Bill Text: MI HB5356 | 2015-2016 | 98th Legislature | Introduced
Bill Title: Human services; medical services; medical assistance program; expand to include eye and vision examinations for certain school-age children. Amends sec. 109 of 1939 PA 280 (MCL 400.109). TIE BAR WITH: HB 5307'16, HB 5355'16
Spectrum: Slight Partisan Bill (Republican 5-2)
Status: (Introduced - Dead) 2016-02-16 - Bill Electronically Reproduced 02/11/2016 [HB5356 Detail]
Download: Michigan-2015-HB5356-Introduced.html
HOUSE BILL No. 5356
February 11, 2016, Introduced by Reps. Zemke, Crawford, Hughes, Glardon, Lucido, Geiss and Callton and referred to the Committee on Education.
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.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, 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 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.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 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 school-aged child may receive services
required under section 1176(3)(b) of the revised school code, 1976
PA 451, MCL 380.1176.
(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 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 1397m-5.
Enacting section 1. This amendatory act takes effect 90 days
after the date it is enacted into law.
Enacting section 2. This amendatory act does not take effect
unless all of the following bills of the 98th Legislature are
enacted into law:
(a) Senate Bill No.____ or House Bill No.____ (request no.
03705'15).
(b) Senate Bill No.____ or House Bill No.____ (request no.
03705'15 a).
(c) Senate Bill No.____ or House Bill No.____ (request no.
03731'15).
