HOUSE BILL No. 5076


     September 23, 1997, Introduced by Rep. Gubow and referred to the Committee on Insurance.


        A bill to amend 1980 PA 350, entitled

   "The nonprofit health care corporation reform act,"

   (MCL 550.1101 to 550.1704) by adding section 418.

               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 DENY PAYMENT FOR EMERGENCY HEALTH SERVICES


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 1    UP TO THE POINT OF STABILIZATION PROVIDED TO A MEMBER UNDER THIS

 2    SUBSECTION BECAUSE OF EITHER OF THE FOLLOWING:

 3         (A) THE FINAL DIAGNOSIS.

 4         (B) PRIOR AUTHORIZATION WAS NOT GIVEN BY THE HEALTH CARE

 5    CORPORATION BEFORE EMERGENCY HEALTH SERVICES WERE PROVIDED.

 6         (2) AS USED IN THIS SECTION, "STABILIZATION" MEANS THE POINT

 7    AT WHICH NO MATERIAL DETERIORATION OF A CONDITION IS LIKELY,

 8    WITHIN REASONABLE MEDICAL PROBABILITY, TO RESULT FROM OR OCCUR

 9    DURING TRANSFER OF THE PATIENT.






































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