Bill Text: MI HB4401 | 2015-2016 | 98th Legislature | Introduced

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Bill Title: Health facilities; nursing homes; nursing home quality assurance assessment sunset; eliminate. Amends sec. 20161 of 1978 PA 368 (MCL 333.20161).

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2015-03-26 - Printed Bill Filed 03/26/2015 [HB4401 Detail]

Download: Michigan-2015-HB4401-Introduced.html

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HOUSE BILL No. 4401

 

March 25, 2015, Introduced by Rep. VerHeulen and referred to the Committee on Appropriations.

 

      A bill to amend 1978 PA 368, entitled

 

"Public health code,"

 

by amending section 20161 (MCL 333.20161), as amended by 2013 PA

 

137.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

 1        Sec. 20161. (1) The department shall assess fees and other

 

 2  assessments for health facility and agency licenses and

 

 3  certificates of need on an annual basis as provided in this

 

 4  article. Except as otherwise provided in this article, fees and

 

 5  assessments shall be paid as provided in the following schedule:

 

 

6       (a) Freestanding surgical

7  outpatient facilities................$238.00 per facility.

8       (b) Hospitals...................$8.28 per licensed bed.

9       (c) Nursing homes, county

1  medical care facilities, and

2  hospital long-term care units........$2.20 per licensed bed.

3       (d) Homes for the aged..........$6.27 per licensed bed.

4       (e) Clinical laboratories.......$475.00 per laboratory.

5       (f) Hospice residences..........$200.00 per license

6                                       survey; and $20.00 per

7                                       licensed bed.

8       (g) Subject to subsection

9  (13), quality assurance assessment

10 for nursing homes and hospital

11 long-term care units.................an amount resulting

12                                      in not more than 6%

13                                      of total industry

14                                     revenues.

15      (h) Subject to subsection

16 (14), quality assurance assessment

17 for hospitals........................at a fixed or variable

18                                      rate that generates

19                                      funds not more than the

20                                      maximum allowable under

21                                      the federal matching

22                                      requirements, after

23                                      consideration for the

24                                      amounts in subsection

25                                      (14)(a) and (i).

 

 

26        (2) If a hospital requests the department to conduct a

 

27  certification survey for purposes of title XVIII or title XIX of

 

28  the social security act, the hospital shall pay a license fee

 

 1  surcharge of $23.00 per bed. As used in this subsection, "title

 

 2  XVIII" and "title XIX" mean those terms as defined in section

 

 3  20155.

 

 4        (3) All of the following apply to the assessment under this

 

 5  section for certificates of need:

 

 6        (a) The base fee for a certificate of need is $3,000.00 for

 

 7  each application. For a project requiring a projected capital

 

 8  expenditure of more than $500,000.00 but less than $4,000,000.00,

 

 9  an additional fee of $5,000.00 is added to the base fee. For a

 

10  project requiring a projected capital expenditure of

 

11  $4,000,000.00 or more but less than $10,000,000.00, an additional

 

12  fee of $8,000.00 is added to the base fee. For a project

 

13  requiring a projected capital expenditure of $10,000,000.00 or

 

14  more, an additional fee of $12,000.00 is added to the base fee.

 

15        (b) In addition to the fees under subdivision (a), the

 

16  applicant shall pay $3,000.00 for any designated complex project

 

17  including a project scheduled for comparative review or for a

 

18  consolidated licensed health facility application for acquisition

 

19  or replacement.

 

20        (c) If required by the department, the applicant shall pay

 

21  $1,000.00 for a certificate of need application that receives

 

22  expedited processing at the request of the applicant.

 

23        (d) The department shall charge a fee of $500.00 to review

 

24  any letter of intent requesting or resulting in a waiver from

 

25  certificate of need review and any amendment request to an

 

26  approved certificate of need.

 

27        (e) A health facility or agency that offers certificate of

 

 1  need covered clinical services shall pay $100.00 for each

 

 2  certificate of need approved covered clinical service as part of

 

 3  the certificate of need annual survey at the time of submission

 

 4  of the survey data.

 

 5        (f) The department of community health shall use the fees

 

 6  collected under this subsection only to fund the certificate of

 

 7  need program. Funds remaining in the certificate of need program

 

 8  at the end of the fiscal year shall not lapse to the general fund

 

 9  but shall remain available to fund the certificate of need

 

10  program in subsequent years.

 

11        (4) If licensure is for more than 1 year, the fees described

 

12  in subsection (1) are multiplied by the number of years for which

 

13  the license is issued, and the total amount of the fees shall be

 

14  collected in the year in which the license is issued.

 

15        (5) Fees described in this section are payable to the

 

16  department at the time an application for a license, permit, or

 

17  certificate is submitted. If an application for a license,

 

18  permit, or certificate is denied or if a license, permit, or

 

19  certificate is revoked before its expiration date, the department

 

20  shall not refund fees paid to the department.

 

21        (6) The fee for a provisional license or temporary permit is

 

22  the same as for a license. A license may be issued at the

 

23  expiration date of a temporary permit without an additional fee

 

24  for the balance of the period for which the fee was paid if the

 

25  requirements for licensure are met.

 

26        (7) The department may charge a fee to recover the cost of

 

27  purchase or production and distribution of proficiency evaluation

 

 1  samples that are supplied to clinical laboratories under section

 

 2  20521(3).

 

 3        (8) In addition to the fees imposed under subsection (1), a

 

 4  clinical laboratory shall submit a fee of $25.00 to the

 

 5  department for each reissuance during the licensure period of the

 

 6  clinical laboratory's license.

 

 7        (9) The cost of licensure activities shall be supported by

 

 8  license fees.

 

 9        (10) The application fee for a waiver under section 21564 is

 

10  $200.00 plus $40.00 per hour for the professional services and

 

11  travel expenses directly related to processing the application.

 

12  The travel expenses shall be calculated in accordance with the

 

13  state standardized travel regulations of the department of

 

14  technology, management, and budget in effect at the time of the

 

15  travel.

 

16        (11) An applicant for licensure or renewal of licensure

 

17  under part 209 shall pay the applicable fees set forth in part

 

18  209.

 

19        (12) Except as otherwise provided in this section, the fees

 

20  and assessments collected under this section shall be deposited

 

21  in the state treasury, to the credit of the general fund. The

 

22  department may use the unreserved fund balance in fees and

 

23  assessments for the criminal history check program required under

 

24  this article.

 

25        (13) The quality assurance assessment collected under

 

26  subsection (1)(g) and all federal matching funds attributed to

 

27  that assessment shall be used only for the following purposes and

 

 1  under the following specific circumstances:

 

 2        (a) The quality assurance assessment and all federal

 

 3  matching funds attributed to that assessment shall be used to

 

 4  finance medicaid Medicaid nursing home reimbursement payments.

 

 5  Only licensed nursing homes and hospital long-term care units

 

 6  that are assessed the quality assurance assessment and

 

 7  participate in the medicaid Medicaid program are eligible for

 

 8  increased per diem medicaid Medicaid reimbursement rates under

 

 9  this subdivision. A nursing home or long-term care unit that is

 

10  assessed the quality assurance assessment and that does not pay

 

11  the assessment required under subsection (1)(g) in accordance

 

12  with subdivision (c)(i) or in accordance with a written payment

 

13  agreement with the state shall not receive the increased per diem

 

14  medicaid Medicaid reimbursement rates under this subdivision

 

15  until all of its outstanding quality assurance assessments and

 

16  any penalties assessed pursuant to under subdivision (f) have

 

17  been paid in full. Nothing in this This subdivision shall be

 

18  construed to does not authorize or require the department to

 

19  overspend tax revenue in violation of the management and budget

 

20  act, 1984 PA 431, MCL 18.1101 to 18.1594.

 

21        (b) Except as otherwise provided under subdivision (c),

 

22  beginning October 1, 2005, the quality assurance assessment is

 

23  based on the total number of patient days of care each nursing

 

24  home and hospital long-term care unit provided to nonmedicare

 

25  patients within the immediately preceding year and shall be

 

26  assessed at a uniform rate on October 1, 2005 and subsequently on

 

27  October 1 of each following year, and is payable on a quarterly

 

 1  basis, the first payment due 90 days after the date the

 

 2  assessment is assessed.

 

 3        (c) Within 30 days after September 30, 2005, the department

 

 4  shall submit an application to the federal centers Centers for

 

 5  medicare Medicare and medicaid services Medicaid Services to

 

 6  request a waiver pursuant to under 42 CFR 433.68(e) to implement

 

 7  this subdivision as follows:

 

 8        (i) If the waiver is approved, the quality assurance

 

 9  assessment rate for a nursing home or hospital long-term care

 

10  unit with less than 40 licensed beds or with the maximum number,

 

11  or more than the maximum number, of licensed beds necessary to

 

12  secure federal approval of the application is $2.00 per

 

13  nonmedicare non-Medicare patient day of care provided within the

 

14  immediately preceding year or a rate as otherwise altered on the

 

15  application for the waiver to obtain federal approval. If the

 

16  waiver is approved, for all other nursing homes and long-term

 

17  care units the quality assurance assessment rate is to be

 

18  calculated by dividing the total statewide maximum allowable

 

19  assessment permitted under subsection (1)(g) less the total

 

20  amount to be paid by the nursing homes and long-term care units

 

21  with less than 40 or with the maximum number, or more than the

 

22  maximum number, of licensed beds necessary to secure federal

 

23  approval of the application by the total number of nonmedicare

 

24  non-Medicare patient days of care provided within the immediately

 

25  preceding year by those nursing homes and long-term care units

 

26  with more than 39, but less than the maximum number of licensed

 

27  beds necessary to secure federal approval. The quality assurance

 

 1  assessment, as provided under this subparagraph, shall be

 

 2  assessed in the first quarter after federal approval of the

 

 3  waiver and shall be subsequently assessed on October 1 of each

 

 4  following year, and is payable on a quarterly basis, the first

 

 5  payment due 90 days after the date the assessment is assessed.

 

 6        (ii) If the waiver is approved, continuing care retirement

 

 7  centers are exempt from the quality assurance assessment if the

 

 8  continuing care retirement center requires each center resident

 

 9  to provide an initial life interest payment of $150,000.00, on

 

10  average, per resident to ensure payment for that resident's

 

11  residency and services and the continuing care retirement center

 

12  utilizes all of the initial life interest payment before the

 

13  resident becomes eligible for medical assistance under the

 

14  state's medicaid Medicaid plan. As used in this subparagraph,

 

15  "continuing care retirement center" means a nursing care facility

 

16  that provides independent living services, assisted living

 

17  services, and nursing care and medical treatment services, in a

 

18  campus-like setting that has shared facilities or common areas,

 

19  or both.

 

20        (d) Beginning May 10, 2002, the department of community

 

21  health shall increase the per diem nursing home medicaid Medicaid

 

22  reimbursement rates for the balance of that year. For each

 

23  subsequent year in which the quality assurance assessment is

 

24  assessed and collected, the department of community health shall

 

25  maintain the medicaid Medicaid nursing home reimbursement payment

 

26  increase financed by the quality assurance assessment.

 

27        (e) The department of community health shall implement this

 

 1  section in a manner that complies with federal requirements

 

 2  necessary to assure that the quality assurance assessment

 

 3  qualifies for federal matching funds.

 

 4        (f) If a nursing home or a hospital long-term care unit

 

 5  fails to pay the assessment required by subsection (1)(g), the

 

 6  department of community health may assess the nursing home or

 

 7  hospital long-term care unit a penalty of 5% of the assessment

 

 8  for each month that the assessment and penalty are not paid up to

 

 9  a maximum of 50% of the assessment. The department of community

 

10  health may also refer for collection to the department of

 

11  treasury past due amounts consistent with section 13 of 1941 PA

 

12  122, MCL 205.13.

 

13        (g) The medicaid Medicaid nursing home quality assurance

 

14  assessment fund is established in the state treasury. The

 

15  department of community health shall deposit the revenue raised

 

16  through the quality assurance assessment with the state treasurer

 

17  for deposit in the medicaid Medicaid nursing home quality

 

18  assurance assessment fund.

 

19        (h) The department of community health shall not implement

 

20  this subsection in a manner that conflicts with 42 USC 1396b(w).

 

21        (i) The quality assurance assessment collected under

 

22  subsection (1)(g) shall be prorated on a quarterly basis for any

 

23  licensed beds added to or subtracted from a nursing home or

 

24  hospital long-term care unit since the immediately preceding July

 

25  1. Any adjustments in payments are due on the next quarterly

 

26  installment due date.

 

27        (j) In each fiscal year governed by this subsection,

 

 1  medicaid Medicaid reimbursement rates shall not be reduced below

 

 2  the medicaid Medicaid reimbursement rates in effect on April 1,

 

 3  2002 as a direct result of the quality assurance assessment

 

 4  collected under subsection (1)(g).

 

 5        (k) The state retention amount of the quality assurance

 

 6  assessment collected pursuant to under subsection (1)(g) shall be

 

 7  equal to 13.2% of the federal funds generated by the nursing

 

 8  homes and hospital long-term care units quality assurance

 

 9  assessment, including the state retention amount. The state

 

10  retention amount shall be appropriated each fiscal year to the

 

11  department of community health to support medicaid Medicaid

 

12  expenditures for long-term care services. These funds shall

 

13  offset an identical amount of general fund/general purpose

 

14  revenue originally appropriated for that purpose.

 

15        (l) Beginning October 1, 2015, the department shall no longer

 

16  assess or collect the quality assurance assessment or apply for

 

17  federal matching funds. The quality assurance assessment

 

18  collected under subsection (1)(g) shall no longer be assessed or

 

19  collected after September 30, 2011, in the event that the quality

 

20  assurance assessment is not eligible for federal matching funds.

 

21  Any portion of the quality assurance assessment collected from a

 

22  nursing home or hospital long-term care unit that is not eligible

 

23  for federal matching funds shall be returned to the nursing home

 

24  or hospital long-term care unit.

 

25        (14) The quality assurance dedication is an earmarked

 

26  assessment collected under subsection (1)(h). That assessment and

 

27  all federal matching funds attributed to that assessment shall be

 

 1  used only for the following purpose and under the following

 

 2  specific circumstances:

 

 3        (a) To maintain the increased medicaid Medicaid

 

 4  reimbursement rate increases as provided for in subdivision (c).

 

 5        (b) The quality assurance assessment shall be assessed on

 

 6  all net patient revenue, before deduction of expenses, less

 

 7  medicare Medicare net revenue, as reported in the most recently

 

 8  available medicare Medicare cost report and is payable on a

 

 9  quarterly basis, the first payment due 90 days after the date the

 

10  assessment is assessed. As used in this subdivision, "medicare

 

11  "Medicare net revenue" includes medicare Medicare payments and

 

12  amounts collected for coinsurance and deductibles.

 

13        (c) Beginning October 1, 2002, the department of community

 

14  health shall increase the hospital medicaid Medicaid

 

15  reimbursement rates for the balance of that year. For each

 

16  subsequent year in which the quality assurance assessment is

 

17  assessed and collected, the department of community health shall

 

18  maintain the hospital medicaid Medicaid reimbursement rate

 

19  increase financed by the quality assurance assessments.

 

20        (d) The department of community health shall implement this

 

21  section in a manner that complies with federal requirements

 

22  necessary to assure that the quality assurance assessment

 

23  qualifies for federal matching funds.

 

24        (e) If a hospital fails to pay the assessment required by

 

25  subsection (1)(h), the department of community health may assess

 

26  the hospital a penalty of 5% of the assessment for each month

 

27  that the assessment and penalty are not paid up to a maximum of

 

 1  50% of the assessment. The department of community health may

 

 2  also refer for collection to the department of treasury past due

 

 3  amounts consistent with section 13 of 1941 PA 122, MCL 205.13.

 

 4        (f) The hospital quality assurance assessment fund is

 

 5  established in the state treasury. The department of community

 

 6  health shall deposit the revenue raised through the quality

 

 7  assurance assessment with the state treasurer for deposit in the

 

 8  hospital quality assurance assessment fund.

 

 9        (g) In each fiscal year governed by this subsection, the

 

10  quality assurance assessment shall only be collected and expended

 

11  if medicaid Medicaid hospital inpatient DRG and outpatient

 

12  reimbursement rates and disproportionate share hospital and

 

13  graduate medical education payments are not below the level of

 

14  rates and payments in effect on April 1, 2002 as a direct result

 

15  of the quality assurance assessment collected under subsection

 

16  (1)(h), except as provided in subdivision (h).

 

17        (h) The quality assurance assessment collected under

 

18  subsection (1)(h) shall no longer be assessed or collected after

 

19  September 30, 2011 in the event that the quality assurance

 

20  assessment is not eligible for federal matching funds. Any

 

21  portion of the quality assurance assessment collected from a

 

22  hospital that is not eligible for federal matching funds shall be

 

23  returned to the hospital.

 

24        (i) The state retention amount of the quality assurance

 

25  assessment collected pursuant to subsection (1)(h) shall be equal

 

26  to 13.2% of the federal funds generated by the hospital quality

 

27  assurance assessment, including the state retention amount. The

 

 1  state retention percentage shall be applied proportionately to

 

 2  each hospital quality assurance assessment program to determine

 

 3  the retention amount for each program. The state retention amount

 

 4  shall be appropriated each fiscal year to the department of

 

 5  community health to support medicaid Medicaid expenditures for

 

 6  hospital services and therapy. These funds shall offset an

 

 7  identical amount of general fund/general purpose revenue

 

 8  originally appropriated for that purpose.

 

 9        (15) The quality assurance assessment provided for under

 

10  this section is a tax that is levied on a health facility or

 

11  agency.

 

12        (16) As used in this section, "medicaid" "Medicaid" means

 

13  that term as defined in section 22207.