Bill Text: MI SB0333 | 2013-2014 | 97th Legislature | Introduced
Bill Title: Insurance; health benefits; health care transparency database; require department of community health to establish, require health carriers to submit data, and require release of certain data and preparation of reports. Amends 1978 PA 368 (MCL 333.1101 - 333.25211) by adding pt. 29.
Spectrum: Partisan Bill (Republican 10-0)
Status: (Introduced - Dead) 2013-04-30 - Referred To Committee On Health Policy [SB0333 Detail]
Download: Michigan-2013-SB0333-Introduced.html
SENATE BILL No. 333
April 30, 2013, Introduced by Senators MARLEAU, KAHN, MOOLENAAR, JANSEN, GREEN, SCHUITMAKER, EMMONS, PAPPAGEORGE, HUNE and JONES and referred to the Committee on Health Policy.
A bill to amend 1978 PA 368, entitled
"Public health code,"
(MCL 333.1101 to 333.25211) by adding part 29.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
PART 29
HEALTH CARE TRANSPARENCY
Sec. 2901. This part may be referred to as the "Michigan
health care transparency law".
Sec. 2903. (1) For purposes of this part, the words and
phrases defined in sections 2905 to 2907 have the meanings ascribed
to them in those sections.
(2) In addition, article 1 contains general definitions and
principles of construction applicable to all articles in this code.
Sec. 2905. (1) "Advisory committee" means the Michigan health
care transparency advisory committee created in section 2914.
(2) "Carrier" means a health carrier.
(3) "Commissioner" means the director of the department of
insurance and financial services.
(4) "CPT code" means the applicable current procedural
terminology code as adopted by the American medical association or,
if a CPT code is not available, the applicable code under an
appropriate uniform coding scheme approved by the director.
(5) "Database" means the Michigan health care transparency
database established pursuant to this part.
Sec. 2907. (1) "Health benefit plan" means a policy, contract,
certificate, or agreement offered or issued by a health carrier to
provide, deliver, arrange for, pay for, or reimburse any of the
costs of health care services. Health benefit plan does not include
any of the following:
(a) Coverage only for accident or disability income insurance
or a combination of those coverages.
(b) Coverage issued as a supplement to liability insurance.
(c) Liability insurance, including general liability insurance
and automobile liability insurance.
(d) Worker's compensation or similar insurance.
(e) Automobile medical payment insurance.
(f) Credit-only insurance.
(g) Coverage for on-site medical clinics.
(h) Other similar insurance coverage, specified in federal
regulations issued pursuant to the health insurance portability and
accountability act of 1996, Public Law 104-191, under which
benefits for health care services are secondary or incidental to
other insurance benefits.
(i) A plan that provides the following benefits if those
benefits are provided under a separate policy, certificate, or
contract of insurance or are otherwise not an integral part of the
plan:
(i) Limited scope dental or vision benefits.
(ii) Benefits for long-term care, nursing home care, home
health care, community-based care, or any combination of those
benefits.
(iii) Other similar, limited benefits specified in federal
regulations issued pursuant to the health insurance portability and
accountability act of 1996, Public Law 104-191.
(j) A plan that provides the following benefits if the
benefits are provided under a separate policy, certificate, or
contract of insurance, there is no coordination between the
provision of the benefits and any exclusion of benefits under any
group health benefit plan maintained by the same plan sponsor, and
the benefits are paid with respect to an event without regard to
whether benefits are provided with respect to such an event under
any group health benefit plan maintained by the same plan sponsor:
(i) Coverage only for a specified disease or illness.
(ii) Hospital indemnity or other fixed indemnity insurance.
(k) Any of the following if offered as a separate policy,
certificate, or contract of insurance:
(i) A medicare supplemental policy as defined in section
1882(g)(1) of the social security act, 42 USC 1395ss.
(ii) Coverage supplemental to the coverage provided by the
TRICARE program under 10 USC 1071 to 1110b.
(iii) Similar coverage supplemental to coverage provided under a
group health plan.
(2) "Health care service" means any health or medical care
procedure or service rendered by a health provider that meets
either of the following requirements:
(a) Provides testing, diagnosis, prevention, or treatment of
human disease or dysfunction.
(b) Dispenses drugs, medical devices, medical appliances, or
medical goods for the treatment of human disease or dysfunction.
(3) "Health carrier" means any of the following entities that
are subject to the insurance laws and regulations of this state or
otherwise subject to the jurisdiction of the commissioner:
(a) A health insurer operating pursuant to the insurance code
of 1956, 1956 PA 218, MCL 500.100 to 500.8302.
(b) A health maintenance organization operating pursuant to
the insurance code of 1956, 1956 PA 218, MCL 500.100 to 500.8302.
(c) A health care corporation operating pursuant to the
nonprofit health care corporation reform act, 1980 PA 350, MCL
550.1101 to 550.1704.
(d) A nonprofit dental care corporation operating under 1963
PA 125, MCL 550.351 to 550.373.
(e) Any other person providing a plan of health insurance,
health benefits, or health services.
(4) For the purposes of data submission to the database in
this part only, "health carrier" includes all of the following:
(a) The medical services administration.
(b) A third party administrator as that term is defined in
section 2 of the third party administrator act, 1984 PA 218, MCL
550.902, if the claims processed are under a service contract with
a person not otherwise considered a health carrier under this part.
(c) An entity that establishes or sponsors a noninsured
benefit plan. As used in this subdivision, "noninsured benefit
plan" means a health benefit plan without coverage by a health
insurer described in subsection (3)(a), a health maintenance
organization described in subsection (3)(b), or a health care
corporation described in subsection (3)(c), or the portion of a
health benefit plan without coverage by a health care corporation,
health maintenance organization, or insurer that has a specific or
aggregate excess loss coverage.
(5) "Health facility" means a health facility or agency as
that term is defined in section 20106.
(6) "Health professional" means an individual who is licensed
or otherwise authorized to engage in the practice of a health
profession under article 15.
(7) "Health provider" means a health facility or health
professional that renders a health care service to a human patient.
Sec. 2909. (1) The director shall establish and administer a
Michigan health care transparency database to compile statewide
data from carriers on the cost of health care services rendered to
residents of this state by health providers in this state. The
director shall ensure that the database is operational by 1 year
after the effective date of this part. In performing his or her
duties under this part, the director shall consult with the
advisory committee.
(2) In addition to any other data required by rule promulgated
under this part, the director shall ensure that the database is
able to collect all of the following from carriers:
(a) For each type of patient encounter with a health provider
designated by the director, all of the following:
(i) The demographic characteristics of the patient.
(ii) The principal diagnosis.
(iii) The health care service rendered to the patient.
(iv) The date and location where the health care service was
rendered.
(v) The claim for the health care service and the portion of
the claim paid by the carrier and the portion payable by the
patient.
(vi) If applicable, the health professional's universal
identification number.
(b) Appropriate data from a carrier relating to prescription
drugs for each type of patient encounter with a pharmacist
designated by the director.
(c) Appropriate data relating to health care costs,
utilization, or resources from carriers and governmental agencies.
(3) The director shall seek to obtain all available money from
any funding source, including federal, state, and local
governmental agencies and private entities, to support the
administration and operation of the database.
Sec. 2911. (1) The department shall promulgate rules under the
administrative procedures act of 1969 that, subject to the
requirements of this part, govern the access and retrieval of all
data collected and stored in the database and any claims
clearinghouse approved by the director. The department, in
consultation with the commissioner and the advisory committee, may
promulgate rules that, subject to the requirements of this part,
provide for the electronic submission of data and submission and
transfer of uniform claim forms in use in this state.
(2) The director and any rules promulgated under this part
shall ensure that patient privacy is protected in compliance with
state and federal medical privacy laws. The director shall ensure
that a person that submits data is allowed a period of time to
review and validate the accuracy of the data before it is released
to the public. The director shall provide that any data that are
subject to a health professional-patient privilege created or
recognized by law are submitted in a manner that does not disclose
the identity of the individual protected.
(3) To protect the integrity of the database, to ensure the
proper use of the database, and to ensure the efficient and proper
administration of the database, a person or governmental agency
shall not permit inspection of data contained in the database,
disclose data contained in the database, or copy or issue a copy of
all or part of data contained in the database except as authorized
by this part, by rule, or by order of a court of competent
jurisdiction. The database and data or any part of the data
contained in the database are not subject to the freedom of
information act, 1976 PA 442, MCL 15.231 to 15.246. In addition to
any other requirement under this part, the department shall
establish procedures that provide for adequate standards of
security for the database.
(4) To the extent practicable, the director shall ensure that
data collection under this part meets both of the following
requirements:
(a) It utilizes any standardized claim form or electronic
transfer system being used in this state by carriers and health
providers.
(b) It is in alignment with national, regional, and other
uniform all-payer claims databases' standards.
(5) The director may establish a fee to charge carriers for
the submission of data. If a fee is established as provided in this
subsection, a carrier shall pay the fee to submit data as provided
in this part. The director shall charge all carriers the same rate
for the submission of data. The director shall not charge a carrier
that pays a fee under this subsection any additional fee for
receiving any data released from the database.
Sec. 2913. (1) In establishing, administering, or modifying
the database, the director shall ensure that the database is
compatible with data collected and used by carriers and health
providers. The director shall establish a process that requires
carriers to submit data to the database on a quarterly basis. A
carrier shall submit data as required by the director under this
subsection and shall pay the fee, if any, established by the
director under section 2911.
(2) In establishing, administering, or modifying the database,
the director shall develop a means of releasing data from the
database in a manner that complies with state and federal law
relating to medical privacy and the protection of personal
identifying information. The director shall accommodate requests
for all or parts of the claims data from consumers, representatives
of consumers, health providers, academic researchers, or other
persons. The director may establish a fee to charge persons for the
release of data requested under this subsection. If established,
the fee must be reasonable and designed to recover the cost to the
department of releasing the data under this subsection.
(3) The director may contract for services necessary to carry
out the data collection, processing, and storage activities
required under this part. Unless permission is specifically granted
by the director, a third party under contract with the director
under this subsection shall not release, publish, or otherwise use
any data to which the third party has access under its contract and
shall otherwise comply with the requirements of this part.
(4) A carrier that violates this section is subject to an
administrative fine of $10,000.00 for each day that the carrier
fails to file data as required by the director. The director shall
report to the commissioner a carrier that has failed to file data
as required by the director for a period of 12 months or more.
Sec. 2914. (1) The Michigan health care transparency advisory
committee is created in the department. Notwithstanding section
2215, the advisory committee is created on an ongoing basis.
(2) The director and the commissioner are ex officio members
of the advisory committee without vote. The governor and the
director shall appoint the members first appointed to the advisory
committee within 45 days after the effective date of this part.
Members appointed to the advisory committee are subject to the
advice and consent of the senate. The governor shall appoint 3
members and the director shall appoint other members as he or she
considers necessary to meet the requirements of this subsection and
to perform the duties of the advisory committee under this part.
The governor and the director shall appoint members so that the
advisory committee consists of representatives of health carriers,
health providers, and purchasers, including but not limited to
small businesses and individuals, of health benefit plans.
(3) Except as otherwise provided in this subsection, appointed
members of the advisory committee shall serve for terms of 4 years
or until a successor is appointed and approved to serve, whichever
is later. For the members initially appointed under subsection (2),
the director may designate staggered terms so that not more than
half of the appointed members' terms will expire in any 1 year.
(4) Members of the advisory committee shall serve without
compensation.
(5) On or before 90 days after the effective date of this
part, the director shall call the first meeting of the advisory
committee. At the first meeting, the advisory committee shall elect
from among its members a chairperson and other officers it
considers necessary or appropriate. After the first meeting, the
advisory committee shall meet at least quarterly, or more
frequently at the call of the director or the chairperson or if
requested by 4 or more members.
(6) The advisory committee shall assist the director in the
establishment, maintenance, implementation, administration, and
modification of the database under this part.
Sec. 2915. (1) At least 30 days before the database is
operational, as determined by the director, the director shall
notify the legislature and the persons subject to this part of the
date that the database will begin operation in this state. Upon the
database becoming operational, the director shall publicize the
database in a manner designed to notify residents of this state
that the database is operational in this state.
(2) Annually, beginning with the first day of the thirteenth
month after the database is determined to be operational under
subsection (1), the director shall publish an annual report for the
immediately preceding 12-month period that includes all of the
following:
(a) For the health care services selected by the director, a
description of all of the following:
(i) The variation in fees charged by health facilities and
health professionals.
(ii) The geographic variation in the utilization of those
health care services.
(b) The total reimbursement for all health care services.
(c) The total reimbursement for each health care specialty.
(d) The total reimbursement for each CPT code.
(e) The annual rate of change in reimbursement for health care
services by health care specialties and by CPT code.
(f) Any other information the commission considers
appropriate, including information on capitated health care
services.
(3) Subject to this part, the director shall make the data
collected by the database and its reports available on its internet
website.
(4) Notwithstanding subsection (2), for the first annual
report required under subsection (2), the director shall only
include regionalized data that do not include any of the following:
(a) The identification of specific health providers.
(b) The identification of specific carriers.
Sec. 2917. The director, in compliance with state and federal
medical privacy laws and the requirements of this part, may share
data contained in the database with a state department or agency
that has a legitimate need for or use of the data. A state
department or agency and its officers, directors, or employees are
subject to this part with regard to any data it, he, or she
receives from the database under this section.
