REGULATORY ACTIVITY:

• Issued a memorandum which supersedes a previous memorandum regarding the rescission of Bulletin 2006-17 (issued June 7, 2017).

REGULATORY ACTIVITY:

• Issued bulletin 2020-18-INS.  This bulletin applies to automobile insurers that plan to issue refunds or premium waivers to their customers as a result of the COVID-19 pandemic and advises them of the filing requirements for these plans. In light of the COVID-19 emergency, DIFS will expedite its review and urges insurers to submit the following information as soon as possible.

REGULATORY ACTIVITY:

• Issued bulletin 2020-08-INS regarding temporary regulatory flexibility re COVID-19. To view the bulletin, go to https://www.michigan.gov/documents/difs/Bulletin_2020-08-INS_684451_7.pdf.

REGULATORY ACTIVITY:

• Bulletin 2020-03-INS was issued regarding choice of bodily injury liability coverage limits form and personal injury protection choice forms. This bulletin supersedes Bulletin 2019-29-INS in order to re-publish the Choice of Bodily Injury Liability Coverage Limits Form and Michigan Selection of Personal Injury Protection (PIP) Medical Coverage Forms.  The Michigan Selection of Personal Injury Protection (PIP) Medical Coverage Form for individual / personal policies has been amended to clarify the amount of coverage available from the Michigan Assigned Claims Plan when a person loses Qualified Health Coverage. The Choice of Bodily Injury Liability Coverage Limits Form (BI Form) has not been amended but has been republished.  The Michigan Selection of Personal Injury Protection (PIP) Medical Coverage Form for commercial policies is unchanged from the version published with Bulletin 2019-24-INS. However, it is being re-published along with the amended form for convenience.  Insurers must include the DIFS BI Form and the appropriate PIP Choice Form(s) in any form filings. To view this bulletin, go to https://www.michigan.gov/difs/0,5269,7-303-12900_12906---,00.html.
• Issued Bulletin 2020-05-INS regarding Medicare and no-fault automobile insurance.  After July 1, 2020, Michigan Medicare enrollees who renew or purchase a new no-fault automobile insurance policy can choose to “opt out” of Personal Protection Insurance (PIP) medical benefits. To do so, the enrollee must demonstrate that they are enrolled in Medicare Parts A and B and that their spouse or any relative of either who resides in the same household has qualified health coverage (QHC) or automobile insurance coverage that includes PIP medical benefits.  Medicare will pay for Medicare-covered services to enrollees who opt out of PIP medical benefits, are injured in an automobile accident, and have no other available coverage. The enrollee will remain financially responsible for coinsurances, copayments, deductibles, and for any services Medicare does not cover, such as transportation to and from medical appointments, vehicle modifications, case management services, residential treatment programs, long-term and custodial care, and replacement services.  Please see Medicare’s booklet titled “Your Guide to Who Pays First” for more information.   To view the bulletin, go to https://www.michigan.gov/difs/0,5269,7-303-12900_12906---,00.html.

REGULATORY ACTIVITY:

• Issued bulletin 2019-26-INS regarding choice of bodily injury liability coverage limits form and personal injury protection (PIP) choice forms. This bulletin supersedes bulletin 2019-24-INS in order to re-publish choice of bodily injury liability coverage limits form and Michigan selection of personal injury protection medical coverage forms. To view the bulletin, go to https://www.michigan.gov/difs/0,5269,7-303-12900_12906---,00.html
• Issued bulletin 2019-29-INS regarding Choice of Bodily Injury Liability Coverage Limits Form and Personal Injury Protection (PIP) Choice Forms. To view the bulletin, go to https://www.michigan.gov/difs/0,5269,7-303-12900_12906---,00.html 

REGULATORY ACTIVITY:

• Posted bulletin 2019-24-INS regarding choice of bodily injury liability coverage limits form and personal injury protection choice forms.  To view the bulletin, go to https://www.michigan.gov/difs/0,5269,7-303-12900_12906---,00.html
• Published bulletin 2019-25-INS regarding catastrophic claims association reporting. The bulletin was published on November 21, 2019.  The bulletin supersedes Bulletin 2007-04-INS which is also rescinded.  To view the bulletin, go to https://www.michigan.gov/difs/0,5269,7-303-12900_12906---,00.html.

REGULATORY ACTIVITY:

• Published bulletin 2019-16-INS regarding Michigan Catastrophic Claims Association Fee Calculation.  To view the bulletin, go to https://www.michigan.gov/difs/0,5269,7-303-12900_12906---,00.html.
• Posted bulletin 2019-18-INS regarding the enforcement of statute Section 2105(6) effective date. To view the bulletin, go to https://www.michigan.gov/difs/0,5269,7-303-12900_12906---,00.html.
• Posted bulletin 2019-19-INS regarding Michigan Catastrophic Claims Association Deficiency Calculation. To view the bulletin, go to https://www.michigan.gov/difs/0,5269,7-303-12900_12906---,00.html.
• Issued Bulletin 2019-21 INS regarding Statute Section 3163 Certifications.  To view the bulletin, go to https://www.michigan.gov/difs/0,5269,7-303-12900_12906---,00.html.

REGULATORY ACTIVITY:

• Published bulletin 2019-14-INS regarding annual adjustment of the maximum work loss benefit and survivors' loss benefit payable under policies of personal protection insurance.  This bulletin supersedes bulletin 2018-19-INS.
• Posted a notice of new rules to be added regarding Utilization Review Rules (Insurance and Financial Services, Insurance). These rules are mandatory under Section 3157a of the Insurance Code, MCL 500.3157a, which was added by Public Act 21 of 2019. Section 3157a was intended to help lower overall costs of automobile insurance by ensuring that persons injured in motor vehicle accidents receive an appropriate level of care. Under that section, DIFS is required to promulgate rules that will establish criteria or standards for utilization review that identify utilization of treatment, products, services, or accommodations under the no-fault automobile insurance statute that are above the usual range of utilization based on medically accepted standards. “Utilization review” is the initial evaluation by an insurer or the Michigan Catastrophic Claims Association of the appropriateness, based on medically accepted standards, of the level and the quality of treatment, products, services, or accommodations provided under personal protection insurance benefits. The rules must include a process by which medical providers submit records to, and comply with, any decision of, DIFS regarding utilization review. To view the posting, go to https://dtmb.state.mi.us/DTMBORR/AdminCode.aspx?AdminCode=Department&Dpt=IF&Level_1=Insurance.

LEGISLATIVE ACTIONS:

• Published Bulletin 2019-11-INS regarding the legislation enacted this year.  The bulletin addresses the statutory cause of actions by a provider against a no-fault insurer that had been denied under a decision by the courts. The courts stated that health care providers did not have a cause of action. The recently passed statute establishes that a health care provider does have a cause of action.  The bulletin also addressed other aspects of the recently enacted statutes.  To view the bulletin, go to  https://www.michigan.gov/difs/0,5269,7-303-12900_12906---,00.html.

REGULATORY ACTIVITY:

• Published bulletin 2019-11-INS regarding disputes between no-fault automobile insurers and health care providers. This bulletin exceeds bulletin 2018-13-INS issued in June 6, 2018. Public Acts 21 and 22, enacted on June 11, 2019, amended numerous provisions of the Insurance Code of 1956, MCL 500.100 et seq. (Code), including Section 3112, MCL 500.3112. Section 3112, after amendment, now provides: "A health care provider listed in section 3157 may make a claim and assert a direct cause of action against an insurer, or under the assigned claims plan under sections 3171 to 3175, to recover overdue benefits payable for charges for products, services, or accommodations provided to an injured person." As amended, Section 3112 overturns Covenant Medical Center, Inc v State Farm Mutual Auto Ins Co, 500 Mich  191; 895 NW2d 490 (2017), which held that health care providers did not have  a statutory cause of action against no-fault insurers for recovery of personal protection insurance benefits. The amended statute provides the "statutory cause of action" found lacking by the Supreme Court in Covenant.   In addition, the amended statute renders Bulletin 2018-13-INS obsolete because the bulletin was issued to explain the impact of the Covenant decision on disputes between no-fault automobile insurers and health care providers. Bulletin  2018-13-INS  also  addressed  the "reasonableness"  of health  care  providers'  charges,  and  auto insurers'  obligation  to  pay  "reasonable  charges"  for  "reasonably  necessary"  products,  services,  and accommodations for an injured person's care. Public Acts 21 and 22 did not alter this fundamental principle. Public Act 21 also requires the implementation of reimbursement rate caps beginning July 1, 2021. Until that date, auto insurers and health care providers are reminded that "an insurance carrier need pay no more than a reasonable charge and that a health care provider can charge no more than that." McGill v Automobile Association of Michigan, 207 Mich App 402, 502; 526 NW2d 12 (1994). "Consequently, insurers must determine in each instance whether a charge is reasonable in light of the service or product provided." Advocacy Org for Patients & Providers v Auto  Club Ins Association, 257 Mich App 365, 379; 670 NW2d  569 (2003).(1)  In light of the immediate effect of the amendment to Section 3112, health care providers may assert a direct cause of action  against  an  insurer  or  the  Michigan  Assigned  Claims  Plan  when  there  is  a  dispute  over  the , reasonableness of charges.

In this regard, the Director notes that Michigan courts have expressly approved an insurer's determination of reasonableness when the insurer reimbursed 100% of a health care provider's charge where it did not exceed the highest charge for the same procedure charged by 80% of other providers rendering the same service. See Advocacy Org, reasonableness of charges.

Any questions regarding this bulletin should be directed to:

Department of Insurance and Financial Services

Office of General Counsel

530 W. Allegan Street - 8th Floor

P.O. Box 30220

Lansing, Michigan 48909-7720

Toll Free: (877) 999-6442 supra, 257

To view this bulletin, go to https://www.michigan.gov/difs/0,5269,7-303-12900_12906---,00.html.