Bill Text: MI HB5233 | 2011-2012 | 96th Legislature | Introduced

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Bill Title: Insurance; health; reimbursement for physical therapy services; allow insurers to withhold unless patient has a prescription from a licensed health professional. Amends secs. 3107b, 3405, 3475 & 3631 of 1956 PA 218 (MCL 500.3107b et seq.).

Spectrum: Slight Partisan Bill (Republican 2-1)

Status: (Introduced - Dead) 2012-02-02 - Recommendation Concurred In [HB5233 Detail]

Download: Michigan-2011-HB5233-Introduced.html

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HOUSE BILL No. 5233

 

December 15, 2011, Introduced by Reps. Shirkey, Liss and O'Brien and referred to the Committee on Insurance.

 

     A bill to amend 1956 PA 218, entitled

 

"The insurance code of 1956,"

 

by amending sections 3107b, 3405, 3475, and 3631 (MCL 500.3107b,

 

500.3405, 500.3475, and 500.3631), section 3107b as amended by 2009

 

PA 222 and sections 3405, 3475, and 3631 as amended by 2009 PA 227.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

     Sec. 3107b. Reimbursement or coverage for expenses within

 

personal protection insurance coverage under section 3107 is not

 

required for either any of the following:

 

     (a) A practice of optometric optometry service, unless that

 

service was included in the definition of practice of optometry

 

under section 17401 of the public health code, 1978 PA 368, MCL

 

333.17401, as of May 20, 1992.

 

     (b) A practice of chiropractic service, unless that service

 

was included in the definition of practice of chiropractic under

 

section 16401 of the public health code, 1978 PA 368, MCL

 

333.16401, as of January 1, 2009.

 

     (c) A practice of physical therapy service or practice as a

 

physical therapist assistant service, unless that service was

 

provided by a licensed physical therapist or physical therapist

 

assistant under the supervision of a licensed physical therapist

 

pursuant to a prescription issued by an individual holding a

 

license issued under part 166, 170, 175, or 180 of the public

 

health code, 1978 PA 368, MCL 333.16601 to 333.16648, 333.17001 to

 

333.17084, 333.17501 to 333.17556, or 333.18001 to 333.18058, or

 

the equivalent license issued by another state.

 

     Sec. 3405. (1) For the purpose of doing business as an

 

organization under the prudent purchaser act, 1984 PA 233, MCL

 

550.51 to 550.63, an insurer authorized in this state to write

 

disability insurance that provides coverage for hospital, nursing,

 

medical, surgical, or sick-care benefits may enter into prudent

 

purchaser agreements with providers of hospital, nursing, medical,

 

surgical, or sick-care services pursuant to this section and the

 

prudent purchaser act, 1984 PA 233, MCL 550.51 to 550.63.

 

     (2) An insurer may offer disability insurance policies under

 

which the insured persons shall be required, as a condition of

 

coverage, to obtain hospital, nursing, medical, surgical, or sick-

 

care services exclusively from health care providers who have

 

entered into prudent purchaser agreements. A person to whom such a

 

policy described in this subsection is offered shall also be

 

offered a policy that does not do any of the following:

 

     (a) Does not, as As a condition of coverage, require insured

 

persons to obtain services exclusively from health care providers

 

who have entered into prudent purchaser agreements.

 

     (b) Does not give Give a financial advantage or other

 

advantage to an insured person who elects to obtain services from

 

health care providers who have entered into prudent purchaser

 

agreements.

 

     (3) An insurer may offer disability insurance policies under

 

which insured persons who elect to obtain hospital, nursing,

 

medical, surgical, or sick-care services from health care providers

 

who have entered into prudent purchaser agreements shall realize a

 

financial advantage or other advantage by selecting such providers

 

who have entered into prudent purchaser agreements. Policies

 

offered pursuant to under this subsection shall not, as a condition

 

of coverage, require insured persons to obtain such hospital,

 

nursing, medical, surgical, or sick-care services exclusively from

 

health care providers who have entered into prudent purchaser

 

agreements. A person to whom such a policy described in this

 

subsection is offered shall also be offered a policy that does not

 

do any of the following:

 

     (a) Does not, as As a condition of coverage, require insured

 

persons to obtain services exclusively from health care providers

 

who have entered into prudent purchaser agreements.

 

     (b) Does not give Give a financial advantage or other

 

advantage to an insured person who elects to obtain services from

 

health care providers who have entered into prudent purchaser

 

agreements.

 

     (4) The rates charged by an insurer for coverage under

 

policies issued under this section shall not be unreasonably lower

 

than what is necessary to meet the expenses of the insurer for

 

providing this coverage and shall not have an anticompetitive

 

effect or result in predatory pricing in relation to prudent

 

purchaser agreement coverages offered by other organizations.

 

     (5) An insurer shall not discriminate against a class of

 

health care providers when entering into prudent purchaser

 

agreements with health care providers for its provider panel. This

 

subsection does not do any of the following:

 

     (a) Prohibit the formation of a provider panel consisting of a

 

single class of providers when if a service provided for in the

 

specifications of a purchaser may legally be provided only by a

 

single class of providers.

 

     (b) Prohibit the formation of a provider panel that conforms

 

to the specifications of a purchaser of the coverage authorized by

 

this section so long as if the specifications do not exclude any

 

class of health care providers who may legally perform the services

 

included in the coverage.

 

     (c) Require an organization that has uniformly applied the

 

standards filed pursuant to under section 3(3) of the prudent

 

purchaser act, 1984 PA 233, MCL 550.53, to contract with any

 

individual provider.

 

     (6) Nothing in this 1984 amendatory act PA 280 applies to any

 

contract that is in existence before December 20, 1984, or the

 

renewal of such that contract.

 

     (7) Notwithstanding any other provision of this act, if

 

coverage under a prudent purchaser agreement provides for benefits

 

for services that are within the scope of practice of optometry, an

 

insurer is not required to provide coverage or reimburse for a

 

practice of optometric optometry service unless that service was

 

included in the definition of practice of optometry under section

 

17401 of the public health code, 1978 PA 368, MCL 333.17401, as of

 

May 20, 1992.

 

     (8) Notwithstanding any other provision of this act, if

 

coverage under a prudent purchaser agreement provides for benefits

 

for services that are within the scope of practice of chiropractic,

 

an insurer is not required to provide coverage or reimburse for a

 

practice of chiropractic service unless that service was included

 

in the definition of practice of chiropractic under section 16401

 

of the public health code, 1978 PA 368, MCL 333.16401, as of

 

January 1, 2009.

 

     (9) Notwithstanding any other provision of this act, if

 

coverage under a prudent purchaser agreement provides for benefits

 

for services provided by a licensed physical therapist or physical

 

therapist assistant under the supervision of a licensed physical

 

therapist, an insurer is not required to provide coverage or

 

reimburse for a practice of physical therapy service or practice as

 

a physical therapist assistant service unless that service was

 

provided by a licensed physical therapist or physical therapist

 

assistant under the supervision of a licensed physical therapist

 

pursuant to a prescription issued by an individual holding a

 

license issued under part 166, 170, 175, or 180 of the public

 

health code, 1978 PA 368, MCL 333.16601 to 333.16648, 333.17001 to

 

333.17084, 333.17501 to 333.17556, or 333.18001 to 333.18058, or

 

the equivalent license issued by another state.

 

     Sec. 3475. (1) Notwithstanding any provision of any policy of

 

insurance or certificate, if an insurance policy or certificate

 

provides for reimbursement for any service which may be that is

 

legally performed by a person fully licensed as a psychologist

 

under part 182 of the public health code, 1978 PA 368, MCL

 

333.18201 to 333.18237; by a podiatrist licensed under part 180 of

 

the public health code, 1978 PA 368, MCL 333.18001 to 333.18058; or

 

by a chiropractor licensed under part 164 of the public health

 

code, 1978 PA 368, MCL 333.16401 to 333.16431; reimbursement under

 

the insurance policy or certificate shall not be denied if the

 

service is rendered by a person fully licensed as a psychologist

 

under part 182 of the public health code, 1978 PA 368, MCL

 

333.18201 to 333.18237; by a podiatrist licensed under part 180 of

 

the public health code, 1978 PA 368, MCL 333.18001 to 333.18058; or

 

by a chiropractor licensed under part 164 of the public health

 

code, 1978 PA 368, MCL 333.16401 to 333.16431; within the statutory

 

provisions provided in his or her individual practice act.

 

     (2) This section does not require coverage for a psychologist

 

in any insurance policy. and This section does not require coverage

 

or reimbursement for a any of the following:

 

     (a) A practice of chiropractic service unless that service was

 

included in the definition of practice of chiropractic under

 

section 16401 of the public health code, 1978 PA 368, MCL

 

333.16401, as of January 1, 2009.

 

     (b) A practice of physical therapy service or practice as a

 

physical therapist assistant service unless that service was

 

provided by a licensed physical therapist or physical therapist

 

assistant under the supervision of a licensed physical therapist

 

pursuant to a prescription issued by an individual holding a

 

license issued under part 166, 170, 175, or 180 of the public

 

health code, 1978 PA 368, MCL 333.16601 to 333.16648, 333.17001 to

 

333.17084, 333.17501 to 333.17556, or 333.18001 to 333.18058, or

 

the equivalent license issued by another state.

 

     (3) This section shall does not apply to a policy or

 

certificate written pursuant to section 3405 or 3631 involving a

 

prudent purchaser agreement.

 

     Sec. 3631. (1) For the purpose of doing business as an

 

organization under the prudent purchaser act, 1984 PA 233, MCL

 

550.51 to 550.63, an insurer authorized to write group disability

 

insurance or family expense insurance that provides coverage for

 

hospital, nursing, medical, surgical, or sick-care benefits may

 

enter into prudent purchaser agreements with providers of hospital,

 

nursing, medical, surgical, or sick-care services pursuant to this

 

section and the prudent purchaser act, 1984 PA 233, MCL 550.51 to

 

550.63.

 

     (2) An insurer may offer group disability insurance policies

 

or family expense policies under which the insured persons shall be

 

required, as a condition of coverage, to obtain hospital, nursing,

 

medical, surgical, or sick-care services exclusively from health

 

care providers who have entered into prudent purchaser agreements.

 

     (3) An individual who is a member of a group who is offered

 

the option of being under a policy pursuant to under subsection (2)

 

shall also be offered the option of being insured under a policy

 

pursuant to under subsection (4). This subsection applies only if

 

the group in which the individual is a member has 25 or more

 

members or if the provider panel that is providing the services

 

under the group policy is limited by the organization to a specific

 

number pursuant to section 3(1) of the prudent purchaser act, 1984

 

PA 233, MCL 550.53.

 

     (4) An insurer may offer group disability insurance policies

 

or family expense policies under which insured persons who elect to

 

obtain hospital, nursing, medical, surgical, or sick-care services

 

from health care providers who have entered into prudent purchaser

 

agreements shall realize a financial advantage or other advantage

 

by selecting such a provider providers who have entered into

 

prudent purchaser agreements. Policies offered pursuant to under

 

this subsection shall not, as a condition of coverage, require

 

insured persons to obtain such hospital, nursing, medical,

 

surgical, or sick-care services exclusively from health care

 

providers who have entered into prudent purchaser agreements.

 

     (5) An Subject to subsection (6), an individual who is a

 

member of a group who is offered the option of being insured under

 

a policy pursuant to under subsection (2) or (4) shall also be

 

offered the option of being insured under a policy that does not do

 

any of the following:

 

     (a) Does not, as As a condition of coverage, require insured

 

persons to obtain services exclusively from health care providers

 

who have entered into prudent purchaser agreements.

 

     (b) Does not give Give a financial advantage or other

 

advantage to an insured person who elects to obtain services from

 

health care providers who have entered into prudent purchaser

 

agreements.

 

     (6) Subsection (5) applies only if the group in which the

 

individual is a member has 25 or more members and if the group on

 

December 20, 1984 had health care coverage through the group

 

sponsor.

 

     (7) The rates charged by an insurer for coverage under

 

policies issued under this section shall not be unreasonably lower

 

than what is necessary to meet the expenses of the insurer for

 

providing this coverage and shall not have an anticompetitive

 

effect or result in predatory pricing in relation to prudent

 

purchaser agreement coverages offered by other organizations.

 

     (8) An insurer shall not discriminate against a class of

 

health care providers when entering into prudent purchaser

 

agreements with health care providers for its provider panel. This

 

subsection does not do any of the following:

 

     (a) Prohibit the formation of a provider panel consisting of a

 

single class of providers when if a service provided for in the

 

specifications of a purchaser may legally be provided only by a

 

single class of providers.

 

     (b) Prohibit the formation of a provider panel that conforms

 

to the specifications of a purchaser of the coverage authorized by

 

this section so long as if the specifications do not exclude any

 

class of health care providers who may legally perform the services

 

included in the coverage.

 

     (c) Require an organization that has uniformly applied the

 

standards filed pursuant to under section 3(3) of the prudent

 

purchaser act, 1984 PA 233, MCL 550.53, to contract with any

 

individual provider.

 

     (9) Nothing in this 1984 amendatory act PA 280 applies to any

 

contract that is in existence before December 20, 1984, or the

 

renewal of such that contract.

 

     (10) Notwithstanding any other provision of this act, if

 

coverage under a prudent purchaser agreement provides for benefits

 

for services that are within the scope of practice of optometry, an

 

insurer is not required to provide coverage or reimburse for a

 

practice of optometric optometry service unless that service was

 

included in the definition of practice of optometry under section

 

17401 of the public health code, 1978 PA 368, MCL 333.17401, as of

 

May 20, 1992.

 

     (11) Notwithstanding any other provision of this act, if

 

coverage under a prudent purchaser agreement provides for benefits

 

for services that are within the scope of practice of chiropractic,

 

an insurer is not required to provide coverage or reimburse for a

 

practice of chiropractic service unless that service was included

 

in the definition of practice of chiropractic under section 16401

 

of the public health code, 1978 PA 368, MCL 333.16401, as of

 

January 1, 2009.

 

     (12) Notwithstanding any other provision of this act, if

 

coverage under a prudent purchaser agreement provides for benefits

 

for services provided by a licensed physical therapist or physical

 

therapist assistant under the supervision of a licensed physical

 

therapist, an insurer is not required to provide coverage or

 

reimburse for a practice of physical therapy service or practice as

 

a physical therapist assistant service unless that service was

 

provided by a licensed physical therapist or physical therapist

 

assistant under the supervision of a licensed physical therapist

 

pursuant to a prescription issued by an individual holding a

 

license issued under part 166, 170, 175, or 180 of the public

 

health code, 1978 PA 368, MCL 333.16601 to 333.16648, 333.17001 to

 

333.17084, 333.17501 to 333.17556, or 333.18001 to 333.18058, or

 

the equivalent license issued by another state.

 

     Enacting section 1. This amendatory act does not take effect

 

unless House Bill No. 4603 of the 96th Legislature is enacted into

 

law.