Bill Text: MI HB4548 | 2013-2014 | 97th Legislature | Introduced

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Bill Title: Human services; medical services; covered providers; expand to include licensed dental hygienists. Amends sec. 109 of 1939 PA 280 (MCL 400.109).

Spectrum: Moderate Partisan Bill (Republican 5-1)

Status: (Introduced - Dead) 2013-04-17 - Printed Bill Filed 04/17/2013 [HB4548 Detail]

Download: Michigan-2013-HB4548-Introduced.html

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HOUSE BILL No. 4548

 

April 16, 2013, Introduced by Reps. MacMaster, Kowall, Lauwers, Pagel, Durhal and VerHeulen and referred to the Committee on Health Policy.

 

     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 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 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.

 

     (h) An eligible individual may receive dental hygiene services

 

provided by a dental hygienist as authorized under section 16611 or

 

16625 of the public health code, 1978 PA 368, MCL 333.16611 and

 

333.16625. The department of community health shall authorize

 

reimbursement to be made directly to the dental hygienist for

 

dental hygiene services provided by the dental hygienist under the

 

supervision of a dentist as authorized under section 16611 or 16625

 

of the public health code, 1978 PA 368, MCL 333.16611 and

 

333.16625.

 

     (2) The director 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) 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.