HOUSE BILL NO. 6154

A bill to amend 1956 PA 218, entitled

"The insurance code of 1956,"

(MCL 500.100 to 500.8302) by adding section 3406cc.

the people of the state of michigan enact:

Sec. 3406cc. (1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall provide coverage for medically necessary treatment related to or as a result of an acquired brain injury. An insurer described in this subsection shall not impose any lifetime limitation or unreasonable annual limitation on the number of days for acute and postacute care for the coverage required under this subsection.

(2) As used in this section:

(a) "Acquired brain injury" means any injury to the brain that occurs after birth and can be caused by infectious diseases, metabolic disorders, endocrine disorders or diminished oxygen, brain tumors, toxins, disease that affects the blood supply to the brain, stroke, or a traumatic brain injury.

(b) "Cognitive communication therapy" means therapy that treats problems with communication that have an underlying cause in a cognitive deficit rather than a primary language or speech deficit and is provided by a speech-language pathologist licensed under part 176 of the public health code, 1978 PA 368, MCL 333.17601 to 333.17613.

(c) "Cognitive rehabilitation therapy" means a process of relearning cognitive skills essential for basic and instrumental daily living that involves licensed occupational therapists, licensed speech-language pathologists, and licensed physical therapists and those they supervise through the coordinated specialized, integrated therapeutic treatments that are provided in dynamic settings designed for efficient and effective relearning following damage to brain cells or brain chemistry due to brain injury.

(d) "Community reintegration services" means services that provide incremental guided real-world therapeutic training to develop skills essential for an individual to participate in life to do all of the following:

(i) Reenter employment.

(ii) Go to school and engage in other productive activity.

(iii) Safely live independently.

(iv) Participate in the individual's community while avoiding rehospitalization and long-term support needs.

(e) "Functional rehabilitation therapy and remediation" means a medically structured approach to rehabilitation for brain disorders that includes licensed occupational therapists, licensed speech language pathologists, licensed physical therapists, and those they supervise by statute that emphasize learning by doing, and focuses relearning a specific task in a prescribed format, with maximum opportunity for repeated correct practice. Compensatory strategies are developed for those skills that are persistently impaired and individuals are trained on daily implementation. To ensure acquisition and use, focus is set on relearning those skills essential for safe daily living in the environment in which they will be used in home and community settings.

(f) "Medical necessity" or "medically necessary" means health care services that are consistent with generally accepted principles of professional medical practice.

(g) "Neurobehavioral therapy" means a set of medical and therapeutic assessments and treatments provided by appropriately licensed occupational therapists, licensed speech language pathologists, licensed physical therapists, and other relevant licensed health care professionals focused on behavioral impairments through the development of pro-social behavior.

(h) "Neurocognitive therapy" means treatment of disorders in which the primary clinical deficit is in cognitive function that has not been present since birth and is a decline from a previously attained level of function.

(i) "Neurofeedback therapy" means a direct training of brain function to enhance self-regulatory capacity or an individual's ability to exert control over behavior, thoughts, and feelings. It is a form of biofeedback whereby a patient can learn to control brain activity that is measured and recorded by an electroencephalogram.

(j) "Neuropsychological testing" means a set of medical and therapeutic assessment and treatments provided by appropriately licensed occupational therapists, licensed speech language pathologists, licensed physical therapists, and other relevant licensed health care professionals focused on amelioration of cognitive, emotional, psychosocial, and behavioral deficits caused by brain injury.

(k) "Psychophysiological testing and treatment" means a set of medical and therapeutic assessment and treatments focused on psychophysiological disorders or physical disorders with psychological overlay.

(l) "Postacute residential treatment" includes integrated medical and therapeutic services, treatment, education, and skills training within a 24/7 real-world environment of care, including home and community settings. Maximum opportunity for correct practice of skills in the context of use develops new neural pathways that ensure ongoing skill use and avoidance of rehospitalization and long-term care.