewal Effective on or after July 2, 2020 – If the insured does not provide a signed and completed BI selection form, the insurer shall issue the policy with $250,000/$500,000 limits.
   
   Subsequent Renewals – If the insured does not request the BI selection form or a change in coverage, the insurer shall renew the policy with the existing BI limits.

The following questions were posted on 10/11/19.

1. When are carriers required to obtain a signed PIP Selection/Rejection form?

   Carriers are required to provide a PIP Selection/Rejection form:

   1. at the time of new business; and
   2. at renewal.
   
   If the customer does not return a completed form at application, the carrier should issue the policy with unlimited PIP. Under 3107c, if the customer does not return a completed form at renewal, but pays their renewal premium, the statute allows for a “rebuttable presumption” that the insured wants to maintain the current limit and the carrier can renew the policy with the same PIP selection. However, under 3107d, if the insured had previously rejected PIP and does not return a completed form, the renewal should be issued with unlimited PIP.



2. What form is the company required to use for customers to select their BI limits?

   Companies must use the form issued by the Director. Companies are permitted to add their form number and a logo if desired. Companies are not permitted to make any other changes.

The following questions were posted on 12/06/19.

PIP and BI Forms Bulletin

1. When will the PIP and BI selection forms be issued by DIFS?

   The Choice of Bodily Injury Liability Coverage Limits Form and Personal Injury Protection (PIP) Choice Forms have been transmitted to companies via Bulletin 2023-11-INS. Word versions have also been emailed to company SERFF contacts.

BI Form

1. What CSL limit is equivalent to $250,000 per person/$500,000 per occurrence?

   $510,000 CSL is the appropriate CSL equivalent to $250,000/$500,000 as you must add $10,000 for property damage.

2. Will the BI form be updated to accommodate companies that only offer CLS?

   No, the BI form was created to follow the statute which requires insurers to issue a policy at $250,000/$500,000 if the form is not returned.

3. Can companies modify the BI form if they only offer CSL?

   Companies must use the BI form issued by the Director. When you provide the applicant/insured the options and price for each option, you may explain that their policy will be issued at $510,000 if you do not offer split limits

4. Must a company change the limits on a policy with CSL limits greater than or equal to $510,000 if the customer does not return the BI form?

   Customers with a CSL limit greater than or equal to $510,000 will not need to have their limit changed if they do not return the form.

PIP Form

1. Is the intent of the department that the Commercial form would be the only form used by Commercial Auto customers/applicants?

   If the named insured is an individual, you should use the individual form. If the named insured is a Business/Company, you should use the Commercial/Business form.

2. The Commercial form does not provide options for the $50,000 Medicaid nor the $250,000 Opt out options when Medicare &/or other qualifying health insurance is carried. Are we correct in interpreting this to mean that these options do not apply to Commercial Auto policies?

   If the named insured is a business/company, they are not eligible for the PIP options of $50,000, $250,000 with exclusions, or no PIP.

The following question was posted on 05/28/20.

Accreditation FAQs

1. Do entities that provide ancillary services to injured persons—such as case management, transportation, or guardianship/conservatorship planning—need to be accredited under MCL 500.3157?

   No. These entities do not “provide[] post-acute brain and spinal rehabilitation care” under MCL 500.3157(15)(g) and therefore do not need to be accredited.

2. Do pharmacies need to be accredited under MCL 500.3157?

   No. These entities do not “provide[] post-acute brain and spinal rehabilitation care” under MCL 500.3157(15)(g) and therefore do not need to be accredited by CARF or The Joint Commission.

3. Do providers of durable medical equipment need to be accredited under MCL 500.3157?

   No. These entities do not “provide[] post-acute brain and spinal rehabilitation care” under MCL 500.3157(15)(g) and therefore do not need to be accredited by CARF or The Joint Commission.

The following question was posted on 06/03/20.

1. Do family members who provide attendant care need to be accredited under MCL 500.3157?

   No. These persons do not “provide[] post-acute brain and spinal rehabilitation care” under MCL 500.3157(15)(g) and therefore do not need to be accredited by CARF or The Joint Commission.

The following question was posted on 06/23/20.

1. Do vocational rehabilitation counselors need to be accredited under MCL 500.3157?

   No. These persons do not “provide[] post-acute brain and spinal rehabilitation care” under MCL 500.3157(15)(g) and therefore do not need to be accredited by CARF or The Joint Commission.

The following question was posted on 07/23/20.

1. Do providers of recreational therapy need to be accredited under MCL 500.3157?

   No. These persons do not “provide[] post-acute brain and spinal rehabilitation care” under MCL 500.3157(15)(g) and therefore do not need to be accredited by CARF or The Joint Commission.

The following question was posted on 08/06/20.

1. Do entities that provide post-acute brain and spinal rehabilitation care need to be accredited under MCL 500.3157(12) if the entity providing the care has a specialty license issued by the Department of Licensing and Regulatory Affairs (LARA)?

   Yes. Entities that “provide[] post-acute brain and spinal rehabilitation care” under MCL 500.3157(15)(g) need to be accredited by CARF or The Joint Commission. Please see Bulletin 2020-27-INS for further information.

The following question was posted on 09/08/20.

1. Do providers of psychotherapy need to be accredited under MCL 500.3157?

   No. These persons do not “provide[] post-acute brain and spinal rehabilitation care” under MCL 500.3157(15)(g) and therefore do not need to be accredited by CARF or The Joint Commission.

The following question was posted on 09/17/20.

1. Do stand-alone individual providers that provide post-acute brain and spinal rehabilitation care need to be accredited under MCL 500.3157?

   MCL 500.3157(15)(g) defines a neurological rehabilitation clinic as "a person that provides post-acute brain and spinal rehabilitation care." A "person" is defined in MCL 500.114 and includes an individual in addition to an institution, company, association, organization, or any other legal entity. However, CARF and the Joint Commission do not accredit individuals. CARF and the Joint Commission only accredit entities. Therefore, an individual provider that "provides post-acute brain and spinal rehabilitation care" is not required to be accredited by CARF or The Joint Commission.

The following question was posted on 10/16/20.

1. Do chiropractors need to be accredited under MCL 500.3157?

   Accreditation is required for any “person that provides post-acute brain and spinal rehabilitation care.” See MCL 500.3157(15)(g). Chiropractors whose services are limited to spinal rehabilitation care do not need to be accredited under MCL 500.3157.

2. Do speech pathologists need to be accredited under MCL 500.3157?

   No. These entities do not “provide[] post-acute brain and spinal rehabilitation care” under MCL 500.3157(15)(g) and therefore do not need to be accredited by CARF or The Joint Commission.

The following question was posted on 01/14/21.

1. Do persons that provide care for post-acute brain injury only or persons that provide care for spinal rehabilitation only need to be accredited under MCL 500.3157?

   Section 3157(15)(g) defines a neurological rehabilitation clinic as “a person that provides post-acute brain and spinal rehabilitation care.” Accreditation is required to the extent that a person is providing both post-acute brain and spinal rehabilitation care.

The following question was posted on 06/01/21.

1. Do agencies that provide only attendant care need to be accredited under MCL 500.3157?

   No. These entities do not “provide[] post-acute brain and spinal rehabilitation care” under MCL 500.3157(15)(g) and therefore do not need to be accredited by CARF or The Joint Commission.

The following question was posted on 06/21/21.

1. What documentation does a neurological rehabilitation clinic need to show to prove that it is accredited, or in the process of becoming accredited, under MCL 500.3157(12)?

   If a neurological rehabilitation clinic files a provider appeal under MCL 500.3157a, and if the appeal involves a dispute over whether the clinic is accredited, then DIFS will ask the clinic for proof of accreditation. DIFS will not collect or post accreditation documentation.

The following question was posted on 07/19/21.

1. Do post-acute patient care facilities that do not provide both post-acute brain and spinal rehabilitation care need to be accredited under MCL 500.3157?

   No. If a post-acute patient care facility does not “provide[] post-acute brain and spinal rehabilitation care” under MCL 500.3157(15)(g), it does not need to be accredited by CARF or The Joint Commission.

1. Can insurers endorse policies mid-term to add the new limits/coverages?

   If the insurer’s system can accommodate such changes, they are permitted to endorse a policy mid-term with the new limits/coverage if the change is effective on or after July 2, 2020 and if requested by the insured. Please note that any such endorsement must be filed and approved by DIFS and reflect all coverage and rating changes that would otherwise be available on a separately issued policy effective on or after 7/2/2020, including but not limited to the new bodily injury limit options, PIP limit options, attendant care riders, new mini-tort limit, and all rates including the new MCCA assessment. In addition, insurers must use their approved bodily injury and PIP selection forms in the same manner as if the policy were being issued or renewed after 7/2/2020.

   If an insured requests a PA 21/22-compliant policy and the insurer’s system cannot accommodate a mid-term change, the insurer must offer to cancel and reissue a policy. For more information, please see Bulletin 2020-31-INS.  

The following question was posted on 10/11/19.
 

1. Do the reforms apply to commercial insurance?

   Yes. Commercial Auto risks must comply with the changes outlined in all sections modified (except Chapter 21) to the extent they are applicable to Commercial Auto.

The following question was posted on 10/22/19.
 

1. If I have questions that haven’t been answered here, who can I send them to?

   When new questions and responses are added to the site, notification will be sent. Should you have questions or comments about the FAQ, such as suggested content, please contact DIFS through our dedicated email address for all PA 21 and PA 22 information: DIFS-PA21-22@michigan.gov.

The following question was posted on 12/06/19.

Attendant Care and the MCCA

1. DIFS has received many questions about MCCA and Attendant Care reimbursement and reporting. These questions should be directed to the MCCA.

   DIFS has received many questions about MCCA and Attendant Care reimbursement and reporting. These questions should be directed to the MCCA.

The following question was posted on 10/28/20.

1. What is considered appropriate documentation to confirm Medicaid enrollment?

   Documentation may be in the form of a current Medicaid card. The guide below provides a sample list of Medicaid cards that can be used to show proof of enrollment.
   
   Medicaid ID Card Guide

1. Where can I find more information about the fee schedule?
   
   The statutorily required fee schedule took effect on July 2, 2021. More information can be found on the DIFS Fee Schedule Resources Webpage.
2. How does the fee schedule apply to new and existing claims?
   
   The fee schedule applies to new and existing claims for treatment rendered after July 1, 2021. However, absent additional guidance from the Michigan Supreme Court, MCL 500.3157(7) and MCL 500.3157(10) may not be applied to claims related to persons injured in accidents that occurred prior to June 11, 2019.
3. The Act allows for the development and use of managed care networks. With respect to that:
    
   1. Does DIFS have an expectation relative to the amount of discount?
      
      An insurer will be required to demonstrate that the discount is appropriate for the coverage provided.
   2. Would the new fee schedule and utilization language also apply?
      
      Yes, the fee schedule (Section 3157) and utilization review (Section 3157a) will apply to managed care networks.
4. When would DIFS use FAIR Health data?
   
   If applicable, DIFS will use FAIR Health data in the course of a Utilization Review provider appeal if a provider does not submit a charge description master or average amount charged as of January 1, 2019. DIFS may also refer FAIR Health data to determine whether a charge is “reasonable” under MCL 500.3157(1).
5. Which FAIR Health product does DIFS propose to use?
   
   DIFS will use FAIR Health's charge benchmark suite of modules. The specific module will depend on which health care service is at issue and which type of provider is filing an appeal. Please note that the most recent benchmark release does not include any applicable adjustments based on the Consumer Price Index. See MCL 500.3157(9).
6. If a procedure code is listed in two different FAIR Health benchmarks, which charge will DIFS use?
   
   Certain codes may be billed by both professional providers and health care facilities using different medical billing forms. FAIR Health maintains data billed by such providers and facilities separately, resulting in different benchmarks. The benchmark used will depend on the type of provider.
7. Will DIFS post FAIR Health data?
   
   No. However, FAIR Health will give providers access to its data for a small administrative fee.
8. I have a question about what type of code or modifier to use. Can DIFS answer my question?
   
   No. DIFS cannot provide guidance on billing and coding questions, including whether to include a modifier or which type of code to use.
9. Do health care providers need to be Medicare-certified to be eligible for reimbursement for no-fault claims?
   
   No. Under MCL 500.3157(1), a provider must "lawfully render treatment" in order to be reimbursed.
10. Under the administrative rules, which Medicare fee schedule should be used?
    
    Under the administrative rules, the fee schedule is "the Medicare fee schedule or prospective payment system in effect on March 1 of the service year in which the services are rendered and for the area in which such services are rendered." "Service year" means the period from July 2 through July 1 of the following year. For example, for services rendered between July 2, 2021 and July 1, 2022, the applicable fee schedule would be the one in effect as of March 1, 2021.
11. Will DIFS publish providers' charge description masters?
    
    As a convenience, DIFS developed webpages where providers can voluntarily post their charge description masters so that insurers have ready access to them. To access, visit the DIFS Fee Schedule Resources Webpage. DIFS has not authenticated posted charge masters, and is not responsible for any information contained within them.
12. Which providers are entitled to payments based on indigent volume under MCL 500.3157(4)(a) and MCL 500.3157(5)?
    
    Under the fee schedule, a provider that has over 20% indigent volume is entitled to increased reimbursements. "Indigent volume" is determined "pursuant to the methodology used by the Department of Health and Human Services in determining inpatient medical/surgical factors used in measuring eligibility for Medicaid disproportionate share payments." The methodology employed by DHHS applies only to hospitals; there is no methodology applicable to non-hospital providers. Accordingly, only hospitals that are eligible for Medicaid disproportionate share payments, and thus who have "indigent volume," will qualify for increased reimbursement under MCL 500.3157(4) and (5).
13. Where can providers learn more about medical billing or coding?
    
    The Medicare Learning Network (MLN) provides free educational materials for health care professionals on CMS programs, policies, and initiatives including trainings, events, and other resources on a variety of medical billing and coding topics.
14. What types of services are eligible for enhanced reimbursement for a hospital that is a level I or level II trauma center?
    
    MCL 500.3157(6) states that the enhanced reimbursement applies to "a hospital that is a level I or level II trauma center that renders treatment to an injured person for an accidental bodily injury covered by personal protection insurance, if the treatment is for an emergency medical condition and rendered before the patient is stabilized and transferred." If the treatment is not for an emergency medical condition and rendered before a patient is stabilized and transferred, then the hospital is not eligible for enhanced reimbursement.

1. What is Utilization Review and how does it affect auto insurers?
   
   Under R 500.61 through R 500.69, established under the authority granted to the DIFS Director by MCL 500.3157a, each automobile insurer providing personal protection insurance in Michigan is required to establish a Utilization Review program to determine the medical appropriateness of treatment received by insureds after an auto accident after July 1, 2020. Those determinations must be based on “medically accepted standards” and may later be appealed by the health care provider who submitted the claim if they disagree with the insurer’s determination. See Rules 64 and 65 for more information on the Determination and Provider Appeals Process.

2. When must each insurer implement a Utilization Review Program?
   
   Under Rule 66, within 60 days of the effective date of these rules, insurers must have in place a utilization review program to review records and bills for treatment, training, products, services, and accommodations provided to an injured person that is above the usual range of utilization based on medically accepted standards. The effective date of the rules was December 18, 2020; therefore each insurer must have the Utilization Review program in place and file their application for certification no later than February 16, 2021. Insurers must file Application for Unconditional Certification of Auto Insurance Utilization Review Program (FIS 2362) with DIFS for review and approval. An insurer may not rely on a third party reviewer to submit an application on the insurer’s behalf. An unconditional certification renewal application must be submitted to DIFS at least 90 days before the expiration of the current certification.

3. Should an auto insurer wait for DIFS’ certification approval prior to implementing their utilization review program?
   
   No. The auto insurer’s utilization review program must be in place on or before February 16, 2021. If there are any deficiencies in the auto insurer’s application, DIFS will issue a conditional certification. The auto insurer will have up to one year to correct any deficiencies noted.

4. What duties does each insurer have under Utilization Review?
   
   For additional information and clarification of duties, please see R 500.61 through R 500.69, which were required under MCL 500.3157a(3). In general, each insurer providing personal protection insurance in Michigan must:

   • Under Rule 66, establish a Utilization Review program no later than February 16, 2021, using Application for Unconditional Certification of Auto Insurance Utilization Review Program (FIS 2362) and, under Rule 67, apply for renewal of the program’s certification at least 90 days before it is set to expire.
   • Under Rule 64, when necessary, gather sufficient information to enable the insurer to identify overutilized or otherwise inappropriate treatment, product, training, service, or accommodation provided after July 1, 2020 to an injured person who is insured under a policy of no-fault automobile insurance issued under chapter 31 or chapter 31A of the act, MCL 500.3101 to 500.3179 and 500.3181 to 500.3189.  Under Rule 69, all information gathered under these reviews must be retained for at least two years after the request.
   • Under Rule 63, submit any request for additional information or explanation to the provider within 30 days of the receipt of a disputed bill.
   • Under Rule 64, issue a written notice of the determination to the provider within 30 days when a determination is made that a treatment, product, training, service, or accommodation is not medically appropriate.
   • Under Rule 65, if the insurer wishes to reply to a provider appeal, the insurer must respond within 21 days after the date of the notice.
   • Under Rule 68, submit an annual report to the Department no later than March 31 of each year. This report shall consist of a form prescribed by the department and will include utilization review data and activities.

5. Can an auto insurer’s application for certification be denied for not meeting DIFS’ standards?
   
   No. DIFS’ will either provide a designation of either unconditional or conditional for certification applications. In the event of a conditional certification, the insurer must resolve all deficiencies before reapplying for unconditional certification.  

6. Can an auto insurer complete a single Application for Initial Certification of No-Fault Utilization Review Program (FIS 2357) form with multiple NAIC numbers?
   
   Yes, but only if the following is true: (1) the contact information noted on the application form is the same for all included companies; (2) the utilization review program must be same for all included companies. When completing one application for multiple companies and NAIC numbers, please attach all company names and NAIC numbers on a separate document with the application.
   
   Note: Separate applications must be used for each company and NAIC number if its Utilization Review program will differ in any way.

7. Can a third-party reviewer file an application for Initial Certification of No-Fault Utilization Review Program (FIS 2357) form on behalf of an auto insurer?
   
   No. The auto insurer is responsible for submitting the application to DIFS. Contact information and authorized signature in the application must be for the auto insurer.

The following questions were posted on 06/30/22.

1. Our insurer just filed a new personal auto program recently. Are we required to submit a rate filing to demonstrate that the savings from the fee schedule have been passed along to our insureds?
   
   Any insurer that has a filed product effective prior to July 2, 2021 must submit a filing demonstrating compliance with the statute. New insurers without affiliates that do not have realized savings on accidents that occurred prior to July 2, 2021 must demonstrate that there are no savings by completing the required exhibit and providing an explanation of why there are no savings realized.
   Insurers that consolidate insurers or introduce new affiliated insurers are required to demonstrate compliance with passing along savings realized pursuant to MCL 500.2111f(8) for individuals who suffered accidental bodily injury from motor vehicle accidents that occurred before July 2, 2021, regardless of which affiliate or new insurer the individual is insured with."
   
   
2. Is the  filing demonstrating compliance with section 2111f(8) applicable to motorcycle filings?
   
   The requirements shared regarding section 2111f(8) do not apply to motorcycle programs.
   
   
3. If we do not have any planned filings for 2022, is the DIFS still requesting that insurers submit a rate filing with the attached exhibits to demonstrate the realized savings from the application of MCL 500.3157(2) through (12) pursuant to MCL 500.2111f(8)?
   
   DIFS is requiring all insurers to submit a filing between the dates of 7/2/2022 and 9/9/2022 to demonstrate compliance with MCL 500.2111f(8).
   
   
4. Information contained in the Michigan Appendix may contain confidential information. Can this information be submitted confidentially?
   
   Insurers do not have to file a copy of their Michigan Appendix unless specifically requested in an objection. Any information that meets the definition of Trade Secret in accordance with MCL 445.1902 may request to have this information kept as confidential in the filing. If DIFS does not feel the materials meet the definition of trade secret, an objection will be issued to address with the insurer.
   
   
5. If the insurer did not file the new Michigan Appendix, does that still need to be filed?
   
   The insurer should file a Michigan Appendix immediately. Requirement details can be found in the P&C Forms & Instructions booklet.
   
   
6. Does the filing of a “Michigan Appendix” apply to Michigan domiciled insurers or the entire industry?
   
   This requirement will apply to both domestic and foreign insurers.
   
   
7. How long will insurers need to file the new exhibit for 2111f(8) savings?
   
   In accordance with MCL 500.2111f(8), insurers will be required demonstrate compliance with MCL 500.2111f(8) with all rate filings.
   
   
8. Will insurers be required to file the new exhibit for 2111f(8) savings annually?
   
   Filing requirements for future periods will be published at a later date.
   
   
9. If the insurer overstates its savings initially, then passes on too much of the savings in the next year, then how would the insurer recoup the excess returned funds?
   
   Any overstated savings would be reported and adjusted in a future filing.
   
   
10. Will insurers be expected to provide indications as part of the fee schedule filings if filing to change its rates?
    
    If insurers are not filing to revise rates at this time, a full indication is not required with this filing.
    
    
11. How are insurers to reflect the savings from 2111f(2) separately from 2111f(8)?
    
    The PIP Rate Reduction exhibit is intended to demonstrate compliance with the reduction in rates from MCL 500.2111f(2). The Savings Realized Exhibit is intended to demonstrate compliance with the savings realized from the implementation of the fee schedule from MCL 500.2111f(8). The insurer must determine the amount of savings they have realized from the application of the fee schedule in MCL 500. 3157(2) - (12) and report on the new exhibit.
    
    
12. Where in the PIP Rate Reduction Exhibit would we show that we have excluded the medical fee savings realized?
    
    Insurers should adjust their re-rated premiums in Section 3 of the PIP Rate Reduction Exhibit to remove the effect of fee schedule savings and may do so using the percentage from the Realized Savings exhibit. The adjustment should be documented in the filing memorandum.