HOUSE BILL No. 6495


     November 7, 2002, Introduced by Reps. Newell and Richner and referred to the Committee on Insurance and Financial
Services.


        A bill to amend 1956 PA 218, entitled

   "The insurance code of 1956,"

   by amending section 3580 (MCL 500.3580), as added by 2000 PA

   249.

               THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

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             Sec. 3580.  (1) The commissioner shall prepare and beginning

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        January 1, 2001 and annually thereafter publish a consumer guide

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        to health maintenance organizations as provided in this section.

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             (2) The consumer guide to health maintenance organizations

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        shall include all of the following for the most recent year and

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        for the immediately preceding year for which the information is

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        available:

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             (a) The national accreditation status of and any limitation

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        on accreditation for each health maintenance organization.




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             (b) Measurements of the quality of care provided by each

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        health maintenance organization, as required by the commissioner,

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        including, but not limited to, the following health employer data

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        information set categories:

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             (i) Child and adolescent care.

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             (ii) Maternity care.

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             (iii) Cardiac care.

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             (iv) Staying healthy.

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             (v) Member satisfaction.

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             (vi) Women's health.

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             (c) The toll-free telephone number at the office of finan-

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        cial and insurance services that consumers may call to make

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        requests for the consumer guide and make inquiries and complaints

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        about health maintenance organizations.

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             (d) A summary for each health maintenance organization of

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        the  report required to be provided to the commissioner under

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        section 23 of the patient's right to independent review act.

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        INFORMATION REQUIRED TO BE MAINTAINED UNDER SECTION 23(3) OF THE

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        PATIENT'S RIGHT TO INDEPENDENT REVIEW ACT, 2000 PA 251, MCL

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        550.1923, THAT SHALL INCLUDE, BUT IS NOT LIMITED TO, ALL OF THE

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        FOLLOWING:

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             (i) THE TOTAL NUMBER OF REQUESTS FOR EXTERNAL REVIEW.

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             (ii) THE NUMBER OF REQUESTS FOR EXTERNAL REVIEW RESOLVED

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        UPHOLDING THE ADVERSE DETERMINATION OR FINAL ADVERSE DETERMINA-

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        TION AND THE NUMBER RESOLVED REVERSING THE ADVERSE DETERMINATION

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        OR FINAL ADVERSE DETERMINATION.





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             (iii) THE AVERAGE LENGTH OF TIME FOR RESOLUTION.

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             (iv) A SUMMARY OF THE TYPES OF COVERAGES OR CASES FOR WHICH

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        AN EXTERNAL REVIEW WAS SOUGHT.

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             (v) THE NUMBER OF EXTERNAL REVIEWS THAT WERE TERMINATED AS

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        THE RESULT OF A RECONSIDERATION BY THE HEALTH MAINTENANCE ORGANI-

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        ZATION OF ITS ADVERSE DETERMINATION OR FINAL ADVERSE DETERMINA-

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        TION AFTER THE RECEIPT OF ADDITIONAL INFORMATION FROM THE COVERED

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        PERSON OR THE COVERED PERSON'S AUTHORIZED REPRESENTATIVE.

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             (3) The commissioner may request, and a health maintenance

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        organization and the department of community health shall provide

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        in a timely manner, audited health employer information set data

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        and other information that the commissioner needs to prepare the

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        annual consumer guide under subsection (1).

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             (4) The annual consumer guide under subsection (1) shall be

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        written in plain English and shall be presented in a manner that

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        facilitates comparisons among individual health maintenance

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        organizations.  The commissioner shall promote and publicize to

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        the general public the existence of the annual consumer guide.

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        The commissioner shall distribute the guide to members of the

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        public upon request and shall provide access to the consumer

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        guide through the internet.

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             Enacting section 1.  This amendatory act does not take

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        effect unless Senate Bill No. _______ or House Bill No. _______

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        (request no. 07200'02) of the 91st Legislature is enacted into

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        law.







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