June 22, 2006, Introduced by Rep. Mortimer and referred to the Committee on Health Policy.
A bill to amend 1956 PA 218, entitled
"The insurance code of 1956,"
(MCL 500.100 to 500.8302) by adding section 3406s.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 3406s. (1) An insurer that delivers, issues for delivery,
or renews in this state on or after January 1, 2007 an expense-
incurred hospital, medical, or surgical policy or certificate and a
health maintenance organization that issues or renews a group or
individual contract on or after January 1, 2007 shall provide
coverage for the treatment of genetic inborn errors of metabolism
that involve amino acid, carbohydrate, and fat metabolism and for
which medically standard methods of diagnosis, treatment, and
monitoring exist.
(2) Coverage under this section shall include expenses of
diagnosing, monitoring, and controlling disorders by nutritional
and medical assessment, including clinical services, biochemical
analysis, medical supplies, prescription drugs, corrective lenses
for conditions related to the genetic inborn error of metabolism,
nutritional management, and special medical foods used in treatment
to compensate for the metabolic abnormality and to maintain
adequate nutritional status.
(3) Coverage under this section shall not have deductibles,
copayment, coinsurance, dollar limits, or durational limits that
are less favorable than those for physical illness generally.
(4) As used in this section:
(a) "Genetic inborn error of metabolism" means a rare,
inherited disorder that meets all of the following:
(i) Is present at birth.
(ii) If untreated, results in mental retardation or death.
(iii) Causes the necessity for consumption of special medical
foods.
(b) "Special medical foods" means nutritional substances in
any form that meet all of the following:
(i) Are formulated to be consumed or administered internally
under the supervision of a physician.
(ii) Are specifically processed or formulated to be distinct in
1 or more nutrients present in natural food.
(iii) Are intended for the medical and nutritional management of
patients with limited capacity to metabolize ordinary foodstuffs or
certain nutrients contained in ordinary foodstuffs or who have
other specific nutrient requirements as established by medical
evaluation.
(iv) Are essential to optimize growth, health, and metabolic
homeostasis.
(c) "Treatment" means medical services provided by licensed
health care professionals, including physicians and dietitians,
with specific training in managing patients diagnosed with genetic
inborn errors of metabolism.