Bill Text: MI SB0595 | 2011-2012 | 96th Legislature | Introduced
Bill Title: Insurance; health; Michigan basic health program for certain low-income residents; establish in lieu of benefits under a health exchange as allowed under the patient protection and affordable care act. Creates new act.
Spectrum: Partisan Bill (Republican 3-0)
Status: (Introduced - Dead) 2011-09-07 - Referred To Committee On Health Policy [SB0595 Detail]
Download: Michigan-2011-SB0595-Introduced.html
SENATE BILL No. 595
September 7, 2011, Introduced by Senators KAHN, PAPPAGEORGE and RICHARDVILLE and referred to the Committee on Health Policy.
A bill to establish a basic health program; to create a basic
health program trust fund; to provide for the powers and duties of
certain state and local governmental officers and entities; to
allow for the promulgation of rules; and to promote the
availability and affordability of health coverage in this state.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 1. (1) This act shall be known and may be cited as the
"Michigan basic health program act".
(2) As used in this act, the words and phrases defined in
sections 3 to 7 have the meanings ascribed to them in those
sections.
Sec. 3. (1) "Administrator" means the director of the
department or his or her designee.
(2) "Automatic assignment protocol" means the protocol for
assigning individuals to standard health plans as currently used by
the department of community health for medicaid managed care plans
and as modified by the administrator to promote the availability
and affordability of health coverage in this state consistent with
section 1331 of the patient protection and affordable care act, 42
USC 18051.
(3) "Department" means the department of community health.
(4) "Eligible individual" means an individual who meets all of
the following:
(a) Is a resident.
(b) Is not eligible to enroll in medicaid, medicare, or the
state children's health insurance program authorized under title
XIX of the social security act, 42 USC 1396 to 1396w-5, for
benefits that at a minimum consist of the essential health benefits
as described in section 1302(b) of the patient protection and
affordable care act, 42 USC 18022.
(c) Has household income that exceeds 133% of the federal
poverty line but does not exceed 200% of the federal poverty line
for the size of the family involved.
(d) Is not eligible for minimum essential coverage, as defined
in section 5000A(f) of the internal revenue code of 1986, 26 USC
5000A, or is eligible for an employer-sponsored plan that is not
affordable coverage as determined under section 5000A(e)(2) of the
internal revenue code of 1986, 26 USC 5000A.
(e) Has not attained age 65 as of the beginning of the plan
year.
(5) "Exchange" means an American health benefit exchange
established by this state pursuant to the patient protection and
affordable care act.
(6) "Federal poverty line" means the poverty line published
periodically in the federal register by the United States
department of health and human services under its authority to
revise the poverty line under 42 USC 9902.
(7) "Fund" means the basic health program trust fund created
in section 9.
Sec. 5. (1) "Medicaid" means a program for medical assistance
established under title XIX of the social security act, 42 USC 1396
to 1396w-5.
(2) "Medicare" means the federal medicare program established
under title XVIII of the social security act, 42 USC 1395 to
1395kkk-1.
(3) "Patient protection and 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, and includes regulations promulgated
under those acts.
(4) "Program" means the basic health program established under
this act.
Sec. 7. (1) "Resident" means an individual who voluntarily
lives in this state with the intention of making his or her home in
this state and not for a temporary purpose and who is not receiving
public assistance from another state.
(2) "Service area" means the geographic area approved by the
administrator within which a standard health plan meets the
requirements for the minimum provider network development as
determined by the administrator under section 13.
(3) "Standard health plan" means a managed care health plan
that this state contracts with as part of the program that meets
all of the following requirements:
(a) Only enrolls eligible individuals.
(b) Provides at least the essential health benefits described
in section 1302(b) of the patient protection and affordable care
act, 42 USC 18022.
(c) Has and maintains a medical loss ratio of at least 85% as
provided in section 1331(b)(3) of the patient protection and
affordable care act, 42 USC 18051.
Sec. 9. (1) The basic health program trust fund is created
within the state treasury.
(2) The state treasurer may receive money or other assets from
any source other than general fund state funds for deposit into the
fund. The state treasurer shall direct the investment of the fund.
The state treasurer shall credit to the fund interest and earnings
from fund investments.
(3) Money in the fund at the close of the fiscal year shall
remain in the fund and shall not lapse to the general fund.
(4) The department is the administrator of the fund for
auditing purposes.
(5) The administrator shall expend money from the fund without
further appropriation for the purposes of reducing the premiums and
cost-sharing of, or to provide additional benefits for, eligible
individuals enrolled in standard health plans in the program.
Sec. 11. The department shall establish, implement, and
administer a basic health program in compliance with this act and
section 1331 of the patient protection and affordable care act, 42
USC 18051.
Sec. 13. (1) In negotiating with a licensed health maintenance
organization regarding its managed care health plans for
participation in the program as a standard health plan, the
administrator shall adopt a uniform procedure that includes a
request for proposals that includes all of the following:
(a) Standards regarding the quality of services to be provided
under the managed care health plan that are at least as rigid as
those currently required of managed care health plans participating
in the state medicaid program.
(b) Standards regarding the financial integrity of managed
care health plans sponsored by responding health maintenance
organizations.
(c) Standards regarding history and experience of responding
health maintenance organizations in addressing the health care
needs of, and providing quality health care services to, low-income
residents.
(d) Standards for minimum provider network development to
ensure that the managed care health plan's network for each service
area within which it will participate has a sufficient number, mix,
and geographic distribution to meet the target populations' needs
and to ensure adequate service availability.
(2) Only managed care health plans that are provided by
licensed health maintenance organizations in this state and that
have an active medicaid contract with the department at the time of
the release of the request for proposals under subsection (1) are
eligible to participate in the program. A managed care health plan
that is not subject to the provisions of section 9010 of the
patient protection and affordable care act is not eligible to
participate in the program.
(3) The administrator shall select 3 standard health plans in
each service area within this state that has mandatory participant
populations of less than 100,000 and 4 standard health plans in
each service area that has mandatory participant populations of
100,000 or more. The administrator may select a standard health
plan for participation in more than 1 service area.
(4) In selecting standard health plans, the administrator
shall give preference to licensed health maintenance organizations
that are currently under a medicaid contract with the department
and that have meaningful and proven chronic care, disease
management, and preventive care programs.
Sec. 15. An individual who is a qualified individual under
section 1312 of the patient protection and affordable care act, 42
USC 18032, and who is eligible for enrollment in a qualified health
plan offered through the exchange is not an eligible individual
under this act and shall not be enrolled in a standard health plan.
Sec. 17. (1) Upon enrollment, an eligible individual shall
have 15 days during which to choose a standard health plan in his
or her service area. The administration shall enroll an eligible
individual who does not choose a standard health plan during the
15-day choice period in a standard health plan through the
automatic assignment protocol.
(2) An eligible individual enrolled in a standard health plan
under subsection (1) may request disenrollment at any time, without
cause, during the first 90 days of enrollment.
(3) The administrator shall establish an annual, 30-day open
enrollment period during which an eligible individual may disenroll
from 1 standard health plan and enroll in another standard health
plan participating in his or her service area.
Sec. 19. (1) The administrator shall do all of the following:
(a) Ensure that the participating standard health plans
provide essential health benefits as described in section 1302(b)
of the patient protection and affordable care act, 42 USC 18022.
(b) Evaluate performance measures as determined by the
administrator.
(c) Contract with standard health plans as provided in this
act.
(d) Seek approval from the secretary of the United States
department of health and human services to do either of the
following:
(i) Use a portion of the federal funds to be provided to the
state under this program to fund administration of the program.
(ii) Use a portion of premiums paid by eligible individuals to
fund administration of the program.
(e) Coordinate, to the extent possible, the medicaid managed
care program, the basic health program, and the exchange.
(f) Any other activity necessary to fulfill his or her duties
under this act.
(2) The administrator may promulgate rules under the
administrative procedures act of 1969, 1969 PA 306, MCL 24.201 to
24.328, that he or she considers necessary to implement this act.
