May 19, 2015, Introduced by Rep. Lane and referred to the Committee on Appropriations.
A bill to amend 1939 PA 280, entitled
"The social welfare act,"
by amending section 109 (MCL 400.109), as amended by 2012 PA 48.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 109. (1) The following medical services may be provided
under this act:
(a) Hospital services that an eligible individual may receive
consist of medical, surgical, or obstetrical care, together with
necessary drugs, X-rays, physical therapy, prosthesis,
transportation, and nursing care incident to the medical, surgical,
or obstetrical care. The period of inpatient hospital service shall
be the minimum period necessary in this type of facility for the
proper care and treatment of the individual. Necessary
hospitalization to provide dental care shall be provided if
certified by the attending dentist with the approval of the
department of community health. An individual who is receiving
medical treatment as an inpatient because of a diagnosis of
tuberculosis or mental disease may receive service under this
section, notwithstanding the mental health code, 1974 PA 258, MCL
330.1001 to 330.2106, and 1925 PA 177, MCL 332.151 to 332.164. The
department of community health shall pay for hospital services
according to the state plan for medical assistance adopted under
section 10 and approved by the United States department of health
and human services.
(b) An eligible individual may receive physician services
authorized by the department of community health. The service may
be furnished in the physician's office, the eligible individual's
home, a medical institution, or elsewhere in case of emergency. A
physician shall be paid a reasonable charge for the service
rendered. Reasonable charges shall be determined by the department
of community health and shall not be more than those paid in this
state for services rendered under title XVIII.
(c) An eligible individual may receive nursing home services
in a state licensed nursing home, a state-licensed adult foster
care facility, a medical care facility, or other facility or
identifiable unit of that facility, certified by the appropriate
authority as meeting established standards for a nursing home under
the laws and rules of this state and the United States department
of health and human services, to the extent found necessary by the
attending physician, dentist, or certified Christian Science
practitioner. An eligible individual may receive nursing services
in an extended care services program established under section
22210 of the public health code, 1978 PA 368, MCL 333.22210, to the
extent found necessary by the attending physician when the combined
length of stay in the acute care bed and short-term nursing care
bed exceeds the average length of stay for medicaid hospital
diagnostic related group reimbursement. The department of community
health shall not make a final payment under title XIX for benefits
available under title XVIII without documentation that title XVIII
claims have been filed and denied. The department of community
health shall pay for nursing home services according to the state
plan for medical assistance adopted according to section 10 and
approved by the United States department of health and human
services. A county shall reimburse a county maintenance of effort
rate determined on an annual basis for each patient day of medicaid
nursing home services provided to eligible individuals in long-term
care facilities or adult foster care facilities owned by the county
and licensed to provide nursing home services. For purposes of
determining rates and costs described in this subdivision, all of
the following apply:
(i) For county owned facilities with per patient day updated
variable costs exceeding the variable cost limit for the county
facility, county maintenance of effort rate means 45% of the
difference between per patient day updated variable cost and the
concomitant nursing home-class variable cost limit, the quantity
offset by the difference between per patient day updated variable
cost and the concomitant variable cost limit for the county
facility. The county rate shall not be less than zero.
(ii) For county owned facilities with per patient day updated
variable costs not exceeding the variable cost limit for the county
facility, county maintenance of effort rate means 45% of the
difference between per patient day updated variable cost and the
concomitant nursing home class variable cost limit.
(iii) For county owned facilities with per patient day updated
variable costs not exceeding the concomitant nursing home class
variable cost limit, the county maintenance of effort rate shall
equal zero.
(iv) For the purposes of this section: "per patient day updated
variable costs and the variable cost limit for the county facility"
shall be determined according to the state plan for medical
assistance; for freestanding county facilities the "nursing home
class variable cost limit" shall be determined according to the
state plan for medical assistance and for hospital attached county
facilities the "nursing class variable cost limit" shall be
determined
pursuant according to the state plan for medical
assistance plus $5.00 per patient day; and "freestanding" and
"hospital attached" shall be determined according to the federal
regulations.
(v) If the county maintenance of effort rate computed under
this section exceeds the county maintenance of effort rate in
effect as of September 30, 1984, the rate in effect as of September
30, 1984 shall remain in effect until a time that the rate computed
under this section is less than the September 30, 1984 rate. This
limitation remains in effect until December 31, 2017. For each
subsequent county fiscal year the maintenance of effort may not
increase by more than $1.00 per patient day each year.
(vi) For county owned facilities, reimbursement for plant costs
will continue to be based on interest expense and depreciation
allowance unless otherwise provided by law.
(d) An eligible individual may receive pharmaceutical services
from a licensed pharmacist of the person's choice as prescribed by
a licensed physician or dentist and approved by the department of
community health. In an emergency, but not routinely, the
individual may receive pharmaceutical services rendered personally
by a licensed physician or dentist on the same basis as approved
for pharmacists.
(e) An eligible individual may receive other medical and
health services as authorized by the department of community
health.
(f) Psychiatric care may also be provided according to the
guidelines established by the department of community health to the
extent of appropriations made available by the legislature for the
fiscal year.
(g) An eligible individual may receive screening, laboratory
services, diagnostic services, early intervention services, and
treatment for chronic kidney disease under guidelines established
by the department of community health. A clinical laboratory
performing a creatinine test on an eligible individual under this
subdivision shall include in the lab report the glomerular
filtration rate (eGFR) of the individual and shall report it as a
percent of kidney function remaining.
(2) The director of the department of community health shall
provide notice to the public, according to applicable federal
regulations, and shall obtain the approval of the committees on
appropriations of the house of representatives and senate of the
legislature of this state, of a proposed change in the statewide
method or level of reimbursement for a service, if the proposed
change is expected to increase or decrease payments for that
service by 1% or more during the 12 months after the effective date
of the change.
(3) If the department of community health requires a federal
waiver or amendment to the state plan for medical assistance to
implement the changes to the provisions of this section, the
department of community health shall apply immediately upon
enactment of the amendatory act that added this subsection for that
federal waiver or amendment to the state plan for medical
assistance.
(4) (3)
As used in this act:
(a) "Title XVIII" means title XVIII of the social security
act, 42 USC 1395 to 1395kkk-1.
(b) "Title XIX" means title XIX of the social security act, 42
USC 1396 to 1396w-5.
(c) "Title XX" means title XX of the social security act, 42
USC 1397 to 1397m-5.