The Michigan Auto No‐Fault Rehabilitation Clinic Fee Schedule

The Michigan Auto No‐Fault Rehabilitation Clinic Fee Schedule

Frequently Asked Questions

Why is this bill needed when we just passed no‐fault reforms in 2019?

• The new law had an unintended consequence of seriously inhibiting the ability of some health care providers to continue

providing needed services for some of our most vulnerable citizens; therefore, the law needs this technical repair.

Does this bill seek to undermine the good changes in the law just passed?

• No. PA21 was adopted by the legislature with broad bi‐partisan support. This Fee Schedule fix is not trying to undo the new

law, rather it simply corrects an unintended consequence and avoidable crisis of care.

Why can’t we just “wait and see” what happens after the 55% provision goes into effect in July?

• An estimated 3,000 or more individuals needing significant long‐term residential supports and supervision following

catastrophic accidents will see their care placed in jeopardy or needlessly disrupted due to anticipated business closures.

The job losses will begin before July 1, 2021.

• This is an avoidable crisis of care due to an unintended consequence that simply needs to be fixed immediately. This Fee

Schedule technical fix does just that.

Does this Fee Schedule increase payment rates to providers over historical rates?

• No – this Fee Schedule fix will enable PA21 to do exactly as intended. Pay the lesser of an approximate of 200% of Medicare

– or – provider rates in effect as of 1/1/2019, as adjusted by CPI.

• No one gets a raise, while many services get a reduced maximum payment.

• This meets the intent of the law.

Does this Fee Schedule pay more than PA21’s 55% would?

• In most cases, the answer is yes, providers would be paid a capped but sustainable amount approximating 200% Medicare.

• If a provider was charging reasonable rates, this proposal allows providers to be paid the lesser of the Fee Schedule’s

reasonable approximation of 200% Medicare – or – provider rates in effect as of 1/1/2019 (in keeping with the intent of the

law).

• It was a mistake to apply the 55% provision to the market‐based rates typical of providers outside of hospitals. This Fee

Schedule simply corrects that mistake.

Why does this proposal base the Schedule on an approximation of 200% Medicare?

• Because 200% of Medicare was the Intent of PA21. The Project Team was looking for a technical fix to the law, not a change

to the legislative intent.

• Additionally, the Schedule seems to render a reasonable and viable amount, while also achieving the legislative goal of

reducing the charges of those charging more, thus reducing the overall costs.

Do Providers get paid only from this Fee Schedule?

• No – If a provider delivers a service where Medicare has an amount payable, the provider would be paid under the

provisions of §3157(2)‐(6). IE: 200% of Medicare. (The Rule)

• If the provider delivers a service where Medicare does not have an amount payable, the provider would be paid the lesser

of this Fee Schedule proposal or provider charges on 1/1/2019. (The Exception)

Why didn’t the Project Team just use Workers Comp?

• The Workers’ Compensation Fee Schedule is based on Medicare codes. As a result, Workers’ Comp has most of the same

limitations as the Medicare list of services.

• Under Work Comp, there are no listed services or amounts payable for a wide variety of No‐Fault benefits such as

Residential Rehabilitation, Long‐Term Care, Attendant Care and several other allowable benefits.

• Thus, this Fee Schedule solution is needed to fill these important gaps.

Will this Schedule help reduce litigation?

• Yes – This Schedule will provide greater definitions for services and levels of residential care, resulting in fewer disputes.

• A goal of PA21 was to reduce litigation. We believe this Schedule will assist in that regard relative to payments for allowable

expenses.

How will Insurance Companies meet their premium reduction requirements?

• Use of a Fee Schedule was just one of the many cost‐saving measures included in PA21. Other measures include: Utilization

Review, Managed Care, Anti‐fraud, shifting Order of Priority to ACP, ACP Caps, and PIP Choice. Combined, these measures

should provide ample savings opportunities.

• PA21’s 200% Medicare Fee Schedule remains unchanged and will provide significant savings beginning July 2021. This Fee

Schedule fix properly aligns with those cost savings solutions, providing savings as well, but without harming an industry,

vulnerable patients, and policyholders.

The MCCA is concerned their assessment will have to be increased. What say you?

• The MCCA is fully funded per statute.

• The MCCA will pay less for services under this Fee Schedule fix than was paid over the past several years, resulting in

Savings which meets the intent (Lower Prices Paid).

• Additionally, going forward, the MCCA will see fewer new claims connected to covered vehicles due to PA21 shifting and

capping coverage to the Assigned Claims Plan and never making their way to the MCCA (Lower Volume of Claims).

• Finally, use of a Fee Schedule was just one of many cost‐savings measures in PA21, including: Utilization Review, Managed

Care, Anti‐fraud, shifting Order of Priority to ACP, ACP Caps, and PIP Choice. All of these provisions will contribute towards a

lower MCCA assessments.

02/26/2021