April 28, 2005, Introduced by Senators JACOBS and EMERSON and referred to the Committee on Appropriations.
A bill to amend 1956 PA 218, entitled
"The insurance code of 1956,"
by amending section 224b (MCL 500.224b), as amended by 2002 PA 621.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec.
224b. (1) The department of community health shall assess
on
a quality assurance
assessment fee as follows:
(a) On each health maintenance organization that has a
medicaid managed care contract awarded by the state and
administered by the department of community health, a quality
assurance assessment fee that equals 6% of non-medicare premiums
collected by that health maintenance organization.
(b) On each medicaid managed care organization that is a
specialty prepaid health plan under section 109f of the social
welfare act, 1939 PA 280, MCL 400.109f, and that has a medicaid
managed care contract awarded by the state and administered by the
department of community health, a quality assurance assessment fee
that equals 6% of non-medicare capitation payments collected by
that medicaid managed care organization.
(2) The quality assurance assessment fee collected under
subsection (1) and all federal matching funds attributed to that
fee shall be used for the following purposes and under the
following specific circumstances:
(a) The quality assurance assessment fee shall be implemented
on May 10, 2002 for health maintenance organizations described in
subsection (1)(a) and on August 1, 2005 for medicaid managed care
organizations described in subsection (1)(b).
(b) The quality assurance assessment fee shall be assessed on
the non-medicare premiums collected by each health maintenance
organization
described in subsection (1) (1)(a)
based on the
health maintenance organization's most recent statement filed with
the commissioner pursuant to sections 438 and 438a. Except as
otherwise provided, the quality assurance assessment fee shall be
payable on a quarterly basis with the first payment due 90 days
after the date the fee is assessed. If a health maintenance
organization does not have non-medicare premium revenue listed in a
filing under section 438 or 438a, the assessment shall be based on
an estimate by the department of community health of the health
maintenance organization's non-medicare premiums for the quarter
and shall be payable upon receipt.
(c) The quality assurance assessment fee shall be assessed on
the non-medicare capitation payments collected by each medicaid
managed care organization described in subsection (1)(b) based on
the medicaid managed care organization's most recent financial
status report filed with the department of community health. Except
as otherwise provided, the quality assurance assessment fee shall
be payable on a quarterly basis with the first payment due 90 days
after the date the fee is assessed.
(d) (c)
The quality assurance assessment fee shall only be
assessed
on a health maintenance organization an organization
described in subsection (1)(a) or (b) that has in effect a medicaid
managed care contract awarded by the state and administered by the
department of community health at the time of the assessment.
(e) (d)
Beginning October 1, 2007, the quality assurance
assessment fee shall no longer be assessed or collected.
(f) (e)
The department of community health shall implement
this section in a manner that complies with federal requirements.
If the department of community health is unable to comply with the
federal requirements for federal matching funds under this section
for organizations described in subsection (1)(a) or is unable to
use the fiscal year 2001-2002 level of support for federal matching
dollars other than for a change in covered benefits or covered
population required under the state's medicaid contract with health
maintenance organizations, the quality assurance assessment fee
under this
section subsection (1)(a) shall no longer be assessed
or collected.
(g) If the department of community health is unable to comply
with the federal requirements for federal matching funds under this
section for organizations described in subsection (1)(b) or is
unable to use the fiscal year 2004-2005 level of support for
federal matching dollars other than for a change in covered
benefits or covered population required under the state's medicaid
contract with the managed care organization, the quality assurance
assessment fee under subsection (1)(b) shall no longer be assessed
or collected.
(h) (f)
If a health maintenance an organization
fails to
pay the quality assurance assessment fee required under subsection
(1),
the department of community health may assess the health
maintenance
organization a penalty of 5% of the assessment for
each month that the assessment and penalty are not paid up to a
maximum of 50% of the assessment. The department of community
health may also refer for collection to the department of treasury
past due amounts consistent with section 13 of 1941 PA 122, MCL
205.13.
(i) (g)
The medicaid health maintenance organization quality
assurance assessment fund is established as a separate fund in the
state treasury. The designated medicaid managed care organization
quality assurance assessment fund is established as a separate fund
in the state treasury. The department of community health shall
deposit the revenue raised through the quality assurance assessment
fee under subsection (1)(a) with the state treasurer for deposit in
the medicaid health maintenance organization quality assurance
assessment fund. The department of community health shall deposit
the revenue raised through the quality assurance assessment fee
under subsection (1)(b) with the state treasurer for deposit in the
designated medicaid managed care organization quality assurance
assessment fund.
(j) (h)
In all fiscal years governed by this section,
medicaid reimbursement rates shall not be reduced below the
medicaid payment rates in effect on April 1, 2002 for organizations
described in subsection (1)(a) or below the medicaid payment rates
in effect on July 1, 2005 for organizations described in subsection
(1)(b) as a direct result of the quality assurance assessment fee
assessed under this section. This subdivision does not apply to a
change in medicaid reimbursement rates caused by a change in
covered benefits or change in covered populations required under
the
state's medicaid contract with health maintenance
organizations described in subsection (1)(a) or (b).
(i)
The amounts listed in this subdivision are appropriated
for
the department of community health, subject to the conditions
set
forth in this section, for the fiscal year ending September 30,
2003:
MEDICAL
SERVICES
Health
plan services........................... $ 1,476,781,100
Gross
appropriation............................ $ 1,476,781,100
Appropriated
from:
Federal
revenues:
Total
federal revenues......................... 817,495,900
Special
revenue funds:
Medicaid
quality assurance assessment.......... 55,747,000
State
general fund/general purpose............. $ 603,538,200
(3) As used in this section:
(a)
"Medicaid" means title XIX of the social security act,
chapter
531, 49 Stat. 620, 42 U.S.C. 1396 to 1396r-6 and 1396r-8
42 USC 1396 to 1396v.
(b)
"Medicare" means title XVIII of the social security act,
chapter
531, 49 Stat. 620, 42 U.S.C. 1395 to 1395b, 1395b-2, 1395b-
6
to 1395b-7, 1395c to 1395i, 1395i-2 to 1395i-5, 1395j to 1395t,
1395u
to 1395w, 1395w-2 to 1395w-4, 1395w-21 to 1395w-28, 1395x to
1395yy,
and 1395bbb to 1395ggg 42
USC 1395 to 1395hhh.