Bill Text: MI HB4576 | 2013-2014 | 97th Legislature | Engrossed
Bill Title: Occupations; insurance; licensing and regulation for navigators; provide for. Amends secs. 102, 249a, 1201, 1238 & 1242 of 1956 PA 218 (MCL 500.102 et seq.) & adds secs. 1229, 1230, 1231, 1231a & 1231b.
Spectrum: Partisan Bill (Republican 2-0)
Status: (Passed) 2014-12-31 - Assigned Pa 566'14 With Immediate Effect 2014 Addenda [HB4576 Detail]
Download: Michigan-2013-HB4576-Engrossed.html
HB-4576, As Passed Senate, December 15, 2014
SENATE SUBSTITUTE FOR
HOUSE BILL NO. 4576
A bill to amend 1956 PA 218, entitled
"The insurance code of 1956,"
by amending section 102 (MCL 500.102), as amended by 2000 PA 252,
and by adding chapter 12A.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec.
102. (1) "Commissioner" as As used in this act:
(a)
"Commissioner" means the commissioner
of the office of
financial
and insurance services.director.
(b) (2)
"Department" as used in
this act means the office of
financial
and insurance services.department
of insurance and
financial services.
(c) "Director" means, unless the context clearly implies a
different meaning, the director of the department.
CHAPTER 12A
Sec. 1261. As used in this chapter:
(a) "Affordable care act" means the patient protection and
affordable care act, Public Law 111-148, as amended by the health
care and education reconciliation act of 2010, Public Law 111-152.
(b) "Business entity" means a corporation, association,
partnership, limited liability company, limited liability
partnership, or other legal entity.
(c) "Certificate" means a document issued by the director
authorizing a person to act as a navigator or certified application
counselor for the qualifications specified in the document. The
certificate itself does not create any actual, apparent, or
inherent authority in the certificate holder to represent or commit
an insurer.
(d) "Certificate holder" means a person issued a certificate
under this chapter.
(e) "Certified application counselor" means an individual who
is certified under this chapter and is authorized by the United
States department of health and human services to perform the
duties described in 45 CFR 155.225.
(f) "Exchange" means an American health benefits exchange
established or operating under the affordable care act.
(g) "Insurance" means any of the kinds of insurance described
in chapter 6.
(h) "Insurance producer" means a person required to be
licensed under the laws of this state to sell, solicit, or
negotiate insurance.
(i) "Navigator" means a person that receives any funding from
an exchange or the federal government and is designated or selected
by an exchange or the federal government to perform any of the
duties described in 42 USC 18031(i)(3).
(j) "Negotiate" means the act of conferring directly with or
offering advice directly to a purchaser or prospective purchaser of
a particular contract of insurance concerning any of the
substantive benefits, terms, or conditions of the contract,
provided that the person engaged in that act either sells insurance
or obtains insurance from insurers for purchasers.
(k) "Qualified health plan" means that term as defined in
section 1301 of the affordable care act.
(l) "Sell" means to exchange a contract of insurance by any
means, for money or its equivalent, on behalf of an insurance
company.
(m) "Solicit" means attempting to sell insurance or asking or
urging a person to apply for a particular kind of insurance from a
particular company.
Sec. 1262. (1) An individual shall not act as a navigator or
certified application counselor unless he or she has filed an
application under section 1263 and is certified with this state as
a navigator or certified application counselor, as applicable.
(2) Unless certified, an individual shall not receive funding
from an exchange.
(3) Subject to the affordable care act, a certificate holder
shall do all of the following:
(a) Conduct public education activities to raise awareness of
the availability of qualified health plans.
(b) Distribute fair and impartial information concerning
enrollment in all qualified health plans offered within the
exchange and the availability of the premium tax credits under
section 36B of the internal revenue code of 1986, 26 USC 36B, and
cost-sharing reduction under section 1402 of the affordable care
act.
(c) Facilitate selection of a qualified health plan.
(d) Provide referrals to appropriate state agencies for an
enrollee with a grievance, complaint, or question regarding the
enrollee's health plan, coverage, or a determination under such
plan coverage.
(e) Provide information in a manner that is culturally and
linguistically appropriate to the needs of the population served by
the exchange.
(4) A certificate holder shall not do any of the following:
(a) Sell, solicit, or negotiate health insurance.
(b) Recommend a particular health benefit plan.
(c) Provide any information or services related to insurance
regulated under this act other than health benefit plans or other
products offered in the exchange.
(5) If an exchange is operational in this state, the director
shall determine whether a program to certify and train navigators
and certified application counselors protects the privacy and
security of personally identifiable information of the residents of
this state under the laws of this state. If the director determines
that the program does not protect the residents of this state under
this subsection, the director shall do all of the following:
(a) Establish a certification and training program that must
include, but is not limited to, all of the following:
(i) A criminal history check using the department of state
police's internet criminal history access tool (ICHAT).
(ii) Training on privacy and security of personal identifying
information, training on ethics, training on provisions of the
affordable care act relating to navigators and certified
application counselors and any necessary state-specific training as
determined by the director.
(b) Develop an application and disclosure form by which an
applicant for a certificate shall disclose any potential conflicts
of interest, as well as any other information required by the
director.
(c) Submit an annual report to the standing committees of the
senate and house of representatives with jurisdiction over health
policy. The report must include all of the following:
(i) The director's assessment of any federal program to certify
and train navigators and certified application counselors.
(ii) Any changes implemented by the department as a result of a
federal program to train navigators and certified application
counselors.
Sec. 1263. (1) An individual applying for a certificate shall
file with the director the uniform application required by the
director and shall declare under penalty of refusal, suspension, or
revocation of the certificate that the statements made in the
application are true, correct, and complete to the best of the
individual's knowledge and belief. An application for a certificate
shall not be approved unless the director finds that the individual
meets all of the following criteria:
(a) Is at least 18 years of age.
(b) Has not committed an act listed that would be a ground for
denial, suspension, or revocation of an insurance producer's
license in section 1239(1).
(c) Has completed all required training courses under section
1262.
(d) Has paid the fees required by the director.
(e) Has successfully passed any required examination.
(f) Has successfully completed a criminal history check under
section 1262.
(2) A business entity acting as a navigator or certified
application counselor shall obtain a certificate. A business entity
applying for a certificate shall file with the director the uniform
business entity application required by the director. An
application for a certificate under this subsection shall not be
approved unless the director finds that the business entity meets
all of the following:
(a) The business entity has paid the fees required by the
director.
(b) The business entity has designated an individual
certificate holder responsible for the business entity's compliance
with this chapter.
(c) The business entity has not committed an act listed in
section 1239(1).
(3) The director may require the production of any documents
reasonably necessary to verify the information contained in an
application.
Sec. 1264. (1) In addition to any other powers under this act,
the director may place on probation, suspend, or revoke a
certificate or may levy a civil fine under section 1270 or any
combination of actions, and the director shall refuse to issue a
certificate under section 1263, for any 1 or more causes that would
be a ground for refusal, suspension, or revocation of an insurance
producer's license under section 1239. The director may revoke a
certificate of a person or refuse to issue a certificate for a
person that receives financial compensation, including monetary and
in-kind compensation, gifts, or any compensation related to
enrollment from an insurer offering qualified health benefits
through an exchange operating in this state. The director may deny,
suspend, approve, renew, or revoke a certificate if the director
considers it necessary to protect insureds and the public.
(2) The certificate of a business entity may be suspended,
revoked, or refused if the director finds, after hearing, that an
individual certificate holder's violation was known or should have
been known by 1 or more of the partners, officers, or managers
acting on behalf of the business entity and the violation was
neither reported to the director nor corrective action taken.
(3) The director may examine the books and records of a
certificate holder to determine whether the certificate holder is
conducting its business in accordance with this chapter. For the
purpose of facilitating the examination, the certificate holder
shall allow the director free access, at reasonable times, to all
of the certificate holder's books and records relating to
transactions to which this chapter applies.
Sec. 1265. A business entity issued a certificate shall, in a
manner prescribed by the director, make available a list of all
individual certificate holders that the business entity employs or
supervises or with which the business entity is otherwise
affiliated.
Sec. 1266. A business entity that terminates the employment,
engagement, affiliation, or other relationship with an individual
certificate holder shall notify the director using a format
prescribed by the director of the termination within 30 days
following the effective date of the termination if the reason for
termination is 1 of the reasons listed in section 1239(1) or the
business entity has knowledge the individual was found by a court
or government body to have engaged in any of the activities listed
in section 1239(1).
Sec. 1268. (1) When applying for a certificate, the applicant
shall report his or her mailing and electronic mail address to the
director. A certificate holder shall notify the director of a
change in his or her mailing or electronic mail address within 30
days after the change. The director shall maintain the mailing and
electronic mail address of each certificate holder on file.
(2) A notice of hearing or service of process may be served
upon a certificate holder in an action or proceeding for a
violation of this act by mailing the notice or process by first-
class mail to the certificate holder's mailing address reported to
the director under subsection (1).
Sec. 1269. (1) The director shall refuse to grant a
certificate to an applicant who fails to meet the requirements of
this chapter. Notice of the refusal shall be in writing and shall
set forth the basis for the refusal. If the applicant submits a
written request within 30 days after mailing of the notice of
refusal, the director shall promptly conduct a hearing in which the
applicant shall be given an opportunity to show compliance with the
requirements of this chapter.
(2) The director, after notice of and opportunity for a
hearing, may suspend or revoke a certificate of a certificate
holder who fails to maintain the standards required for initial
certification or who violates this act.
(3) Without prior hearing, the director may order summary
suspension of a certificate if he or she finds that protection of
the public requires emergency action and incorporates this finding
in his or her order. The suspension shall be effective on the date
specified in the order or upon service of a certified copy of the
order on the certificate holder, whichever is later. If requested,
the director shall conduct a hearing on the suspension within a
reasonable time but not later than 20 days after the effective date
of the summary suspension unless the person whose certificate is
suspended requests a later date. At the hearing, the director shall
determine if the suspension should be continued or if the
suspension should be withdrawn, and, if proper notice is given, may
determine if the certificate should be revoked. The director shall
announce his or her decision within 30 days after conclusion of the
hearing. The suspension shall continue until the decision is
announced.
(4) The director, or his or her designated deputy, may issue
subpoenas to require the attendance and testimony of witnesses and
the production of documents necessary to the conduct of the hearing
and may designate a department employee to make service. The
subpoenas issued by the director, or his or her designated deputy,
may be enforced upon petition to the circuit court of Ingham county
to show cause why a contempt order should not be issued, as
provided by law.
Sec. 1270. (1) If the director finds that a person has
violated this chapter, after an opportunity for a hearing under the
administrative procedures act of 1969, 1969 PA 306, MCL 24.201 to
24.328, the director shall reduce the findings and decision to
writing and shall issue and cause to be served upon the person
charged with the violation a copy of the findings and an order
requiring the person to cease and desist from the violation. In
addition, the director may order any of the following:
(a) Payment of a civil fine of not more than $500.00 for each
violation. However, if the person knew or reasonably should have
known that he or she was in violation of this chapter, the director
may order the payment of a civil fine of not more than $2,500.00
for each violation. An order of the director under this subsection
shall not require the payment of civil fines exceeding $25,000.00.
A fine collected under this subdivision shall be turned over to the
state treasurer and credited to the general fund of this state.
(b) The suspension or revocation of the certificate.
(2) The director may by order, after notice and opportunity
for hearing, reopen and alter, modify, or set aside, in whole or in
part, an order issued under this section, if in the opinion of the
director conditions of fact or of law have changed to require that
action, or if the public interest requires that action.
(3) If a person knowingly violates a cease and desist order
under this chapter and has been given notice and an opportunity for
a hearing held under the administrative procedures act of 1969,
1969 PA 306, MCL 24.201 to 24.328, the director may order a civil
fine of not more than $10,000.00 for each violation, or a
suspension or revocation of the certificate, or both. An order
issued by the director under this subsection shall not require the
payment of civil fines exceeding $50,000.00. A fine collected under
this subsection shall be turned over to the state treasurer and
credited to the general fund of this state.
(4) The director may apply to the circuit court of Ingham
county for an order of the court enjoining a violation of this
chapter.
Sec. 1271. The director shall develop and implement a process
for receipt, investigation, and referral to a federal exchange of
citizen complaints regarding navigators and certified application
counselors. The director shall submit an annual report that
describes this process to the standing committees of the senate and
house of representatives with jurisdiction of health policy.
Sec. 1272. This chapter does not authorize or shall not be
construed to authorize the establishment or operation of an
American health benefit exchange in this state under the affordable
care act.
Enacting section 1. (1) This amendatory act shall not be
construed to do any of the following:
(a) Authorize this state or an agency of this state to conduct
or oversee state-level governmental consumer assistance functions
for an American health benefit exchange established or operating in
this state under the patient protection and affordable care act,
Public Law 111-148, as amended by the health care and education
reconciliation act of 2010, Public Law 111-152.
(b) Convey any administrative, statutory, rule-making, or
other power to this state or an agency of this state to authorize,
establish, or operate an American health benefit exchange in this
state that did not exist before the effective date of this
amendatory act.
(2) It is the intent of this legislature that any consumer
assistance functions by or overseen by this state or an agency of
this state with regard to an American health benefit exchange shall
be conducted in a manner that utilizes and highlights Michigan-
based resources, including insurance producers, in order to best
serve the residents of this state and to ensure appropriate health
care decisions.
Enacting section 2. This amendatory act applies to policies,
certificates, or contracts delivered, issued for delivery, or
renewed in this state on and after the effective date of this
amendatory act.
