July 31, 2013, Introduced by Senators COLBECK and SCHUITMAKER and referred to the Committee on Government Operations.
A bill to ensure access to quality health care and the
availability of qualified health plans in this state without
expanding government assistance programs; to promote the
availability and affordability of health care coverage in this
state; to create a mechanism for residents of this state to secure
essential health benefits; to establish a regulatory program for a
private marketplace and data interface; to create a fund; to
provide for the powers and duties of certain state and local
governmental officers and entities; and to allow for the
promulgation of rules.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 1. (1) This act shall be known and may be cited as the
"patient-centered care act".
(2) As used in this act, the words and phrases defined in
sections 3 to 5 have the meanings ascribed to them in those
sections.
Sec. 3. (1) "Department" means the department of insurance and
financial services.
(2) "Director" means the director of the department.
(3) "Exchange" means an entity licensed under this act to
provide a marketplace for residents to secure essential health
benefits through a qualified health plan or government assistance
program.
(4) "Federal act" means the patient protection and affordable
care act, Public Law 111-148, as amended by the health care and
education reconciliation act of 2010, Public Law 111-152.
(5) "Fund" means the low-income trust fund created in section
11.
(6) "Government assistance program" means a program of health
care assistance offered by a federal, state, or local governmental
entity including, but not limited to, medicaid, medicare, the
MIChild program, the veterans health administration, and any other
program of health care assistance identified by the department.
Sec. 5. (1) "Medicaid" means a program for medical assistance
established under title XIX of the social security act, 42 USC 1396
to 1396w-5, and administered by the department of community health
under the social welfare act, 1939 PA 280, MCL 400.1 to 400.119b.
(2) "Medicare" means the federal medicare program established
under title XVIII of the social security act, 42 USC 1395 to
1395kkk-1.
(3) "Qualified health plan" means a benefit plan that is
certified as a qualified health plan under section 7.
(4) "Resident" means an individual who is a citizen of the
United States, who voluntarily lives in this state with the
intention of making his or her home in this state and not for a
temporary purpose, and who is not receiving public assistance from
another state.
Sec. 7. (1) For the purpose of available coverage choices for
residents, the department shall certify as a qualified health plan
a benefit plan that complies with 42 USC 18021 and that meets the
requirements of this section.
(2) In certifying a benefit plan as a qualified health plan
under this section, the director shall ensure that the benefit plan
meets all of the following requirements:
(a) Is offered by a health insurer issuer as described in 42
USC 18021(a)(1)(C).
(b) Offers access to quality health care by providing coverage
under a package of benefits that is equal to or greater than that
required as an essential health benefits package as defined in 42
USC 18022. The department shall consider all of the following when
makings its determination under this subdivision:
(i) The availability in the package of benefits under a
traditional insurance option.
(ii) The availability in the package of direct primary care
services.
(iii) The availability in the package of fee-for-service
options, but only if there is a sufficient balance in the benefit
package account to cover minimum essential benefits in combination
with other coverage.
(iv) The availability in the package of any combination of the
options described in subparagraphs (i) to (iii).
Sec. 9. (1) Subject to subsection (7), the department shall
establish and administer a program to license private entities as
an exchange in this state. The department shall develop an
application form and require the submission of documents and
information sufficient to determine if the applicant is eligible
for a license or renewal of a license as an exchange under this
section. The director shall issue a license or renewal of a license
to a person who applies to be an exchange in this state and who
meets all of the following requirements:
(a) The individuals who are identified as being a part of or
associated with the exchange are of good moral character as defined
in section 1200 of the insurance code of 1956, 1956 PA 218, MCL
500.1200.
(b) The person submits with a license or license renewal
application a plan of operation that details its ability to meet
the requirements of this section.
(2) The department shall investigate and determine the merits
of each application submitted by a person under this section. The
department may request additional information from an applicant or
licensee under this section. An applicant or licensee shall comply
with requests for additional information from the department in a
timely manner.
(3) In addition to criteria established by the department
under this section, the department shall determine that the
exchange to be operated by the applicant or licensee meets all of
the following requirements before issuing a license or license
renewal under this section:
(a) Is designed to offer 1 or more qualified health plans to
residents.
(b) Will comply with all data security requirements
established for an exchange under this act.
(c) Is designed so that the enrollment process provides a
resident with the option to provide information necessary to
determine the resident's eligibility for government assistance
programs.
(d) Will ensure accuracy in all aspects of the operation of
the exchange.
(e) Will operate with fiscal solvency.
(f) Will comply with all data security requirements
established by the department under this act.
(g) Will seamlessly and securely make data transmissions that
are required under this act.
(h) Will convey government assistance program eligibility
information to residents.
(i) Will comply with any other applicable federal or state law
governing the privacy of any personally identifying information or
health or medical information of a resident.
(j) Will ensure that a resident who is eligible for a
government assistance program receives a discount from the base
cost of a benefit package in a manner that will enable the resident
to realize 100% of the value of the government assistance program.
(k) If the department determines that enrollment in a
government assistance program through an exchange is not allowed
under the federal act, will issue a coupon to a resident who is
eligible for a government assistance program that may be redeemed
by the resident at the appropriate government assistance program
portal or other appropriate state or local agency.
(4) In developing security standards and data transmission
requirements applicable to an exchange under this act, the
department shall ensure all of the following:
(a) That no information beyond that information necessary to
determine eligibility for government assistance programs is
transmitted to any person outside of the exchange.
(b) That a standardized data schema is used for exchanges to
collect the information that is necessary to determine eligibility
for government assistance programs and convey information
pertaining to that eligibility.
(5) The department shall develop and maintain a government
assistance program portal for use by exchanges and, if the
department determines appropriate, by government assistance
programs, that facilitates the receipt and transmission of data but
only for uses approved by the department under this act.
(6) The department shall reconcile eligibility for multiple
government assistance programs to ensure that benefit eligibility
is determined in the context of cumulative benefits received as a
means of reducing fraud.
(7) The department shall request the United States department
of health and human services for a determination of whether an
exchange to be licensed under this section will be considered to
meet the qualifications of an exchange for the purposes described
in 41 USC 13031. If the department determines that an exchange to
be licensed under this section will not meet the qualifications of
an exchange for the purposes described in 41 USC 13031, the
department shall only issue a license under this section to
nonprofit entities that meet those qualifications.
Sec. 11. (1) The low-income trust fund is created within the
state treasury.
(2) The state treasurer may receive money or other assets from
any source for deposit into the fund. The state treasurer shall
direct the investment of the fund. The state treasurer shall credit
to the fund interest and earnings from fund investments.
(3) Money in the fund at the close of the fiscal year shall
remain in the fund and shall not lapse to the general fund.
(4) The department is the administrator of the fund for
auditing purposes.
(5) The director shall expend money from the fund only for the
purposes of implementing and administering this act and for any
other purpose enumerated in this act.
(6) If the social welfare act, 1939 PA 280, MCL 400.1 to
400.119b, is amended to provide that recipients of the medical
assistance program and the MIChild program are migrated from those
programs and enrolled in qualified health plans that include a
health savings account component through an exchange as provided in
this act, and money saved from that migration is deposited into the
fund, the director shall expend the amount of money deposited into
the fund for the benefit of those former recipients to pay any
deductibles under high-deductible health insurance plan components
of a qualified health plan as triggered by the health care services
needed by the former recipients. The director shall continue to pay
the deductibles for those former recipients until such time as each
former recipient's individual health savings account balance is
determined by the department to be actuarially sufficient to cover
his or her deductibles.
Sec. 13. The department may promulgate rules under the
administrative procedures act of 1969, 1969 PA 306, MCL 24.201 to
24.328, that it determines necessary to implement and administer
this act.