HOUSE BILL No. 4538

 

April 8, 2003, Introduced by Reps. Condino, Minore, Sak, Clack, Vagnozzi, Hood, Smith, Tobocman, Murphy, Adamini, Brown, Byrum, Lipsey, Law and Gieleghem and referred to the Committee on Insurance.

        

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                 A bill to amend 1956 PA 218, entitled                                             

                                                                                

    "The insurance code of 1956,"                                               

                                                                                

    (MCL 500.100 to 500.8302) by adding sections 3575 and 3577.                 

                                                                                

                THE PEOPLE OF THE STATE OF MICHIGAN ENACT:                      

                                                                                

1       Sec. 3575.  (1) A health maintenance organization shall                     

                                                                                

2   exercise ordinary care when making a health care treatment                  

                                                                                

3   decision and is liable for damages for harm to an enrollee                  

                                                                                

4   proximately caused by its failure to exercise ordinary care.                

                                                                                

5       (2) A health maintenance organization is liable for damages                 

                                                                                

6   for harm to an enrollee proximately caused by a health care                 

                                                                                

7   treatment decision made by a health maintenance organization                

                                                                                

8   employee, agent, ostensible agent, or representative acting on              

                                                                                

9   behalf of the health maintenance organization and over whom the             

                                                                                

10  health maintenance organization has the right to exercise                   

                                                                                

11  influence or control or has exercised influence or control that             

                                                                                


                                                                                

1   resulted in the failure to exercise ordinary care.  However, a              

                                                                                

2   finding that a health professional is an employee, agent,                   

                                                                                

3   ostensible agent, or representative of a health maintenance                 

                                                                                

4   organization shall not be based solely on proof that the                    

                                                                                

5   individual's name appears in a listing of approved providers made           

                                                                                

6   available to the health maintenance organization's enrollees.               

                                                                                

7       (3) Both of the following are defenses in an action brought                 

                                                                                

8   pursuant to subsection (1) or (2):                                          

                                                                                

9       (a) Neither the health maintenance organization nor its                     

                                                                                

10  employee, agent, ostensible agent, or representative controlled,            

                                                                                

11  influenced, or participated in the health care treatment                    

                                                                                

12  decision.                                                                   

                                                                                

13      (b) The health maintenance organization did not deny or delay               

                                                                                

14  payment for any treatment prescribed or recommended by a provider           

                                                                                

15  to the enrollee.                                                            

                                                                                

16      (4) This section does not create an obligation for a health                 

                                                                                

17  maintenance organization to provide to an enrollee treatment that           

                                                                                

18  is not covered by the health maintenance organization contract              

                                                                                

19  with the enrollee.                                                          

                                                                                

20      (5) This section does not create any liability on the part of               

                                                                                

21  an employer or employer purchasing group that purchases coverage            

                                                                                

22  or assumes risk on behalf of its employees.                                 

                                                                                

23      (6) For purposes of the revised judicature act of 1961, 1961                

                                                                                

24  PA 236, MCL 600.101 to 600.9948, this section does not create a             

                                                                                

25  medical malpractice cause of action.                                        

                                                                                

26      (7) As used in this section:                                                

                                                                                

27      (a) "Health care treatment decision" means either a                         

                                                                                


                                                                                

1   determination as to when the health maintenance organization                

                                                                                

2   actually provides medical services or a decision that affects the           

                                                                                

3   quality of the diagnosis, care, or treatment provided to the                

                                                                                

4   health maintenance organization's enrollees.                                

                                                                                

5       (b) "Ordinary care" means for a health maintenance                          

                                                                                

6   organization that degree of care that a health maintenance                  

                                                                                

7   organization of ordinary prudence would use under the same or               

                                                                                

8   similar circumstances.  For an employee, agent, ostensible agent,           

                                                                                

9   or representative acting on behalf of the health maintenance                

                                                                                

10  organization, ordinary care means that degree of care that a                

                                                                                

11  person of ordinary prudence in the same profession, specialty, or           

                                                                                

12  area of practice as that person would use under the same or                 

                                                                                

13  similar circumstances.                                                      

                                                                                

14      Sec. 3577.  A health maintenance organization shall not                     

                                                                                

15  enter into a contract with a health professional or health                  

                                                                                

16  facility that includes an indemnification or hold harmless clause           

                                                                                

17  for the acts or conduct of the health maintenance organization.             

                                                                                

18      Enacting section 1.  Section 3575 of the insurance code of                  

                                                                                

19  1956, 1956 PA 218, MCL 500.3575, as added by this amendatory act,           

                                                                                

20  applies only to causes of action that are filed on or after the             

                                                                                

21  effective date of this amendatory act.