Michigan LPC regulation, in plain English.

If you have seen a post claiming otherwise, the useful thing you can do is link colleagues to the bill text rather than to the summary. Confirm the current version and status on the Michigan Legislature’s own record before relying on any account of it, including this one.

Confirmed

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Still evolving

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What it means for you

If you treat Medicaid patients in private practice and a BH-COVER code appears on a patient’s record, you can no longer bill that patient’s MHP. You need a PIHP contract or a Single Case Agreement to keep treating them. Otherwise the patient may have to move to a CMHSP-affiliated provider.

Next event: be there

Join the protest at BCBSM headquarters.

Stand up for access to mental health care. Organized with Healer’s Choice, alongside the coalition.

When

Friday, August 21, 2026, 12:00pm

Where

BCBSM Headquarters, 600 East Lafayette Boulevard, Detroit

Questions

advocacy@healerschoice.org

Take the impact survey

The surveys stay open to practice owners, fully licensed clinicians, limited licensed clinicians and clients. Aggregated results go to Michigan legislators and DIFS. Three short surveys, one per audience:

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Published. The full statewide impact assessment is approved and live, with the findings, the downloadable report, the client handout and role-based letter templates. Read the impact assessment.

Other ways to act

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What SA means nationally

“Nurse practitioner rendering service in collaboration with a physician.”

The HCPCS Level II definition. It is what Google, AAPC and your coding book will tell you, and it is correct as far as it goes.

What it means on a BCBSM claim

“This is an incident-to claim.”

Blue Cross is using SA to identify which claims are billed incident-to, so those claims can be separated from the rest. No nurse practitioner is involved.

Worked through

Dr. Smith is your supervising clinician and the billing provider. Jamie, an LLPC, sees the patient and provides a 90837. You bill 90837-SA under Dr. Smith’s NPI, and Blue Cross pays Dr. Smith’s contracted rate. Nobody takes a rate cut in Phase 1. What that claim no longer earns is the value-based piece.

What you keep

• •Your contracted rate. It does not drop in Phase 1.
• •Your billing structure. The claim still goes out under the supervising clinician.
• •Your supervision model.
• •Payment. The claims are still payable.

What you lose

• •Value-based reimbursement on those claims.
• •PGIP incentive payments.
• •Quality bonus eligibility.
• •For some group practices, MMHCA estimates that is 5 to 15% of revenue on the affected claims.

Who this does not touch

Medicare Plus Blue. BCN Advantage. Michigan Medicaid, which is MDHHS and not Blue Cross at all.

If you hear that Blue Cross is ending incident-to for Medicare, that is not what is happening in Michigan. This is the commercial book of business.

Phase 2 is the one that hurts

SA is the soft landing. On March 1, 2027 limited licensed clinicians lose office-based incident-to altogether, and what incident-to remains is paid at 80% of the fee schedule.

Facility-based settings keep it. That is the whole substance of the disagreement, and it is why the impact assessment exists.

Three ways out, none of them small

• •Move those caseloads to fully licensed clinicians.
• •Become facility-based: hospital outpatient, a CMHSP, or outpatient psychiatric center qualification.
• •Restructure how supervision works in the practice.

Which of these Michigan law actually allows.

Not a route

Co-location with a medical practice

The clinician works in the same building as a family practice and bills through it. This is still office-based incident-to. Physical proximity does not create facility status.

Real clinical benefit. Not a billing answer.

Not a route

Primary care behavioral health embedding

A behavioral health clinician embedded in a primary care practice, with warm handoffs and same-day access. Clinically this is one of the best models there is. It is also still incident-to, and a primary care office is not a behavioral health facility.

Not a route

Employment by the primary care practice

The physician practice employs the clinician directly. The employment relationship does not change the billing structure or the setting, and a family practice is not an outpatient psychiatric center.

Not a route

A referral agreement or memorandum of understanding

Valuable for care coordination and worth having on its own merits. It changes nothing about billing structure or facility status.

Not a route

A physician joins the counselor-owned practice as an owner

This is the one people reach for when the others fail, and it runs into a different wall: Michigan corporate law, not Blue Cross policy. A professional corporation may only have shareholders licensed to provide the service the corporation provides.

MCL 450.1284(1) for professional corporations and MCL 450.4904(2) for PLLCs say the same thing: where the service falls under the Public Health Code, every shareholder, member and manager must be licensed to render the same professional service.

The same-license rule, in both statutes

“If a professional limited liability company renders a professional service that is included within the public health code … all members and managers of the company must be licensed or legally authorized in this state to render the same professional service.” MCL 450.4904(2).

The professional corporation act says the same thing at MCL 450.1284(1). Whichever form your practice takes, the rule is the same, and it decides what the entity may render, not merely who owns it. An LPC-owned entity is organized to render counseling. Practising medicine through it is not a staffing decision.

There is an exception. Counselors are not in it.

Michigan does permit some mixed-license professional entities. Subsections (3) and (4) of MCL 450.4904 name them:

• •Chiropractic, part 164
• •Medicine, part 170
• •Osteopathic medicine and surgery, part 175
• •Podiatric medicine and surgery, part 180
• •Physician’s assistants, alongside the above

Counseling is part 181. It is not on the list, and neither are social work or marriage and family therapy. The legislature has opened this door before, most recently for chiropractors in 2023. It has not opened it for counselors.

The staff Blue Cross requires

“A multidisciplinary staff for the provision of services which must include: a board-certified or board-eligible psychiatrist; a fully licensed psychologist or master’s level limited licensed psychologist … a licensed master’s social worker, or LMSW.”

Three required disciplines, not one. The same document lists licensed professional counselors and marriage and family therapists as staff a facility may also include. LPCs are permitted. They are not among the three that qualify the facility.

“Significant involvement by a psychiatrist in an OPC facility includes regularly scheduled hours in the facility, and availability for emergency consultation within two hours.”

Regularly scheduled hours on site, and a two-hour emergency consultation window. That is a materially different commitment from a remote oversight contract.

Everything else Blue Cross requires

• •Organization as a legal entity.
• •Full accreditation of each site, by address, for three or four years, by the Joint Commission, AOA, COA, CARF, NCQA, or an MDHHS certification letter for community mental health services.
• •A comprehensive range of mental health services available to the community, which may include psychiatric evaluation and medication management, psychological testing, group and family therapy and crisis services.
• •Emergency services available on a 24-hour basis through program staff.
• •An organized patient record system meeting Blue Cross documentation requirements.
• •Quality and care coordination responsibility resting with the named core leadership team.
• •An on-site visit including review of a sample of medical records. The facility must be ready for it when the application is submitted.
• •A separate application, and approval, for every location.
• •Absence of inappropriate utilization patterns, tested through subscriber complaints, medical necessity audits, peer review and utilization management.
• •Recredentialing every two to three years to verify continued compliance.

What it costs

Psychiatrist arrangements run roughly $150 to $300 an hour depending on scope. That is a range members have reported to MMHCA, not a Blue Cross figure, and it covers only the psychiatrist. Accreditation, the psychologist and LMSW roles, 24-hour emergency cover and the records system are all separate.

Do the arithmetic before anything else. For a solo practice with twenty limited licensed hours a week this does not pencil out. For a group carrying a hundred, it might, and it still may not.

Where to start

• •Read the standards yourself: Clinical program requirements for behavioral health outpatient psychiatric care facility, revised March 13, 2026.
• •Ask Blue Cross, in writing, whether your specific practice and proposed staffing model would satisfy current participation requirements.
• •Price accreditation first, not the psychiatrist. It is the long pole and the one nobody budgets for.
• •Take the structure to a Michigan health care attorney before you sign anything.

MMHCA’s recommendation

Do not sign a psychiatrist employment or contractual agreement in reliance on this pathway until Blue Cross confirms in writing that your specific practice and proposed staffing model satisfy current participation requirements.

We have found no Blue Cross document stating that a counseling practice which hires a psychiatrist thereby qualifies as an OPC. What is published is a list of facility standards, of which psychiatrist staffing is one. The gap between those two things is where the money gets spent.

The question MMHCA has put to Blue Cross

Does Blue Cross consider an independently owned counseling practice that adds a psychiatrist to become an eligible OPC facility, or must additional operational, accreditation and facility requirements also be satisfied?

The published standards answer it one way. It matters that Blue Cross answers it in writing, because the pathway has been offered to practices in general terms and the standards are specific. Until then, treat “apply to become an OPC” as the beginning of a long process rather than a solution to a March 2027 deadline.

And a second question, for counsel rather than for Blue Cross: may a counselor-owned professional corporation or PLLC employ psychiatrists and provide physician services at all, without changing its ownership or organizational structure?

That one is Michigan corporate and professional entity law, not payer policy, and a willing payer does not settle it. Michigan health care counsel has reviewed MMHCA’s reading, that the same-license rule at MCL 450.1284(1) and MCL 450.4904(2) bars it, and confirmed it verbally; written confirmation has been requested and will be cited here when it arrives.

A different structure: collaborative care

Stop trying to preserve incident-to. Bill something else.

In the collaborative care model a primary care practice, a behavioral health care manager and a consulting psychiatrist manage a caseload together, tracked in a registry and reviewed weekly. It is the best-evidenced integration model there is, and it has its own CPT codes, so it does not depend on incident-to at all.

What it is not

• •Collaborative care is built for screening and brief intervention on depression and anxiety, not ongoing intensive psychotherapy.
• •Clients who need long-term therapy still have to be referred out.
• •Bundled monthly payment will not necessarily match per-session therapy revenue.
• •It requires real practice transformation: a registry, outcome measures such as the PHQ-9 and GAD-7, and integration with the primary care team.
• •The medical practice is the billing entity. You are working inside someone else’s practice, not running your own.

The bottom line

No partnership creates the exception. Adding a physician to a private practice does not make it a facility, and adding one as an owner is closed to a counselor-owned practice under Michigan corporate law. What is left is genuine restructuring, a different billing model, or adapting the staffing. That is the shape of the problem, and it is why the association is arguing the policy rather than the paperwork.

What to do next

What MMHCA is advocating for

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What you can do today

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