June 16, 2009, Introduced by Reps. Meadows and Sheltrown and referred to the Committee on Health Policy.
A bill to amend 1980 PA 350, entitled
"The nonprofit health care corporation reform act,"
(MCL 550.1101 to 550.1704) by adding section 416e.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 416e. A health care corporation that issues or renews in
this state on or after January 1, 2010 a group certificate shall
provide for both of the following:
(a) That cost-sharing requirements and benefit or service
limitations for outpatient biologically based mental illness
services do not place a greater financial burden on the member and
are not more restrictive than those requirements and limitations
for outpatient medical services.
(b) That cost-sharing requirements and benefit or service
limitations for inpatient hospital biologically based mental
illness services do not place a greater financial burden on the
member and are not more restrictive than those requirements and
limitations for inpatient hospital medical services.
(2) Subsection (1) applies if both of the following are met:
(a) The biologically based mental illness is clinically
diagnosed by a mental health professional.
(b) The prescribed treatment is not experimental or
investigational, having proven its clinical effectiveness in
accordance with generally accepted medical standards.
(3) Subsection (1) does not apply to a health care corporation
to which all of the following apply:
(a) The health care corporation submits documentation
certified by an independent member of the American academy of
actuaries to the commissioner showing that incurred claims for
diagnostic and treatment services for biologically based mental
illness for a period of at least 6 months independently caused the
health care corporation's costs for claims and administrative
expenses for the coverage of all other physical diseases and
disorders to increase by more than 1% per year.
(b) The health care corporation submits a signed letter from
an independent member of the American academy of actuaries to the
commissioner opining that the increase described in subdivision (a)
could reasonably justify an increase of more than 1% in the annual
premiums or rates charged by the health care corporation for the
coverage of all other physical diseases and disorders.
(c) The commissioner, pursuant to the administrative
procedures act of 1969, 1969 PA 306, MCL 24.201 to 24.328, makes
the following determinations from the documentation and opinion
submitted pursuant to subdivisions (a) and (b):
(i) Incurred claims for diagnostic and treatment services for
biologically based mental illnesses for a period of at least 6
months independently caused the health care corporation's costs for
claims and administrative expenses for the coverage of all other
physical diseases and disorders to increase by more than 1% per
year.
(ii) The increase in costs reasonably justifies an increase of
more than 1% in the annual premiums or rates charged by the health
care corporation for the coverage of all other physical diseases
and disorders.
(4) This section does not prohibit a health care corporation
from doing any of the following:
(a) Negotiating separately with mental health care providers
on reimbursement rates and the delivery of health care services.
(b) Offering certificates that provide benefits solely for the
diagnosis and treatment of biologically based mental illnesses.
(c) Managing the provision of benefits for the diagnosis or
treatment of biologically based mental illnesses through the use of
preadmission screening, by requiring prior authorization before
treatment, or through the use of any other mechanism designed to
limit coverage to that treatment that is determined to be
necessary.
(d) Enforcing the terms and conditions of the certificate.
(5) This section does not apply to any certificate that
provides coverage for medicare supplement.
(6) As used in this section:
(a) "Biologically based mental illness" means schizophrenia,
schizoaffective disorder, major depressive disorder, bipolar
disorder, paranoia and other psychotic disorders, obsessive-
compulsive disorder, and panic disorder, as those terms are defined
in the diagnostic and statistical manual of mental disorders
published by the American psychiatric association.
(b) "Mental health professional" means any of the following:
(i) A physician licensed to practice medicine or osteopathic
medicine and surgery in this state under article 15 of the public
health code, 1978 PA 368, MCL 333.16101 to 333.18838.
(ii) A psychologist licensed to practice in this state under
article 15 of the public health code, 1978 PA 368, MCL 333.16101 to
333.18838.
(iii) A master's social worker licensed under article 15 of the
public health code, 1978 PA 368, MCL 333.16101 to 333.18838.
(iv) A professional counselor licensed under article 15 of the
public health code, 1978 PA 368, MCL 333.16101 to 333.18838.