Bill Text: MI HB4009 | 2009-2010 | 95th Legislature | Introduced
Bill Title: Insurance; health care corporations; coverage for prosthetics and orthotics; provide for. Amends sec. 415 of 1980 PA 350 (MCL 550.1415) & adds sec. 415a.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2009-01-27 - Printed Bill Filed 01/23/2009 [HB4009 Detail]
Download: Michigan-2009-HB4009-Introduced.html
HOUSE BILL No. 4009
January 22, 2009, Introduced by Rep. Liss and referred to the Committee on Health Policy.
A bill to amend 1980 PA 350, entitled
"The nonprofit health care corporation reform act,"
by amending section 415 (MCL 550.1415) and by adding section 415a.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec.
415. (1) Not later than 12 months after the effective
date
of this act, a health care corporation shall offer or include
coverage,
in all group and nongroup certificates, to provide
benefits
for prosthetic devices to maintain or replace the body
part
of an individual whose covered illness or injury has required
the
removal of that body part. However, certificates resulting from
collective
bargaining agreements shall be exempted from this
subsection.
This coverage shall provide that reasonable charges for
medical
care and attendance for an individual fitted with a
prosthetic
device shall be covered benefits after the individual's
attending
physician has certified the medical necessity or
desirability
for a proposed course of rehabilitative treatment.
(2)
Not later than 12 months after the effective date of this
act,
a A health care corporation shall include coverage, in
all
group
and nongroup certificates , to provide benefits for
prosthetic devices to maintain or replace the body part of an
individual who has undergone a mastectomy. This coverage shall
provide that reasonable charges for medical care and attendance for
an individual who receives reconstructive surgery following a
mastectomy or who is fitted with a prosthetic device shall be
covered
benefits after the individual's attending treating
physician has certified the medical necessity or desirability of a
proposed course of rehabilitative treatment. The cost and fitting
of a prosthetic device following a mastectomy is included within
the
type of coverage intended by this subsection section.
Sec. 415a. (1) A health care corporation shall include in all
group and nongroup certificates benefits for prosthetics and
orthotics that, at a minimum, equal the prosthetics and orthotics
coverage provided for under 42 USC 1395k, 1395l, and 1395m and 42
CFR 410.100, 414.202, 414.210, and 414.228. Benefits shall include
replacement for the prosthetic or orthotic if required because of a
change in the member's physical condition and for repair or
replacement if determined appropriate by the member's treating
physician. Benefits may be limited to the most appropriate model
that adequately meets the medical needs of the member as determined
by the member's treating physician.
(2) A health care corporation may require prior authorization
for prosthetics and orthotics in the same manner that prior
authorization is required for any other covered benefit. A health
care corporation may impose copayments and coinsurance amounts on
prosthetics and orthotics not to exceed the copayment and
coinsurance amounts imposed for prosthetics and orthotics under
part B of medicare, 42 USC 1395j to 1395w-4. A health care
corporation shall reimburse for prosthetics and orthotics at no
less than the fee schedule for prosthetics and orthotics under the
medicare reimbursement fee schedule established by the centers for
medicare and medicaid services based on the health care common
procedure coding system. A health care corporation shall not impose
any annual or lifetime dollar maximum on prosthetics and orthotics
benefits other than an annual or lifetime dollar maximum that
applies in the aggregate to all terms and services covered under
the certificate.
(3) As used in this section:
(a) "Orthotics" means all services requiring custom orthoses.
(b) "Prosthetics" means external extremity prosthetics for the
appendicular skeleton.
Enacting section 1. This amendatory act takes effect 180 days
after the date it is enacted into law.
