Bill Text: MI HB6285 | 2017-2018 | 99th Legislature | Introduced
Bill Title: Human services; medical services; single payer health care; create. Creates new act.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2018-09-05 - Bill Electronically Reproduced 08/15/2018 [HB6285 Detail]
Download: Michigan-2017-HB6285-Introduced.html
HOUSE BILL No. 6285
August 15, 2018, Introduced by Reps. Rabhi, Love, Wittenberg, Elder, Peterson, LaGrand, Geiss, Green, Hammoud, Chang, Hoadley, Sabo, Sowerby, Zemke and Ellison and referred to the Committee on Health Policy.
A bill to provide for the establishment of a universal and
unified health care system and to reform the current payment system
for health care coverage in this state; to create certain boards
and committees and prescribe their powers and duties; to provide
for the powers and duties of certain state and local governmental
officers and agencies; to establish a fund; to provide for the
promulgation of rules; and to prescribe penalties and provide
remedies.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
CHAPTER 1
Sec. 101. This act shall be known and may be cited as the
"MIcare act".
Sec. 102. As used in this act:
(a) "Ambulance" means that term as defined in section 20902 of
the public health code, 1978 PA 368, MCL 333.20902.
(b) "Board" means the MIcare board created in section 302.
(c) "Department" means the department of health and human
services.
(d) "Director" means the director of the department or his or
her designee.
Sec. 103. As used in this act:
(a) "Exchange" means that term as defined in section 1261 of
the insurance code of 1956, 1956 PA 218, MCL 500.1261.
(b) "Federal act" means the federal patient protection and
affordable care act, Public Law 111-148, as amended by the federal
health care and education reconciliation act of 2010, Public Law
111-152, and any regulations promulgated under those acts.
(c) "Fund" means the MIcare fund created in section 410.
Sec. 104. As used in this act:
(a) "Health carrier" means any of the following entities that
are subject to the insurance laws and regulations of this state or
otherwise subject to the jurisdiction of the director of the
department of insurance and financial services:
(i) A health insurer operating under the insurance code of
1956, 1956 PA 218, MCL 500.100 to 500.8302.
(ii) A health maintenance organization operating under the
insurance code of 1956, 1956 PA 218, MCL 500.100 to 500.8302.
(iii) A health care corporation operating under the nonprofit
health care corporation reform act of 1980, 1980 PA 350, MCL
550.1101 to 550.1704.
(iv) A nonprofit dental care corporation operating under 1963
PA 125, MCL 550.351 to 550.373.
(v) Any other entity providing a plan of health insurance,
health benefits, or health services.
(b) "Health care professional" means an individual,
partnership, corporation, facility, or institution licensed,
registered, certified, or otherwise authorized by state law to
provide professional health services.
(c) "Health care system" means the local, state, regional, or
national system of delivering health services, including
administrative costs, capital expenditures, preventive care, and
wellness services.
(d) "Health service" means any treatment or procedure
delivered by a health care professional to maintain an individual's
physical or mental health or to diagnose or treat an individual's
physical or mental health condition, including services ordered by
a health care professional for chronic care management, preventive
care, wellness services, and medically necessary services to assist
in activities of daily living.
(e) "Hospice" means that term as defined in section 20106 of
the public health code, 1978 PA 368, MCL 333.20106.
(f) "Hospital" means any of the following:
(i) That term as defined in section 20106 of the public health
code, 1978 PA 368, MCL 333.20106.
(ii) A hospital located outside of this state.
(iii) That term as defined in section 100b of the mental
health code, 1974 PA 258, MCL 330.1100b.
(g) "Integrated delivery system" means a group of health care
professionals, associated either through employment by a single
entity or through a contractual arrangement, that provides health
services for a defined population of patients.
Sec. 105. As used in this act:
(a) "Manufacturers of prescribed products" means any of the
following:
(i) A manufacturer as defined in section 17706 of the public
health code, 1978 PA 368, MCL 333.17706.
(ii) A caregiver as defined in section 3 of the Michigan
medical marihuana act, 2008 IL 1, MCL 333.26423.
(iii) A person that holds a license as a grower, processor,
provisioning center, or safety compliance facility under the
medical marihuana facilities licensing act, 2016 PA 281, MCL
333.27101 to 333.27801.
(b) "Medicaid" means that term as defined in section 3801 of
the insurance code of 1956, 1956 PA 218, MCL 500.3801.
(c) "Medicare" means that term as defined in section 3801 of
the insurance code of 1956, 1956 PA 218, MCL 500.3801.
(d) "MIcare" means the universal health care system
established under this act and designed to provide health care
coverage through a simplified, public administrative system and
single claims payment system.
(e) "MIChild" means the state child health plan in this state
under title XXI of the social security act, 42 USC 1397aa to
1397mm.
(f) "Treatment of autism spectrum disorders" means that term
as defined in section 3 of the autism coverage reimbursement act,
2012 PA 101, MCL 550.1833.
Sec. 107. (1) The director shall coordinate health care system
reform efforts among executive branch agencies, departments, and
offices and shall coordinate with the board.
(2) The director shall ensure that executive branch agencies,
departments, and offices responsible for the development,
improvement, and implementation of this state's health care system
reform do so in a manner that is coordinated, timely, equitable,
patient-centered, and evidence-based and that seeks to inform and
improve the quality of patient care and public health, contain
costs, and attract and retain well-paying jobs in this state.
(3) The director shall provide information and testimony on
the efforts under this act to the senate and house of
representatives standing committees on health issues on request.
CHAPTER 2
Sec. 201. (1) The health care reform efforts under this act
must include simplified administration processes and delivery
reform in order to have a publicly financed and publicly
administered program of universal and unified health care
operational after the occurrence of specific events, including the
receipt of a waiver from the federal health benefit exchange
requirement from the United States Department of Health and Human
Services.
(2) In order to begin the planning efforts, the director shall
establish a strategic plan that includes time lines and allocations
of the responsibilities associated with health care system reform,
to improve health outcomes, to further this state's existing health
care system reform efforts, and to further all of the requirements
of this section.
Sec. 202. (1) As provided in chapter 4, all residents of this
state are eligible for MIcare, a universal health care program that
will provide health care coverage through a single payment system.
To the maximum extent allowable under federal law and through
waivers from requirements of federal law, MIcare includes health
care coverage provided under Medicaid, under Medicare, under
MIChild, by employers that choose to participate, and to state and
local government employees including public school employees.
(2) If the federal act is modified by congressional, judicial,
or federal administrative action that prohibits implementation of a
health benefit exchange; eliminates federal funds available to
individuals, employees, or employers; or eliminates the waiver
under section 1332 of the federal act, 42 USC 18052, the director
shall continue, and adjust as appropriate, the planning and cost-
containment activities provided in this act related to MIcare and
to creation of a unified, simplified administration and payment
system, including identifying the financing impacts of such a
modification on this state and its effects on the activities
proposed in this act.
Sec. 205. The director shall supervise and oversee, as
appropriate, the planning efforts, a continuation of the planning
necessary to ensure an adequate, well-trained primary care
workforce; necessary retraining for any employees dislocated from
health care professionals or from health carriers because of the
simplification in the administration of health care; consolidation
of multiple payment sources into a single payment system; and
unification of health system planning, regulation, and public
health.
Sec. 207. The director shall obtain waivers, exemptions,
agreements, legislation, or a combination of these items to ensure
that, to the extent possible under federal law, all federal
payments provided within this state for health services are paid
directly to MIcare. MIcare shall assume responsibility for the
benefits and services previously paid for by the federal programs,
including Medicaid, Medicare, MIChild, and, after implementation,
the exchange. In obtaining the waivers, exemptions, agreements,
legislation, or combination of those items, the director shall
negotiate with the federal government a federal contribution for
health care services in this state that reflects medical inflation,
the state gross domestic product, the size and age of the
population, the number of residents of this state living below the
poverty level, the number of Medicare-eligible individuals, and
other factors that may be advantageous to this state and that do
not decrease in relation to the federal contribution to other
states as a result of the waivers, exemptions, agreements, or
savings from implementation of MIcare.
Sec. 209. The board, in collaboration with the director, shall
develop a work plan for the board. The board may include in the
work plan any necessary processes for implementation of the board's
duties, a time line for implementation of the board's duties, and a
plan for ensuring sufficient staff to implement the board's duties.
The board shall submit the work plan developed under this section
to the senate and house of representatives standing committees on
health issues within 3 months after the effective date of this act.
CHAPTER 3
Sec. 301. As a framework for reforming health care in this
state, the director shall utilize and ensure that the health care
system in this state satisfies all of the following principles:
(a) That universal access to and coverage for high-quality,
medically necessary health services is ensured for all residents of
this state.
(b) That systemic barriers, including, but not limited to,
cost, inadequate information, transportation needs, and geographic
distribution of providers, do not prevent residents of this state
from accessing necessary health services.
(c) That all residents of this state receive affordable and
appropriate health services at the appropriate time in the
appropriate setting.
(d) That overall costs for health services are contained and
that growth in health care spending in this state balances the
health care needs of the population with the ability to pay for
necessary health services.
(e) That the health care system in this state be transparent
in design, efficient in operation, and accountable to the residents
of this state. The director shall ensure public participation by
residents of this state in the design, implementation, evaluation,
and accountability mechanisms of the health care system.
(f) That primary care be preserved and enhanced so that
residents of this state have health services available to them,
preferably within their own communities. Other aspects of this
state's health care infrastructure, including, but not limited to,
the educational and research missions of the state's academic
medical institutions and other postsecondary educational
institutions, the nonprofit missions of the community hospitals,
population health missions of public and private community health
organizations, and the critical access designation of rural
hospitals, must be supported in such a way that all residents of
this state have access to necessary health services and that these
health services are sustainable.
(g) That every resident of this state is able to choose his or
her health care professionals.
(h) That residents of this state are aware of the costs of the
health services they receive. For this purpose, the cost of health
services should be transparent and easy to understand.
(i) That the health care system recognize the primacy of the
relationship between a patient and his or her health care
professionals, respecting the professional judgment of health care
professionals and the informed decisions of patients.
(j) That this state's health care system seek continuous
improvement of health care quality and safety and of the health of
the residents of this state and reduce morbidity and increase life
expectancy. For this reason, the director shall ensure that the
system is evaluated regularly for improvements in access, outcomes,
and cost containment.
(k) That appropriate rules and enforcement mechanisms are in
place to ensure that health care provider work hours and staffing
ratios support the health and safety of both providers and
patients.
(l) That this state's health care system include mechanisms
for containing all system costs and eliminating unnecessary
expenditures, including by reducing administrative costs, by
reducing costs that do not contribute to improved health outcomes,
and by leveraging the unified payment system to negotiate prices.
The director shall ensure that efforts to reduce overall health
care costs identify sources of excess cost growth.
(m) That the system must enable health care professionals to
provide, on a solvent basis, effective and efficient health
services that are in the public interest.
(n) That this state's health care system operate as a
partnership between consumers, employers, health care
professionals, hospitals, and the state and federal governments.
Sec. 302. (1) The MIcare board is created as an autonomous
entity in the department. The board is an independent body with the
powers and duties as provided for under this act. The department
shall provide suitable office space for the board and the employees
of the board.
(2) The board shall promote the general good of this state by
doing all of the following:
(a) Improving the health of the residents of this state as
measured by rates of disability, disease, and life expectancy.
(b) Reducing the per-capita rate of growth in expenditures for
health services in this state across all payers while ensuring that
access to health services and the quality of health services
received by residents of this state are not compromised.
(c) Enhancing the patient and health care professional
experience during the delivery of health services.
(d) Recruiting and retaining high-quality health care
professionals.
(e) Achieving administrative simplification in health care
financing and delivery.
(f) Consolidating as many payment sources as feasible into a
unified claims payment system.
Sec. 303. (1) The board consists of 13 members, 1 of whom
serves as chair. All of the members must be state employees and are
exempt from the classified state civil service. The chair must
receive compensation equal to that of a justice of the supreme
court, and the remaining members must receive compensation equal to
2/3 of the amount received by the chair.
(2) The speaker and minority leader of the house of
representatives shall nominate the members of the board using the
qualifications described in this section. The governor shall
appoint the members from the nominees with the advice and consent
of the senate. The governor shall not appoint a nominee who was
denied confirmation by the senate within the past 2 years.
(3) The members of the board shall elect the chair who shall
serve for a term of 4 years. The term of office of each member
other than the chair is 4 years, except that of the members first
appointed, 3 each shall serve terms of 1 year, 2 years, 3 years,
and 4 years.
(4) The speaker of the house of representatives and the
minority leader of the house of representatives shall each submit
to the governor the names of 13 candidates they have determined are
qualified to be appointed to the board. Of these 26 qualified
candidates, the governor shall appoint 13 to the board subject to
the advice and consent of the senate. The governor shall appoint no
more than 7 members nominated by the same party, unless 1 or more
candidates were nominated by both parties.
(5) Subject to the nomination and appointment process, a
member may serve more than 1 term.
(6) A member of the board may be removed only for cause. The
board shall promulgate rules under the administrative procedures
act of 1969, 1969 PA 306, MCL 24.201 to 24.328, to define the basis
and process for removal.
(7) Except as otherwise provided in this subsection, a board
member shall not, during his or her term on the board, be an
officer of, director of, organizer of, employee of, consultant to,
or attorney for any person subject to supervision or regulation by
the board, or of any health carrier. However, for an individual
health care professional, the employment restriction under this
subsection applies only to administrative or managerial employment
or affiliation with a hospital or other health care facility and
does not limit generally the ability of the individual health care
professional to practice his or her profession.
(8) A board member shall not participate in creating or
applying any law, rule, or policy or in making any other
determination if the board member, individually or as a fiduciary,
or the board member's spouse, parent, or child wherever residing or
any other member of the board member's family residing in his or
her household has an economic interest in the matter before the
board or has any more than a de minimis interest that could be
substantially affected by the proceeding.
(9) Subsections (7) and (8) do not prohibit a board member
from, or require a board member to recuse himself or herself from
board activities as a result of, any of the following:
(a) Being an insurance policyholder or receiving health
services on the same terms as are available to the public
generally.
(b) Owning a stock, bond, or other security in an entity
subject to supervision or regulation by the board or any health
carrier that is purchased by or through a mutual fund, blind trust,
or other mechanism if a person other than the board member chooses
the stock, bond, or security.
(c) Receiving retirement benefits through a defined benefit
plan from an entity subject to supervision or regulation by the
board or any health carrier.
(10) A board member shall not, during his or her term on the
board, solicit, engage in negotiations for, or otherwise discuss
future employment or a future business relationship of any kind
with any person subject to supervision or regulation by the board
or any health carrier.
(11) A former board member shall not appear before the board
or any other executive branch agency, department, or office on
behalf of a person subject to supervision or regulation by the
board or any health carrier for a period of 1 year following his or
her last day as a member of the board.
(12) In nominating candidates for the board, the speaker and
minority leader of the house of representatives shall assess
candidates using the following criteria:
(a) Commitment to the principles expressed in section 301.
(b) Knowledge of or expertise in health care policy, health
care delivery, or health care financing, and openness to
alternative approaches to health care.
(c) Possession of desirable personal characteristics,
including integrity, impartiality, empathy, experience, diligence,
administrative and communication skills, social consciousness,
public service, and regard for the public good.
(d) Knowledge, expertise, and characteristics that complement
those of the other members of the board and demographic
characteristics that contribute to the demographic
representativeness of the board in relation to the population of
this state.
(e) Impartiality and the ability to remain free from undue
influence by a personal, business, or professional relationship
with any person subject to supervision or regulation by the board
or any health carrier.
(13) Subject to subsection (14), the board must include
members with the following types of experience:
(a) Two members with experience or expertise in population
health.
(b) One member with experience or expertise in health care
financing or health care economics.
(c) Two members with experience or expertise in health care
benefit design.
(d) One member with experience or expertise in health care
administration.
(e) One member who is a licensed health care professional with
recent experience in primary care.
(f) One member who is a licensed health care professional with
recent experience in acute care.
(g) One member who is a licensed health care professional with
recent experience in mental health care or behavioral health.
(h) One member who is a licensed health care professional with
recent experience in dental care.
(i) One member who is a licensed physician.
(j) One member who is a registered nurse.
(k) One member who is eligible for community mental health
services at the time of initial nomination.
(l) One member who is eligible for Medicare at the time of
initial nomination.
(m) One member who is eligible for employer health coverage at
the time of initial nomination.
(n) One member who is eligible for Medicaid at the time of
initial nomination.
(14) The same member may fulfill 1 or more of the types of
experience required under subsection (13).
(15) If a vacancy occurs on the board, or if an incumbent does
not declare that he or she will be a candidate to succeed himself
or herself, the speaker of the house of representatives and the
minority leader of the house of representatives shall each submit
to the governor the names of as many qualified candidates as there
are vacancies, providing to the governor a combined list of 2
candidates for each vacancy.
(16) The governor shall make an appointment to fill a vacancy
on the board from the list of qualified candidates submitted under
subsection (15). The appointment must not result in more than 7
simultaneously serving members of the board having been nominated
by the same party, unless 1 or more members were nominated by both
parties. The appointment is subject to the advice and consent of
the senate.
Sec. 304. (1) The chair of the board has general charge of the
offices and employees of the board but may hire a manager to
oversee the administration and operation.
(2) The board shall establish a consumer, patient, business,
and health care professional advisory group to provide input and
recommendations to the board. A member of the advisory group under
this subsection who is not a state employee or whose participation
is not supported through his or her employment or association shall
receive per diem compensation, and reimbursement of expenses up to
$5,000.00 per year.
(3) The board may establish additional advisory groups and
subcommittees as needed to carry out its duties. The board shall
appoint diverse health care professionals and consumers
demographically representative of the population of this state to
the additional advisory groups and subcommittees as appropriate.
(4) In carrying out its duties under this act, the board shall
seek the advice of appropriate individuals and entities regarding
the policies, procedures, and rules established under this act.
Appropriate individuals and entities are those who represent the
interests of residents of this state who are patients and consumers
of health services and health care coverage and who may suggest
policies, procedures, or rules to the board to protect those
patients' and consumers' interests.
Sec. 305. (1) The board shall execute its powers and duties
under this act consistent with the principles expressed in this
chapter.
(2) The board shall do all of the following:
(a) Oversee the development and implementation, and evaluate
the effectiveness, of health care payment and delivery system
reforms designed to control the rate of growth in the costs of
health services and maintain health care quality in this state.
(b) As provided in this subdivision, promulgate rules under
the administrative procedures act of 1969, 1969 PA 306, MCL 24.201
to 24.328, to implement methodologies for achieving payment reform
and containing costs and improving outcomes. Rules may relate to
the creation of health care professional cost-containment or
outcome targets, bundled payments, risk-adjusted capitated
payments, or other uniform payment methods and amounts for
integrated delivery systems, health care professionals, or other
provider arrangements. Before promulgating rules under this
subdivision, the board shall report the board's proposed
methodologies to the senate and house of representatives standing
committees on health issues. In developing methodologies under this
subdivision, the board shall engage residents of this state in
seeking ways to equitably distribute health services while
acknowledging the connection between fair and sustainable payment
and access to health care.
(c) Review this state's health care information infrastructure
work done by the health information technology commission created
under section 2503 of the public health code, 1978 PA 368, MCL
333.2503, to ensure that the necessary standards, claims payment
databases, electronic health records, and other infrastructure are
in place to enable this state to achieve the principles expressed
in this chapter.
(d) Set rates for health care professionals under section 306,
to be implemented over time, and make adjustments to the rules on
reimbursement methodologies as needed.
(e) Within 9 months after the effective date of this act and
before promulgating rules, review the benefit package for qualified
health plans under the exchange. The board shall report to the
senate and house of representatives standing committees on health
issues within 15 days after its review of the initial benefit
package and any subsequent substantive changes to the benefit
package.
(f) Develop and maintain a method for evaluating systemwide
performance and quality, including identification of the
appropriate process and outcome measures as follows:
(i) For determining public and health care professional
satisfaction with the health care system.
(ii) For assessing the effectiveness of prevention and health
promotion programs.
(iii) For cost containment and limiting the growth in
expenditures for health services.
(iv) For determining the adequacy of the supply and
distribution of health care resources in this state.
(v) For determining and tracking rates of morbidity and
premature mortality for relevant populations, and determining and
tracking life expectancy and other quantifiable indicators of
population health as appropriate.
(vi) For assessing the frequency and severity of medical
errors and preventable adverse outcomes.
(vii) For assessing the care received by MIcare beneficiaries
in relation to evidence-based clinical practice guidelines.
(viii) For assessing the adequacy of staffing ratios and
health provider work hour rules and enforcement in protecting
patients and providers.
(ix) For assessing the contribution of health care costs to
personal and business bankruptcies in this state before and after
implementation of MIcare.
(x) For determining timeliness of health care service
delivery.
(xi) To address access to and quality of mental health and
substance abuse services.
(xii) For other indicators as determined by the board.
(g) Within 18 months after the effective date of this act,
study the feasibility of replacing health coverage for accidental
bodily injury currently provided by motor vehicle insurers under
section 3105 of the insurance code of 1956, 1956 PA 218, MCL
500.3105, with MIcare coverage. The board shall report to the
senate and house of representatives standing committees on health
issues and insurance within 15 days after completing its study on
the differences in covered benefits, projected costs, projected
reductions in motor vehicle insurance premiums, assets available to
the catastrophic claims association created under section 3104 of
the insurance code of 1956, 1956 PA 218, MCL 500.3104, to pay motor
vehicle health claims, and proposed additional revenue sources.
(h) Within 24 months after the effective date of this act,
study the feasibility of replacing health coverage currently
provided under the worker's disability compensation act of 1969,
1969 PA 317, MCL 418.101 to 418.941, with MIcare coverage. The
board shall report to the senate and house of representatives
standing committees on health issues and insurance within 15 days
after completing its study on the differences in covered benefits,
federal requirements for state worker's compensation systems,
projected costs, projected reductions in worker's compensation
insurance premiums, assets available in the funds under chapter 5
of the worker's disability compensation act of 1969, 1969 PA 317,
MCL 418.501 to 418.561, to pay worker's compensation health claims,
and proposed additional revenue sources.
(i) Within 12 months after the effective date of this act,
study the feasibility of including long-term care in the MIcare
benefits package. The board shall report to the senate and house of
representatives standing committees on health issues and insurance
within 15 days after completing its study on the need for long-term
care services in this state, the relative value of covering
attendant and home care services to enable care in the least
restrictive environment, the advisability of setting separate
procedures to establish residency for long-term care coverage
eligibility, projected costs, federal funding available to pay
long-term care claims, and proposed additional revenue sources.
(3) The board shall do all of the following with regard to
MIcare:
(a) Before implementing MIcare, consider recommendations from
the department and the director of the department of insurance and
financial services, and define the MIcare benefit package within
the parameters established in chapter 4.
(b) When providing its recommendations for the benefit package
under subdivision (a), present a report on the benefit package
proposal to the senate and house of representatives standing
committees on health issues. The report must describe the health
services to be covered in the MIcare benefit package. If the
legislature is not in session at the time that the board makes its
recommendations, the board shall send its report electronically or
by first-class mail to each member of the senate and house of
representatives standing committees on health issues.
(c) Before implementing MIcare and annually after
implementation, recommend to the legislature and the governor a 3-
year MIcare budget under section 409, to be adjusted annually in
response to realized revenues and expenditures, that reflects any
modifications to the benefit package and includes recommended
appropriations, revenue estimates, and necessary modifications to
tax rates, fees, and other assessments, if any.
(4) On or before the first January 15 after the effective date
of this act and on or before each January 15 after that date, the
board shall submit a report of its activities for the preceding
state fiscal year to the senate and house of representatives
standing committees on health issues. The report must include any
changes to the payment rates for health care professionals under
section 306, any new developments with respect to health
information technology, the evaluation criteria adopted under
subsection (2)(f) and any related modifications, the results of the
systemwide performance and quality evaluations required by
subsection (2)(f) and any resulting recommendations, the process
and outcome measures used in the evaluation, any recommendations
for modifications to state law, and any actual or anticipated
impacts on the work of the board as a result of modifications to
federal laws, regulations, or programs. The report must identify
how the work of the board comports with the principles expressed in
this chapter.
(5) All reports prepared by the board must be available to the
public on request and must be posted on the board's internet
website.
(6) The board is subject to the freedom of information act,
1976 PA 442, MCL 15.231 to 15.246, and the open meetings act, 1976
PA 267, MCL 15.261 to 15.275.
Sec. 306. (1) The board shall ensure payments to health care
professionals that are consistent with efficiency, economy, and
quality of care and that will permit health care professionals to
provide, on a solvent basis, effective and efficient health
services that are in the public interest. The board shall ensure
that the amount paid to health care professionals is sufficient to
enlist enough health care professionals to ensure that health
services are available to all residents of this state and are
distributed equitably.
(2) The board shall set reasonable rates for health care
professionals, manufacturers and retailers of prescribed products,
medical supply companies, and other companies providing health
services or health supplies based on methodologies under section
305, in order to have a consistent reimbursement amount accepted by
these persons. The board shall also set rates for covered benefits
provided by persons who are not licensed health care professionals
that provide services such as home services and transportation
services. In establishing rates, the board may consider legitimate
differences in costs among health care professionals, including the
cost of providing a specific necessary service or services that may
not be available elsewhere in this state, and the need for health
care professionals in particular areas of this state, particularly
in underserved geographic or practice shortage areas. This
subsection does not limit the ability of a health care professional
to accept less than the rate established in this subsection from a
patient without health insurance or other coverage for the health
service received.
(3) The board shall approve payment methodologies that
encourage cost containment; provision of high-quality, evidence-
based health services in an integrated setting; patient self-
management; access to primary care health services for underserved
individuals, populations, and areas; and healthy lifestyles. The
payment methodologies must be consistent with evidence-based
practices and may include fee-for-service payments if the board
determines those payments to be appropriate.
(4) To the extent required to avoid federal antitrust
violations and in furtherance of the policy identified in
subsection (1), the board shall facilitate and supervise the
participation of health care professionals in the process described
in subsection (2).
(5) As a base rate for any benefit described in section 405(1)
that is covered by Medicare Part A or B, the board shall set a rate
that is 10% more than the rate provided by Medicare. The board may
adjust the base rate to ensure access to services in specific
geographic areas or types of care, or to improve outcomes or
control costs in accordance with section 305.
(6) As a base rate for coverage of a medical device or
prescription drug that is covered by the Department of Veterans
Affairs, the board shall set the rate equal to the rate provided by
the Department of Veterans Affairs. The board may adjust the base
rate to ensure access to medically necessary devices or drugs, or
to improve outcomes or control costs in accordance with section
305.
Sec. 309. The director shall ensure that, in accordance with
state and federal privacy laws, the board has access to data and
analysis held by any executive branch agency, department, or office
that is necessary to carry out the board's powers and duties as
described in this act.
Sec. 310. The board may promulgate rules under the
administrative procedures act of 1969, 1969 PA 306, MCL 24.201 to
24.328, as needed to carry out this chapter.
Sec. 311. (1) The board shall adopt procedures for
administrative appeals of its actions, orders, or other
determinations. The procedures must provide for the issuance of a
final order and the creation of a record sufficient to serve as the
basis for judicial review under subsection (2).
(2) A person aggrieved by a final action, order, or other
determination of the board is entitled, on exhaustion of all
administrative appeals available under subsection (1), to judicial
review as provided in chapter 6 of the administrative procedures
act of 1969, 1969 PA 306, MCL 24.301 to 24.306.
CHAPTER 4
Sec. 401. MIcare is established to provide, as a public good,
comprehensive, affordable, high-quality, publicly financed, and
publicly administered health care coverage for all residents of
this state in a seamless and equitable manner regardless of income,
assets, health status, or availability of other health coverage.
MIcare must improve value in health care by doing all of the
following:
(a) Establishing innovative payment mechanisms to improve
outcomes and contain costs.
(b) Reducing unnecessary administrative expenditures through a
publicly administered system.
(c) Negotiating lower prices with the leverage of a unified
payment system.
Sec. 402. (1) MIcare must be implemented 90 days after the
last of the following to occur:
(a) Receipt of a waiver under section 1332 of the federal act,
42 USC 18052, under subsection (2).
(b) Enactment of a law establishing the financing for MIcare.
(c) Approval by the board of the initial MIcare benefit
package under section 305.
(d) Enactment of the appropriations for the initial MIcare
benefit package proposed by the board under section 305.
(e) A determination by the board that each of the following
conditions will be met:
(i) When implemented, MIcare will not have a negative
aggregate impact on this state's economy.
(ii) The financing for MIcare is sustainable.
(iii) Administrative expenses will be reduced.
(iv) Cost-containment efforts will result in a reduction in
the rate of growth in this state's per capita health care spending.
(v) Health care professionals will be reimbursed at levels
sufficient to allow this state to recruit and retain high-quality
health care professionals.
(2) As soon as allowed under federal law, the director shall
seek a waiver to allow this state to suspend operation of the
exchange and to enable this state to receive the appropriate
federal fund contribution in lieu of the federal premium tax
credits, cost-sharing subsidies, and small business tax credits
provided in the federal act. The director may seek a waiver from
other provisions of the federal act as necessary to ensure the
operation of MIcare.
Sec. 403. (1) On implementation, a resident of this state is
eligible for MIcare, regardless of whether an employer offers
health insurance for which he or she is eligible. The department
shall promulgate rules under the administrative procedures act of
1969, 1969 PA 306, MCL 24.201 to 24.328, to establish standards for
proof and verification that an individual is a resident of this
state.
(2) Except as otherwise provided in this subsection, if an
individual is determined to be eligible for MIcare based on
information later found to be false, the department shall make
reasonable efforts to recover from the individual the amounts
expended through MIcare for health services on his or her behalf.
In addition, if the individual knowingly provided the false
information, he or she is subject to an administrative fine of not
more than $5,000.00. The department shall include information on
the MIcare application to provide notice to applicants of the
penalty for knowingly providing false information as established in
this subsection. An individual determined to be eligible for MIcare
whose health services are paid in whole or in part by Medicaid
funds who commits fraud is subject to the medicaid false claim act,
1977 PA 72, MCL 400.601 to 400.615, instead of the administrative
penalty described in this subsection. This subsection does not
limit or restrict prosecutions under any applicable provision of
law, including the health care false claim act, 1984 PA 323, MCL
752.1001 to 752.1011.
(3) Except as otherwise provided in this section, a person who
is not a resident of this state is not eligible for MIcare. Except
as otherwise provided in this subsection, an individual covered
under MIcare shall inform the department within 60 days after
becoming a resident of another state. An individual who obtains or
attempts to obtain health services through MIcare more than 60 days
after becoming a resident of another state shall reimburse the
department for the amounts expended for his or her care and is
subject to an administrative penalty of not more than $1,000.00 for
a first violation and not more than $2,000.00 for any subsequent
violation. An individual whose health services are paid in whole or
in part by Medicaid funds who obtains or attempts to obtain health
services through MIcare more than 60 days after becoming a resident
of another state is subject to the medicaid false claim act, 1977
PA 72, MCL 400.601 to 400.615, instead of the administrative
penalty described in this subsection. This subsection does not
limit or restrict prosecutions under any applicable provision of
law, including the health care false claim act, 1984 PA 323, MCL
752.1001 to 752.1011.
(4) Administrative penalties collected under this section must
be transmitted to the state treasurer for deposit into the fund.
Sec. 404. (1) The department shall establish a procedure to
enroll residents of this state in MIcare. The department shall
develop and implement a program to train department employees and
community health workers to enroll residents in MIcare.
(2) The department shall promulgate rules under the
administrative procedures act of 1969, 1969 PA 306, MCL 24.201 to
24.328, to establish a process to allow health care professionals
to presume an individual is eligible based on the information
provided on a simplified application. After submission of the
application, the department shall collect additional information as
necessary to determine whether Medicaid, Medicare, MIChild, or
other federal funds may be applied toward the cost of the health
services provided, but shall provide payment for any health
services received by the individual from the time the application
is submitted. If an individual presumed eligible for MIcare under
this subsection is later determined not to be eligible for the
program, the department shall make reasonable efforts to recover
from the individual the amounts expended through MIcare for health
services on his or her behalf.
(3) The department shall promulgate rules under the
administrative procedures act of 1969, 1969 PA 306, MCL 24.201 to
24.328, to ensure that residents of this state who are temporarily
out of the state and who intend to return and reside in this state
remain eligible for MIcare while outside this state.
(4) A nonresident visiting this state, or his or her health
carrier, must be billed for all health services received by that
individual in this state. The department may enter into
intergovernmental arrangements or contracts with other states and
countries to provide reciprocal coverage for temporary visitors and
shall promulgate rules under the administrative procedures act of
1969, 1969 PA 306, MCL 24.201 to 24.328, to carry out this
subsection.
Sec. 405. (1) MIcare includes coverage for medically necessary
benefits, including, but not limited to, all of the following:
(a) Primary care.
(b) Preventive care.
(c) Chronic care.
(d) Acute episodic care.
(e) Hospital services.
(f) Mental health services.
(g) Prescription drugs.
(h) Medical devices.
(i) Dental care.
(j) Vision care.
(k) Hearing care.
(l) Care for substance use disorder.
(m) Reproductive health care and obstetrical care.
(n) Long-term care, including in-home care.
(o) Laboratory services, including blood lead testing for a
child who is not 7 years of age, in accordance with Centers for
Disease Control guidelines.
(p) Gender transition. As used in this subdivision, "gender
transition" means the process of changing an individual's outward
appearance, including physical sex characteristics, to accord with
the individual's gender identity.
(q) Organ donation and transplantation.
(r) Treatment of autism spectrum disorders.
(s) Ambulance services.
(t) Hospice care.
(2) The benefits package for all MIcare recipients must, at a
minimum, include any essential benefits for plans under the federal
act.
(3) MIcare must not include premiums or cost-sharing
requirements. The board shall not impose deductibles, co-insurance,
co-pays, or individual caps on coverage amounts. The board shall
include all costs of covered benefits in the budget recommended to
the legislature under section 409 without assuming any revenue will
be derived from premiums or cost-sharing.
(4) MIcare must not discriminate in the design and
administration of benefits or in the payment of claims because of
sexual orientation, gender identity, disability, or any status for
which discrimination is prohibited under section 102 of the
Elliott-Larsen civil rights act, 1976 PA 453, MCL 37.2102. For all
recipients, MIcare must comply with the nondiscrimination
requirements in section 1557 of the federal act and with the final
rule interpreting that section.
(5) MIcare must not limit coverage of preexisting conditions.
(6) The board shall approve the benefit package and present it
to the legislature as part of its recommendations for the MIcare
budget.
Sec. 406. (1) For individuals eligible for Medicaid or
MIChild, the MIcare benefit package must include the benefits
required by federal law, as well as any additional benefits
provided as part of the MIcare benefit package.
(2) On implementation of MIcare, the benefit package for
individuals eligible for Medicaid or MIChild must also include any
optional Medicaid benefits under 42 USC 1396d or health services
covered under MIChild as provided in 42 USC 1397cc. Beginning with
the second year of MIcare and going forward, the board may,
consistent with federal law, modify these optional benefits, while
at all times the benefit package for these individuals includes at
least the benefits described in subsection (1).
(3) For children eligible for benefits paid for with Medicaid
or MIChild funds, the MIcare benefit package must include early and
periodic screening, diagnosis, and treatment services as defined
under federal law.
(4) For individuals eligible for Medicare, the MIcare benefit
package must include the benefits provided to these individuals
under federal law, and any additional benefits provided as part of
the MIcare benefit package.
Sec. 407. (1) The department shall administer MIcare. The
department shall not enter into contracts with nongovernmental
entities to administer claims or payments, design benefits,
administer appeals, or provide customer service.
(2) If the department receives a federal waiver to administer
Medicaid or MIChild programs as part of MIcare, the department
shall not renew any contract with a managed care organization.
(3) In hiring staff necessary to administer MIcare, the
department shall develop and implement procedures consistent with
civil service rules to preferentially recruit individuals displaced
from health carriers and health provider administration because of
efficiency gains in the administration of health care.
Sec. 408. (1) This chapter does not require an individual with
health coverage other than MIcare to terminate that coverage.
(2) An individual enrolled in MIcare may elect to maintain
supplemental health insurance if the individual so chooses.
(3) Residents of this state must not be billed any additional
amount for the receipt of health services covered by MIcare.
(4) The department shall seek permission from the Centers for
Medicare and Medicaid Services to be the administrator for the
Medicare program in this state. If the department is unsuccessful
in obtaining that permission, MIcare must be the secondary payer
with respect to any health service that may be covered in whole or
in part by Medicare.
(5) MIcare must be the secondary payer with respect to any
health service that may be covered in whole or in part by any other
health benefit plan, including, but not limited to, private health
insurance, retiree health benefits, or federal health benefit plans
offered by the Department of Veterans Affairs, by the military, or
to federal employees.
(6) The department may seek a waiver under 42 USC 1315 to
include Medicaid and under 42 USC 1397gg to include MIChild in
MIcare. If the department is unsuccessful in obtaining 1 or both of
these waivers, MIcare shall be the secondary payer with respect to
any health service that may be covered in whole or in part by
Medicaid or MIChild, as applicable.
(7) Any prescription drug coverage offered by MIcare must be
consistent with the standards and procedures applicable under the
pharmaceutical best practices initiative established under section
9703 of the public health code, 1978 PA 368, MCL 333.9703, or
provided to a qualifying patient under the Michigan medical
marihuana act, 2008 IL 1, MCL 333.26421 to 333.26430.
(8) MIcare must maintain a robust and adequate network of
health care professionals located in this state or regularly
serving residents of this state, including mental health and
substance abuse professionals. The department shall contract with
outside entities as needed to allow for the appropriate portability
of coverage under MIcare for residents of this state who are
temporarily out of this state.
(9) The department shall make available the necessary
information, forms, access to eligibility or enrollment systems,
and billing procedures to health care professionals to ensure
immediate enrollment for individuals in MIcare at the point of
service or treatment.
(10) An individual aggrieved by an adverse decision of the
department or board may appeal that final decision in the manner
provided in the administrative procedures act of 1969, 1969 PA 306,
MCL 24.201 to 24.328.
(11) The department, in collaboration with other relevant
departments, shall monitor the extent to which residents of other
states move to this state for the purpose of receiving health
services and the impact, positive or negative, of any such
migration on this state's health care system and on this state's
economy, and make appropriate recommendations to the legislature
based on its findings.
Sec. 409. The board, in collaboration with the department,
shall annually develop a 3-year MIcare budget for proposal to the
legislature and to the governor, to be adjusted annually in
response to realized revenues and expenditures, that reflects any
modifications to the benefit package and includes recommended
appropriations, revenue estimates, and necessary modifications to
tax rates and other assessments. The budget must not include cost-
sharing or premiums.
Sec. 410. (1) The MIcare fund is created in the state treasury
as the single source to finance health care coverage for MIcare.
(2) The state treasurer may receive money or other assets from
any source for deposit into the fund. The state treasurer shall
direct the investment of the fund. The state treasurer shall credit
to the fund interest and earnings from fund investments. The state
treasurer shall deposit all of the following into the fund:
(a) Transfers or appropriations from the general fund,
authorized by the legislature.
(b) If authorized by a waiver from federal law, federal funds
for Medicaid, Medicare, MIChild, and the exchange.
(c) The proceeds from grants, donations, contributions, taxes,
and any other sources of revenue as may be provided by statute or
by rule.
(d) Administrative fines collected under this act.
(3) Money in the fund at the close of the fiscal year must
remain in the fund and must not lapse to the general fund. The
department is the administrator of the fund for auditing purposes.
(4) The department shall expend money from the fund, on
appropriation, only for 1 or more of the following purposes:
(a) The administration and delivery of and payment for health
services covered by MIcare as provided in this act.
(b) Expenses related to the duties and operation of the board.
Sec. 411. This chapter does not limit the ability of
collective bargaining units to negotiate for health care coverage
pursuant to law. This act does not supersede existing collective
bargaining agreements.
Sec. 412. The department shall provide a process for
soliciting public input on the MIcare benefit package on an ongoing
basis, including a mechanism by which members of the public may
request inclusion of particular benefits or services. The process
may include receiving written comments on proposed new or amended
rules or holding public hearings, or both.
Sec. 413. The department may promulgate rules under the
administrative procedures act of 1969, 1969 PA 306, MCL 24.201 to
24.328, to carry out the purposes of this chapter. If promulgating
rules relating to the MIcare benefit package, the director shall
ensure that the rules are consistent with the benefit package
defined by the board under this act.
