There is no uniform or legally-mandated hourly rate for attendant care in Michigan. Factors that will influence the rate include: (1) the “reasonableness” of the rate; (2) the injury involved; (3) the assistance required; and (4) the limits set by the No-Fault fee schedule.
Typically, the hourly rate for attendant care will be determined either through a negotiated agreement between the insurance company and the provider or through litigation.
To learn more, please check out our page on “Michigan Attendant Care – FAQs.”
What is attendant care?
This service is one of the No-Fault PIP benefits available to seriously injured car accident victims. It pays for a family member, a caregiver or a nurse to provide necessary care to help victims with his or her activities of daily living that they are too injured to do on their own.
What is the hourly rate for attendant care in Michigan?
There is no set hourly rate for attendant care in Michigan. Instead, the amount is based on what is a reasonable amount for the assistance required based on the underlying injuries. However, the rate cannot exceed the maximum amount payable under the No-Fault law’s Medicare-based fee schedule.
What is a reasonable hourly rate for attendant care in Michigan?
Michigan’s No-Fault law requires that all charges for these services must be “reasonable,” but it does not define what reasonable is. Instead, reasonableness is inherently fact-based and specific to the injuries that require the assistance and the degree of treatment that is provided.
The amount cannot exceed what a provider “customarily charges” for like care, nor can it exceed the limits set by the Medicare-based fee schedule. (MCL 500.3107(1)(a); 500.3157(1), (2), (7) and (14))
What factors determine the hourly rate for attendant care in Michigan for family members?
The Michigan Supreme Court in Douglas v. Allstate Insurance Company (#143503, July 30, 2012) said the factors include: (1) The rates charged by “individual caregivers” on the open market; and (2) the rates at which “health care agencies compensate their employees,” but not what they “charge their patients.”
The reimbursement rate for family members who provide in-home attendant care is also subject to the No-Fault fee schedule in MCL 500.3157(7).
How does the Medicare-based fee schedule affect the hourly rate for attendant care in Michigan?
The No-Fault law’s Medicare-based fee schedule limits the hourly rate for attendant care in Michigan by imposing a maximum amount that can be paid for attendant care “rendered after July 1, 2021.” (MCL 500.3157(14)) This applies to rates charged by agencies as well as victim’s family members for in-home care.
For attendant care services provided after July 1, 2021, that are covered by Medicare, the provider will be paid between 200% and 190% of the Medicare reimbursement rate. (MCL 500.3157(2))
However, for attendant services provided after July 1, 2021, that are not covered by Medicare, the provider will be paid between 55% and 52.5% of his or her “charge description master in effect on January 1, 2019” or “the average amount the person charged for [attendant care] on January 1, 2019.” (MCL 500.3157(7)(a))
Examples of the attendant care services that will likely not be fully covered by the new Medicare-based fee schedule include: (1) 24/7 assistance at home; (2) assistance provided by a family member; and (3) personal assistance that involves assisting a car accident victim with bathing, dressing, and using the bathroom.
IMPORTANT: On July 31, 2023, the Michigan Supreme Court ruled in Andary vs. USAA that the No-Fault Medicare-based fee schedule and the limitations on in-home, family-provided attendant care that were added to the No-Fault law in 2019 do not apply retroactively to car accident victims who were injured while covered by an insurance policy issued before June 11, 2019. That means that if (1) the crash that caused your injuries for which you’re receiving attendant care occurred prior to June 11, 2019, and (2) you were covered by a valid No-Fault insurance policy at the time of the crash, then the No-Fault fee schedule’s limits on the hourly rate for your attendant care do not apply.
Can you challenge the hourly rate for attendant care in Michigan?
Initially you or an attorney hired on your behalf can negotiate with the auto insurance company about what is a reasonable hourly rate for attendant care in Michigan. If an amount cannot be voluntarily agreed upon, your attorney can file a Michigan No-Fault insurance lawsuit where the reasonableness of the payment would be litigated.
When negotiating with the auto insurance company, it is important to remind the claims adjuster that if a reasonable rate for family-provided, in-home assistance cannot be agreed on, then a commercial agency will likely have to be hired. Commercial agency provided assistance is considerably more expensive.
What does the hourly rate for attendant care cover in Michigan?
It compensates a caregiver, nurse, or family member who provides a car accident victim with assistance with “activities of daily living.” Activities of daily living include such things as providing assistance with bathing, dressing, eating, and even with using the toilet. These are all activities of our daily life that someone who is seriously injured in an auto accident may not be able to perform independently because of his or her accident-related injuries or limitations. These services can also include monitoring and supervision when someone has a serious brain injury or psychiatric disorder that makes such supervision necessary to protect the safety of an accident victim.
These services involve providing a car accident victim with assistance with the activities including: (1) administering and/or taking medication; (2) walking; (3) moving about both inside and outside a victim’s home; (4) carrying and lifting items for the victim; (5) wound care; and (6) helping a victim get in and out of bed. There are dozens of other examples of these services. It is always specific to the individual, his or her needs and the level and the level of sophistication of the assistance and treatment that is required.
In many cases involving catastrophic injury after an auto accident, assistance is provided on a 24/7 basis.
Who pays for the care?
The “priority” rules in the No-Fault law will always determine whether your own auto insurance company or another insurer will pay for these No-Fault benefits. Generally, it will be your own insurer or that of your spouse or a relative who lives in your home. It could also be the Michigan Assigned Claims Plan.
Who is paid the hourly rate for attendant care in Michigan?
It is paid to the people who provide the assistance to seriously injured car accident victims. The providers could be nurses or home-health aides. Also, the providers can be family members, close friends and/or legal guardians of the car crash victim.
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