Bill Text: MI HB5228 | 2017-2018 | 99th Legislature | Introduced
Bill Title: Insurance; insurers; insurer preventing pharmacist from disclosing price information to consumer; prohibit. Amends sec. 3529 of 1956 PA 218 (MCL 500.3529).
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2017-11-09 - Bill Electronically Reproduced 11/08/2017 [HB5228 Detail]
Download: Michigan-2017-HB5228-Introduced.html
HOUSE BILL No. 5228
November 8, 2017, Introduced by Reps. Rendon and Whiteford and referred to the Committee on Health Policy.
A bill to amend 1956 PA 218, entitled
"The insurance code of 1956,"
by amending section 3529 (MCL 500.3529), as amended by 2005 PA 306.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 3529. (1) A health maintenance organization may contract
with or employ health professionals on the basis of cost, quality,
availability of services to the membership, conformity to the
administrative procedures of the health maintenance organization,
and other factors relevant to delivery of economical, quality care,
but shall not discriminate solely on the basis of the class of
health professionals to which the health professional belongs.
(2) A health maintenance organization shall enter into
contracts with providers through which health care services are
usually provided to enrollees under the health maintenance
organization plan.
(3)
An affiliated provider contract shall must prohibit the
provider from seeking payment from the enrollee for services
provided
pursuant to under the provider contract, except that the
contract may allow affiliated providers to collect copayments,
coinsurances, and deductibles directly from enrollees.
(4)
An affiliated provider contract shall must contain
provisions assuring all of the following:
(a) The provider meets applicable licensure or certification
requirements.
(b) Appropriate access by the health maintenance organization
to records or reports concerning services to its enrollees.
(c) The provider cooperates with the health maintenance
organization's quality assurance activities.
(d) For a provider that is a pharmacy or pharmacist, that the
provider will disclose the current selling price of a drug as
provided in section 17757 of the public health code, 1978 PA 368,
MCL 333.17757.
(5)
The commissioner director may waive the contract
requirement under subsection (2) if a health maintenance
organization has demonstrated that it is unable to obtain a
contract and accessibility to patient care would not be
compromised.
When If 10% or more of a health maintenance
organization's elective inpatient admissions, or projected
admissions for a new health maintenance organization, occur in
hospitals with which the health maintenance organization does not
have contracts or agreements that protect enrollees from liability
for authorized admissions and services, the health maintenance
organization may be required to maintain a hospital reserve fund
equal to 3 months' projected claims from such hospitals.
(6) A health maintenance organization shall submit to the
commissioner
director for approval standard contract formats
proposed for use with its affiliated providers and any substantive
changes to those contracts. The contract format or change is
considered approved 30 days after filing unless approved or
disapproved within the 30 days. As used in this subsection,
"substantive changes to contract formats" means a change to a
provider contract that alters the method of payment to a provider,
alters the risk assumed by each party to the contract, or affects a
provision required by law.
(7) A health maintenance organization or applicant shall
provide evidence that it has employed, or has executed affiliation
contracts with, a sufficient number of providers to enable it to
deliver the health maintenance services it proposes to offer.
