THE NONPROFIT HEALTH CARE CORPORATION REFORM ACT (EXCERPT) Act 350 of 1980
550.1401d Services performed by physician's assistant; reimbursement; conditions; applicability of section; supervision by physician; definitions.
Sec. 401d.
(1) Subject to subsections (2) and (3), if a health care corporation group or nongroup certificate provides for health care benefits for services performed by a physician's assistant, those benefits or reimbursement for those benefits at the prevailing rate shall not be denied if the services were performed by a physician's assistant acting within the scope of his or her license and provided that the following are met:
(a) If the services were performed by a physician's assistant working for a physician or facility specializing in a particular area of medicine, a physician that specializes in that area of medicine was physically present on the premises when the physician's assistant performed the services.
(b) If the services were performed by a physician's assistant working for a physician or facility engaging in general family practice, a physician need not have been physically present on the premises when the physician's assistant performed the services so long as a consulting physician is within 150 miles or 3 hours' commute to where the services are performed.
(2) This section applies to a physician's assistant who performs services in any of the following:
(a) A county with a population of 25,000 or less.
(b) A certified rural health clinic.
(c) A health professional shortage area.
(3) For purposes of subsection (1), a physician supervising a physician's assistant shall do so from within Michigan or from a state bordering Michigan.
(4) As used in this section:
(a) “Health professional shortage area” means that term as defined in section 332(a)(1) of subpart II of part C of title III of the public health service act, chapter 373, 90 Stat. 2270, 42 U.S.C. 254e.
(b) “Medicaid” means the program of medical assistance established under title XIX of the social security act, chapter 531, 49 Stat. 620, 42 U.S.C. 1396 to 1396g and 1396i to 1396u.
(c) “Medicare” means the federal medicare program established under title XVIII of the social security act, chapter 531, 49 Stat. 620, 42 U.S.C. 1395 to 1395b, 1395b-2, 1395c to 1395i, 1395i-2 to 1395i-4, 1395j to 1395t, 1395u to 1395w-2, 1395w-4 to 1395zz, and 1395bbb to 1395ccc.
(d) “Physician's assistant” means an individual licensed as a physician's assistant under article 15 of the public health code, Act No. 368 of the Public Acts of 1978, being sections 333.16101 to 333.18838 of the Michigan Compiled Laws.
(e) “Rural health clinic” means a rural health clinic as defined under section 1861 of part C of title XVIII of the social security act, chapter 531, 49 Stat. 620, 42 U.S.C. 1395x, and certified to participate in medicaid and medicare.
History: Add. 1991, Act 102, Imd. Eff. Sept. 6, 1991 ;-- Am. 1993, Act 258, Imd. Eff. Nov. 29, 1993 Popular Name: Blue Cross-Blue Shield Popular Name: Act 350
THE NONPROFIT HEALTH CARE CORPORATION REFORM ACT (EXCERPT) Act 350 of 1980
550.1401d Services performed by physician's assistant; reimbursement; conditions; applicability of section; supervision by physician; definitions.
Sec. 401d.
(1) Subject to subsections (2) and (3), if a health care corporation group or nongroup certificate provides for health care benefits for services performed by a physician's assistant, those benefits or reimbursement for those benefits at the prevailing rate shall not be denied if the services were performed by a physician's assistant acting within the scope of his or her license and provided that the following are met:
(a) If the services were performed by a physician's assistant working for a physician or facility specializing in a particular area of medicine, a physician that specializes in that area of medicine was physically present on the premises when the physician's assistant performed the services.
(b) If the services were performed by a physician's assistant working for a physician or facility engaging in general family practice, a physician need not have been physically present on the premises when the physician's assistant performed the services so long as a consulting physician is within 150 miles or 3 hours' commute to where the services are performed.
(2) This section applies to a physician's assistant who performs services in any of the following:
(a) A county with a population of 25,000 or less.
(b) A certified rural health clinic.
(c) A health professional shortage area.
(3) For purposes of subsection (1), a physician supervising a physician's assistant shall do so from within Michigan or from a state bordering Michigan.
(4) As used in this section:
(a) “Health professional shortage area” means that term as defined in section 332(a)(1) of subpart II of part C of title III of the public health service act, chapter 373, 90 Stat. 2270, 42 U.S.C. 254e.
(b) “Medicaid” means the program of medical assistance established under title XIX of the social security act, chapter 531, 49 Stat. 620, 42 U.S.C. 1396 to 1396g and 1396i to 1396u.
(c) “Medicare” means the federal medicare program established under title XVIII of the social security act, chapter 531, 49 Stat. 620, 42 U.S.C. 1395 to 1395b, 1395b-2, 1395c to 1395i, 1395i-2 to 1395i-4, 1395j to 1395t, 1395u to 1395w-2, 1395w-4 to 1395zz, and 1395bbb to 1395ccc.
(d) “Physician's assistant” means an individual licensed as a physician's assistant under article 15 of the public health code, Act No. 368 of the Public Acts of 1978, being sections 333.16101 to 333.18838 of the Michigan Compiled Laws.
(e) “Rural health clinic” means a rural health clinic as defined under section 1861 of part C of title XVIII of the social security act, chapter 531, 49 Stat. 620, 42 U.S.C. 1395x, and certified to participate in medicaid and medicare.
History: Add. 1991, Act 102, Imd. Eff. Sept. 6, 1991 ;-- Am. 1993, Act 258, Imd. Eff. Nov. 29, 1993 Popular Name: Blue Cross-Blue Shield Popular Name: Act 350
THE NONPROFIT HEALTH CARE CORPORATION REFORM ACT (EXCERPT) Act 350 of 1980
550.1401d Services performed by physician's assistant; reimbursement; conditions; applicability of section; supervision by physician; definitions.
Sec. 401d.
(1) Subject to subsections (2) and (3), if a health care corporation group or nongroup certificate provides for health care benefits for services performed by a physician's assistant, those benefits or reimbursement for those benefits at the prevailing rate shall not be denied if the services were performed by a physician's assistant acting within the scope of his or her license and provided that the following are met:
(a) If the services were performed by a physician's assistant working for a physician or facility specializing in a particular area of medicine, a physician that specializes in that area of medicine was physically present on the premises when the physician's assistant performed the services.
(b) If the services were performed by a physician's assistant working for a physician or facility engaging in general family practice, a physician need not have been physically present on the premises when the physician's assistant performed the services so long as a consulting physician is within 150 miles or 3 hours' commute to where the services are performed.
(2) This section applies to a physician's assistant who performs services in any of the following:
(a) A county with a population of 25,000 or less.
(b) A certified rural health clinic.
(c) A health professional shortage area.
(3) For purposes of subsection (1), a physician supervising a physician's assistant shall do so from within Michigan or from a state bordering Michigan.
(4) As used in this section:
(a) “Health professional shortage area” means that term as defined in section 332(a)(1) of subpart II of part C of title III of the public health service act, chapter 373, 90 Stat. 2270, 42 U.S.C. 254e.
(b) “Medicaid” means the program of medical assistance established under title XIX of the social security act, chapter 531, 49 Stat. 620, 42 U.S.C. 1396 to 1396g and 1396i to 1396u.
(c) “Medicare” means the federal medicare program established under title XVIII of the social security act, chapter 531, 49 Stat. 620, 42 U.S.C. 1395 to 1395b, 1395b-2, 1395c to 1395i, 1395i-2 to 1395i-4, 1395j to 1395t, 1395u to 1395w-2, 1395w-4 to 1395zz, and 1395bbb to 1395ccc.
(d) “Physician's assistant” means an individual licensed as a physician's assistant under article 15 of the public health code, Act No. 368 of the Public Acts of 1978, being sections 333.16101 to 333.18838 of the Michigan Compiled Laws.
(e) “Rural health clinic” means a rural health clinic as defined under section 1861 of part C of title XVIII of the social security act, chapter 531, 49 Stat. 620, 42 U.S.C. 1395x, and certified to participate in medicaid and medicare.
History: Add. 1991, Act 102, Imd. Eff. Sept. 6, 1991 ;-- Am. 1993, Act 258, Imd. Eff. Nov. 29, 1993 Popular Name: Blue Cross-Blue Shield Popular Name: Act 350
