HOUSE BILL No. 4991 June 26, 1997, Introduced by Reps. Palamara and Profit and referred to the Committee on Insurance. A bill to amend 1980 PA 350, entitled "The nonprofit health care corporation reform act," by amending section 401 (MCL 550.1401), as amended by 1984 PA 66. THE PEOPLE OF THE STATE OF MICHIGAN ENACT: 1 Sec. 401. (1) A health care corporation established, main- 2 tained, or operating in this state shall offer health care bene- 3 fits to all residents of this state, and may offer other health 4 care benefits as the corporation specifies with the approval of 5 the commissioner. 6 (2) A health care corporation may limit the health care ben- 7 efits that it will furnish, except as provided in this act, and 8 may divide the health care benefitswhichTHAT it elects to 9 furnish into classes or kinds. 03691'97 DKH 2 1 (3) A health care corporation shall not do any of the 2 following: 3 (a) Refuse to issue or continue a certificate to 1 or more 4 residents of this state, except while the individual, based on a 5 transaction or occurrence involving a health care corporation, is 6 serving a sentence arising out of a charge of fraud, is satisfy- 7 ing a civil judgment, or is making restitution pursuant to a vol- 8 untary payment agreement between the corporation and the 9 individual. 10 (b) Refuse to continue in effect a certificate with 1 or 11 more residents of this state, other than for failure to pay 12 amounts due for a certificate, except as allowed for refusal to 13 issue a certificate under subdivision (a). 14 (c) Limit the coverage available under a certificate, with- 15 out the prior approval of the commissioner, unless the limitation 16 is as a result of: an agreement with the person paying for the 17 coverage; an agreement with the individual designated by the per- 18 sons paying for or contracting for the coverage; or a collective 19 bargaining agreement. 20 (D) CANCEL BENEFITS ON, REFUSE TO PROVIDE BENEFITS FOR, OR 21 REFUSE TO ISSUE OR CONTINUE A CERTIFICATE FOR A SUBSCRIBER OR 22 APPLICANT SOLELY BECAUSE OF THE GENETIC INFORMATION OF THAT SUB- 23 SCRIBER OR APPLICANT. AS USED IN THIS SUBDIVISION, "GENETIC 24 INFORMATION" MEANS ANY INFORMATION ABOUT AN INDIVIDUAL THAT IS 25 DERIVED FROM THE PRESENCE, ABSENCE, ALTERATION, OR MUTATION OF A 26 GENE OR GENES, OR THE PRESENCE OR ABSENCE OF A SPECIFIC DNA 27 MARKER OR MARKERS, AND THAT HAS BEEN OBTAINED EITHER FROM AN 03691'97 3 1 ANALYSIS OF THE INDIVIDUAL'S DNA OR FROM AN ANALYSIS OF THE DNA 2 OF A PERSON TO WHOM THE INDIVIDUAL IS RELATED. 3 (4)Nothing in subsection (3) shallSUBSECTION (3) DOES 4 NOT prevent a health care corporation from denying to a resident 5 of this state coverage under a certificate for any of the follow- 6 ing grounds: 7 (a) That the individual was not a member of a groupwhich8 THAT had contracted for coverage under this certificate. 9 (b) That the individual is not a member of a group with a 10 size greater than a minimum size established for a certificate 11 pursuant to sound underwriting requirements. 12 (c) That the individual does not meet requirements for cov- 13 erage contained in a certificate. 14 (5) A certificate may provide for the coordination of bene- 15 fits, subrogation, and the nonduplication of benefits. Savings 16 realized by the coordination of benefits, subrogation, and nondu- 17 plication of benefits shall be reflected in the rates for those 18 certificates. If a group certificate issued by the corporation 19 contains a coordination of benefits provision, the benefits shall 20 be payable pursuant to the coordination of benefits act, 1984 PA 21 64, MCL 550.251 TO 550.255. 22 (6) A health care corporation shall have the right to status 23 as a party in interest, whether by intervention or otherwise, in 24 any judicial, quasi-judicial, or administrative agency proceeding 25 in this state for the purpose of enforcing any rights it may have 26 for reimbursement of payments made or advanced for health care 27 services on behalf of 1 or more of its subscribers or members. 03691'97 4 1 (7) A health care corporation shall not directly reimburse a 2 provider in this state who has not entered into a participating 3 contract with the corporation. 4 (8) A health care corporation shall not limit or deny cover- 5 age to a subscriber or limit or deny reimbursement to a provider 6 on the ground that services were rendered while the subscriber 7 was in a health care facility operated by this state or a politi- 8 cal subdivision of this state. A health care corporation shall 9 not limit or deny participation status to a health care facility 10 on the ground that the health care facility is operated by this 11 state or a political subdivision of this state, if the facility 12 meets the standards set by the corporation for all other facili- 13 ties of that type, government-operated or otherwise. To qualify 14 for participation and reimbursement, a facility shall, at a mini- 15 mum, meet all of the following requirements, which shall apply to 16 all similar facilities: 17 (a) Be accredited by the joint commission on accreditation 18 of hospitals. 19 (b) Meet the certification standards of the medicare program 20 and the medicaid program. 21 (c) Meet all statutory requirements for certificate of 22 need. 23 (d) Follow generally accepted accounting principles and 24 practices. 25 (e) Have a community advisory board. 26 (f) Have a program of utilization and peer review to assure 27 that patient care is appropriate and at an acute level. 03691'97 5 1 (g) Designate that portion of the facilitywhichTHAT is 2 to be used for acute care. 03691'97 Final page. DKH