Bill Text: MI HB5458 | 2023-2024 | 102nd Legislature | Introduced
Bill Title: Human services: medical services; sickle cell disease program; require Medicaid managed care organizations to participate in. Amends 1939 PA 280 (MCL 400.1 - 400.119b) by adding sec. 106c.
Spectrum: Partisan Bill (Democrat 16-0)
Status: (Introduced) 2024-02-21 - Bill Electronically Reproduced 02/20/2024 [HB5458 Detail]
Download: Michigan-2023-HB5458-Introduced.html
HOUSE BILL NO. 5458
A bill to amend 1939 PA 280, entitled
"The social welfare act,"
(MCL 400.1 to 400.119b) by adding section 106c.
the people of the state of michigan enact:
Sec. 106c. (1) The department shall ensure the availability of accessible, quality health care for individuals with sickle cell disease who are enrolled in Medicaid managed care organizations that have a contract with the department to provide services to Medicaid members in the comprehensive health care program.
(2) Not later than the fiscal year 2025 contract year, the department shall require comprehensive health care program Medicaid managed care organizations to implement a sickle cell disease quality strategy for children and adults with sickle cell disease that includes, but is not limited to, the following components:
(a) Measurable goals to improve the identification of members with sickle cell disease within 90 days after enrolling in the contracted health plan.
(b) Adequate provider network capacity to ensure timely access to sickle cell disease specialty service providers, including, but not limited to, hematologists.
(c) Care coordination strategies and supports to help members with sickle cell disease access sickle cell disease specialists and other related care supports.
(d) Delivery of a department-approved training curriculum to educate primary care providers on sickle cell disease, including information on emergency warning signs and complications, evidence-based practices and treatment guidelines, and when to make referrals to specialty sickle cell disease treatment providers.
(3) The department shall also do the following:
(a) Not later than the fiscal year 2025 contract year, require each comprehensive health care program Medicaid managed care organization to report, on a quarterly basis, an unduplicated count of children and adults identified as having sickle cell disease enrolled with the contracted plan during the quarter. The department shall publish these reports, by contracted plan, on the department's website.
(b) Not later than January 1, 2026, and in partnership with the comprehensive health care program Medicaid managed care organizations, identify, document, and share best practices regarding sickle cell disease care management and care coordination with Medicaid-enrolled primary care and sickle cell disease specialty providers with a goal of improving services for members with sickle cell disease and their families.
(c) Leveraging the department Public Health Strategic Plan to Address Sickle Cell Disease Across the Lifespan 2015-2018 and the entities and its strategic planning participants, enter into a contract not later than January 1, 2025, with a publicly funded university to develop a sickle cell disease-focused comprehensive assessment tool or a supplement to an existing comprehensive assessment tool to screen members identified with sickle cell disease for comorbidities, medical history for the treatment of sickle cell disease including disease-modifying medications and pain management, psychosocial history, barriers to accessing or completing treatments, social supports, other care coordinators working with the member, community resources being used or needed, quality of life, and personal preferences for engagement with a care coordinator.
(d) Not later than the fiscal year 2026 contract year, establish performance measures relative to access to care and available therapies, engagement in treatment, and outcomes for individuals with sickle cell disease, with the metrics to be reported annually by the comprehensive health care program Medicaid managed care organizations and with incentive payments attached to the measures.
(e) Not later than January 1, 2026, develop a plan for improving the transition from pediatric care to adult care for adolescents with sickle cell disease who are aging out of the Medicaid program, and a plan for helping qualified beneficiaries maintain Medicaid coverage under another eligibility category, to maintain continuity of care.
(4) The department shall provide an annual sickle cell disease management and accountability report to the senate and house appropriations committees and the senate and house fiscal agencies, including the status of sickle cell disease-focused access to care, quality of services, health outcomes, and disparities in this state.
(5) The department shall incorporate the sickle cell disease management and accountability standards into the contracts, including financial or administrative penalties for lack of performance. Contracted plan rates must be adjusted to reflect enhanced care or other provisions that are shifted to the contracted plans.
