Bill Text: MI HB4459 | 2019-2020 | 100th Legislature | Introduced
Bill Title: Health: other; charges by nonparticipating providers; regulate. Amends 1978 PA 368 (MCL 333.1101 - 333.25211) by adding art. 18. TIE BAR WITH: HB 4990'19, HB 4460'19, HB 4991'19
Spectrum: Bipartisan Bill
Status: (Passed) 2020-10-28 - Assigned Pa 234'20 With Immediate Effect [HB4459 Detail]
Download: Michigan-2019-HB4459-Introduced.html
HOUSE BILL No. 4459
April 16, 2019, Introduced by Reps. Hauck, Witwer, Liberati, Koleszar and Wozniak 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 article 18.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
ARTICLE 18. SURPRISE BILLING PROTECTIONS
Sec. 24501. As used in this article:
(a) "Covered person" means a policyholder, subscriber,
enrollee, or other individual participating in a health benefit
plan.
(b) "Emergency patient" means that term as defined in section
20904.
(c) "Health benefit plan" means that term as defined in
section 21501.
(d) "Nonemergency patient" means that term as defined in
section 20908.
(e) "Nonparticipating health facility" means a health facility
that has not contracted with the patient's health benefit plan to
provide services under the covered person's policy.
(f) "Nonparticipating provider" means a provider who provides
health care services at a participating health facility who does
not have a contract with the health benefit plan to provide
services at a prenegotiated rate.
(g) "Participating health facility" means a health facility
that has contracted with the patient's health benefit plan to
provide services under the covered person's policy. A participating
health facility includes, but is not limited to, the following
providers:
(i) A hospital as that term is defined in section 20106.
(ii) A freestanding surgical outpatient facility as that term
is defined in section 20104.
(iii) A skilled nursing facility as that term is defined in
section 20109.
(iv) A physician's office or other outpatient setting.
(v) A laboratory.
(vi) A radiology or imaging center.
(h) "Participating provider" means that term as defined in
section 21501.
(i) "Patient's representative" means that term as defined in
section 21501.
Sec. 24503. (1) For a covered emergency service provided by a
nonparticipating provider at a participating health facility or a
nonparticipating health facility and for a covered nonemergency
service provided by a nonparticipating provider at a participating
health facility, if the covered person does not have the ability or
opportunity to choose a participating provider, or the only
provider available at the health facility to perform the service is
a nonparticipating provider, the nonparticipating provider shall
accept as payment in full 125% of the amount that would be covered
by Medicare for the service in that Medicare fee locality,
excluding any in-network coinsurance, copayments, or deductibles.
(2) A nonparticipating provider of an emergency service or a
nonparticipating provider of a nonemergency service as provided in
subsection (1) shall not collect or attempt to collect from the
covered person, directly or indirectly, any excess amount other
than applicable coinsurance, copayments, or deductibles.
(3) The department may impose an administrative fine on a
licensed provider for a violation of this section.
Enacting section 1. This amendatory act does not take effect
unless Senate Bill No.____ or House Bill No. 4460 (request no.
02857'19) of the 100th Legislature is enacted into law.
