Michigan-2013-SB0913-Engrossed

SB-0913, As Passed Senate, May 8, 2014

SUBSTITUTE FOR

SENATE BILL NO. 913

A bill to amend 2011 PA 142, entitled

"Health insurance claims assessment act,"

by amending section 3 (MCL 550.1733).

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

Sec. 3. (1) For dates of service beginning on or after January

1, 2012 and ending on June 30, 2014, subject to subsections (2),

(3), and (4), there is levied upon and there shall be collected

from every carrier and third party administrator an assessment of

1% on that carrier's or third party administrator's paid claims.

For dates of service beginning on or after July 1, 2014 and ending

on December 31, 2017, subject to this subsection and subsections

(2), (3), and (4), there is levied upon and there shall be

collected from every carrier and third party administrator an

Senate Bill No. 913 as amended May 8, 2014

assessment of 0.75% on that carrier's or third party

administrator's paid claims. For dates of service beginning on or

after July 1, 2014 and ending on December 31, 2017, subject to this

subsection and subsections (2), (3), and (4), the assessment levied

under this subsection will increase to 1.0% if the federal

government informs this state that the use tax revenues assessed on

entities under section 3f of the use tax act, 1937 PA 94, MCL

205.93f, will not be federally reimbursed. If the assessment is

increased as provided in this subsection, the increased assessment

levied is <<effective on the date that

>> the federal government informs this

state that the revenue collected from the use tax assessed on

medicaid managed care organizations under section 3f of the use tax

act, 1937 PA 94, MCL 205.93f, will not be federally reimbursed. For

the purposes of this subsection, a fiscal quarter begins on the

first day of January, April, July, or October.

(2) A carrier with a suspension or exemption under section

3717 of the insurance code of 1956, 1956 PA 218, MCL 500.3717, on

~~the effective date of this act~~ September 20, 2011 is subject to an

assessment of 0.1%.

(3) All of the following apply to a group health plan that

uses the services of a third party administrator or excess loss or

stop loss insurer:

(a) A group health plan sponsor ~~shall~~ is not be responsible

for an assessment under this ~~subsection~~ section for a paid claim

~~where~~ if the assessment on that claim has been paid by a third

party administrator or excess loss or stop loss insurer, except as

otherwise provided in section 3a(2).

(b) Except as otherwise provided in subdivision (d), the third

party administrator ~~shall be~~ is responsible for all assessments on

paid claims paid by the third party administrator.

excess loss or stop loss insurer ~~shall be~~ is responsible for all

assessments on paid claims paid by the excess loss or stop loss

insurer.

(d) If there is both a third party administrator and an excess

loss or stop loss insurer servicing the group health plan, the

third party administrator ~~shall be~~ is responsible for all

assessments for paid claims that are not reimbursed by the excess

loss or stop loss insurer and the excess loss or stop loss insurer

~~shall be~~ is responsible for all assessments for paid claims that

are reimbursable to the excess loss or stop loss insurer.

(4) The assessment under this section shall not exceed

$10,000.00 per insured individual or covered life annually.

(5) To the extent an assessment paid under this section for

paid claims for a group health plan or individual subscriber is

inaccurate due to subsequent claim adjustments or recoveries,

subsequent filings shall be adjusted to accurately reflect the

correct assessment based on actual claims paid.

(6) If Through June 30, 2014, if the assessment under this

section collects revenue in an amount greater than $400,000,000.00,

adjusted annually by the medical inflation rate since 2011, each

carrier and third party administrator that paid the assessment

shall receive a proportional credit against the carrier's or third

party administrator's assessment in the immediately succeeding

year. Beginning July 1, 2014, if the sum of the assessment under

this section and the portion of the use tax assessed on entities

under section 3f of the use tax act, 1937 PA 94, MCL 205.93f, that

is dedicated to the general fund, less the general fund amount

necessary to reimburse those entities for the cost of the use tax,

is greater than $400,000,000.00, as adjusted annually by the

medical inflation rate since 2011 but not to exceed an amount

greater than $450,000,000.00, each carrier and third party

administrator that paid the assessment shall receive a proportional

credit against the carrier's or third party administrator's

assessment in the immediately succeeding year. The department shall

send a notice of credit to each carrier or third party

administrator entitled to a credit under this subsection not later

than July 1. A carrier or third party administrator entitled to a

credit under this subsection shall apply that credit to the July 30

payment. Any unused credit shall be carried forward and applied to

subsequent payments. If a carrier or third party administrator

entitled to a credit under this subsection has no liability under

this act in the immediately succeeding year or if this act is no

longer in effect, the department shall issue that carrier or third

party administrator a refund in the amount of any unused credit. If

a third party administrator receives a credit or refund under this

subsection, the third party administrator shall apply that credit

or refund to the benefit of the entity for which it processed the

claims under a service contract.

Enacting section 1. This amendatory act does not take effect