HOUSE BILL No. 5327


     February 9, 2000, Introduced by Reps. Godchaux, Vander Roest, Van Woerkom, Birkholz, Dennis, Schermesser, DeHart,
Rocca, Gieleghem, Faunce, Bovin, Brater, Voorhees, Martinez, DeWeese, Green, Scranton and Spade and referred to the Committee
on Insurance and Financial Services.


        A bill to amend 1978 PA 368, entitled

   "Public health code,"

   (MCL 333.1101 to 333.25211) by adding section 21053g.

               THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

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           SEC. 21053G.  (1) A HEALTH MAINTENANCE ORGANIZATION SHALL

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      PROVIDE COVERAGE IN EACH GROUP AND INDIVIDUAL CONTRACT FOR GEN-

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      ERAL ANESTHESIA AND ASSOCIATED FACILITY CHARGES FOR DENTAL PROCE-

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      DURES RENDERED IN A HOSPITAL OR SURGICAL CARE SETTING IF ALL OF

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      THE FOLLOWING ARE MET:

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           (A) THE CLINICAL STATUS OR UNDERLYING MEDICAL CONDITION OF

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      THE ENROLLEE, AS DETERMINED BY THE ENROLLEE'S PRIMARY CARE PHYSI-

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      CIAN, PEDIATRICIAN, OR DENTIST, REQUIRES DENTAL PROCEDURES THAT

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      ORDINARILY WOULD NOT REQUIRE GENERAL ANESTHESIA TO BE RENDERED IN

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      A HOSPITAL OR SURGICAL CARE SETTING.




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           (B) THE ENROLLEE MEETS 1 OR MORE OF THE FOLLOWING:

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           (i) IS UNDER 7 YEARS OF AGE.

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           (ii) IS DEVELOPMENTALLY DISABLED, REGARDLESS OF AGE.

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           (iii) HAS HEALTH THAT IS COMPROMISED AND FOR WHOM GENERAL

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      ANESTHESIA REGARDLESS OF AGE IS MEDICALLY NECESSARY AS DETERMINED

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      BY THE ENROLLEE'S PRIMARY CARE PHYSICIAN, PEDIATRICIAN, OR

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      DENTIST.

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           (2) A HEALTH MAINTENANCE ORGANIZATION MAY REQUIRE PRIOR

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      AUTHORIZATION OF GENERAL ANESTHESIA AND ASSOCIATED FACILITY

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      CHARGES FOR DENTAL CARE PROCEDURES IN THE SAME MANNER THAT PRIOR

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      AUTHORIZATION IS REQUIRED FOR OTHER COVERED BENEFITS.  COVERAGE

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      FOR ANESTHESIA AND ASSOCIATED FACILITY CHARGES UNDER THIS SECTION

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      IS SUBJECT TO ALL OTHER TERMS AND CONDITIONS OF THE CONTRACT THAT

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      APPLY GENERALLY TO OTHER BENEFITS.

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           (3) THIS SECTION DOES NOT REQUIRE A CONTRACT TO PROVIDE COV-

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      ERAGE FOR THE DENTAL PROCEDURE ITSELF, INCLUDING, BUT NOT LIMITED

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      TO, THE DENTIST'S PROFESSIONAL FEE.























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