Bill Text: MI HB5097 | 2009-2010 | 95th Legislature | Introduced
Bill Title: Insurance; health; mental health parity; establish in certain circumstances. Amends 1956 PA 218 (MCL 500.100 - 500.8302) by adding sec. 3406s.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2009-06-17 - Printed Bill Filed 06/17/2009 [HB5097 Detail]
Download: Michigan-2009-HB5097-Introduced.html
HOUSE BILL No. 5097
June 16, 2009, Introduced by Rep. Meadows and referred to the Committee on Judiciary.
A bill to amend 1956 PA 218, entitled
"The insurance code of 1956,"
(MCL 500.100 to 500.8302) by adding section 3406s.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 3406s. (1) An insurer that delivers, issues for delivery,
or renews in this state on or after January 1, 2010 a group
expense-incurred hospital, medical, or surgical policy or
certificate and a health maintenance organization that issues or
renews a group contract on or after January 1, 2010 shall provide
for both of the following:
(a) That cost-sharing requirements and benefit or service
limitations for outpatient biologically based mental illness
services do not place a greater financial burden on the insured or
enrollee and are not more restrictive than those requirements and
limitations for outpatient medical services.
(b) That cost-sharing requirements and benefit or service
limitations for inpatient hospital biologically based mental
illness services do not place a greater financial burden on the
insured or enrollee and are not more restrictive than those
requirements and limitations for inpatient hospital medical
services.
(2) Subsection (1) applies if both of the following are met:
(a) The biologically based mental illness is clinically
diagnosed by a mental health professional.
(b) The prescribed treatment is not experimental or
investigational, having proven its clinical effectiveness in
accordance with generally accepted medical standards.
(3) Subsection (1) does not apply to an insurer or health
maintenance organization to which all of the following apply:
(a) The insurer or health maintenance organization submits
documentation certified by an independent member of the American
academy of actuaries to the commissioner showing that incurred
claims for diagnostic and treatment services for biologically based
mental illness for a period of at least 6 months independently
caused the insurer's or health maintenance organization's costs for
claims and administrative expenses for the coverage of all other
physical diseases and disorders to increase by more than 1% per
year.
(b) The insurer or health maintenance organization submits a
signed letter from an independent member of the American academy of
actuaries to the commissioner opining that the increase described
in subdivision (a) could reasonably justify an increase of more
than 1% in the annual premiums or rates charged by the insurer or
health maintenance organization for the coverage of all other
physical diseases and disorders.
(c) The commissioner, pursuant to the administrative
procedures act of 1969, 1969 PA 306, MCL 24.201 to 24.328, makes
the following determinations from the documentation and opinion
submitted pursuant to subdivisions (a) and (b):
(i) Incurred claims for diagnostic and treatment services for
biologically based mental illnesses for a period of at least 6
months independently caused the insurer's or health maintenance
organization's costs for claims and administrative expenses for the
coverage of all other physical diseases and disorders to increase
by more than 1% per year.
(ii) The increase in costs reasonably justifies an increase of
more than 1% in the annual premiums or rates charged by the insurer
or health maintenance organization for the coverage of all other
physical diseases and disorders.
(4) This section does not prohibit an insurer or health
maintenance organization from doing any of the following:
(a) Negotiating separately with mental health care providers
on reimbursement rates and the delivery of health care services.
(b) Offering policies, certificates, and contracts that
provide benefits solely for the diagnosis and treatment of
biologically based mental illnesses.
(c) Managing the provision of benefits for the diagnosis or
treatment of biologically based mental illnesses through the use of
preadmission screening, by requiring prior authorization before
treatment, or through the use of any other mechanism designed to
limit coverage to that treatment that is determined to be
necessary.
(d) Enforcing the terms and conditions of the policy,
certificate, or contract.
(5) This section does not apply to any policy, certificate, or
contract that provides coverage for specific diseases or accidents
only, or to any hospital indemnity, medicare supplement, long-term
care, disability income, or 1-time limited duration policy or
certificate of no longer than 6 months.
(6) As used in this section:
(a) "Biologically based mental illness" means schizophrenia,
schizoaffective disorder, major depressive disorder, bipolar
disorder, paranoia and other psychotic disorders, obsessive-
compulsive disorder, and panic disorder, as those terms are defined
in the diagnostic and statistical manual of mental disorders
published by the American psychiatric association.
(b) "Mental health professional" means any of the following:
(i) A physician licensed to practice medicine or osteopathic
medicine and surgery in this state under article 15 of the public
health code, 1978 PA 368, MCL 333.16101 to 333.18838.
(ii) A psychologist licensed to practice in this state under
article 15 of the public health code, 1978 PA 368, MCL 333.16101 to
333.18838.
(iii) A master's social worker licensed under article 15 of the
public health code, 1978 PA 368, MCL 333.16101 to 333.18838.
(iv) A professional counselor licensed under article 15 of the
public health code, 1978 PA 368, MCL 333.16101 to 333.18838.
