May 31, 2016, Introduced by Senator JONES and referred to the Committee on Insurance.
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
calendar year 2016.
(c) The department approves the application of the carrier or
third party administrator before July 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
claim approved under section 5 that meets the conditions of
subsection (7).