SENATE BILL NO. 524


   April 20, 1999, Introduced by Senator BYRUM 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 section 21052b.

               THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 1         SEC. 21052B.  (1) IF AN AFFILIATION BETWEEN A HEALTH MAINTE-

 2    NANCE ORGANIZATION AND A HEALTH PROFESSIONAL IS TERMINATED OR

 3    BENEFITS OR COVERAGE PROVIDED BY A HEALTH PROFESSIONAL IS TERMI-

 4    NATED BECAUSE OF A CHANGE IN THE TERMS OF PROVIDER PARTICIPATION

 5    IN A GROUP HEALTH MAINTENANCE ORGANIZATION CONTRACT AND A COVERED

 6    ENROLLEE IS UNDERGOING A COURSE OF TREATMENT FROM THE HEALTH PRO-

 7    FESSIONAL AT THE TIME OF THE TERMINATION, THE HEALTH MAINTENANCE

 8    ORGANIZATION SHALL DO BOTH OF THE FOLLOWING:

 9         (A) NOTIFY THE ENROLLEE ON A TIMELY BASIS OF THE

10    TERMINATION.




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 1         (B) WITH THE HEALTH PROFESSIONAL'S CONSENT, PERMIT THE

 2    ENROLLEE TO CONTINUE AN ONGOING COURSE OF TREATMENT WITH THE

 3    HEALTH PROFESSIONAL FOR A TRANSITIONAL PERIOD AS PROVIDED IN THIS

 4    SECTION IF IT IS MEDICALLY NECESSARY FOR THE ENROLLEE TO CONTINUE

 5    AN ONGOING COURSE OF TREATMENT WITH THE PROVIDER.

 6         (2) EXCEPT AS PROVIDED IN SUBSECTIONS (3) AND (4), COVERAGE

 7    UNDER THIS SECTION EXTENDS FOR A TRANSITIONAL PERIOD OF UP TO 120

 8    DAYS FROM THE NOTICE DATE DESCRIBED IN SUBSECTION (1)(A).

 9         (3) IF AN ENROLLEE IS PREGNANT, MEDICAL NECESSITY IS CONSID-

10    ERED DEMONSTRATED AND COVERAGE UNDER THIS SECTION EXTENDS THROUGH

11    POSTPARTUM CARE DIRECTLY RELATED TO THE PREGNANCY.

12         (4) IF AN ENROLLEE IS DETERMINED TO BE TERMINALLY ILL PRIOR

13    TO A HEALTH PROFESSIONAL'S TERMINATION AND THE HEALTH PROFES-

14    SIONAL WAS TREATING THE TERMINAL ILLNESS BEFORE THE DATE OF TER-

15    MINATION, COVERAGE UNDER THIS SECTION EXTENDS FOR THE REMAINDER

16    OF THE ENROLLEE'S LIFE FOR CARE DIRECTLY RELATED TO THE TREATMENT

17    OF THE TERMINAL ILLNESS.

18         (5) AS USED IN THIS SECTION:

19         (A) "TERMINAL ILLNESS" MEANS THAT TERM AS DEFINED IN

20    SECTION 5653.

21         (B) "TERMINATED" OR "TERMINATION" INCLUDES THE EXPIRATION OR

22    NONRENEWAL OF A CONTRACT OR AN AFFILIATION WITH A HEALTH PROFES-

23    SIONAL BY A HEALTH MAINTENANCE ORGANIZATION, BUT DOES NOT INCLUDE

24    A TERMINATION BY THE HEALTH MAINTENANCE ORGANIZATION FOR FAILURE

25    TO MEET APPLICABLE QUALITY STANDARDS OR FOR FRAUD.







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