Reimbursement Advocacy Alert

Wednesday, November 12, 2025

News & Media

Reimbursement Advocacy Alert

The Michigan State Medical Society (MSMS) Health Care Delivery Department receives news from several of Michigan’s health plans and insurers related to policies, programs, and education opportunities. Below are some updates which may be of interest to physicians and other health care team members.

Molina’s In Lieu of Services (ILOS) Nutrition Benefits

In June 2025, Molina launched four In Lieu of Services (ILOS) nutrition benefits in all Molina service areas (Regions 2, 3, 4, 5, 6, and 10). Molina offers medically tailored home delivered meals, healthy home delivered meals, healthy food packs, and produce prescriptions to eligible and qualifying members who meet the clinical risk, social risk, and medical necessity criteria for ILOS benefits, as defined by MDHHS. Additional details can be found in the MDHHS ILOS Policy.

As a new Medicaid benefit, ILOS for nutrition aims to improve health outcomes by offering medically appropriate, cost-effective alternatives to traditional Medicaid services for qualifying members. If you have a Molina member who meets the clinical risk and social risk criteria for ILOS and wish to submit a Pre-Authorization for ILOS benefits, the ILOS Pre-Authorization form is accessible via the Availity provider portal in the resources section under the payer spaces functionality.

This benefit is meant to improve outcomes for members who have food insecurity and an uncontrolled chronic condition causing unnecessary utilization. Referred members will also need to meet medical necessity criteria in order to qualify for the ILOS nutrition benefit.

Molina will be hosting a second ILOS Informational Webinar for Network Providers in early 2026. Details regarding this webinar will be shared in future Provider Network communications.

For more information on Molina’s ILOS nutrition benefits, please reach out to: Erin Conklin, Program Manager, Community Reinvestment.

HAP New Plans and Plan Changes Coming in 2026

Below is a high-level overview of the new HAP plans and changes to current plans effective January 1, 2026.

HAP Commercial Plan Henry Ford Health Select

A new health plan designed to deliver coordinated care and help Michigan businesses manage rising healthcare costs. It offers rich benefits and covers a wide service area. It’s available to small and large employer groups in Genesee, Jackson, Lapeer, Macomb, Oakland, Washtenaw, and Wayne counties. It replaces Henry Ford Choice, Genesys Choice, and Pivotal products.

Henry Ford Health Select is structured as an HMO and an EPA, giving members access to Henry Ford Health, including more than 9,400 affiliated providers, more than 550 care sites and 13 Henry Ford Health acute care hospitals, and ancillary services — including lab, imaging, durable medical equipment, therapy, urgent care and behavioral health — through HAP’s HMO network.

HAP Medicare Advantage Plan – New Plan

HAP Medicare Diabetes and Heart (HMO C-SNP)

A C-SNP plan is a Medicare Advantage plan specifically designed for individuals with certain chronic health conditions. The plan focuses on providing specialized care and support for managing those conditions. Our plan, HAP Medicare Diabetes and Heart (HMO C-SNP), covers the following conditions:

Diabetes mellitus
Chronic heart failure
Cardiovascular disorders

Proof of Condition

Members enrolling in this plan must have their provider attest to their condition by completing our Provider Verification of Chronic Condition form. The form can be found when you log in at hap.org (under Quick Links) or on hap.org/providers. Your patient might bring you the form.

Provider Network

The C-SNP provider network includes HAP Medicare HMO contracted providers. If you are contracted with HAP Medicare HMO, then you are participating in this plan. If you are open to new patients, you are required to see members in this plan.

Members can only see in-network providers. No out-of-network coverage except for emergencies; urgently needed services when the network is unavailable; and when HAP authorizes the use of out-of-network providers.

BCBSM Coding corner: Properly documenting diabetes mellitus

Diabetes is one of the most common chronic conditions affecting patient health and risk scores across Affordable Care Act, Medicare Advantage and Medicaid models. Accurate documentation of diabetes mellitus is important. It ensures coding completeness, supports risk adjustment and reflects true patient complexity.

BCBSM High-intensity in-home care program available through HarmonyCares (HMO/PPO)

Blue Cross Blue Shield of Michigan and Blue Care Network offer a high-intensity in-home care program to our eligible Medicare Advantage members through HarmonyCares. Through this program, the HarmonyCares physician-led interdisciplinary team provides in-home chronic disease management services to complement the care provided by primary care providers. HarmonyCares isn’t a replacement for members’ PCPs or specialists.