SB1007, As Passed House, Sep, 20, 2016SB1007, As Passed House, Sep, 20, 2016

SUBSTITUTE FOR

SENATE BILL NO. 1007

     A bill to amend 2012 PA 101, entitled

"Autism coverage reimbursement act,"

by amending section 7 (MCL 550.1837).

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

     Sec. 7. (1) The autism coverage 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) The department shall be is the administrator of the fund

for auditing purposes. The department shall expend money from the

fund, upon on appropriation, only for the purpose of creating,

operating, and funding the program.

     (4) The Except as otherwise provided in subsection (7), the

department shall reimburse carriers and third party administrators

from the fund in the order in which the applications are approved

under the program. If there is insufficient money in the fund to

reimburse a carrier or third party administrator for paid claims

approved under section 5, then reimbursement shall must not be

made. However, applications that are approved but not reimbursed

may be paid if revenues of the fund become available.

     (5) The department shall develop and implement a process to

notify carriers, third party administrators, and the legislature

that funds in this program may be insufficient to cover future

claims when the department reasonably believes that within 60 days

the funds in the program will be insufficient to pay claims. The

process shall, at a minimum, do all of the following:

     (a) Identify a specific date by which carriers and third party

administrators will no longer receive reimbursement for claims

submitted to the program.

     (b) Outline a clear process indicating the order in which

claims pending with the program will be paid.

     (c) Outline a clear process indicating the order in which

claims that were pending with the program when funds became

insufficient will be paid if funds subsequently become available.

     (6) Money in the fund at the close of the fiscal year shall

remain in the fund and shall not lapse to the general fund.

     (7) Subject to subsection (8), from money appropriated to the

fund in calendar year 2016, the department shall reimburse a

carrier or third party administrator for a paid claim approved

under section 5 pursuant to the formula under subsection (8) if the

following conditions are met:

     (a) The carrier or third party administrator submits its

application under section 5 before May 1, 2016.

     (b) The services for which the carrier or third party

administrator is seeking reimbursement were provided before January

1, 2016.

     (c) The department has not already fully reimbursed the

carrier or third party administrator for the paid claim.

     (d) The department approves the paid claim of the carrier or

third party administrator before August 1, 2016.

     (8) The department shall reimburse a carrier or third party

administrator under subsection (7) pursuant to the following

formula:

     (a) First, divide the money appropriated to the fund in

calendar year 2016 by the total paid claims approved under section

5 that meet the conditions under subsection (7).

     (b) Second, multiply the calculation under subdivision (a) by

the amount of the carrier's or third party administrator's paid

claims approved under section 5 that meet the conditions of

subsection (7).