Bill Text: MI HB4522 | 2019-2020 | 100th Legislature | Introduced

---

Bill Title: Human services; medical services; Healthy Michigan; eliminate language related to cost exceeding savings. Amends sec. 105d of 1939 PA 280 (MCL 400.105d).

Spectrum: Partisan Bill (Democrat 50-1)

Status: (Introduced - Dead) 2019-05-01 - Bill Electronically Reproduced 05/01/2019 [HB4522 Detail]

Download: Michigan-2019-HB4522-Introduced.html

---

 

 

 

 

 

 

 

 

 

 

HOUSE BILL No. 4522

 

 

April 30, 2019, Introduced by Reps. Sowerby, Warren, Lasinski, Cynthia Johnson, Hertel, Wittenberg, Camilleri, Love, Clemente, Tate, Witwer, Pohutsky, Ellison, Hammoud, Kennedy, Coleman, Pagan, Chirkun, Sneller, Bolden, Guerra, Stone, Hood, Shannon, Gay-Dagnogo, Kuppa, Hope, Haadsma, Robinson, Brixie, Liberati, Garrett, Whitsett, Hoadley, Brenda Carter, Tyrone Carter, Elder, Peterson, Neeley, Sabo, Manoogian, Koleszar, Byrd, Jones, Yancey, Anthony, Cambensy, Maddock, Garza, Greig and Rabhi and referred to the Committee on Health Policy.

 

     A bill to amend 1939 PA 280, entitled

 

"The social welfare act,"

 

by amending section 105d (MCL 400.105d), as amended by 2018 PA 208.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

     Sec. 105d. (1) The department shall seek a waiver from the

 

United States Department of Health and Human Services to do,

 

without jeopardizing federal match dollars or otherwise incurring

 

federal financial penalties, and upon approval of the waiver shall

 

do, all of the following:

 

     (a) Enroll individuals eligible under section

 

1396a(a)(10)(A)(i)(VIII) of title XIX who meet the citizenship

 

provisions of 42 CFR 435.406 and who are otherwise eligible for the

 

medical assistance program under this act into a contracted health

 

plan that provides for an account into which money from any source,

 

including, but not limited to, the enrollee, the enrollee's

employer, and private or public entities on the enrollee's behalf,

 

can be deposited to pay for incurred health expenses, including,

 

but not limited to, co-pays. The account shall be administered by

 

the department and can be delegated to a contracted health plan or

 

a third party administrator, as considered necessary.

 

     (b) Ensure that contracted health plans track all enrollee co-

 

pays incurred for the first 6 months that an individual is enrolled

 

in the program described in subdivision (a) and calculate the

 

average monthly co-pay experience for the enrollee. The average co-

 

pay amount shall be adjusted at least annually to reflect changes

 

in the enrollee's co-pay experience. The department shall ensure

 

that each enrollee receives quarterly statements for his or her

 

account that include expenditures from the account, account

 

balance, and the cost-sharing amount due for the following 3

 

months. The enrollee shall be required to remit each month the

 

average co-pay amount calculated by the contracted health plan into

 

the enrollee's account. The department shall pursue a range of

 

consequences for enrollees who consistently fail to meet their

 

cost-sharing requirements, including, but not limited to, using the

 

MIChild program as a template and closer oversight by health plans

 

in access to providers.

 

     (c) Give enrollees described in subdivision (a) a choice in

 

choosing among contracted health plans.

 

     (d) Ensure that all enrollees described in subdivision (a)

 

have access to a primary care practitioner who is licensed,

 

registered, or otherwise authorized to engage in his or her health

 

care profession in this state and to preventive services. The

department shall require that all new enrollees be assigned and

 

have scheduled an initial appointment with their primary care

 

practitioner within 60 days of initial enrollment. The department

 

shall monitor and track contracted health plans for compliance in

 

this area and consider that compliance in any health plan incentive

 

programs. The department shall ensure that the contracted health

 

plans have procedures to ensure that the privacy of the enrollees'

 

personal information is protected in accordance with the health

 

insurance portability and accountability act of 1996, Public Law

 

104-191.

 

     (e) Require enrollees described in subdivision (a) with annual

 

incomes between 100% and 133% of the federal poverty guidelines to

 

contribute not more than 5% of income annually for cost-sharing

 

requirements. Cost-sharing includes co-pays and required

 

contributions made into the accounts authorized under subdivision

 

(a). Contributions required in this subdivision do not apply for

 

the first 6 months an individual described in subdivision (a) is

 

enrolled. Required contributions to an account used to pay for

 

incurred health expenses shall be 2% of income annually. Except as

 

otherwise provided in subsection (20), notwithstanding this

 

minimum, required contributions may be reduced by the contracting

 

health plan. The reductions may occur only if healthy behaviors are

 

being addressed as attested to by the contracted health plan based

 

on uniform standards developed by the department in consultation

 

with the contracted health plans. The uniform standards shall

 

include healthy behaviors such as completing a department approved

 

annual health risk assessment to identify unhealthy

characteristics, including alcohol use, substance use disorders,

 

tobacco use, obesity, and immunization status. Except as otherwise

 

provided in subsection (20), co-pays can be reduced if healthy

 

behaviors are met, but not until annual accumulated co-pays reach

 

2% of income except co-pays for specific services may be waived by

 

the contracted health plan if the desired outcome is to promote

 

greater access to services that prevent the progression of and

 

complications related to chronic diseases. If the enrollee

 

described in subdivision (a) becomes ineligible for medical

 

assistance under the program described in this section, the

 

remaining balance in the account described in subdivision (a) shall

 

be returned to that enrollee in the form of a voucher for the sole

 

purpose of purchasing and paying for private insurance.

 

     (f) Implement a co-pay structure that encourages use of high-

 

value services, while discouraging low-value services such as

 

nonurgent emergency department use.

 

     (g) During the enrollment process, inform enrollees described

 

in subdivision (a) about advance directives and require the

 

enrollees to complete a department-approved advance directive on a

 

form that includes an option to decline. The advance directives

 

received from enrollees as provided in this subdivision shall be

 

transmitted to the peace of mind registry organization to be placed

 

on the peace of mind registry.

 

     (h) Develop incentives for enrollees and providers who assist

 

the department in detecting fraud and abuse in the medical

 

assistance program. The department shall provide an annual report

 

that includes the type of fraud detected, the amount saved, and the

outcome of the investigation to the legislature.

 

     (i) Allow for services provided by telemedicine from a

 

practitioner who is licensed, registered, or otherwise authorized

 

under section 16171 of the public health code, 1978 PA 368, MCL

 

333.16171, to engage in his or her health care profession in the

 

state where the patient is located.

 

     (2) For services rendered to an uninsured individual, a

 

hospital that participates in the medical assistance program under

 

this act shall accept 115% of Medicare rates as payments in full

 

from an uninsured individual with an annual income level up to 250%

 

of the federal poverty guidelines. This subsection applies whether

 

or not either or both of the waivers requested under this section

 

are approved, the patient protection and affordable care act is

 

repealed, or the state terminates or opts out of the program

 

established under this section.

 

     (3) Not more than 7 calendar days after receiving each of the

 

official waiver-related written correspondence from the United

 

States Department of Health and Human Services to implement the

 

provisions of this section, the department shall submit a written

 

copy of the approved waiver provisions to the legislature for

 

review.

 

     (4) The department shall develop and implement a plan to

 

enroll all existing fee-for-service enrollees into contracted

 

health plans if allowable by law, if the medical assistance program

 

is the primary payer and if that enrollment is cost-effective. This

 

includes all newly eligible enrollees as described in subsection

 

(1)(a). The department shall include contracted health plans as the

mandatory delivery system in its waiver request. The department

 

also shall pursue any and all necessary waivers to enroll persons

 

eligible for both Medicaid and Medicare into the 4 integrated care

 

demonstration regions. The department shall identify all remaining

 

populations eligible for managed care, develop plans for their

 

integration into managed care, and provide recommendations for a

 

performance bonus incentive plan mechanism for long-term care

 

managed care providers that are consistent with other managed care

 

performance bonus incentive plans. The department shall make

 

recommendations for a performance bonus incentive plan for long-

 

term care managed care providers of up to 3% of their Medicaid

 

capitation payments, consistent with other managed care performance

 

bonus incentive plans. These payments shall comply with federal

 

requirements and shall be based on measures that identify the

 

appropriate use of long-term care services and that focus on

 

consumer satisfaction, consumer choice, and other appropriate

 

quality measures applicable to community-based and nursing home

 

services. Where appropriate, these quality measures shall be

 

consistent with quality measures used for similar services

 

implemented by the integrated care for duals demonstration project.

 

This subsection applies whether or not either or both of the

 

waivers requested under this section are approved, the patient

 

protection and affordable care act is repealed, or the state

 

terminates or opts out of the program established under this

 

section.

 

     (5) The department shall implement a pharmaceutical benefit

 

that utilizes co-pays at appropriate levels allowable by the

Centers for Medicare and Medicaid Services to encourage the use of

 

high-value, low-cost prescriptions, such as generic prescriptions

 

when such an alternative exists for a branded product and 90-day

 

prescription supplies, as recommended by the enrollee's prescribing

 

provider and as is consistent with section 109h and sections 9701

 

to 9709 part 97 of the public health code, 1978 PA 368, MCL

 

333.9701 to 333.9709. This subsection applies whether or not either

 

or both of the waivers requested under this section are approved,

 

the patient protection and affordable care act is repealed, or the

 

state terminates or opts out of the program established under this

 

section.

 

     (6) The department shall work with providers, contracted

 

health plans, and other departments as necessary to create

 

processes that reduce the amount of uncollected cost-sharing and

 

reduce the administrative cost of collecting cost-sharing. To this

 

end, a minimum 0.25% of payments to contracted health plans shall

 

be withheld for the purpose of establishing a cost-sharing

 

compliance bonus pool beginning October 1, 2015. The distribution

 

of funds from the cost-sharing compliance pool shall be based on

 

the contracted health plans' success in collecting cost-sharing

 

payments. The department shall develop the methodology for

 

distribution of these funds. This subsection applies whether or not

 

either or both of the waivers requested under this section are

 

approved, the patient protection and affordable care act is

 

repealed, or the state terminates or opts out of the program

 

established under this section.

 

     (7) The department shall develop a methodology that decreases

the amount an enrollee's required contribution may be reduced as

 

described in subsection (1)(e) based on, but not limited to,

 

factors such as an enrollee's failure to pay cost-sharing

 

requirements and the enrollee's inappropriate utilization of

 

emergency departments.

 

     (8) The program described in this section is created in part

 

to extend health coverage to the state's low-income citizens and to

 

provide health insurance cost relief to individuals and to the

 

business community by reducing the cost shift attendant to

 

uncompensated care. Uncompensated care does not include courtesy

 

allowances or discounts given to patients. The Medicaid hospital

 

cost report shall be part of the uncompensated care definition and

 

calculation. In addition to the Medicaid hospital cost report, the

 

department shall collect and examine other relevant financial data

 

for all hospitals and evaluate the impact that providing medical

 

coverage to the expanded population of enrollees described in

 

subsection (1)(a) has had on the actual cost of uncompensated care.

 

This shall be reported for all hospitals in the state. By December

 

31, 2014, the department shall make an initial baseline

 

uncompensated care report containing at least the data described in

 

this subsection to the legislature and each December 31 after that

 

shall make a report regarding the preceding fiscal year's evidence

 

of the reduction in the amount of the actual cost of uncompensated

 

care compared to the initial baseline report. The baseline report

 

shall use fiscal year 2012-2013 data. Based on the evidence of the

 

reduction in the amount of the actual cost of uncompensated care

 

borne by the hospitals in this state, the department shall

proportionally reduce the disproportionate share payments to all

 

hospitals and hospital systems for the purpose of producing general

 

fund savings. The department shall recognize any savings from this

 

reduction by September 30, 2016. All the reports required under

 

this subsection shall be made available to the legislature and

 

shall be easily accessible on the department's website.

 

     (9) The department of insurance and financial services shall

 

examine the financial reports of health insurers and evaluate the

 

impact that providing medical coverage to the expanded population

 

of enrollees described in subsection (1)(a) has had on the cost of

 

uncompensated care as it relates to insurance rates and insurance

 

rate change filings, as well as its resulting net effect on rates

 

overall. The department of insurance and financial services shall

 

consider the evaluation described in this subsection in the annual

 

approval of rates. By December 31, 2014, the department of

 

insurance and financial services shall make an initial baseline

 

report to the legislature regarding rates and each December 31

 

after that shall make a report regarding the evidence of the change

 

in rates compared to the initial baseline report. All the reports

 

required under this subsection shall be made available to the

 

legislature and shall be made available and easily accessible on

 

the department's website.

 

     (10) The department shall explore and develop a range of

 

innovations and initiatives to improve the effectiveness and

 

performance of the medical assistance program and to lower overall

 

health care costs in this state. The department shall report the

 

results of the efforts described in this subsection to the

legislature and to the house and senate fiscal agencies by

 

September 30, 2015. The report required under this subsection shall

 

also be made available and easily accessible on the department's

 

website. The department shall pursue a broad range of innovations

 

and initiatives as time and resources allow that shall include, at

 

a minimum, all of the following:

 

     (a) The value and cost-effectiveness of optional Medicaid

 

benefits as described in federal statute.

 

     (b) The identification of private sector, primarily small

 

business, health coverage benefit differences compared to the

 

medical assistance program services and justification for the

 

differences.

 

     (c) The minimum measures and data sets required to effectively

 

measure the medical assistance program's return on investment for

 

taxpayers.

 

     (d) Review and evaluation of the effectiveness of current

 

incentives for contracted health plans, providers, and

 

beneficiaries with recommendations for expanding and refining

 

incentives to accelerate improvement in health outcomes, healthy

 

behaviors, and cost-effectiveness and review of the compliance of

 

required contributions and co-pays.

 

     (e) Review and evaluation of the current design principles

 

that serve as the foundation for the state's medical assistance

 

program to ensure the program is cost-effective and that

 

appropriate incentive measures are utilized. The review shall

 

include, at a minimum, the auto-assignment algorithm and

 

performance bonus incentive pool. This subsection applies whether

or not either or both of the waivers requested under this section

 

are approved, the patient protection and affordable care act is

 

repealed, or the state terminates or opts out of the program

 

established under this section.

 

     (f) The identification of private sector initiatives used to

 

incent individuals to comply with medical advice.

 

     (11) By December 31, 2015, the department shall review and

 

report to the legislature the feasibility of programs recommended

 

by multiple national organizations that include, but are not

 

limited to, the council of state governments, the national

 

conference of state legislatures, and the American legislative

 

exchange council, Council of State Governments, the National

 

Conference of State Legislatures, and the American Legislative

 

Exchange Council, on improving the cost-effectiveness of the

 

medical assistance program.

 

     (12) The department in collaboration with the contracted

 

health plans and providers shall create financial incentives for

 

all of the following:

 

     (a) Contracted health plans that meet specified population

 

improvement goals.

 

     (b) Providers who meet specified quality, cost, and

 

utilization targets.

 

     (c) Enrollees who demonstrate improved health outcomes or

 

maintain healthy behaviors as identified in a health risk

 

assessment as identified by their primary care practitioner who is

 

licensed, registered, or otherwise authorized to engage in his or

 

her health care profession in this state. This subsection applies

whether or not either or both of the waivers requested under this

 

section are approved, the patient protection and affordable care

 

act is repealed, or the state terminates or opts out of the program

 

established under this section.

 

     (13) The performance bonus incentive pool for contracted

 

health plans that are not specialty prepaid health plans shall

 

include inappropriate utilization of emergency departments,

 

ambulatory care, contracted health plan all-cause acute 30-day

 

readmission rates, and generic drug utilization when such an

 

alternative exists for a branded product and consistent with

 

section 109h and sections 9701 to 9709 part 97 of the public health

 

code, 1978 PA 368, MCL 333.9701 to 333.9709, as a percentage of

 

total. These measurement tools shall be considered and weighed

 

within the 6 highest factors used in the formula. This subsection

 

applies whether or not either or both of the waivers requested

 

under this section are approved, the patient protection and

 

affordable care act is repealed, or the state terminates or opts

 

out of the program established under this section.

 

     (14) The department shall ensure that all capitated payments

 

made to contracted health plans are actuarially sound. This

 

subsection applies whether or not either or both of the waivers

 

requested under this section are approved, the patient protection

 

and affordable care act is repealed, or the state terminates or

 

opts out of the program established under this section.

 

     (15) The department shall maintain administrative costs at a

 

level of not more than 1% of the department's appropriation of the

 

state medical assistance program. These administrative costs shall

be capped at the total administrative costs for the fiscal year

 

ending September 30, 2016, except for inflation and project-related

 

costs required to achieve medical assistance net general fund

 

savings. This subsection applies whether or not either or both of

 

the waivers requested under this section are approved, the patient

 

protection and affordable care act is repealed, or the state

 

terminates or opts out of the program established under this

 

section.

 

     (16) The department shall establish uniform procedures and

 

compliance metrics for utilization by the contracted health plans

 

to ensure that cost-sharing requirements are being met. This shall

 

include ramifications for the contracted health plans' failure to

 

comply with performance or compliance metrics. This subsection

 

applies whether or not either or both of the waivers requested

 

under this section are approved, the patient protection and

 

affordable care act is repealed, or the state terminates or opts

 

out of the program established under this section.

 

     (17) The department shall withhold, at a minimum, 0.75% of

 

payments to contracted health plans, except for specialty prepaid

 

health plans, for the purpose of expanding the existing performance

 

bonus incentive pool. Distribution of funds from the performance

 

bonus incentive pool is contingent on the contracted health plan's

 

completion of the required performance or compliance metrics. This

 

subsection applies whether or not either or both of the waivers

 

requested under this section are approved, the patient protection

 

and affordable care act is repealed, or the state terminates or

 

opts out of the program established under this section.

     (18) The department shall withhold, at a minimum, 0.75% of

 

payments to specialty prepaid health plans for the purpose of

 

establishing a performance bonus incentive pool. Distribution of

 

funds from the performance bonus incentive pool is contingent on

 

the specialty prepaid health plan's completion of the required

 

performance of compliance metrics that shall include, at a minimum,

 

partnering with other contracted health plans to reduce nonemergent

 

emergency department utilization, increased participation in

 

patient-centered medical homes, increased use of electronic health

 

records and data sharing with other providers, and identification

 

of enrollees who may be eligible for services through the United

 

States Department of Veterans Affairs. This subsection applies

 

whether or not either or both of the waivers requested under this

 

section are approved, the patient protection and affordable care

 

act is repealed, or the state terminates or opts out of the program

 

established under this section.

 

     (19) The department shall measure contracted health plan or

 

specialty prepaid health plan performance metrics, as applicable,

 

on application of standards of care as that relates to appropriate

 

treatment of substance use disorders and efforts to reduce

 

substance use disorders. This subsection applies whether or not

 

either or both of the waivers requested under this section are

 

approved, the patient protection and affordable care act is

 

repealed, or the state terminates or opts out of the program

 

established under this section.

 

     (20) By October 1, 2018, in addition to the waiver requested

 

in subsection (1), the department shall seek an additional waiver

from the United States Department of Health and Human Services that

 

requires individuals who are between 100% and 133% of the federal

 

poverty guidelines and who have had medical assistance coverage for

 

48 cumulative months beginning on the date of their enrollment into

 

the program described in subsection (1) by the date of the waiver

 

implementation to choose 1 of the following options:

 

     (a) Complete a healthy behavior as provided in subsection

 

(1)(e) with intentional effort given to making subsequent year

 

healthy behaviors incrementally more challenging in order to

 

continue to focus on eliminating health-related obstacles

 

inhibiting enrollees from achieving their highest levels of

 

personal productivity and pay a premium of 5% of income. A required

 

contribution for a premium is not eligible for reduction or refund.

 

     (b) Suspend eligibility for the program described in

 

subsection (1)(a) until the individual complies with subdivision

 

(a).

 

     (21) The department shall notify enrollees 60 days before the

 

enrollee would lose coverage under the current program that this

 

coverage is no longer available to them and that, in order to

 

continue coverage, the enrollee must comply with the option

 

described in subsection (20)(a).

 

     (22) The medical coverage for individuals described in

 

subsection (1)(a) shall remain in effect for not longer than a 16-

 

month period after submission of a new or amended waiver request

 

under subsection (20) if a new or amended waiver request is not

 

approved within 12 months after submission. The department must

 

notify individuals described in subsection (1)(a) that their

coverage will be terminated by February 1, 2020 if a new or amended

 

waiver request is not approved within 12 months after submission.

 

     (23) If a new or amended waiver requested under subsection

 

(20) is denied by the United States Department of Health and Human

 

Services, medical coverage for individuals described in subsection

 

(1)(a) shall remain in effect for a 16-month period after the date

 

of submission of the new or amended waiver request unless the

 

United States Department of Health and Human Services approves a

 

new or amended waiver described in this subsection within the 12

 

months after the date of submission of the new or amended waiver

 

request. A request for a new or amended waiver under this

 

subsection must comply with the other requirements of this section

 

and must be provided to the chairs of the senate and house of

 

representatives appropriations committees and the chairs of the

 

senate and house of representatives appropriations subcommittees on

 

the department budget, at least 30 days before submission to the

 

United States Department of Health and Human Services. If a new or

 

amended waiver request under this subsection is not approved within

 

the 12-month period described in this subsection, the department

 

must give 4 months' notice that medical coverage for individuals

 

described in subsection (1)(a) shall be terminated.

 

     (24) If a new or amended waiver requested under subsection

 

(20) is canceled by the United States Department of Health and

 

Human Services or is invalidated, medical coverage for individuals

 

described in subsection (1)(a) shall remain in effect for 16 months

 

after the date of submission of a new or amended waiver unless the

 

United States Department of Health and Human Services approves a

new or amended waiver described in this subsection within the 12

 

months after the date of submission of the new or amended waiver. A

 

request for a new or amended waiver under this subsection must

 

comply with the other requirements of this section and must be

 

provided to the chairs of the senate and house of representatives

 

appropriations committees and the senate and house of

 

representatives appropriations subcommittees on the department

 

budget at least 30 days before submission to the United States

 

Department of Health and Human Services. If a new or amended waiver

 

under this subsection is not approved within the 12-month period

 

described in this subsection, the department must give 4 months'

 

notice that medical coverage for individuals described in

 

subsection (1)(a) shall be terminated.

 

     (25) If a new or amended waiver request under subsection (23)

 

or (24) is approved by the United States Department of Health and

 

Human Services but does not comply with the other requirements of

 

this section, medical coverage for individuals described in

 

subsection (1)(a) shall be terminated 4 months after the new or

 

amended waiver has been determined to be in noncompliance. The

 

department must notify individuals described in subsection (1)(a)

 

at least 4 months before the termination date that enrollment shall

 

be terminated and the reason for termination.

 

     (26) Individuals described in 42 CFR 440.315 are not subject

 

to the provisions of the waiver described in subsection (20).

 

     (27) The department shall make available at least 3 years of

 

state medical assistance program data, without charge, to any

 

vendor considered qualified by the department who indicates

interest in submitting proposals to contracted health plans in

 

order to implement cost savings and population health improvement

 

opportunities through the use of innovative information and data

 

management technologies. Any program or proposal to the contracted

 

health plans must be consistent with the state's goals of improving

 

health, increasing the quality, reliability, availability, and

 

continuity of care, and reducing the cost of care of the eligible

 

population of enrollees described in subsection (1)(a). The use of

 

the data described in this subsection for the purpose of assessing

 

the potential opportunity and subsequent development and submission

 

of formal proposals to contracted health plans is not a cost or

 

contractual obligation to the department or the state.

 

     (28) This section does not apply if either of the following

 

occurs:

 

     (a) If the department is unable to obtain either of the

 

federal waivers requested in subsection (1) or (20).

 

     (b) If federal government matching funds for the program

 

described in this section are reduced below 100% and annual state

 

savings and other nonfederal net savings associated with the

 

implementation of that program are not sufficient to cover the

 

reduced federal match. The department shall determine and the state

 

budget office shall approve how annual state savings and other

 

nonfederal net savings shall be calculated by June 1, 2014. By

 

September 1, 2014, the calculations and methodology used to

 

determine the state and other nonfederal net savings shall be

 

submitted to the legislature. The calculation of annual state and

 

other nonfederal net savings shall be published annually on January

15 by the state budget office. If the annual state savings and

 

other nonfederal net savings are not sufficient to cover the

 

reduced federal match, medical coverage for individuals described

 

in subsection (1)(a) shall remain in effect until the end of the

 

fiscal year in which the calculation described in this subdivision

 

is published by the state budget office.

 

     (28) (29) The department shall develop, administer, and

 

coordinate with the department of treasury a procedure for

 

offsetting the state tax refunds of an enrollee who owes a

 

liability to the state of past due uncollected cost-sharing, as

 

allowable by the federal government. The procedure shall include a

 

guideline that the department submit to the department of treasury,

 

not later than November 1 of each year, all requests for the offset

 

of state tax refunds claimed on returns filed or to be filed for

 

that tax year. For the purpose of this subsection, any nonpayment

 

of the cost-sharing required under this section owed by the

 

enrollee is considered a liability to the state under section

 

30a(2)(b) of 1941 PA 122, MCL 205.30a.

 

     (29) (30) For the purpose of this subsection, any nonpayment

 

of the cost-sharing required under this section owed by the

 

enrollee is considered a current liability to the state under

 

section 32 of the McCauley-Traxler-Law-Bowman-McNeely lottery act,

 

1972 PA 239, MCL 432.32, and shall be handled in accordance with

 

the procedures for handling a liability to the state under that

 

section, as allowed by the federal government.

 

     (30) (31) By November 30, 2013, the department shall convene a

 

symposium to examine the issues of emergency department

overutilization and improper usage. The department shall submit a

 

report to the legislature that identifies the causes of

 

overutilization and improper emergency service usage that includes

 

specific best practice recommendations for decreasing

 

overutilization of emergency departments and improper emergency

 

service usage, as well as how those best practices are being

 

implemented. Both broad recommendations and specific

 

recommendations related to the Medicaid program, enrollee behavior,

 

and health plan access issues shall be included.

 

     (31) (32) The department shall contract with an independent

 

third party vendor to review the reports required in subsections

 

(8) and (9) and other data as necessary, in order to develop a

 

methodology for measuring, tracking, and reporting medical cost and

 

uncompensated care cost reduction or rate of increase reduction and

 

their effect on health insurance rates along with recommendations

 

for ongoing annual review. The final report and recommendations

 

shall be submitted to the legislature by September 30, 2015.

 

     (32) (33) For the purposes of submitting reports and other

 

information or data required under this section only, "legislature"

 

means the senate majority leader, the speaker of the house of

 

representatives, the chairs of the senate and house of

 

representatives appropriations committees, the chairs of the senate

 

and house of representatives appropriations subcommittees on the

 

department budget, and the chairs of the senate and house of

 

representatives standing committees on health policy.

 

     (33) (34) As used in this section:

 

     (a) "Patient protection and affordable care act" means the

patient protection and affordable care act, Public Law 111-148, as

 

amended by the federal health care and education reconciliation act

 

of 2010, Public Law 111-152.

 

     (b) "Peace of mind registry" and "peace of mind registry

 

organization" mean those terms as defined in section 10301 of the

 

public health code, 1978 PA 368, MCL 333.10301.

 

     (c) "State savings" means any state fund net savings,

 

calculated as of the closing of the financial books for the

 

department at the end of each fiscal year, that result from the

 

program described in this section. The savings shall result in a

 

reduction in spending from the following state fund accounts: adult

 

benefit waiver, non-Medicaid community mental health, and prisoner

 

health care. Any identified savings from other state fund accounts

 

shall be proposed to the house of representatives and senate

 

appropriations committees for approval to include in that year's

 

state savings calculation. It is the intent of the legislature that

 

for fiscal year ending September 30, 2014 only, $193,000,000.00 of

 

the state savings shall be deposited in the roads and risks reserve

 

fund created in section 211b of article VIII of 2013 PA 59.

 

     (d) "Telemedicine" means that term as defined in section 3476

 

of the insurance code of 1956, 1956 PA 218, MCL 500.3476.

 

     Enacting section 1. This amendatory act takes effect 90 days

 

after the date it is enacted into law.