The Michigan Health Care Services Advisory Council met on January 21st, where state regulators reviewed proposed changes to Michigan’s 2026 fee schedule ruleset.

Healthesystems participated in the meeting, and as an active contributor throughout the rule development process, including a position on the AWP subcommittee, Healthe played a significant role in shaping policy discussions around physician dispensing. A key 2026 change to the ruleset will limit reimbursement for physician dispensed medications to 42 days from the start of care. Kris Kloc, Senior Health Care Specialist at the Workers’ Disability Compensation Agency, clarified payers are not required to reimburse after 42 days but may choose to do so.

Healthe also collaborated with stakeholders to identify and close unintended loopholes involving contrast agent billing. Additionally, the new ruleset eliminates the Michigan specific Modifier GF for non-physicians. One member questioned whether EOBs (Form WC-739) to injured workers is necessary, noting that Michigan is one of the few states that requires it. Director Nolish reaffirmed the form’s importance for transparency and fraud prevention.

The next Council meeting is scheduled for April 15, 2026.

By being actively involved in the rule development process, Healthe ensures that our clinical, operational, and regulatory expertise informs practical, effective policy. This engagement gives us early visibility into emerging changes, allows us to anticipate market impacts, and positions Healthesystems to support our customers with timely guidance and seamless implementation.