|
August =
8, 2011
Public
Act 95 Mandates Electronic Access to Health Care Insurance Data<=
/span>
By:
Marshall W. Grate
Public Act 95, which took effect on July 15, 20=
11,
guarantees that public school districts, intermediate school
districts, or public school academies, that have 100 or more empl=
oyees
in a medical benefit plan, will have access through electronic me=
ans
to all claims utilization and cost information associated with a
medical benefit plan. Public Act 95, which added Sect=
ion
1255a to the Michigan Revised School Code, MCL 380.1255a, actually
supplements the Public Employees' Health Benefit Act, MCL 124.71 =
et
seq. As used in Public Act 95, the term "medical benefit
plan" has the same meaning as used in the Public Employees'
Health Benefit Act:
'Medical Benefit Pl=
an' means
a plan, established and maintained by a carrier or 1 or more publ=
ic
employers, that provides for the payment of medical, optical, or
dental benefits, including, but not limited to, hospital and
physician services, prescription drugs and related benefits, to
public employees. MCL 124.73(c).<=
/p>
A board of educatio=
n of
a school district or intermediate school district or a board of
directors of a public school academy cannot enter into a
contract for a medical benefit plan unless the contract provides =
for
one of two options:
(1) The public scho=
ol
district is the policyholder for the medical benefit plan and at =
all
times during the period of the contract, the school district has
access by electronic means to all claims utilization and cost
information as described in MCL 124.85 of the Employees Health
Benefit Act; OR
(2) That within ten
business days after making a written request, the school district=
is
given access by electronic means to all claims utilization and co=
st
information as described in MCL 124.85.
The Public Employee=
s'
Health Benefits Act requires that any medical benefit plan make
available electronically to Public Employers, with 100 or more
employees in a medical benefit plan, the following information ab=
out
claims utilization and cost information:
- =
The
persons covered under the medical benefit plan, census
information, including date of birth, gender, zip code, and
medical tier such as single and/or family.
- =
Monthly
claims by provider type and service category reported by the
total number and dollar amounts in claims paid and reported
separately for in-network and out-of-network providers.
- =
The
number of claims paid over $50,000 and the total dollar amou=
nt
of those claims.
- =
The
dollar amounts paid for specific and aggregate stop/loss ins=
urance.
- =
The
dollar amount of administrative expenses incurred or paid,
reported separately for medical, pharmacy, dental, and visio=
n.
- =
The
total dollar amount of retentions and other expenses. <=
/o:p>
- =
The
dollar amount of all service fees paid.
- =
The dollar
amount of any fees or commissions paid to agents, consultant=
s,
or brokers by the medical benefit plan or by any public empl=
oyer
or carrier participating in or providing services to the med=
ical
benefit plan, reported separately for medical, pharmacy,
stop/loss, dental, and vision. MCL 124.85(3)(a).<=
/span>
Subsection 2 of Pub=
lic
Act 95 addresses school districts that have fewer than 100 employ=
ees
in a medical benefit plan. Subsection 2 simply reaffirms that Pub=
lic
Act 95 does not affect a school district's right to be the
policyholder for a medical benefit plan under Section 15(3) of PE=
RA,
MCL 423.215(3).
Public Act 95 does =
not
change the Best Practices' five criteria. A school district can s=
till
choose whether to declare itself the policyholder or not as one of
the five best practices.<=
/p>
Regardless of wheth=
er
the school district declares itself the policyholder, before it c=
an
enter into a contract for a medical benefit plan, the school dist=
rict
must ensure that the medical benefit plan provides electronic acc=
ess
to all the claims utilization and cost information in the manner
described above. If you have any questions, contact your Clark Hi=
ll
Educational Practice Group attorney.
|
![3D"Description:](3D"https://imgssl.constantcontact.com/ui/images1/btn_twit_160.png")