HOUSE BILL No. 5858

 

 

April 24, 2018, Introduced by Reps. Whiteford, Rendon, Lucido, Victory, Sheppard, Canfield, Hoadley, Barrett, Kahle, Alexander and Rabhi and referred to the Committee on Health Policy.

 

     A bill to amend 1984 PA 218, entitled

 

"Third party administrator act,"

 

by amending section 2 (MCL 550.902) and by adding section 27.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

     Sec. 2. As used in this act:

 

     (a) "Administrative services manager" or "manager" means an

 

individual responsible for conducting the daily operations of a

 

third party administrator.

 

     (b) "Benefit plan" or "plan" means a medical, surgical,

 

dental, vision, or health care benefit plan and may include

 

coverage under a policy or certificate issued by a carrier.

 

     (c) "Board" means the TPA advisory board created under section

 

19.

 

     (d) "Carrier" means any of the following:

 


     (i) An an insurer, which is including a health maintenance

 

organization, regulated pursuant to under the insurance code of

 

1956, Act No. 218 of the Public Acts of 1956, being sections 1956

 

PA 218, MCL 500.100 to 500.8302, of the Michigan Compiled Laws.

 

     (ii) A medical care corporation regulated pursuant to Act No.

 

108 of the Public Acts of 1939, being sections 550.301 to 550.316

 

of the Michigan Compiled Laws.

 

     (iii) A hospital service corporation regulated pursuant to Act

 

No. 109 of the Public Acts of 1939, being sections 550.501 to

 

550.517 of the Michigan Compiled Laws.

 

     (iv) A health care corporation regulated pursuant to the

 

nonprofit health care corporation reform act, Act No. 350 of the

 

Public Acts of 1980, being sections 550.1101 to 550.1704 of the

 

Michigan Compiled Laws.

 

     (v) A health maintenance organization regulated under part 210

 

of the public health code, Act No. 368 of the Public Acts of 1978,

 

being sections 333.21001 to 333.21099 of the Michigan Compiled

 

Laws.

 

     (vi) A or a dental care corporation regulated pursuant to Act

 

No. 125 of the Public Acts of 1963, being sections under 1963 PA

 

125, MCL 550.351 to 550.373. of the Michigan Compiled Laws.

 

     (e) "Commissioner" means the commissioner of insurance of this

 

state.director.

 

     (f) "Department" means the department of insurance and

 

financial services.

 

     (g) "Director" means the director of the department.

 

     (h) (f) "ERISA" means the employee retirement income security


act of 1974, as amended, Public Law 93-406. , 88 Stat. 829.

 

     (i) (g) "Person" means an individual, sole proprietorship,

 

partnership, corporation, association, or any other legal entity.

 

     (j) (h) "Personal data" means any record or information

 

pertaining to the diagnosis, treatment, or health of an individual

 

covered by a plan.

 

     (k) "Pharmacy" means that term as defined in section 17707 of

 

the public health code, 1978 PA 368, MCL 333.17707.

 

     (l) "Pharmacy benefit manager" means a person that contracts

 

with a pharmacy on behalf of a benefit plan for the pharmacy to

 

provide pharmacy services to individuals covered by the plan and

 

that determines reimbursement to the pharmacy for the pharmacy

 

services provided to individuals covered by the plan. Pharmacy

 

benefit manager does not include a carrier or an employer

 

sponsoring a plan.

 

     (m) (i) "Processes claims" means the administrative services

 

performed in connection with a claim for benefits under a plan.

 

     (n) (j) "Service contract" means the written agreement for the

 

provision of administrative services between the TPA and a plan, a

 

sponsor of a plan, or a carrier.

 

     (o) (k) "Third party administrator" or "TPA" means a person

 

who that processes claims pursuant to a service contract and who

 

that may also provide 1 or more other administrative services

 

pursuant to a service contract, other than under a worker's

 

compensation self-insurance program pursuant to section 611 of the

 

worker's disability compensation act of 1969, Act No. 317 of the

 

Public Acts of 1969, being section 1969 PA 317, MCL 418.611. of the


Michigan Compiled Laws. Third party administrator includes a

 

pharmacy benefit manager. Third party administrator does not

 

include a carrier or employer sponsoring a plan.

 

     Sec. 27. A contract between a pharmacy benefit manager and a

 

pharmacy must provide that the pharmacy may disclose the current

 

selling price of a drug as provided in section 17757 of the public

 

health code, 1978 PA 368, MCL 333.17757. This section applies to a

 

contract described in this section executed, extended, or renewed

 

on or after the effective date of the amendatory act that added

 

this section.