November 8, 2007, Introduced by Reps. Sak, Bennett, Miller, Hammel, LeBlanc, Young, Byrnes, Simpson, Cushingberry, Kathleen Law, Hammon, Bauer, Lindberg, Corriveau, Lemmons, McDowell, Ebli, Virgil Smith, Dean, Melton, Byrum, Clack, Meadows, Cheeks, Gillard, Alma Smith and Scott and referred to the Committee on Education.
A bill to amend 2007 PA 106, entitled
"Public employees health benefit act,"
by amending sections 5 and 15 (MCL 124.75 and 124.85).
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 5. (1) Subject to collective bargaining requirements, a
public employer may provide medical, optical, or dental benefits to
public employees and their dependents by any of the following
methods:
(a) By establishing and maintaining a plan on a self-insured
basis. A plan under this subdivision does not constitute doing the
business of insurance in this state and is not subject to the
insurance laws of this state.
(b) By joining with other public employers and establishing
and maintaining a public employer pooled plan to provide medical,
optical, or dental benefits to not fewer than 250 public employees
on a self-insured basis as provided in this act. A pooled plan
shall accept any public employer that applies to become a member of
the pooled plan, agrees to make the required payments, agrees to
remain in the pool for a 3-year period, and satisfies the other
reasonable provisions of the pooled plan. A public employer that
leaves a pooled plan may not rejoin the pooled plan for 2 years
after leaving the plan. A pooled plan under this subdivision does
not constitute doing the business of insurance in this state and,
except as provided in this act, is not subject to the insurance
laws of this state. A pooled plan under this subdivision may enter
into contracts and sue or be sued in its own name.
(c) By procuring coverage or benefits from 1 or more carriers,
either on an individual basis or with 1 or more other public
employers.
(2)
A public employer or pooled plan procuring coverage or
benefits
from 1 or more carriers shall solicit 4 or more bids when
establishing
a medical benefit plan, including at least 1 bid from
a
voluntary employees' beneficiary association described in section
501(c)(9)
of the internal revenue code, 26 USC 501(c)(9). A public
employer
or pooled plan procuring coverage or benefits from 1 or
more
carriers shall solicit 4 or more bids every 3 years when
renewing
or continuing a medical benefit plan, including at least 1
bid
from a voluntary employees' beneficiary association described
in
section 501(c)(9) of the internal revenue code, 26 USC
501(c)(9).
A public employer or pooled plan that provides for
administration
of a medical benefit plan using an authorized third
party
administrator, an insurer, a nonprofit health care
corporation,
or other entity authorized to provide services in
connection
with a noninsured medical benefit plan shall solicit 4
or
more bids for those administrative services when establishing a
medical
benefit plan. A public employer or pooled plan that
provides
for administration of a medical benefit plan using an
authorized
third party administrator, an insurer, a nonprofit
health
care corporation, or other entity authorized to provide
services
in connection with a noninsured medical benefit plan shall
solicit
4 or more bids for those administrative services every 3
years
when renewing or continuing a medical benefit plan.
(2) (3)
This act does not prohibit a public
employer from
participating, for the payment of medical benefits and claims, in a
purchasing pool or coalition to procure insurance, benefits, or
coverage, or health care plan services or administrative services.
(3) (4)
A public university may establish a
medical benefit
plan to provide medical, dental, or optical benefits to its
employees and their dependents by any of the methods set forth in
this section.
(4) (5)
A medical benefit plan that
provides medical benefits
shall provide to covered individuals case management services that
meet the case management accreditation standards established by the
national committee on quality assurance, the joint commission on
health care organizations, or the utilization review accreditation
commission.
Sec.
15. (1) Notwithstanding subsection (2), a A public
employer that has 100 or more employees in a medical benefit plan
shall be provided with claims utilization and cost information as
provided
in subsection (3) (2).
(2)
A public employer who is in an arrangement with 1 or more
other
public employers, and together have 100 or more employees in
a
medical benefit plan or have signed a letter of intent to enter
together
100 or more public employees into a medical benefit plan,
shall
be provided with claims utilization and cost information as
provided
in subsection (3) that is aggregated for all the public
employees
together of those public employers, and, except as
otherwise
permitted under subsection (1), shall not be separated
out
for any of those public employers.
(2) (3)
All medical benefit plans in this
state shall compile,
and
shall make available electronically as provided in subsections
(1)
and (2) subsection (1), complete and accurate claims
utilization
and cost information for the medical benefit plan in
the
aggregate and for each public employer as follows for the most
recent rate renewal period and under the same basis by which the
public employer has been pooled or rated, including:
(a) For persons covered under the medical benefit plan, census
information, including date of birth, gender, zip code, and medical
tier, such as single, dependent, or family.
(b) Monthly claims by provider type and service category
reported by the total number and dollar amounts of claims paid and
reported separately for in-network and out-of-network providers.
(c) The number of claims paid over $50,000.00 and the total
dollar amount of those claims.
(d) The dollar amounts paid for specific and aggregate stop-
loss insurance.
(e) The dollar amount of administrative expenses incurred or
paid, reported separately for medical, pharmacy, dental, and
vision.
(f) The total dollar amount of retentions and other expenses.
(g) The dollar amount for all service fees paid.
(h) The dollar amount of any fees or commissions paid to
agents, consultants, or brokers by the medical benefit plan or by
any public employer or carrier participating in or providing
services to the medical benefit plan, reported separately for
medical, pharmacy, stop-loss, dental, and vision.
(i) Other information as may be required by the commissioner.
(3) (4)
The claims utilization and cost
information required
to be compiled under this section shall be compiled on an annual
basis
and shall cover a relevant the
most recent rate renewal
period.
For purposes of this subsection, the term "relevant period"
means
the 36-month period ending no more than 120 days prior to the
effective
date or renewal date of the medical benefit plan under
consideration.
However, if the medical benefit plan has been in
effect
for a period of less than 36 months, the relevant period
shall
be that shorter period.
(5)
A public employer or combination of public employers shall
disclose
the claims utilization and cost information required to be
provided
under subsections (1) and (2) to any carrier or
administrator
it solicits to provide benefits or administrative
services
for its medical benefit plan, and to the employee
representative
of employees covered under the medical benefit plan,
and
upon request to any carrier or administrator who requests the
opportunity
to submit a proposal to provide benefits or
administrative
services for the medical benefit plan at the time of
the
request for bids. The public employer shall make the claims
utilization
and cost information required under this section
available
at cost and within a reasonable period of time.
(4) (6)
The claims utilization and cost
information required
under this section shall include only de-identified health
information as permitted under the health insurance portability and
accountability act of 1996, Public Law 104-191, or regulations
promulgated under that act, 45 CFR parts 160 and 164, and shall not
include any protected health information as defined in the health
insurance portability and accountability act of 1996, Public Law
104-191, or regulations promulgated under that act, 45 CFR parts
160 and 164.
(5) (7)
All claims utilization and cost
information described
in this section is required to be compiled beginning 60 days after
the effective date of this act. However, claims utilization and
cost information already being compiled on the effective date of
this act is subject to this section on the effective date of this
act.