Bill Text: MI SB0136 | 2013-2014 | 97th Legislature | Introduced
Bill Title: Health; other; religious liberty and conscience protection act; enact to allow health care payers, health facilities, and health providers a right to decline to provide or pay for certain objectionable health care services. Creates new act.
Spectrum: Partisan Bill (Republican 21-0)
Status: (Introduced - Dead) 2013-04-09 - Referred To Committee Of The Whole With Substitute S-1 [SB0136 Detail]
Download: Michigan-2013-SB0136-Introduced.html
SENATE BILL No. 136
January 31, 2013, Introduced by Senators MOOLENAAR, MARLEAU, MEEKHOF, RICHARDVILLE, JANSEN, HILDENBRAND, GREEN, EMMONS, PAVLOV, BOOHER, JONES, PROOS, BRANDENBURG, ROBERTSON, NOFS, WALKER, CASPERSON, PAPPAGEORGE, COLBECK, HUNE and KOWALL and referred to the Committee on Health Policy.
A bill to protect religious liberty and rights of conscience
in the areas of health care and medical and scientific research as
it pertains to employment, education and training, and
participating in health care services and to the purchasing of or
providing for the purchase of health insurance; to provide immunity
from liability; and to prescribe penalties and provide remedies.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 1. This act shall be known and may be cited as the
"religious liberty and conscience protection act".
Sec. 3. As used in this act:
(a) "Conscience" means sincerely held convictions arising from
a belief in God or the tenets of an established religion, or from
the ethical or moral principles of a generally recognized
philosophy or belief system that an individual asserting those
convictions can reference as a basis for those convictions. For
purposes of this act, the conscience of an entity shall be
determined by reference to existing or proposed religious, moral,
or ethical guidelines, mission statement, constitution, bylaws,
articles of incorporation, or regulations adhered to by the entity.
(b) "Health care payer" or "payer" means an entity or employer
that purchases, contracts for, pays for, arranges payment for, or
facilitates the payment of any health care service, including, but
not limited to, health maintenance organizations, health plans,
health plan sponsors, nonprofit health care corporations, insurance
companies, or management services organizations. Health care payer
does not include an individual.
(c) "Health care purchaser" or "purchaser" means an
individual, entity, or employer seeking to purchase or who has
purchased a health insurance contract, policy, or product.
(d) "Health care service" or "service" means any of the
following:
(i) A phase of patient medical care, treatment, or procedure,
including, but not limited to, patient referral, therapy, testing,
diagnosis or prognosis, research instruction, prescribing, surgery,
dispensing or administering a device, drug, or medication, or other
medical care rendered to a human patient by a health provider or
health facility.
(ii) Medical or scientific research directed toward developing
a therapeutic means of treating human illness, disease, or health
condition.
(e) "Health facility" means any of the following:
(i) A clinical laboratory, as defined in section 20104 of the
public health code, 1978 PA 368, MCL 333.20104.
(ii) A county medical care facility, as defined in section
20104 of the public health code, 1978 PA 368, MCL 333.20104.
(iii) A freestanding surgical outpatient facility, as defined in
section 20104 of the public health code, 1978 PA 368, MCL
333.20104.
(iv) A hospital, as defined in section 20106 of the public
health code, 1978 PA 368, MCL 333.20106.
(v) A hospice, as defined in section 20106 of the public
health code, 1978 PA 368, MCL 333.20106.
(vi) A hospice residence, as defined in section 21401 of the
public health code, 1978 PA 368, MCL 333.21401.
(vii) A nursing home, as defined in section 20109 of the public
health code, 1978 PA 368, MCL 333.20109.
(viii) A facility or agency listed in subparagraphs (i) to (vii)
located in a university, college, or other educational institution.
(ix) The private practice office of a health professional
licensed or otherwise authorized to engage in the practice of a
health profession under article 15 of the public health code, 1978
PA 368, MCL 333.16101 to 333.18838.
(x) A medical clinic that provides health care services.
(xi) A public or private institution that provides health care
services.
(xii) A teaching institution that provides health care
services.
(xiii) A pharmacy that provides health care services. As used in
this subparagraph, "pharmacy" means that term as defined in section
17707 of the public health code, 1978 PA 368, MCL 333.17707.
(xiv) Any other legal entity that provides health care
services.
(f) "Health provider" means any of the following:
(i) Except as otherwise provided in this subparagraph, a
licensed, registered, or certified individual who is employed,
contracted, or granted privileges to participate in a health care
service. This subparagraph does not include an individual who is
employed by or under an independent contract with a health care
payer to provide case or disease management services.
(ii) A faculty or staff member or a student of a university,
college, or educational institution in an educational program where
a health care service is provided or where education and training
regarding the provision of a health care service is conducted.
(g) "Participate in a health care service" means to instruct,
advise, provide, perform, assist in, refer to a particular provider
or institution for, admit for purposes of providing, or conduct
medical or scientific research for a health care service.
Sec. 5. (1) A health facility may assert as a matter of
conscience an objection to participating in a health care service
and may decline to participate in a health care service that
violates its conscience pursuant to this section.
(2) A health facility shall not assert a matter of conscience
objection under subsection (1) under either of the following
circumstances:
(a) The objection is based on the patient's or a group of
patients' status, or a patient's insurance coverage, ability to
pay, or method of payment.
(b) The objection is based on a disagreement with a health
provider employed by, under contract to, or granted privileges by
the health facility regarding the medical appropriateness of a
health care service for a specific patient, the patient has
consented to the provision of the health care service, and the
health facility routinely allows that health care service to be
performed for other patients with similar medical conditions.
(3) A health facility shall provide notice of its assertion of
an objection to participating in a health care service described in
subsection (1) through written public notice or personally in
writing at the time an individual seeks to obtain that health care
service from the health facility.
(4) A health facility's assertion of an objection as described
in subsection (1) to participating in a health care service shall
not be a basis for any of the following:
(a) Civil liability to another person.
(b) Criminal action.
(c) Administrative or licensure action.
(d) Eligibility discrimination against the health facility in
a grant, contract, or program.
Sec. 7. (1) A health care payer may decline to offer a
contract, policy, or product that pays for, arranges payment for,
or facilitates the payment of a health care service that violates
the conscience of the payer.
(2) A health care purchaser may decline to purchase or
financially contribute toward the purchase of a contract, policy,
or product that includes coverage for a health care service that
violates the conscience of the purchaser.
(3) A health care payer and any person that owns, operates,
supervises, or manages a health care payer is not civilly,
criminally, or administratively liable because the health care
payer declines to pay for, arrange payment for, or facilitate
payment of a health care service or declines to purchase or offer a
contract, policy, or product that facilitates payment for a health
care service, if the health care service violates the conscience of
the payer.
(4) A person, public or private institution, or public
official shall not discriminate against a health care payer or any
person, association, corporation, or other entity operating an
existing health care payer or attempting to establish a new health
care payer, in any manner, including, but not limited to, denial,
deprivation, or disqualification with respect to licensure, aid,
assistance, benefit, privilege, or authorization because the health
care payer is planning, proposing, or operating a health care payer
that declines to pay for or arrange payment of a health care
service that violates the conscience of the payer.
(5) A public official, agency, or other entity shall not deny
any form of aid, assistance, grants, or benefits to, or in any
other manner coerce, disqualify, or discriminate against, a health
care payer because the existing or proposed health care payer
declines to pay for or arrange for the payment of a health care
service that violates the conscience of the payer.
(6) Subject to subsection (7), this section does not relieve
an individual who received a health care service or who is
responsible for the payment, in whole or in part, of a health care
service that has been received by a patient, from paying for that
health care service unless that individual provided notice of his
or her objection to that health care service under this section
before the service was rendered. This subsection and subsection (7)
do not apply to the parent or guardian of an unemancipated minor
who is responsible for payment of the minor's health care service,
unless the health care service was provided with the consent of the
parent or guardian.
(7) An individual who received a health care service or who is
responsible for the payment, in whole or in part, of a health care
service that has been received by a patient is responsible for the
individual's share of the payment for a health care service that is
provided under any of the following circumstances:
(a) The health care service was provided under the stated
wishes of the competent patient.
(b) The health care service is stipulated under an existing
power of attorney for health care or a durable power of attorney
and designation of patient advocate under part 5 of article V of
the estates and protected individuals code, 1998 PA 386, MCL
700.5501 to 700.5520.
(c) In the absence of the stated wishes of the patient, the
health care service is in the best interests of the patient as
determined by or is consistent with the orders of the attending
physician or his or her designee.
Sec. 9. (1) Except as otherwise provided in subsection (2),
not later than 6 months after the effective date of this act, an
employer that employs, contracts with, or grants privileges to a
health provider shall adopt and implement a policy to address
situations in which the health provider has an objection to
participating in a health care service as a matter of conscience.
An employer that is subject to this subsection and that, on the
effective date of this act, already has an adopted and implemented
policy in effect that complies with this section is not required to
adopt and implement a new policy. An employer shall comply with all
of the following with regard to its policy described in this
subsection:
(a) The employer shall include a statement that the health
provider will not be penalized for expressing an objection to
participating in a health care service as a matter of conscience or
for requesting accommodation to avoid participating in a health
care service as a matter of conscience.
(b) The employer shall establish a process by which the health
provider may request an accommodation to address the health
provider's objection to participating in a health care service as a
matter of conscience. The employer may require that the health
provider make his or her request for an accommodation in writing.
(c) The employer shall establish a process by which requests
for accommodation under this section are granted or denied and
notice of that decision is given to the requesting health provider.
(2) Subsection (1) does not apply and this subsection applies
to an employer that is a county medical care facility as defined in
section 20104 of the public health code, 1978 PA 368, MCL
333.20104, and to an employer that is a nursing home as defined in
section 20109 of the public health code, 1978 PA 368, MCL
333.20109. Beginning 6 months after the effective date of this act,
a health provider who is employed by, under contract with, or
granted privileges by a county medical care facility or nursing
home may request accommodation to avoid participating in a health
care service to which the health provider objects as a matter of
conscience but only for a health care service that is an act to
remove a life-sustaining device including a ventilator or apparatus
for nonoral hydration or nutrition or is patient care subsequent to
the removal of a life-sustaining device. The health provider shall
make the request for accommodation under this subsection in writing
and give the written request directly to his or her supervisor
assigned by the employer. The health provider shall include in the
written request under this subsection an explanation of his or her
objection and the health care service described in this subsection
to which he or she specifically objects as a matter of conscience.
(3) A health provider may make a request for accommodation
under this section under any of the following conditions:
(a) Upon being offered employment, entering into a contract,
or privileges being granted.
(b) At the time he or she adopts sincerely held convictions
under which he or she objects as a matter of conscience to
participate in the health care service for which he or she is
requesting an accommodation under this section.
(c) Within 24 hours after he or she is asked to participate or
after he or she has received notice or become aware that he or she
is scheduled to participate in a health care service to which he or
she objects as a matter of conscience.
(4) An employer shall not ask a prospective health provider
regarding his or her objection as a matter of conscience or
potential objection as a matter of conscience to participate in a
health care service unless participation in that health care
service meets the following requirements, as applicable:
(a) The health care service is a regular or substantial
portion of the normal course of duties for the employed or
contracted position or under staff privileges the prospective
health provider is seeking.
(b) For an employer described in subsection (2), the health
care service is a health care service to which a health provider
may object to participate in as a matter of conscience under
subsection (2).
(5) An employer shall not refuse to employ, enter into a
contract with, or grant privileges to a health provider because the
health provider is known by the employer to have previously
requested or is currently requesting accommodation under this
section unless participation in that health care service meets the
following requirements, as applicable:
(a) The health care service is a regular or substantial
portion of the normal course of duties for the employed or
contracted position or under staff privileges.
(b) For an employer described in subsection (2), the health
care service is a health care service to which a health provider
may object to participate in as a matter of conscience under
subsection (2).
(6) An employer shall not penalize a health provider for
expressing an objection to participating in a health care service
as a matter of conscience or for requesting accommodation to avoid
participating in a health care service as a matter of conscience.
(7) Upon receipt of a request for accommodation to avoid
participating in a health care service under this section, an
employer shall do all of the following:
(a) Give a written acknowledgment of the health provider's
request within 24 hours after receipt of that request. The employer
shall include in the written acknowledgment a description of the
timeline for granting or denying the request.
(b) Promptly grant or deny the request and give notice of that
decision to the health provider. If the request for accommodation
is denied, the employer shall give the notice in writing and shall
include the reasons for the denial.
(c) Within 7 days after granting a health provider's request,
the employer shall develop a plan for accommodation with the health
provider to ensure that the health provider will not be scheduled
or requested to participate in the health care service to which he
or she objects as a matter of conscience.
(8) An employer shall retain a health provider's request for
accommodation submitted under this section for the duration of the
health provider's employment or period of contract or privileges. A
health provider's request for accommodation that is granted under
this section is valid for the duration of the health provider's
employment or period of contract or privileges or until rescinded
by the health provider in writing.
(9) The protections afforded to a health provider under this
section do not apply to a health provider who has submitted to his
or her employer a request for an accommodation to avoid
participating in a health care service under any of the following
circumstances:
(a) A patient's condition, in the reasonable medical judgment
of an attending physician, medical director, or registered nurse,
requires immediate action to avoid permanent physical harm to the
patient and no other qualified health provider is available to
provide that health care service.
(b) There is a public health emergency.
(c) The health provider first submits a request
contemporaneously to a patient's requiring or requesting the
objectionable health care service and no other health provider is
available to provide the health care service.
(d) The request is based on a patient's or a group of
patients' status or insurance coverage, ability to pay, or method
of payment.
(e) The request is made in the presence of a patient seeking a
health care service to which the health provider objects.
(10) This section does not relieve a health provider from a
duty that exists under current standards of acceptable health care
practice and procedure to inform a patient of the patient's
condition, prognosis, or risk of receiving or forgoing relevant
health care services for the condition, including the availability
of a health care service to which the health provider objects as a
matter of conscience.
(11) A health provider's objection to participating in a
health care service as a matter of conscience as authorized under
this section shall not be the basis for any of the following:
(a) Civil liability to another person.
(b) Criminal action.
(c) Administrative or licensure action.
(d) Eligibility discrimination against the health provider in
a grant, contract, or program, unless participating in the health
care service is an objective of the grant, contract, or program.
(12) Notwithstanding any law to the contrary, a county medical
care facility or nursing home that has granted a request for an
accommodation under this section to a full-time health provider may
include that health provider as a full-time equivalent for the
purposes of staffing levels and staffing ratios.
Sec. 10. (1) Not later than 6 months after the effective date
of this act, a university, college, or educational institution
where education and training regarding the provision of a health
care service is conducted shall adopt and implement a policy
applicable to its students or faculty or staff members that
complies with section 9. A university, college, or educational
institution described in this section that, on the effective date
of this act, already has an adopted and implemented policy in
effect that complies with this section and section 9 is not
required to adopt and implement a new policy.
(2) A university, college, or educational institution
described in subsection (1) shall not refuse admission to an
individual or penalize a student or a member of its faculty or
staff for expressing an objection to participating in a health care
service as a matter of conscience or for requesting accommodation
to avoid participating in a health care service as a matter of
conscience.
Sec. 11. A civil action for damages or reinstatement of
employment, or both, may be brought against a person, including,
but not limited to, a governmental agency, health facility, or
other employer, for penalizing or discriminating against a health
provider, including, but not limited to, penalizing or
discriminating in hiring, promotion, transfer, a term or condition
of employment, licensing, or granting of staff privileges or
appointments, solely because that health provider has submitted a
request for accommodation under section 9 or 10. Civil damages may
be awarded equal to the amount of proven damages and attorney fees.
A civil action filed under this section may include a petition for
injunctive relief against a person alleged to have penalized or
discriminated against a health provider as described in this
section.
Sec. 12. This act does not excuse or limit the liability of a
health care payer, health facility, or health provider for a
refusal to participate in a health care service under any of the
following circumstances:
(a) The payer, facility, or provider has entered into a
contract specifically to participate in the health care service.
(b) The health care provider was employed, contracted with, or
granted privileges by an employer after the effective date of this
act and participation in the health care service objected to is a
regular or substantial portion of the normal course of duties for
the employed or contracted position or under staff privileges.
(c) The payer, facility, or provider has accepted federal or
state money for the sole purpose of, and specifically conditioned
upon, participation in the health care service.
Sec. 13. A person who violates this act is responsible for a
state civil infraction and may be ordered to pay a fine of not more
than $1,000.00 for each day the violation continues or a fine of
not more than $1,000.00 for each occurrence.
Sec. 14. This act does not repeal, supersede, or alter the
conscience provisions of sections 20181 to 20184 of the public
health code, 1978 PA 368, MCL 333.20181 to 333.20184, nor does this
act add additional requirements or conditions to the conscience
provisions of those sections.
Sec. 15. This act does not diminish or affect the rights of a
patient residing in a county medical care facility or a nursing
home, as those rights are enumerated in sections 20201 to 20203 and
section 21765 of the public health code, 1978 PA 368, MCL 333.20201
to 333.20203 and 333.21765, and in 42 CFR 483.10.
