May 10, 2018, Introduced by Senators HORN, STAMAS, MACGREGOR, SHIRKEY, PROOS and SCHMIDT and referred to the Committee on Michigan Competitiveness.
A bill to amend 2011 PA 142, entitled
"Health insurance claims assessment act,"
by amending section 3 (MCL 550.1733), as amended by 2016 PA 50, and
by adding section 1a; and to repeal acts and parts of acts.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 1a. This act is repealed on the first day of the calendar
quarter in which the director of the department of health and human
services notifies the secretary of state in writing that the
federal Centers for Medicare and Medicaid Services has approved its
request for a waiver of the broad-based and uniformity provisions
of section 1903(w)(3)(B) and (C) of title XIX of the social
security act, 42 USC 1396b, for implementation of the insurance
provider assessment act or October 1, 2018, whichever is later.
Sec. 3. (1) For dates of service beginning on or after January
1, 2012 and ending on June 30, 2014, subject to subsections (2),
(3), and (4), there is levied upon and there shall be collected
from every carrier and third party administrator an assessment of
1% on that carrier's or third party administrator's paid claims.
For dates of service beginning on or after July 1, 2014 and ending
on
July 1, 2020, the first
day of the calendar quarter in which the
director of the department of health and human services notifies
the secretary of state in writing that the federal Centers for
Medicare and Medicaid Services has approved its request for a
waiver of the broad-based and uniformity provisions of section
1903(w)(3)(B) and (C) of title XIX of the social security act, 42
USC 1396b, for the insurance provider assessment act or October 1,
2018,
whichever is later, subject to this
subsection and
subsections (2), (3), and (4), there is levied upon and there shall
be collected from every carrier and third party administrator an
assessment of 0.75% on that carrier's or third party
administrator's
paid claims. For dates of service beginning on or
after
July 1, 2014 and ending on July 1, 2020, subject to this
subsection
and subsections (2), (3), and (4), the assessment levied
under
this subsection will increase to 1.0% if the federal
government
informs this state that the use tax revenues assessed on
entities
under section 3f of the use tax act, 1937 PA 94, MCL
205.93f,
will not be federally reimbursed. If the assessment is
increased
as provided in this subsection, the increased assessment
levied
is effective on the date that the federal government informs
this
state that the revenue collected from the use tax assessed on
Medicaid
managed care organizations under section 3f of the use tax
act,
1937 PA 94, MCL 205.93f, will not be federally reimbursed. For
the
purposes of this subsection, a fiscal quarter begins on the
first
day of January, April, July, or October.
(2) A carrier with a suspension or exemption under section
3717 of the insurance code of 1956, 1956 PA 218, MCL 500.3717, on
September 20, 2011 is subject to an assessment of 0.1%.
(3) All of the following apply to a group health plan that
uses the services of a third party administrator or excess loss or
stop loss insurer:
(a) A group health plan sponsor is not responsible for an
assessment under this section for a paid claim if the assessment on
that claim has been paid by a third party administrator or excess
loss or stop loss insurer, except as otherwise provided in section
3a(2).
(b) Except as otherwise provided in subdivision (d), the third
party administrator is responsible for all assessments on paid
claims paid by the third party administrator.
(c) Except as otherwise provided in subdivision (d), the
excess loss or stop loss insurer is responsible for all assessments
on paid claims paid by the excess loss or stop loss insurer.
(d) If there is both a third party administrator and an excess
loss or stop loss insurer servicing the group health plan, the
third party administrator is responsible for all assessments for
paid claims that are not reimbursed by the excess loss or stop loss
insurer and the excess loss or stop loss insurer is responsible for
all assessments for paid claims that are reimbursable to the excess
loss or stop loss insurer.
(4) The assessment under this section shall not exceed
$10,000.00 per insured individual or covered life annually.
(5) To the extent an assessment paid under this section for
paid claims for a group health plan or individual subscriber is
inaccurate due to subsequent claim adjustments or recoveries,
subsequent filings shall be adjusted to accurately reflect the
correct assessment based on actual claims paid.
(6) Through June 30, 2014, if the assessment under this
section collects revenue in an amount greater than $400,000,000.00,
adjusted annually by the medical inflation rate since 2011, each
carrier and third party administrator that paid the assessment
shall receive a proportional credit against the carrier's or third
party administrator's assessment in the immediately succeeding
year. Beginning July 1, 2014, if the sum of the assessment under
this section and the portion of the use tax assessed on entities
under section 3f of the use tax act, 1937 PA 94, MCL 205.93f, that
is dedicated to the general fund, less the general fund amount
necessary to reimburse those entities for the cost of the use tax,
is greater than $400,000,000.00, as adjusted annually by the
medical inflation rate since 2011 but not to exceed an amount
greater than $450,000,000.00, each carrier and third party
administrator that paid the assessment shall receive a proportional
credit against the carrier's or third party administrator's
assessment in the immediately succeeding year. The department shall
send a notice of credit to each carrier or third party
administrator entitled to a credit under this subsection not later
than July 1. A carrier or third party administrator entitled to a
credit under this subsection shall apply that credit to the July 30
payment. Any unused credit shall be carried forward and applied to
subsequent payments. If a carrier or third party administrator
entitled to a credit under this subsection has no liability under
this act in the immediately succeeding year or if this act is no
longer in effect, the department shall issue that carrier or third
party administrator a refund in the amount of any unused credit. If
a third party administrator receives a credit or refund under this
subsection, the third party administrator shall apply that credit
or refund to the benefit of the entity for which it processed the
claims under a service contract.
Enacting section 1. This amendatory act does not take effect
unless Senate Bill No. 994
of the 99th Legislature is enacted into law.