550.1510 Additional determinations by commissioner.
321 words·~1 min read·
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550.1510 Additional determinations by commissioner.
Sec. 510.
(1)After considering the information and factors described in section 509(4), the goals of a health care corporation as provided in section 504, and the objectives contained in the provider class plan, the commissioner shall determined 1 of the following:
(a)That the provider class plan achieves the goals of the corporation as provided in section 504.
(b)That although the provider class plan does not substantially achieve 1 or more of the goals of the corporation, a change in the provider class plan is not required because there has been competent, material, and substantial information obtained or submitted to support a determination that the failure to achieve 1 or more of the goals was reasonable due to factors listed in section 509(4).
(c)That a provider class plan does not substantially achieve 1 or more of the goals of the corporation as provided in section 504.
(2)The commissioner shall notify the health care corporation, and each person who has requested a copy of such notice, of a determination under subsection
(1)by certified or registered mail. Determinations made pursuant to subsection (1)(b) or
(c)shall include a concise written statement of specific findings supporting that determination.
(3)An existing provider contract or reimbursement arrangement shall remain in effect until a new provider class plan has been retained and placed into effect as provided in section 506(4). A provider class plan shall not be subject to further review until the expiration of the time period provided in section 509(1).
(4)A provider class plan with respect to which a determination was made under subsection (1)(a) or
(b)shall not be subject to further review until the expiration of 2 years following the determination.
History: 1980, Act 350, Eff. Apr. 3, 1981
Compiler's Notes: Near the end of subsection (1), “determined” evidently should read “determine.”
Popular Name: Blue Cross-Blue Shield
Popular Name: Act 350