August 15, 2012, Introduced by Senators MARLEAU and JANSEN and referred to the Committee on Health Policy.
A bill to amend 1978 PA 368, entitled
"Public health code,"
(MCL 333.1101 to 333.25211) by adding sections 22216, 22217, and
22218.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 22216. (1) As used in this section and sections 22217 and
22218:
(a) "Commissioner" means the commissioner of the office of
financial and insurance regulation.
(b) "CPT code" means the applicable current procedural
terminology code as adopted by the American medical association or,
if a CPT code is not available, the applicable code under an
appropriate uniform coding scheme approved by the commission.
(c) "Database" means the Michigan medical care database
established under this section.
(d) "Health benefit plan" means a policy, contract,
certificate, or agreement offered or issued by a health carrier to
provide, deliver, arrange for, pay for, or reimburse any of the
costs of health care services. Health benefit plan does not include
any of the following:
(i) Coverage only for accident or disability income insurance
or any combination of those coverages.
(ii) Coverage issued as a supplement to liability insurance.
(iii) Liability insurance, including general liability insurance
and automobile liability insurance.
(iv) Worker's compensation or similar insurance.
(v) Automobile medical payment insurance.
(vi) Credit-only insurance.
(vii) Coverage for on-site medical clinics.
(viii) Other similar insurance coverage, specified in federal
regulations issued pursuant to the health insurance portability and
accountability act of 1996, Public Law 104-191, under which
benefits for health care services are secondary or incidental to
other insurance benefits.
(ix) A plan that provides the following benefits if those
benefits are provided under a separate policy, certificate, or
contract of insurance or are otherwise not an integral part of the
plan:
(A) Limited scope dental or vision benefits.
(B) Benefits for long-term care, nursing home care, home
health care, community-based care, or any combination of those
benefits.
(C) Other similar, limited benefits specified in federal
regulations issued pursuant to the health insurance portability and
accountability act of 1996, Public Law 104-191.
(x) A plan that provides the following benefits if the
benefits are provided under a separate policy, certificate, or
contract of insurance, there is no coordination between the
provision of the benefits and any exclusion of benefits under any
group health benefit plan maintained by the same plan sponsor, and
the benefits are paid with respect to an event without regard to
whether benefits are provided with respect to such an event under
any group health benefit plan maintained by the same plan sponsor:
(A) Coverage only for a specified disease or illness.
(B) Hospital indemnity or other fixed indemnity insurance.
(xi) Any of the following if offered as a separate policy,
certificate, or contract of insurance:
(A) A medicare supplemental policy as defined in section
1882(g)(1) of the social security act, 42 USC 1395ss.
(B) Coverage supplemental to the coverage provided by the
TRICARE program under 10 USC 1071 to 1110b.
(C) Similar coverage supplemental to coverage provided under a
group health plan.
(e) "Health care service" means any health or medical care
procedure or service rendered by a health provider that meets
either of the following requirements:
(i) Provides testing, diagnosis, or treatment of human disease
or dysfunction.
(ii) Dispenses drugs, medical devices, medical appliances, or
medical goods for the treatment of human disease or dysfunction.
(f) "Health carrier" or "carrier" means any of the following
entities that are subject to the insurance laws and regulations of
this state or otherwise subject to the jurisdiction of the
commissioner:
(i) A health insurer operating pursuant to the insurance code
of 1956, 1956 PA 218, MCL 500.100 to 500.8302.
(ii) A health maintenance organization operating pursuant to
the insurance code of 1956, 1956 PA 218, MCL 500.100 to 500.8302.
(iii) A health care corporation operating pursuant to the
nonprofit health care corporation reform act, 1980 PA 350, MCL
550.1101 to 550.1704.
(iv) A nonprofit dental care corporation operating under 1963
PA 125, MCL 550.351 to 550.373.
(v) Any other entity providing a plan of health insurance,
health benefits, or health services.
(g) Notwithstanding section 22205, "health facility" means a
health facility or agency as that term is defined in section 20106.
(h) "Health professional" means an individual who is licensed
or otherwise authorized to engage in a health profession under
article 15.
(i) "Health provider" means a health facility or health
professional that renders a health care service to a patient.
(2) The commission shall establish and administer a Michigan
medical care database to compile statewide data from carriers on
the cost of health care services rendered by health providers in
this state.
(3) A carrier shall not submit any personal identifying
information, including social security number, with regard to any
patient, insured, or enrollee when submitting data required under
this section and section 22217.
(4) In addition to any other data required by rule promulgated
under this part, the commission shall ensure that the database is
able to collect all of the following from carriers:
(a) For each type of patient encounter with a health provider
designated by the commission, all of the following:
(i) The demographic characteristics of the patient.
(ii) The principal diagnosis.
(iii) The health care service rendered to the patient.
(iv) The date and location where the health care service was
rendered.
(v) The charge for the health care service and the portion of
the charge paid by the carrier and the portion payable by the
patient.
(vi) Whether the bill for the health care service was submitted
on an assigned or nonassigned basis.
(vii) If applicable, the health professional's universal
identification number.
(viii) If the health professional rendering the health care
service is a registered professional nurse who has a specialty
certification as a nurse anesthetist or nurse midwife, the
identification modifier for that nurse anesthetist or nurse
midwife.
(b) Appropriate data from a carrier relating to prescription
drugs for each type of patient encounter with a pharmacist
designated by the commission.
(c) Appropriate data relating to health care costs,
utilization, or resources from carriers and governmental agencies.
(5) The commission shall promulgate rules under the
administrative procedures act of 1969 that govern the access and
retrieval of all medical claims data and other data collected and
stored in the database and any claims clearinghouse approved by the
commission. The commission, in consultation with the commissioner,
carriers, health facilities, and health professionals, may
promulgate rules for the electronic submission of data and
submission and transfer of uniform claim forms in use in this
state.
(6) The commission and any rules promulgated by the commission
shall ensure that confidential or privileged patient data are kept
confidential. The commission shall provide that any records or data
that are subject to a health professional-patient privilege created
or recognized by law are filed in a manner that does not collect
personal identifying information and does not disclose the identity
of the individual protected.
(7) To the extent practicable, when collecting the data
required under this section and section 22217, the commission shall
utilize any standardized claim form or electronic transfer system
being used by carriers, health facilities, and health
professionals.
Sec. 22217. (1) In developing the database, the commission
shall consult with representatives of carriers, health facilities,
and health professionals to ensure that the database is compatible
with data collected and used by those individuals and entities. The
commission shall establish a process that requires carriers to
submit data to the database on a quarterly basis.
(2) The commission may contract with 1 or more qualified,
nongovernmental, independent third parties for services necessary
to carry out the data collection, processing, and storage
activities required under this section and sections 22216 and
22218. Unless permission is specifically granted by the commission,
a third party hired by the commission under this subsection shall
not release, publish, or otherwise use any data to which the third
party has access under its contract and shall otherwise comply with
the requirements of this section and sections 22216 and 22218.
(3) A carrier that violates this section is subject to an
administrative fine of $10,000.00 for each failure to file data as
required by the commission. The commission shall report to the
commissioner a carrier that has failed to file data as required by
the commission for a period of 12 months or more.
Sec. 22218. (1) Beginning with the first February 1 after the
effective date of this section, the commission shall publish an
annual report for the immediately preceding calendar year that
includes all of the following:
(a) For the health care services selected by the commission, a
description of all of the following:
(i) The variation in fees charged by health facilities and
health professionals.
(ii) The geographic variation in the utilization of those
health care services.
(b) The total reimbursement for all health care services.
(c) The total reimbursement for each health care specialty.
(d) The total reimbursement for each CPT code.
(e) The annual rate of change in reimbursement for health care
services by health care specialties and by CPT code.
(f) Any other information the commission considers
appropriate, including information on capitated health care
services.
(2) The commission shall make the data collected by the
database and its reports available on its internet website.