Under Michigan law, insurers or health plans must perform health care evaluations once a year to promote the efficient use of resources.1 In addition, health benefit plans that provide insurance to public employers are required to provide the employers with a utilization and cost report electronically. However, any information that the insurer releases, must be de-identified and in compliance with HIPAA regulations.2
| Subtopic | Statute/Regulation | Description |
|---|
| Required utilization/cost reporting | Mich. Admin. Code r. 325.6615 - Health care evaluations | Each insurer or health plan must ensure that health care evaluations are done to promote the efficient use of available health resources. The... |
| Mich. Comp. Laws Ann. § 124.85 - Public employer with 100 or more employees; claims utilization and cost information; compilation; "relevant period" defined; disclosure; availability; protected health information not included; date of compilation | Medical benefit plans operating within Michigan must electronically provide cost and utilization information to all public employers that have,... | |
| Mich. Comp. Laws Ann. § 500.3508 - Quality assessment program; quality improvement program | Quality assessment program; quality improvement program All health maintenance organizations must establish a quality assessment program that... |
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