September 20, 2007, Introduced by Senator KAHN and referred to the Committee on Appropriations.
A bill to amend 1956 PA 218, entitled
"The insurance code of 1956,"
by amending section 224b (MCL 500.224b), as amended by 2005 PA 83.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 224b. (1) The department of community health shall assess
a quality assurance assessment fee as follows:
(a) On each health maintenance organization that has a
medicaid managed care contract awarded by the state and
administered by the department of community health, a quality
assurance assessment fee that equals 6% of non-medicare premiums
collected by that health maintenance organization.
(b) On each medicaid managed care organization that is a
specialty prepaid health plan under section 109f of the social
welfare act, 1939 PA 280, MCL 400.109f, and that has a medicaid
managed care contract awarded by the state and administered by the
department of community health, a quality assurance assessment fee
that equals 6% of non-medicare capitation payments collected by
that medicaid managed care organization.
(2) The quality assurance assessment fee collected under
subsection (1) and all federal matching funds attributed to that
fee shall be used for the following purposes and under the
following specific circumstances:
(a) The quality assurance assessment fee shall be implemented
on May 10, 2002 for health maintenance organizations described in
subsection (1)(a) and on August 1, 2005 for medicaid managed care
organizations described in subsection (1)(b).
(b) The quality assurance assessment fee shall be assessed on
the non-medicare premiums collected by each health maintenance
organization described in subsection (1)(a) based on the health
maintenance organization's most recent statement filed with the
commissioner pursuant to sections 438 and 438a. Except as otherwise
provided, the quality assurance assessment fee shall be payable on
a quarterly basis with the first payment due 90 days after the date
the fee is assessed. If a health maintenance organization does not
have non-medicare premium revenue listed in a filing under section
438 or 438a, the assessment shall be based on an estimate by the
department of community health of the health maintenance
organization's non-medicare premiums for the quarter and shall be
payable upon receipt.
(c) The quality assurance assessment fee shall be assessed on
the non-medicare capitation payments collected by each medicaid
managed care organization described in subsection (1)(b) based on
the medicaid managed care organization's most recent financial
status report filed with the department of community health. Except
as otherwise provided, the quality assurance assessment fee shall
be payable on a quarterly basis with the first payment due 90 days
after the date the fee is assessed.
(d) The quality assurance assessment fee shall only be
assessed on an organization described in subsection (1)(a) or (b)
that has in effect a medicaid managed care contract awarded by the
state and administered by the department of community health at the
time of the assessment.
(e)
Beginning October 1, 2007 2008, the quality assurance
assessment fee shall no longer be assessed or collected.
(f) The department of community health shall implement this
section in a manner that complies with federal requirements. If the
department of community health is unable to comply with the federal
requirements for federal matching funds under this section for
organizations described in subsection (1)(a) or is unable to use
the fiscal year 2001-2002 level of support for federal matching
dollars other than for a change in covered benefits or covered
population required under the state's medicaid contract with health
maintenance organizations, the quality assurance assessment fee
under subsection (1)(a) shall no longer be assessed or collected.
(g) If the department of community health is unable to comply
with the federal requirements for federal matching funds under this
section for organizations described in subsection (1)(b) or is
unable to use the centers for medicare and medicaid services
approved fiscal year 2004-2005 level of support for federal
matching dollars other than for a change in covered benefits or
covered population required under the state's medicaid contract
with the managed care organization, the quality assurance
assessment fee under subsection (1)(b) shall no longer be assessed
or collected.
(h) If an organization fails to pay the quality assurance
assessment fee required under subsection (1), the department of
community health may assess the organization a penalty of 5% of the
assessment for each month that the assessment and penalty are not
paid up to a maximum of 50% of the assessment. The department of
community health may also refer for collection to the department of
treasury past due amounts consistent with section 13 of 1941 PA
122, MCL 205.13.
(i) The medicaid health maintenance organization quality
assurance assessment fund is established as a separate fund in the
state treasury. The designated medicaid managed care organization
quality assurance assessment fund is established as a separate fund
in the state treasury. The department of community health shall
deposit the revenue raised through the quality assurance assessment
fee under subsection (1)(a) with the state treasurer for deposit in
the medicaid health maintenance organization quality assurance
assessment fund. The department of community health shall deposit
the revenue raised through the quality assurance assessment fee
under subsection (1)(b) with the state treasurer for deposit in the
designated medicaid managed care organization quality assurance
assessment fund.
(j) In all fiscal years governed by this section, medicaid
reimbursement rates shall not be reduced below the medicaid payment
rates in effect on April 1, 2002 for organizations described in
subsection (1)(a) or below the medicaid payment rates in effect on
July 1, 2005 for organizations described in subsection (1)(b) as a
direct result of the quality assurance assessment fee assessed
under this section. This subdivision does not apply to a change in
medicaid reimbursement rates caused by a change in covered benefits
or change in covered populations required under the state's
medicaid contract with organizations described in subsection (1)(a)
or (b).
(3) As used in this section:
(a) "Medicaid" means title XIX of the social security act, 42
USC 1396 to 1396v.
(b) "Medicare" means title XVIII of the social security act,
42 USC 1395 to 1395hhh.