SENATE BILL No. 954

February 1, 2000, Introduced by Senators KOIVISTO, A. SMITH, DINGELL, EMERSON,

DE BEAUSSAERT, BYRUM and MURPHY and referred to the Committee on Health Policy.

A bill to amend 1978 PA 368, entitled

"Public health code,"

by amending section 21052a (MCL 333.21052a), as added by 1997 PA

67.

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

1 Sec. 21052a. (1) A health maintenance organization shall

2 not prohibit or discourage a health professional from advocating

3 on behalf of an enrollee for appropriate medical treatment

4 options pursuant to the grievance procedure in section 21034 or

5 21035 or from discussing with an enrollee or provider any of the

6 following:

7 (a) Health care treatments and services.

8 (b) Quality assurance plans required by law, if applicable,

9 INCLUDING WHETHER OR NOT THE HEALTH MAINTENANCE ORGANIZATION

10 MEETS THOSE QUALITY ASSURANCE PLANS.

04952'99 DKH

2

1 (c) The financial relationships between the health

2 maintenance organization and the health professional including

3 all of the following as applicable:

4 (i) Whether a fee-for-service arrangement exists, under

5 which the provider is paid a specified amount for each covered

6 service rendered to the participant.

7 (ii) Whether a capitation arrangement exists, under which a

8 fixed amount is paid to the provider for all covered services

9 that are or may be rendered to each covered individual or

10 family.

11 (iii) Whether payments to providers are made based on stan-

12 dards relating to cost, quality, or patient satisfaction.

13 (2) A HEALTH MAINTENANCE ORGANIZATION SHALL NOT PROHIBIT OR

14 DISCOURAGE A HEALTH PROFESSIONAL FROM TALKING TO THE DEPARTMENT

15 OR THE COMMISSIONER ABOUT DEFICIENCIES IN THE HEALTH MAINTENANCE

16 ORGANIZATION'S QUALITY ASSURANCE PLANS.

04952'99 Final page. DKH