HOUSE BILL No. 6222


     November 5, 1998, Introduced by Rep. Llewellyn and referred to the Committee on Insurance.


        A bill to amend 1978 PA 368, entitled

   "Public health code,"

   by amending section 21042 (MCL 333.21042), as amended by 1982 PA

   354.

               THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 1         Sec. 21042.  (1) A person, INCLUDING A PROVIDER SPONSORED

 2    ORGANIZATION, proposing to operate a system of health care deliv-

 3    ery and financing  which  THAT is to be offered to individuals,

 4    whether or not as members of groups, in exchange for a fixed pay-

 5    ment and organized so that providers and the organization are in

 6    some part at risk for the cost of services in a manner similar to

 7    a health maintenance organization, but fails to meet the require-

 8    ments set forth in this part, may operate such a system if the

 9    department and insurance bureau find that the proposed operation

10    will benefit persons who will be served by it.  The operation


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 1    shall be licensed and regulated in the same manner as a health

 2    maintenance organization under this part including the filing of

 3    periodic reports, except to the extent that the department and

 4    insurance bureau, with the advice of the advisory commission,

 5    agree that the regulation is inappropriate to the system of

 6    health care delivery and financing.  A person operating a system

 7    of health care delivery and financing pursuant to this section

 8    shall not advertise or solicit or in any way identify itself in a

 9    manner implying to the public that it is a health maintenance

10    organization licensed under this article.

11         (2) AS USED IN THIS SECTION, "PROVIDER SPONSORED

12    ORGANIZATION" OR "PSO" MEANS A CORPORATION THAT IS AT LEAST 80%

13    OWNED OR CONTROLLED BY 1 OR MORE HOSPITALS, 1 OR MORE PHYSICIANS,

14    OR ANY COMBINATION OF PHYSICIANS AND HOSPITALS, LICENSED UNDER

15    THIS ACT.  OWNERSHIP OR CONTROL IS PRESUMED TO EXIST IF AT LEAST

16    80% OF THE VOTING RIGHTS OR GOVERNANCE RIGHTS OF THE PSO ARE

17    DIRECTLY OR INDIRECTLY OWNED, CONTROLLED, OR OTHERWISE HELD BY

18    ANY COMBINATION OF HOSPITALS OR PHYSICIANS.





















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