MI| Bulletin 2026-15-INS explains that, following the Michigan Court of Appeals’ West Michigan Home Care Services decision, the cap in MCL 500.3157(2) applies to home health aide and skilled nursing care because Medicare has an “amount payable” for those services, and the Department’s Utilization Review (UR) Section will process provider appeals on that basis. For UR appeals, petitioning providers must either submit the documented Medicare reimbursement rate applicable to the services at issue or provide all data needed for the CMS Home Health PPS Web Pricer (CCN, admission date, from–through service dates, beneficiary CBSA, state and county FIPS codes, and the patient-specific HIPPS code), with UR decisions made only on timely written materials supplied. The bulletin advises providers who believe they are owed additional reimbursement under West Michigan to first seek reprocessing directly with insurers, to collaborate with insurers in determining appropriate Medicare-based rates, and to contact DIFS if disputes remain, while also reminding parties to consult prior Bulletin 2025-11-INS for related no-fault payment and billing guidance.
Michigan DIFS Clarifies No-Fault Cap: New Guidance on Medicare-Based Rates for Home Health Aides and Skilled Nursing Care
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