Case Management, Guardianship Support, Legal Support, PA21

How Public Act 21 Impacts You

 May 11, 2021

By  Deborah L Weiner Katz, OTR/L, CCM, CLCP

Public Act 21 (PA21) became law in Michigan on June 11, 2019. PA21 represents the first comprehensive Michigan No-Fault coverage changes of any substance in approximately 50 years.

Since the law being passed, there’s been some confusion among advocates and providers about what services have been “actually” eliminated by the law vs. “effectively” eliminated by the 55% fee schedule provision.

We wanted to provide some clarity around these questions.

What Was the Law Prior to PA21?

Prior to the law being passed, if someone was injured in an auto accident, the law allowed for the payment of reasonably necessary products, services, and accommodations. There was no defined list of services specifically allowed or excluded. The only requirement was that the services be reasonably necessary.

What’s Been Actually Eliminated with PA21?

With the passage of PA21, an insurance company is no longer required to pay for family provided attendant care for more than 56 hours per week. This is only actual “cut” in services under the new law. Insurance companies may contract with families for more hours if they would like to, but there’s no requirement.

What’s Been Effectively Eliminated with PA21?

After July 1, 2021 many products, services, and accommodations available through Medicare will be subject to a 45% reduction. This reduction will make it impossible or at least quite impractical for many providers to continue to make those services available. As a result, many of these services will, in effect, be eliminated. Patients will still need the care, but there will be very few, if any, providers offering the care.

What Services are Subject to the 45% Reduction?

This is just a partial list of services generally subject to the 45% reduction:

  • Attendant Care
  • Agency Private Duty Home Care
  • Residential Rehabilitation and Long-Term Care Homes
  • Supported Apartment Programs
  • Case Management
  • Day Treatment Activity Program / Services
  • One-on-One Supervision
  • Vocational Counseling
  • Job Coach Training
  • Recreational Therapy
  • Music Therapy
  • Guardianship Services
  • Specialty Wheelchairs & DME
  • Home Modifications
  • Medications
  • Non-Emergency Transportation

This is a short list of services that providers will be able to continue offering:

  • Physical Therapy
  • Occupational Therapy
  • Speech and Language Pathology Services
  • Psychology and other Counseling Services
  • Physician Services
  • Hospitalizations
  • Nursing Home Care

How You Can Help

PA21 has had and will continue to have a negative impact on patients, providers, and families. In short, the 45% reduction was a mistake and needs to be rectified.

Contact your state legislators and share personal stories of how patients and providers have been affected by the passage of PA21. Ask them to support the passage of bills SB314 and HB4486, which would reverse the damage done by PA21.

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