Bill Text: MI HB4609 | 2019-2020 | 100th Legislature | Introduced
Bill Title: Human services; medical services; Medicaid coverage of Lyme disease testing; require. Amends sec. 109 of 1939 PA 280 (MCL 400.109).
Spectrum: Moderate Partisan Bill (Democrat 15-4)
Status: (Introduced - Dead) 2019-05-21 - Bill Electronically Reproduced 05/21/2019 [HB4609 Detail]
Download: Michigan-2019-HB4609-Introduced.html
HOUSE BILL No. 4609
May 16, 2019, Introduced by Reps. Whitsett, Eisen, Peterson, Elder, Yancey, Rendon, Hoitenga, Garza, Chirkun, Tate, Cambensy, Haadsma, Kennedy, Brenda Carter, Wozniak, Neeley, Coleman, Jones and Robinson 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 2018 PA 315.
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. An individual who is receiving medical treatment as an
inpatient because of a diagnosis of mental disease may receive
service under this section, notwithstanding the mental health code,
1974 PA 258, MCL 330.1001 to 330.2106. The department 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. 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 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 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 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 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, 2022. For each
subsequent county fiscal year, the maintenance of effort rate 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. 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.
(f) Psychiatric care may also be provided according to the
guidelines established by the department 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. 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 percentage of kidney function
remaining.
(h) An eligible individual may receive medically necessary
acute medical detoxification for opioid use disorder, medically
necessary inpatient care at an approved facility, or care in an
appropriately licensed substance use disorder residential treatment
facility.
(i) An eligible individual may receive diagnostic and
treatment services for Lyme disease or other related tickborne
illnesses.
(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 1395lll.
(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 1397n-13.
