July 16, 2003, Introduced by Reps. Wojno, Ehardt, Accavitti, Law, Vander Veen and Bieda and referred to the Committee on Health Policy.
A bill to amend 1980 PA 350, entitled
"The nonprofit health care corporation reform act,"
by amending section 418 (MCL 550.1418), as added by 1998 PA 124.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
1 Sec. 418. (1) A health care corporation certificate that
2 provides coverage for emergency health services shall provide
3 coverage for medically necessary services provided to a member
4 for the sudden onset of a medical condition that manifests itself
5 by signs and symptoms of sufficient severity, including severe
6 pain, such that the absence of immediate medical attention could
7 reasonably be expected to result in serious jeopardy to the
8 individual's health or to a pregnancy in the case of a pregnant
9 woman, serious impairment to bodily functions, or serious
10 dysfunction of any bodily organ or part. A health care
11 corporation shall not require a physician to transfer a patient
1 before the physician determines that the patient has reached the
2 point of stabilization. A health care corporation shall not deny
3 payment for emergency health services up to the point of
4 stabilization provided to a member under this subsection because
5 of either of the following:
6 (a) The final diagnosis.
7 (b) Prior authorization was not given by the health care
8 corporation before emergency health services were provided.
9 (2) As used in this section, "stabilization" means the point
10 at which no material deterioration of a condition is likely,
11 within reasonable medical probability, to result from or occur
12 during transfer of the patient.