June 12, 2007, Introduced by Reps. Wojno, Accavitti, Miller and Polidori and referred to the Committee on Insurance.
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 expense-incurred hospital, medical, or
surgical policy or certificate delivered, issued for delivery, or
renewed in this state and a health maintenance organization group
or individual contract shall include coverage for prosthetics and
orthotics that, at a minimum, equals the prosthetics and orthotics
coverage provided for under 42 USC 1395k, 1395l, and 1395n and 42
CFR 410.100, 414.202, 414.210, and 414.228. Coverage shall include
replacement for the prosthetic or orthotic if required because of a
change in the member's physical condition and for repair or
replacement if determined appropriate by the member's treating
physician. Coverage may be limited to the most appropriate model
that adequately meets the medical needs of the member as determined
by the member's treating physician.
(2) An insurer and a health maintenance organization may
require prior authorization for prosthetics and orthotics in the
same manner that prior authorization is required for any other
covered benefit. An insurer and a health maintenance organization
may impose copayments and coinsurance amounts on prosthetics and
orthotics not to exceed the copayment and coinsurance amounts
imposed for prosthetics and orthotics under part B of medicare, 42
USC 1395j to 1395w-4. An insurer and a health maintenance
organization shall reimburse for prosthetics and orthotics at no
less than the fee schedule for prosthetics and orthotics under the
medical reimbursement fee schedule established by the centers for
medicare and medicaid services based on the health care common
procedure coding system. An insurer and a health maintenance
organization shall not impose any annual or lifetime dollar maximum
on prosthetics and orthotics coverage other than an annual or
lifetime dollar maximum that applies in the aggregate to all terms
and services covered under the policy, certificate, or contract.
(3) As used in this section:
(a) "Orthotics" means all services requiring custom orthoses.
(b) "Prosthetics" means external extremity prosthetics for the
appendicular skeleton.
Enacting section 1. This amendatory act takes effect 180 days
after the date it is enacted.