April 24, 2018, Introduced by Reps. Whiteford, Rendon, Lucido, Victory, Sheppard, Canfield, Hoadley, Barrett, Kahle, Alexander and Rabhi and referred to the Committee on Health Policy.
A bill to amend 1984 PA 218, entitled
"Third party administrator act,"
by amending section 2 (MCL 550.902) and by adding section 27.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 2. As used in this act:
(a) "Administrative services manager" or "manager" means an
individual responsible for conducting the daily operations of a
third party administrator.
(b) "Benefit plan" or "plan" means a medical, surgical,
dental, vision, or health care benefit plan and may include
coverage under a policy or certificate issued by a carrier.
(c) "Board" means the TPA advisory board created under section
19.
(d)
"Carrier" means any of the following:
(i) An an
insurer, which is including a health maintenance
organization,
regulated pursuant to under the
insurance code of
1956,
Act No. 218 of the Public Acts of 1956, being sections 1956
PA
218, MCL 500.100 to 500.8302, of
the Michigan Compiled Laws.
(ii) A medical care corporation regulated pursuant to
Act No.
108
of the Public Acts of 1939, being sections 550.301 to 550.316
of
the Michigan Compiled Laws.
(iii) A hospital service corporation regulated pursuant
to Act
No.
109 of the Public Acts of 1939, being sections 550.501 to
550.517
of the Michigan Compiled Laws.
(iv) A health care corporation regulated pursuant to
the
nonprofit
health care corporation reform act, Act No. 350 of the
Public
Acts of 1980, being sections 550.1101 to 550.1704 of the
Michigan
Compiled Laws.
(v) A health maintenance organization regulated under
part 210
of
the public health code, Act No. 368 of the Public Acts of 1978,
being
sections 333.21001 to 333.21099 of the Michigan Compiled
Laws.
(vi) A or
a dental care corporation regulated pursuant
to Act
No.
125 of the Public Acts of 1963, being sections under 1963 PA
125,
MCL 550.351 to 550.373. of
the Michigan Compiled Laws.
(e)
"Commissioner" means the commissioner of insurance of this
state.director.
(f) "Department" means the department of insurance and
financial services.
(g) "Director" means the director of the department.
(h) (f)
"ERISA" means the
employee retirement income security
act
of 1974, as amended, Public Law 93-406. , 88 Stat. 829.
(i) (g)
"Person" means an
individual, sole proprietorship,
partnership, corporation, association, or any other legal entity.
(j) (h)
"Personal data" means any
record or information
pertaining to the diagnosis, treatment, or health of an individual
covered by a plan.
(k) "Pharmacy" means that term as defined in section 17707 of
the public health code, 1978 PA 368, MCL 333.17707.
(l) "Pharmacy benefit manager" means a person that contracts
with a pharmacy on behalf of a benefit plan for the pharmacy to
provide pharmacy services to individuals covered by the plan and
that determines reimbursement to the pharmacy for the pharmacy
services provided to individuals covered by the plan. Pharmacy
benefit manager does not include a carrier or an employer
sponsoring a plan.
(m) (i)
"Processes claims" means
the administrative services
performed in connection with a claim for benefits under a plan.
(n) (j)
"Service contract" means
the written agreement for the
provision of administrative services between the TPA and a plan, a
sponsor of a plan, or a carrier.
(o) (k)
"Third party administrator"
or "TPA" means a person
who
that processes claims pursuant to a service contract and who
that may also provide 1 or more other administrative services
pursuant to a service contract, other than under a worker's
compensation self-insurance program pursuant to section 611 of the
worker's
disability compensation act of 1969, Act No. 317 of the
Public
Acts of 1969, being section 1969
PA 317, MCL 418.611. of
the
Michigan
Compiled Laws. Third party
administrator includes a
pharmacy benefit manager. Third party administrator does not
include a carrier or employer sponsoring a plan.
Sec. 27. A contract between a pharmacy benefit manager and a
pharmacy must provide that the pharmacy may disclose the current
selling price of a drug as provided in section 17757 of the public
health code, 1978 PA 368, MCL 333.17757. This section applies to a
contract described in this section executed, extended, or renewed
on or after the effective date of the amendatory act that added
this section.