Bill Text: MI HB5356 | 2015-2016 | 98th Legislature | Introduced

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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

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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).