MAINTENANCE OF CERTIFICATION

REQUIREMENTS FOR PHYSICIANS

House Bills 5090 & 5091 as introduced

Sponsor:  Rep. Edward J. Canfield, D.O.

Committee:  Health Policy

Complete to 8-19-16

REVISED SUMMARY:

House Bill 5090 would amend two sections of the Public Health Code to clarify that a physician does not need to maintain a national or regional certification that is not specifically required in Article 15 of the Code before receiving a Michigan license or admitting privileges in a hospital.

House Bill 5091 would amend the Insurance Code of 1956 to provide that an insurance company or health maintenance organization (HMO) may not require a physician to maintain a national or regional certification not specifically required by Article 15, before paying or reimbursing a claim.   

House Bill 5090 (proposed MCL 333.16147 and 333.21514)

Under House Bill 5090, in other words, the proposed Section 16147 of the Public Health Code would state that, in spite of any provision in the Code to the contrary, the Department of Licensing and Regulatory Affairs (LARA), the Michigan Board of Medicine, or the Michigan Board of Osteopathic Medicine and Surgery may not require one of its licensed physicians or applicants for a license to maintain a national or regional certification not specifically required in Article 15, before granting a license or license renewal. 

Likewise, the proposed Section 21514 would provide that the owner, operator, or governing body of a hospital may not deny admitting privileges to a physician solely because that physician does not maintain a national or regional certification not specifically required in Article 15. 

House Bill 5091 (proposed MCL 500.2212d)

This bill would add a Section 2212d to the Insurance Code, so that maintenance of national or regional certification of an allopathic or osteopathic physician may not be a condition precedent to the payment or reimbursement of a claim.  This prohibition applies to an insurer that delivers, issues for delivery, or renews in this state an expense-incurred hospital, medical, or surgical policy or certificate issued under Chapters 34 (Disability Insurance Policies) or 36 (Group and Blanket Disability Insurance), as well as an HMO that issues a Health Maintenance Contract under Chapter 35 (Health Maintenance Organizations). 

FISCAL IMPACT:

            House Bills 5090 and 5091 would not likely have a significant fiscal impact on the state or local units of government.

                                                                                        Legislative Analyst:   Jennifer McInerney

                                                                                                Fiscal Analyst:   Paul B.A. Holland

This analysis was prepared by nonpartisan House Fiscal Agency staff for use by House members in their deliberations, and does not constitute an official statement of legislative intent.