HOUSE BILL No. 4394


     February 27, 1997, Introduced by Reps. Palamara, Freeman, DeHart, Mans, Anthony, Cherry, Martinez, LaForge, Willard, Hammerstrom, Schauer, Wojno, Gire, Bobier, Law, Llewellyn, Crissman, Schermesser, Scott, Brown, Goschka, Dalman, Callahan, Bogardus, Baird, Baade, Frank, Green, Thomas, Bodem, Profit, Gubow, Griffin, Leland, Murphy, Rocca, Scranton
and Brater and referred to the Committee on Health Policy.


        A bill to amend 1956 PA 218, entitled

   "The insurance code of 1956,"

   (MCL 500.100 to 500.8302) by adding section 3407a.

               THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 1         SEC. 3407A.  A DISABILITY INSURER SHALL NOT PROHIBIT OR DIS-

 2    COURAGE A HEALTH CARE PROVIDER FROM DISCUSSING WITH AN INSURED OR

 3    PROVIDER ANY OF THE FOLLOWING:

 4         (A) HEALTH CARE TREATMENTS AND SERVICES.

 5         (B) QUALITY ASSURANCE PLANS REQUIRED BY LAW, IF APPLICABLE.

 6         (C) THE FINANCIAL RELATIONSHIPS BETWEEN THE INSURER AND THE

 7    HEALTH CARE PROVIDER INCLUDING ALL OF THE FOLLOWING AS

 8    APPLICABLE:

 9         (i) WHETHER A FEE-FOR-SERVICE ARRANGEMENT EXISTS, UNDER

10    WHICH THE PROVIDER IS PAID A SPECIFIED AMOUNT FOR EACH COVERED

11    SERVICE RENDERED TO THE PARTICIPANT.


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 1         (ii) WHETHER A CAPITATION ARRANGEMENT EXISTS, UNDER WHICH A

 2    FIXED AMOUNT IS PAID TO THE PROVIDER FOR ALL COVERED SERVICES

 3    THAT ARE OR MAY BE RENDERED TO EACH COVERED INDIVIDUAL OR

 4    FAMILY.

 5         (iii) WHETHER PAYMENTS TO PROVIDERS ARE MADE BASED ON STAN-

 6    DARDS RELATING TO COST, QUALITY, OR PATIENT SATISFACTION.












































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