HOUSE BILL No. 5385


     November 13, 1997, Introduced by Reps. Palamara and Profit and referred to the Committee on Health Policy.


        A bill to amend 1980 PA 350, entitled

   "The nonprofit health care corporation reform act,"

   by amending sections 435, 436, 437, and 438 (MCL 550.1435,

   550.1436, 550.1437, and 550.1438), as added by 1991 PA 60.

               THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 1         Sec. 435.  As used in sections 436 to 439, "program" means

 2    the  Michigan caring  MI CHILD program created in section 436.

 3         Sec. 436.  There may be created within each health care cor-

 4    poration  a Michigan caring  AN MI CHILD program for children.

 5    The program shall provide primary health care coverage for chil-

 6    dren as set forth in section 438 and shall be administered by the

 7    health care corporation.  Each program shall be described in a

 8    certificate that sets forth the benefits provided.  A certificate

 9    and the contribution to be charged  shall be  IS subject to the

10    commissioner's approval.  Contribution requirements shall be


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 1    established in accordance with rating methodologies approved by

 2    the commissioner which, over time, shall not result in either

 3    gain or loss to the corporation.  The rating methodology for a

 4    program shall not include any factors otherwise includable pursu-

 5    ant to other sections of this act that are intended to provide

 6    for subsidies, surcharges, or administrative costs.  Any other

 7    provisions of this act that would otherwise apply to a program

 8    but which are inconsistent with the provisions of this section

 9    and sections 437 to 439 are superseded.

10         Sec. 437.  A child is eligible for enrollment in the program

11    if the child meets all of the following:

12         (a) Is less than 19 years of age.

13         (b) Is unmarried.

14         (c) Resides in a household with income  185%  200% or less

15    of the federal poverty level.

16         (d) Is ineligible to receive health care through title XIX

17    of the social security act, chapter 531, 49 Stat. 620, 42

18    U.S.C. 1396 to  1396d, 1396f to 1369g, and 1396i to 1396s  1396F,

19    1396G-1 TO 1396R-6, AND 1396R-8 TO 1396V.

20         (e) Is enrolled in the program with all other eligible sib-

21    lings who have no other health care coverage available.

22         (f) Is a resident of this state.

23         (g) Has no other health care coverage available.

24         Sec. 438.  (1) Notwithstanding any other provision of this

25    act, a health care corporation may limit the benefits it will

26    furnish to an eligible child enrolled in the program to the

27    following  primary  health care benefits:



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 1         (a) Doctor office visits for a sick child.

 2         (b) Medically necessary outpatient diagnostic tests.

 3         (c) Emergency medical and accident care in a doctor's office

 4    or hospital's emergency room.

 5         (d) Medically necessary outpatient surgery and anesthesia.

 6         (e) Preventive care, including, but not limited to, immuni-

 7    zations and well-child visits to a doctor's office.

 8         (F) INPATIENT HOSPITAL SERVICES.

 9         (G) OUTPATIENT HOSPITAL SERVICES.

10         (H) PHYSICIAN'S SURGICAL AND MEDICAL SERVICES.

11         (I) PRESCRIPTION DRUG COVERAGE.

12         (J) MENTAL HEALTH SERVICES.

13         (K)  (f)  Outpatient substance abuse care.

14         (l) VISION SERVICES.

15         (2) With the commissioner's approval, a health care corpora-

16    tion may provide other health care benefits in addition to the

17     primary  health care benefits set forth in subsection (1).























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