HOUSE BILL No. 4392


     February 27, 1997, Introduced by Reps. Schroer, Palamara, DeHart, Cherry, LaForge, Freeman, Martinez, Willard, Hammerstrom, Schauer, Wojno, Gire, Bobier, Law, Llewellyn, Crissman, Schermesser, Scott, Brown, Goschka, Callahan, Bogardus, Baird, Frank, Baade, Green, Thomas, Bodem, Profit, Gubow, Griffin, Leland, Murphy, Rocca, Scranton and Brater and
referred to the Committee on Health Policy.


        A bill to amend 1978 PA 368, entitled

   "Public health code,"

   (MCL 333.1101 to 333.25211) by adding section 21052a.

               THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 1         SEC. 21052A.  A HEALTH MAINTENANCE ORGANIZATION SHALL NOT

 2    PROHIBIT OR DISCOURAGE A HEALTH PROFESSIONAL FROM DISCUSSING WITH

 3    AN ENROLLEE OR PROVIDER ANY OF THE FOLLOWING:

 4         (A) HEALTH CARE TREATMENTS AND SERVICES.

 5         (B) QUALITY ASSURANCE PLANS REQUIRED BY LAW, IF APPLICABLE.

 6         (C) THE FINANCIAL RELATIONSHIPS BETWEEN THE HEALTH MAINTE-

 7    NANCE ORGANIZATION AND THE HEALTH PROFESSIONAL INCLUDING ALL OF

 8    THE FOLLOWING AS APPLICABLE:

 9         (i) WHETHER A FEE-FOR-SERVICE ARRANGEMENT EXISTS, UNDER

10    WHICH THE PROVIDER IS PAID A SPECIFIED AMOUNT FOR EACH COVERED

11    SERVICE RENDERED TO THE PARTICIPANT.


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 1         (ii) WHETHER A CAPITATION ARRANGEMENT EXISTS, UNDER WHICH A

 2    FIXED AMOUNT IS PAID TO THE PROVIDER FOR ALL COVERED SERVICES

 3    THAT ARE OR MAY BE RENDERED TO EACH COVERED INDIVIDUAL OR

 4    FAMILY.

 5         (iii) WHETHER PAYMENTS TO PROVIDERS ARE MADE BASED ON STAN-

 6    DARDS RELATING TO COST, QUALITY, OR PATIENT SATISFACTION.












































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