Year: 2009
Resolution Number: 43
Action Taken: Referred to the Board
Status:
Author(s): Bobby Mukkamala, MD
Sponsor: Praddep Nagaraju, MD
On behalf of: Young Physicians Section
Committee: B (Legislation)
Resolved Section(s):
RESOLVED: That MSMS pursue, through dialogue with the insurance commissioner in Michigan and legislative means, a stop to Blue Cross Blue Shield of Michigan participating in assessment of need of an ambulatory surgery center once it receives certification of need from the state; and be it furtherRESOLVED: That MSMS pursue, through dialogue with the insurance commissioner and legislative means, reform that prohibits Blue Cross Blue Shield of Michigan from dictating how many rooms an ambulatory surgery center can use in its operations once it has determined that the ambulatory surgery center is approved to participate.REFERENCE COMMITTEE RATIONALE: The Committee discussed both the certificate of need as well as the evidence of need process required by Blue Cross Blue Shield of Michigan. While the Committee believes that the additional requirement to meet the evidence of need established by Blue Cross is unnecessary, there are other aspects of this requirement that may hinder the ability of physicians to compete on level terms with the hospital. Also, the Committee was made aware of a previous ruling by the Michigan Insurance Commissioner that makes additional action from that office unlikely. Given the complexity of this issue, the Committee concluded that referral to the Board was the best route in order to formulate an appropriate strategy to address this issue.
RESOLVED: That MSMS pursue, through dialogue with the insurance commissioner in Michigan and legislative means, a stop to Blue Cross Blue Shield of Michigan participating in assessment of need of an ambulatory surgery center once it receives certification of need from the state; and be it furtherRESOLVED: That MSMS pursue, through dialogue with the insurance commissioner and legislative means, reform that prohibits Blue Cross Blue Shield of Michigan from dictating how many rooms an ambulatory surgery center can use in its operations once it has determined that the ambulatory surgery center is approved to participate.REFERENCE COMMITTEE RATIONALE: The Committee discussed both the certificate of need as well as the evidence of need process required by Blue Cross Blue Shield of Michigan. While the Committee believes that the additional requirement to meet the evidence of need established by Blue Cross is unnecessary, there are other aspects of this requirement that may hinder the ability of physicians to compete on level terms with the hospital. Also, the Committee was made aware of a previous ruling by the Michigan Insurance Commissioner that makes additional action from that office unlikely. Given the complexity of this issue, the Committee concluded that referral to the Board was the best route in order to formulate an appropriate strategy to address this issue.
Fiscal Note: NULL
Resolution: View PDF for Duplication of Certificate of Need Process