June 1, 2010, Introduced by Reps. Constan, Miller, Bettie Scott, Switalski, Geiss, Kandrevas, Scripps, Liss, Walsh and Young and referred to the Committee on Government Operations.
A bill to amend 2006 PA 593, entitled
"An act to provide for the sharing of certain health care coverage
information; to provide for the powers and duties of certain
departments and agencies; and to provide penalties and fines,"
by amending sections 1, 3, and 7 (MCL 550.281, 550.283, and
550.287) and by adding section 6.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 1. As used in this act:
(a) "Child support order" means a court order that requires a
named individual to obtain health coverage for a dependent.
(b) (a)
"Department" means the
department of community health.
(c) (b)
"Entity" means a health
insurer; a health maintenance
organization; a nonprofit health care corporation; a managed care
corporation; a preferred provider organization; an organization
operating pursuant to the prudent purchaser act, 1984 PA 233, MCL
550.51 to 550.63; a self-funded health plan; a professional
association, trust, pool, union, or fraternal group, offering
health coverage; a system of health care delivery and financing
operating pursuant to section 3573 of the insurance code of 1956,
1956 PA 218, MCL 500.3573; and a third party administrator.
Effective January 1, 2011, entity includes a party legally
responsible for payment of a health care claim arising out of
chapter 31 of the insurance code of 1956, 1956 PA 218, MCL 500.3101
to 500.3179.
(d) (c)
"Medical assistance"
means the medical assistance
program administered by the state under the social welfare act,
1939 PA 280, MCL 400.1 to 400.119b.
(e) (d)
"Qualified health plan"
means that term as defined in
section 111i of the social welfare act, 1939 PA 280, MCL 400.111i.
Sec. 3. (1) An entity shall provide on a monthly basis to the
department, in a format determined by the department, information
necessary to enable the department or entity to determine whether a
health coverage recipient of the entity is also a medical
assistance recipient or a child support order dependent or is also
subject to a child support order. An entity shall respond to any
department inquiry concerning a request for health coverage
verification.
(2) If a health coverage recipient of the entity is also a
medical assistance recipient, the entity shall do all of the
following by not later than 180 days after the department's
request:
(a) Pay the department for, or assign to the department any
right of recovery owed to the entity for, a covered health claim
for which medical assistance payment has been made.
(b) Respond to any inquiry by the department concerning a
claim for payment for any health care item or service that is
submitted not later than 3 years after the date the health care
item or service was provided.
(3) An entity shall not deny a claim submitted by the
department solely on the basis of the date of submission of the
claim, the method of the submission of the claim, the type or
format of the claim form, or a failure to present proper
documentation at the time the health care item or service that is
the basis of the claim was provided so long as both of the
following apply:
(a) The claim is submitted to the entity within 3 years of the
date that the health care item or service that is the subject of
the claim was provided.
(b) Any action by the state to enforce its rights under this
subdivision is commenced within 6 years of the date that the health
care item or service that is the subject of the claim was provided.
(4) If a health coverage recipient of the entity is also a
medical assistance recipient, the entity shall not deny a health
claim for which medical assistance payment has been made solely
because prior authorization was not received. Where this prior
authorization was not received, the entity shall adjudicate the
health claim as if the prior authorization for the claim had been
requested.
Sec. 6. If the department determines that a health coverage
recipient is also a child support order dependent or is subject to
a child support order, the department may share information
received under section 3 with the department of human services to
enable the department of human services to update its child support
order database.
Sec. 7. An entity that violates this act is subject to an
administrative
fine of not more than $500.00 $750.00
for each day
the entity does not comply with section 3(1) or with a request for
information made pursuant to section 3(2). Upon the department's
determination that a violation of this act has occurred, the entity
has a right to notice of the alleged violation and an opportunity
for a hearing under the administrative procedures act of 1969, 1969
PA 306, MCL 24.201 to 24.328.