SENATE BILL NO. 249


   February 3, 1999, Introduced by Senator BYRUM 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 21052b and

   21052c.

               THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 1         SEC. 21052B.  (1) A HEALTH MAINTENANCE ORGANIZATION SHALL

 2    NOT CONDITION EMPLOYMENT WITH THE HEALTH MAINTENANCE ORGANIZATION

 3    OR CANCEL COVERAGE ON, REFUSE TO PROVIDE COVERAGE FOR, OR REFUSE

 4    TO ISSUE OR RENEW A GROUP OR INDIVIDUAL CONTRACT BECAUSE AN

 5    EMPLOYEE, AN APPLICANT FOR EMPLOYMENT, AN ENROLLEE, OR AN APPLI-

 6    CANT FOR ENROLLMENT REFUSES TO HAVE A GENETIC TEST OR BECAUSE OF

 7    THE RESULTS OF A GENETIC TEST.

 8         (2) AS USED IN THIS SECTION:

 9         (A) "GENETIC CHARACTERISTIC" MEANS AN INHERITED GENE OR

10    CHROMOSOME, OR ALTERATION OF A GENE OR CHROMOSOME, THAT IS


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 1    SCIENTIFICALLY OR MEDICALLY BELIEVED TO PREDISPOSE AN INDIVIDUAL

 2    TO A DISEASE, DISORDER, OR SYNDROME, OR TO BE ASSOCIATED WITH A

 3    STATISTICALLY SIGNIFICANT INCREASED RISK OF DEVELOPMENT OF A DIS-

 4    EASE, DISORDER, OR SYNDROME.

 5         (B) "GENETIC TEST" MEANS A TEST FOR DETERMINING THE PRESENCE

 6    OR ABSENCE OF AN INHERITED GENETIC CHARACTERISTIC IN AN INDIVIDU-

 7    AL, INCLUDING TESTS OF NUCLEIC ACIDS SUCH AS DNA, RNA, AND MITO-

 8    CHONDRIAL DNA, CHROMOSOMES, OR PROTEINS, IN ORDER TO IDENTIFY A

 9    GENETIC CHARACTERISTIC.

10         SEC. 21052C.  A HEALTH MAINTENANCE ORGANIZATION SHALL ESTAB-

11    LISH A POLICY GOVERNING TERMINATION OF HEALTH PROFESSIONALS.  THE

12    POLICY SHALL INCLUDE, BUT IS NOT LIMITED TO, ALL OF THE

13    FOLLOWING:

14         (A) NOTICE TO THE HEALTH PROFESSIONAL OF THE TERMINATION IN

15    THE TIME AND MANNER SPECIFIED IN THE HEALTH PROFESSIONAL'S

16    CONTRACT.

17         (B) METHODS BY WHICH THE TERMINATION POLICY WILL BE MADE

18    KNOWN TO HEALTH PROFESSIONALS AND ENROLLEES.

19         (C) WRITTEN NOTIFICATION TO EACH ENROLLEE AT LEAST 30 BUSI-

20    NESS DAYS PRIOR TO THE TERMINATION OR WITHDRAWAL OF AN ENROLLEE'S

21    PRIMARY CARE HEALTH PROFESSIONAL AND ANY OTHER HEALTH PROFES-

22    SIONAL FROM WHICH THE ENROLLEE IS CURRENTLY RECEIVING A COURSE OF

23    TREATMENT.  THE 30-DAY PRIOR NOTICE TO ENROLLEES MAY BE WAIVED IN

24    CASES OF IMMEDIATE TERMINATION OF A HEALTH PROFESSIONAL WHERE IT

25    WAS NECESSARY FOR THE PROTECTION OF THE HEALTH, SAFETY, AND WEL-

26    FARE OF ENROLLEES.





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 1         (D) ASSURANCE OF CONTINUED COVERAGE OF SERVICES AT THE

 2    CONTRACT PRICE BY A TERMINATED HEALTH PROFESSIONAL FOR UP TO 120

 3    CALENDAR DAYS WHERE IT IS MEDICALLY NECESSARY FOR THE ENROLLEE TO

 4    CONTINUE TREATMENT WITH THE TERMINATED HEALTH PROFESSIONAL.  IF

 5    AN ENROLLEE IS PREGNANT, MEDICAL NECESSITY SHALL BE CONSIDERED

 6    DEMONSTRATED AND COVERAGE SHALL CONTINUE TO THE POSTPARTUM EVALU-

 7    ATION OF THE ENROLLEE, UP TO 6 WEEKS AFTER DELIVERY.  THIS SUBDI-

 8    VISION DOES NOT APPLY IF A HEALTH PROFESSIONAL IS TERMINATED

 9    BASED IN WHOLE OR IN PART ON ISSUES CONCERNING INADEQUATE CARE OR

10    IF QUALITY CONTROL STANDARDS HAVE NOT BEEN MET BY THE HEALTH

11    PROFESSIONAL.


































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