Section 550.1402c - Termination of participation between primary care physician and health care corporation; notice to member; effect of termination; definitions.
THE NONPROFIT HEALTH CARE CORPORATION REFORM ACT (EXCERPT)
Act 350 of 1980
550.1402c Termination of participation between primary care physician and health care corporation; notice to member; effect of termination; definitions.
Sec. 402c.
(1) If participation between a primary care physician and a health care corporation terminates, the physician may provide written notice of this termination within 15 days after the physician becomes aware of the termination to each member who has chosen the physician as his or her primary care physician. If a member is in an ongoing course of treatment with any other physician who is participating with the health care corporation and the participation between the physician and the health care corporation terminates, the physician may provide written notice of this termination to the member within 15 days after the physician becomes aware of the termination. The notices under this subsection may also describe the procedure for continuing care under subsections (2) and (3).
(2) If participation between a member's current physician and a health care corporation terminates, the health care corporation shall permit the member to continue an ongoing course of treatment with that physician as follows:
(a) For 90 days from the date of notice to the member by the physician of the physician's termination with the health care corporation.
(b) If the member is in her second or third trimester of pregnancy at the time of the physician's termination, through postpartum care directly related to the pregnancy.
(c) If the member is determined to be terminally ill prior to a physician's termination or knowledge of the termination and the physician was treating the terminal illness before the date of termination or knowledge of the termination, for the remainder of the member's life for care directly related to the treatment of the terminal illness.
(3) Subsection (2) applies only if the physician agrees to all of the following:
(a) To participate on a per claim basis and to accept as payment in full reimbursement from the health care corporation at the rates applicable prior to the termination.
(b) To adhere to the health care corporation's standards for maintaining quality health care and to provide to the health care corporation necessary medical information related to the care.
(c) To otherwise adhere to the health care corporation's policies and procedures, including, but not limited to, those concerning utilization review, referrals, preauthorizations, and treatment plans.
(4) A health care corporation shall provide written notice to each participating physician that if participation between the physician and the health care corporation terminates, the physician may do both of the following:
(a) Notify the health care corporation's members under the care of the physician of the termination if the physician does so within 15 days after the physician becomes aware of the termination.
(b) Include in the notice under subdivision (a) a description of the procedures for continuing care under subsections (2) and (3).
(5) This section does not create an obligation for a health care corporation to provide to a member coverage beyond the maximum coverage limits permitted by the health care corporation's certificate with the member. This section does not create an obligation for a health care corporation to expand who may be a primary care physician under a certificate.
(6) As used in this section:
(a) “Physician” means an allopathic physician, osteopathic physician, or podiatric physician.
(b) “Terminal illness” means that term as defined in section 5653 of the public health code, 1978 PA 368, MCL 333.5653.
(c) “Terminates” or “termination” includes the nonrenewal, expiration, or ending for any reason of a participation agreement between a physician and a health care corporation, but does not include a termination by the health care corporation for failure to meet applicable quality standards or for fraud.
History: Add. 1999, Act 228, Eff. July 1, 2000 ;-- Am. 2000, Act 485, Imd. Eff. Jan. 11, 2001
Popular Name: Blue Cross-Blue Shield
Popular Name: Act 350