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HB 5980

Insurance: no-fault; treatment and services for injuries; revise. Amends sec. 3157 of 1956 PA 218 (MCL 500.3157). TIE BAR WITH: HB 5981'26

2025-2026 Regular Session Introduced by Noah Arbit and 16 co-sponsors

The bill overhauls no-fault PPI reimbursements by setting Medicare-based payment ceilings, adds accreditation requirements for neurological rehab, and defines rates for residential

bill electronically reproduced 05/14/2026
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Bill Summary · HB 5980

Overview

HB 5980 (Michigan, 2025-2026) amends section 3157 of the Insurance Code (1956 PA 218) to adjust no-fault personal protection insurance (PPI) treatment and services for injuries. The bill introduces detailed payment standards for providers, establishes caps and percentages tied to Medicare, creates special rules for certain facilities and services, and adds accreditation requirements for neurological rehabilitation clinics. A tie-bar links this bill to HB 5981.

Main purpose and intent

  • To modify how insurers reimburse providers for treatment and rehabilitative services related to accidental bodily injuries covered by PPI.
  • To establish new payment ceilings and reimbursement formulas, shifting cost containment within Michigan’s no-fault framework.
  • To regulate specific service categories (residential services, attendant care, emergency trauma care, neurological rehabilitation clinics) and set criteria for eligibility and accreditation.

Key provisions and changes

  • Payment ceilings (no more than certain percentages of Medicare):
    • Subsection (2): Limits on payment/reimbursement for treatment or training after July 1, 2021 through 2023 at 200%/195%/190% of Medicare rates, respectively.
    • Subsection (3): Eligibility for payment at 230%/225%/220% of Medicare rates for same periods.
    • Subsection (7) and related: If Medicare has no amount, apply percentage-based limits to the PDMS (charge description master) charges, with specific percentages depending on which subsection applies (2, 3, 5, or 6) and historical bases (January 1, 2019 rates or charges).
  • Special provisions for indigent/trauma facilities:
    • Subsection (4)(a): Providers with 20–30% indigent volume, or freestanding rehabilitation facilities (fewer than 2 designated per year) may qualify for higher payment under subsection (3)(a) or (3) criteria.
    • Eligible providers meeting criteria may be certified annually by the director and listed to insurers.
    • A higher alternative rate (250% of Medicare) available for those furnishing more than 30% of their services under subsection (4)(a).
  • Trauma center payments:
    • Level I/II trauma centers for emergency treatment prior to stabilization have capped payments (240%/235%/230% of Medicare, over the relevant periods).
  • Residential services:
    • Establishes per-day rates for residential services at three levels (1–3) with specific rates and a bed-hold provision after the first two days at a reduced rate (55% of the applicable rate).
  • Attendant care:
    • Home-based attendant care for musculoskeletal injuries (with certain exclusions) limited to a portion of the typical hourly maximums; exceptions allow contracts to exceed the limit.
    • Defined schedules and codes (e.g., G0156, G156) with percentage-based reimbursement tied to Veterans Affairs fee schedules.
  • Accreditation requirements for neurological rehabilitation clinics:
    • Home care and residential service providers must be accredited by major accrediting bodies (e.g., Joint Commission, CARF, CHAP, ACHC) or other director-recognized entities to receive payments under this section.
    • Transitional allowance for providers in the process of accreditation, with deadlines and continuity constraints.
  • Miscellaneous:
    • Adjustments tied to CPI for medical care starting January 1, 2027 and annually thereafter.
    • Clarifies applicability to post-June 10, 2019 injuries and specific treatment categories (guardianship, home/vehicle modifications, nonemergency transportation, etc.).
    • Defines key terms (e.g., “home care,” “residential services levels,” “rest of state,” “stabilized,” etc.).

Affected parties

  • Medical providers delivering treatment and rehabilitative services to no-fault insured individuals (physicians, hospitals, clinics, rehabilitation facilities, home care workers, residential programs, etc.).
  • Insurers/regulators administering PPI benefits and reimbursement.
  • Patients with accidental injuries covered by PPI, particularly those requiring residential or attendant care, emergency trauma, or neurological rehabilitation.
  • Freestanding rehabilitation facilities and neurological rehab clinics (subject to accreditation).

Procedural and timeline aspects

  • Effective date contingent on enactment of related bills (S05917’25 or HB 5981’25).
  • Applies to treatment and training rendered after July 1, 2021, with staged milestones through 2023; ongoing updates via CPI-based adjustments beginning 2027.
  • Director annually certifies and lists eligible providers for subsection (4)(a) payments.
  • Tie-bar ensures HB 5980 moves in tandem with HB 5981.

Notes

  • The bill is introduced and referred to the Insurance Committee, with multiple sponsors.
  • The provisions are complex and involve multiple metrics (Medicare rates, PDMS charges, CPI adjustments, accreditation standards) that will require administrative guidance for implementation.

Compiled from official sources — confirm details with the bill’s official record.

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