Bill Text: MI SB0975 | 2017-2018 | 99th Legislature | Introduced


Bill Title: Health facilities; certificate of need; requirement to obtain a certificate of need; eliminate. Amends secs. 2612, 20101, 20115, 20145, 20155, 20161, 20164, 20165, 20166, 21551, 21562 & 21563 of 1978 PA 368 (MCL 333.2612 et seq.); repeals sec. 20143 of 1978 PA 368 (MCL 333.20143); repeals sec. 21420 of 1978 PA 368 (MCL 333.21420); repeals pt. 222 of 1978 PA 368 (MCL 333.22201 - 333.22260); repeals sec. 8t of 1945 PA 47 (MCL 331.8t) & repeals sec. 47 of 1969 PA 38 (MCL 331.77).

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced) 2018-05-03 - Referred To Committee On Health Policy [SB0975 Detail]

Download: Michigan-2017-SB0975-Introduced.html

 

 

 

 

 

 

 

 

 

 

 

 

 

SENATE BILL No. 975

 

 

May 3, 2018, Introduced by Senator COLBECK and referred to the Committee on Health Policy.

 

 

      A bill to amend 1978 PA 368, entitled

 

"Public health code,"

 

by amending sections 2612, 20101, 20115, 20145, 20155, 20161,

 

20164, 20165, 20166, 21551, 21562, and 21563 (MCL 333.2612,

 

333.20101, 333.20115, 333.20145, 333.20155, 333.20161, 333.20164,

 

333.20165, 333.20166, 333.21551, 333.21562, and 333.21563), section

 

2612 as added by 1990 PA 138, sections 20101 and 20166 as amended

 

by 1988 PA 332, section 20115 as amended by 2012 PA 499, section

 

20145 as amended by 2015 PA 104, section 20155 as amended by 2015

 

PA 155, section 20161 as amended by 2016 PA 189, section 20164 as

 

amended by 1990 PA 179, section 20165 as amended by 2008 PA 39,

 

section 21551 as amended by 1990 PA 331, and sections 21562 and

 

21563 as added by 1990 PA 252; and to repeal acts and parts of

 

acts.

 


THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

 1        Sec. 2612. (1) The department may establish with Michigan

 

 2  state university State University and other parties determined

 

 3  appropriate by the department a nonprofit corporation pursuant to

 

 4  under the nonprofit corporation act, Act No. 162 of the Public Acts

 

 5  of 1982, being sections 1982 PA 162, MCL 450.2101 to 450.3192. of

 

 6  the Michigan Compiled Laws. The purpose of the corporation shall be

 

 7  is to establish and operate a center for rural health. In

 

 8  fulfilling its purpose, the corporation shall do all of the

 

 9  following:

 

10        (a) Develop a coordinated rural health program that addresses

 

11  critical questions and problems related to rural health and

 

12  provides mechanisms for influencing health care policy.

 

13        (b) Perform and coordinate research regarding rural health

 

14  issues.

 

15        (c) Periodically review state and federal laws and judicial

 

16  decisions pertaining to health care policy and analyze the impact

 

17  on the delivery of rural health care.

 

18        (d) Provide technical assistance and act as a resource for the

 

19  rural health community in this state.

 

20        (e) Suggest changes in medical education curriculum that would

 

21  be beneficial to rural health.

 

22        (f) Assist rural communities with all of the following:

 

23        (i) Applications for grants.

 

24        (ii) The recruitment and retention of health professionals.

 

25        (iii) Needs assessments and planning activities for rural

 

26  health facilities.


 1        (g) Serve as an advocate for rural health concerns.

 

 2        (h) Conduct periodic seminars on rural health issues.

 

 3        (i) Establish and implement a visiting professor program.

 

 4        (j) Conduct consumer oriented rural health education programs.

 

 5        (k) Designate a certificate of need ombudsman to provide

 

 6  technical assistance and consultation to rural health care

 

 7  providers and rural communities regarding certificate of need

 

 8  proposals and applications under part 222. The ombudsman shall also

 

 9  act as an advocate for rural health concerns in the development of

 

10  certificate of need review standards under part 222.

 

11        (2) The incorporators of the corporation shall select a board

 

12  of directors consisting of a representative from each of the

 

13  following organizations:

 

14        (a) The Michigan state medical society State Medical Society

 

15  or its successor. The representative appointed selected under this

 

16  subdivision shall be a physician practicing in a county with a

 

17  population of not more than 100,000.

 

18        (b) The Michigan osteopathic physicians' society Osteopathic

 

19  Association or its successor. The representative appointed selected

 

20  under this subdivision shall be a physician practicing in a county

 

21  with a population of not more than 100,000.

 

22        (c) The Michigan nurses association Nurses Association or its

 

23  successor. The representative appointed selected under this

 

24  subdivision shall be a nurse practicing in a county with a

 

25  population of not more than 100,000.

 

26        (d) The Michigan hospital association Health and Hospital

 

27  Association or its successor. The representative selected under


 1  this subdivision shall be from a hospital in a county with a

 

 2  population of not more than 100,000.

 

 3        (e) The Michigan primary care association Primary Care

 

 4  Association or its successor. The representative appointed selected

 

 5  under this subdivision shall be a health professional practicing in

 

 6  a county with a population of not more than 100,000.

 

 7        (f) The Michigan association Association for local public

 

 8  health Local Public Health or its successor. The representative

 

 9  appointed selected under this subdivision shall be from a county

 

10  health department for a county with a population of not more than

 

11  100,000 or from a district health department with at least 1 member

 

12  county with a population of not more than 100,000.

 

13        (g) The office of the governor.

 

14        (h) The department. of public health.

 

15        (i) The department of commerce licensing and regulatory

 

16  affairs.

 

17        (j) The Michigan senate. The individual selected under this

 

18  subdivision shall be from a district located at least in part in a

 

19  county with a population of not more than 100,000.

 

20        (k) The Michigan house of representatives. The individual

 

21  selected under this subdivision shall be from a district located at

 

22  least in part in a county with a population of not more than

 

23  100,000.

 

24        (3) The board of directors of the corporation shall appoint an

 

25  internal management committee for the center for rural health. The

 

26  management committee shall consist of representatives from each of

 

27  the following:


 1        (a) The college College of human medicine Human Medicine of

 

 2  Michigan state university.State University.

 

 3        (b) The college College of osteopathic medicine Osteopathic

 

 4  Medicine of Michigan state university.State University.

 

 5        (c) The college College of nursing Nursing of Michigan state

 

 6  university.State University.

 

 7        (d) The college College of veterinary medicine Veterinary

 

 8  Medicine of Michigan state university.State University.

 

 9        (e) The cooperative extension service of Michigan state

 

10  university.State University Extension.

 

11        (f) The department. of public health.

 

12        Sec. 20101. (1) The words and phrases defined in sections

 

13  20102 to 20109 apply to all parts in this article except part 222

 

14  and have the meanings ascribed to them in those sections.

 

15        (2) In addition, article 1 contains general definitions and

 

16  principles of construction applicable to all articles in this code.

 

17        Sec. 20115. (1) The department may promulgate rules to further

 

18  define the term "health facility or agency" and the definition of a

 

19  health facility or agency listed in section 20106 as required to

 

20  implement this article. The department may define a specific

 

21  organization as a health facility or agency for the sole purpose of

 

22  certification authorized under this article. For purpose of

 

23  certification only, an organization defined in section 20106(5),

 

24  20108(1), or 20109(4) is considered a health facility or agency.

 

25  The term "health facility or agency" does not mean a visiting nurse

 

26  service or home aide service conducted by and for the adherents of

 

27  a church or religious denomination for the purpose of providing


 1  service for those who depend upon spiritual means through prayer

 

 2  alone for healing.

 

 3        (2) The department shall promulgate rules to differentiate a

 

 4  freestanding surgical outpatient facility from a private office of

 

 5  a physician, dentist, podiatrist, or other health professional. The

 

 6  department shall specify in the rules that a facility including,

 

 7  but not limited to, a private practice office described in this

 

 8  subsection must be licensed under this article as a freestanding

 

 9  surgical outpatient facility if that facility performs 120 or more

 

10  surgical abortions per year and publicly advertises outpatient

 

11  abortion services.

 

12        (3) The department shall promulgate rules that in effect

 

13  republish R 325.3826, R 325.3832, R 325.3835, R 325.3857, R

 

14  325.3866, R 325.3867, and R 325.3868 of the Michigan administrative

 

15  code, Administrative Code, but shall include in the rules standards

 

16  for a freestanding surgical outpatient facility or private practice

 

17  office that performs 120 or more surgical abortions per year and

 

18  that publicly advertises outpatient abortion services. The

 

19  department shall assure ensure that the standards are consistent

 

20  with the most recent United States supreme court Supreme Court

 

21  decisions regarding state regulation of abortions.

 

22        (4) Subject to section 20145, and part 222, the department may

 

23  modify or waive 1 or more of the rules contained in R 325.3801 to R

 

24  325.3877 of the Michigan administrative code Administrative Code

 

25  regarding construction or equipment standards, or both, for a

 

26  freestanding surgical outpatient facility that performs 120 or more

 

27  surgical abortions per year and that publicly advertises outpatient


 1  abortion services, if both of the following conditions are met:

 

 2        (a) The freestanding surgical outpatient facility was in

 

 3  existence and operating on December 31, 2012.

 

 4        (b) The department makes a determination that the existing

 

 5  construction or equipment conditions, or both, within the

 

 6  freestanding surgical outpatient facility are adequate to preserve

 

 7  the health and safety of the patients and employees of the

 

 8  freestanding surgical outpatient facility or that the construction

 

 9  or equipment conditions, or both, can be modified to adequately

 

10  preserve the health and safety of the patients and employees of the

 

11  freestanding surgical outpatient facility without meeting the

 

12  specific requirements of the rules.

 

13        (5) By January 15 each year, the department of community

 

14  health and human services shall provide the following information

 

15  to the department: of licensing and regulatory affairs:

 

16        (a) From data received by the department of community health

 

17  and human services through the abortion reporting requirements of

 

18  section 2835, all of the following:

 

19        (i) The name and location of each facility at which abortions

 

20  were performed during the immediately preceding calendar year.

 

21        (ii) The total number of abortions performed at that facility

 

22  location during the immediately preceding calendar year.

 

23        (iii) The total number of surgical abortions performed at that

 

24  facility location during the immediately preceding calendar year.

 

25        (b) Whether a facility at which surgical abortions were

 

26  performed in the immediately preceding calendar year publicly

 

27  advertises abortion services.


 1        (6) As used in this section:

 

 2        (a) "Abortion" means that term as defined in section 17015.

 

 3        (b) "Publicly advertises" means to advertise using directory

 

 4  or internet advertising including yellow pages, white pages, banner

 

 5  advertising, or electronic publishing.

 

 6        (c) "Surgical abortion" means an abortion that is not a

 

 7  medical abortion as that term is defined in section 17017.

 

 8        Sec. 20145. (1) Before contracting for and initiating a

 

 9  construction project involving new construction, additions,

 

10  modernizations, or conversions of a health facility or agency with

 

11  a capital expenditure of $1,000,000.00 or more, a person shall

 

12  obtain a construction permit from the department. The department

 

13  shall not issue the permit under this subsection unless the

 

14  applicant holds a valid certificate of need if a certificate of

 

15  need is required for the project under part 222.

 

16        (2) To protect the public health, safety, and welfare, the

 

17  department may promulgate rules to require construction permits for

 

18  projects other than those described in subsection (1) and the

 

19  submission of plans for other construction projects to expand or

 

20  change service areas and services provided.

 

21        (3) If a construction project requires a construction permit

 

22  under subsection (1) or (2), but does not require a certificate of

 

23  need under part 222, the department shall require the applicant to

 

24  submit information considered necessary by the department to assure

 

25  that the capital expenditure for the project is not a covered

 

26  capital expenditure as defined in section 22203(9).

 

27        (3) (4) If For a construction project that requires a


 1  construction permit under subsection (1), but does not require a

 

 2  certificate of need under part 222, the department shall require

 

 3  the applicant to submit information on a 1-page sheet, along with

 

 4  the application for a construction permit, consisting of all of the

 

 5  following:

 

 6        (a) A short description of the reason for the project and the

 

 7  funding source.

 

 8        (b) A contact person for further information, including the

 

 9  person's address and phone number.

 

10        (c) The estimated resulting increase or decrease in annual

 

11  operating costs.

 

12        (d) The current governing board membership of the applicant.

 

13        (e) The entity, if any, that owns the applicant.

 

14        (4) (5) The department shall make the information filed under

 

15  subsection (4) shall be made (3) publicly available by the

 

16  department by the same methods used to make information about

 

17  certificate of need applications under former part 222 publicly

 

18  available.

 

19        (5) (6) The review and approval of architectural plans and

 

20  narrative shall must require that the proposed construction project

 

21  is designed and constructed in accord with applicable statutory and

 

22  other regulatory requirements. In performing a construction permit

 

23  review for a health facility or agency under this section, the

 

24  department shall, at a minimum, apply the standards contained in

 

25  the document entitled "The 2007 Minimum Design Standards for Health

 

26  Care Facilities in Michigan" published by the department. and dated

 

27  July 2007. The standards are incorporated by reference for purposes


 1  of this subsection. The department may promulgate rules that are

 

 2  more stringent than the standards if necessary to protect the

 

 3  public health, safety, and welfare.

 

 4        (6) (7) The department shall promulgate rules to further

 

 5  prescribe the scope of construction projects and other alterations

 

 6  subject to review under this section.

 

 7        (7) (8) The department may waive the applicability of this

 

 8  section to a construction project or alteration if the waiver will

 

 9  not affect the public health, safety, and welfare.

 

10        (8) (9) Upon request by the person initiating a construction

 

11  project, the department may review and issue a construction permit

 

12  to a construction project that is not subject to subsection (1) or

 

13  (2) if the department determines that the review will promote the

 

14  public health, safety, and welfare.

 

15        (9) (10) The department shall assess a fee for each review

 

16  conducted under this section. The fee is .5% of the first

 

17  $1,000,000.00 of capital expenditure and .85% of any amount over

 

18  $1,000,000.00 of capital expenditure, up to a maximum of

 

19  $60,000.00.

 

20        (10) (11) As used in this section, "capital expenditure" means

 

21  that term as defined in section 22203(2), except that capital

 

22  expenditure does not include the cost of equipment that is not

 

23  fixed equipment.an expenditure for a single project, including cost

 

24  of construction, engineering, and fixed equipment that under

 

25  generally accepted accounting principles is not properly chargeable

 

26  as an expense of operation. Capital expenditure includes a lease or

 

27  comparable arrangement by or on behalf of a health facility to


 1  obtain a health facility, licensed part of a health facility, or

 

 2  fixed equipment for a health facility, if the actual purchase of a

 

 3  health facility, licensed part of a health facility, or equipment

 

 4  for a health facility would have been considered a capital

 

 5  expenditure under former part 222. Capital expenditure includes the

 

 6  cost of studies, surveys, designs, plans, working drawings,

 

 7  specifications, and other activities essential to the acquisition,

 

 8  improvement, expansion, addition, conversion, modernization, new

 

 9  construction, or replacement of physical plant and fixed equipment.

 

10        Sec. 20155. (1) Except as otherwise provided in this section

 

11  and section 20155a, the department shall make at least 1 visit to

 

12  each licensed health facility or agency every 3 years for survey

 

13  and evaluation for the purpose of licensure. A visit made according

 

14  to a complaint shall must be unannounced. Except for a county

 

15  medical care facility, a home for the aged, a nursing home, or a

 

16  hospice residence, the department shall determine whether the

 

17  visits that are not made according to a complaint are announced or

 

18  unannounced. The department shall ensure that each newly hired

 

19  nursing home surveyor, as part of his or her basic training, is

 

20  assigned full-time to a licensed nursing home for at least 10 days

 

21  within a 14-day period to observe actual operations outside of the

 

22  survey process before the trainee begins oversight

 

23  responsibilities.

 

24        (2) The department shall establish a process that ensures both

 

25  of the following:

 

26        (a) A newly hired nursing home surveyor does not make

 

27  independent compliance decisions during his or her training period.


 1        (b) A nursing home surveyor is not assigned as a member of a

 

 2  survey team for a nursing home in which he or she received training

 

 3  for 1 standard survey following the training received in that

 

 4  nursing home.

 

 5        (3) The department shall perform a criminal history check on

 

 6  all nursing home surveyors in the manner provided for in section

 

 7  20173a.

 

 8        (4) A member of a survey team must not be employed by a

 

 9  licensed nursing home or a nursing home management company doing

 

10  business in this state at the time of conducting a survey under

 

11  this section. The department shall not assign an individual to be a

 

12  member of a survey team for purposes of a survey, evaluation, or

 

13  consultation visit at a nursing home in which he or she was an

 

14  employee within the preceding 3 years.

 

15        (5) The department shall invite representatives from all

 

16  nursing home provider organizations and the state long-term care

 

17  ombudsman or his or her designee to participate in the planning

 

18  process for the joint provider and surveyor training sessions. The

 

19  department shall include at least 1 representative from nursing

 

20  home provider organizations that do not own or operate a nursing

 

21  home representing 30 or more nursing homes statewide in internal

 

22  surveyor group quality assurance training provided for the purpose

 

23  of general clarification and interpretation of existing or new

 

24  regulatory requirements and expectations.

 

25        (6) The department shall make available online the general

 

26  civil service position description related to the required

 

27  qualifications for individual surveyors. The department shall use


 1  the required qualifications to hire, educate, develop, and evaluate

 

 2  surveyors.

 

 3        (7) The department shall ensure that each annual survey team

 

 4  is composed of an interdisciplinary group of professionals, 1 of

 

 5  whom must be a registered nurse. Other members may include social

 

 6  workers, therapists, dietitians, pharmacists, administrators,

 

 7  physicians, sanitarians, and others who may have the expertise

 

 8  necessary to evaluate specific aspects of nursing home operation.

 

 9        (8) The department shall semiannually provide for joint

 

10  training with nursing home surveyors and providers on at least 1 of

 

11  the 10 most frequently issued federal citations in this state

 

12  during the past calendar year. The department shall develop a

 

13  protocol for the review of citation patterns compared to regional

 

14  outcomes and standards and complaints regarding the nursing home

 

15  survey process. The department shall include the review under this

 

16  subsection in the report required under subsection (20). Except as

 

17  otherwise provided in this subsection, each member of a department

 

18  nursing home survey team who is a health professional licensee

 

19  under article 15 shall earn not less than 50% of his or her

 

20  required continuing education credits, if any, in geriatric care.

 

21  If a member of a nursing home survey team is a pharmacist licensed

 

22  under article 15, he or she shall earn not less than 30% of his or

 

23  her required continuing education credits in geriatric care.

 

24        (9) Subject to subsection (12), the department may waive the

 

25  visit required by subsection (1) if a health facility or agency,

 

26  requests a waiver and submits the following as applicable and if

 

27  all of the requirements of subsection (11) are met:


 1        (a) Evidence that it is currently fully accredited by a body

 

 2  with expertise in the health facility or agency type and the

 

 3  accrediting organization is accepted by the United States

 

 4  Department of Health and Human Services for purposes of section

 

 5  1865 of the social security act, 42 USC 1395bb.

 

 6        (b) A copy of the most recent accreditation report, or

 

 7  executive summary, issued by a body described in subdivision (a),

 

 8  and the health facility's or agency's responses to the

 

 9  accreditation report is submitted to the department at least 30

 

10  days from license renewal. Submission of an executive summary does

 

11  not prevent or prohibit the department from requesting the entire

 

12  accreditation report if the department considers it necessary.

 

13        (c) For a nursing home, a standard federal certification

 

14  survey conducted within the immediately preceding 9 to 15 months

 

15  that shows substantial compliance or has an accepted plan of

 

16  correction, if applicable.

 

17        (10) Except as otherwise provided in subsection (14),

 

18  accreditation information provided to the department under

 

19  subsection (9) is confidential, is not a public record, and is not

 

20  subject to court subpoena. The department shall use the

 

21  accreditation information only as provided in this section and

 

22  properly destroy the documentation after a decision on the waiver

 

23  request is made.

 

24        (11) The department shall grant a waiver under subsection (9)

 

25  if the accreditation report submitted under subsection (9)(b) is

 

26  less than 3 years old or the standard federal survey submitted

 

27  under subsection (9)(c) is less than 15 months old and there is no


 1  indication of substantial noncompliance with licensure standards or

 

 2  of deficiencies that represent a threat to public safety or patient

 

 3  care. If the accreditation report or standard federal survey is too

 

 4  old, the department may deny the waiver request and conduct the

 

 5  visits required under subsection (9). Denial of a waiver request by

 

 6  the department is not subject to appeal.

 

 7        (12) This section does not prohibit the department from citing

 

 8  a violation of this part during a survey, conducting investigations

 

 9  or inspections according to section 20156, or conducting surveys of

 

10  health facilities or agencies for the purpose of complaint

 

11  investigations or federal certification. This section does not

 

12  prohibit the bureau of fire services created in section 1b of the

 

13  fire prevention code, 1941 PA 207, MCL 29.1b, from conducting

 

14  annual surveys of hospitals, nursing homes, and county medical care

 

15  facilities.

 

16        (13) At the request of a health facility or agency, the

 

17  department may conduct a consultation engineering survey of a

 

18  health facility and provide professional advice and consultation

 

19  regarding health facility construction and design. A health

 

20  facility or agency may request a voluntary consultation survey

 

21  under this subsection at any time between licensure surveys. The

 

22  fees for a consultation engineering survey are the same as the fees

 

23  established for waivers under section 20161(8).20161(7).

 

24        (14) If the department determines that substantial

 

25  noncompliance with licensure standards exists or that deficiencies

 

26  that represent a threat to public safety or patient care exist

 

27  based on a review of an accreditation report submitted under


 1  subsection (9)(b), the department shall prepare a written summary

 

 2  of the substantial noncompliance or deficiencies and the health

 

 3  facility's or agency's response to the department's determination.

 

 4  The department's written summary and the health facility's or

 

 5  agency's response are public documents.

 

 6        (15) The department or a local health department shall conduct

 

 7  investigations or inspections, other than inspections of financial

 

 8  records, of a county medical care facility, home for the aged,

 

 9  nursing home, or hospice residence without prior notice to the

 

10  health facility or agency. An employee of a state agency charged

 

11  with investigating or inspecting the health facility or agency or

 

12  an employee of a local health department who directly or indirectly

 

13  gives prior notice regarding an investigation or an inspection,

 

14  other than an inspection of the financial records, to the health

 

15  facility or agency or to an employee of the health facility or

 

16  agency, is guilty of a misdemeanor. Consultation visits that are

 

17  not for the purpose of annual or follow-up inspection or survey may

 

18  be announced.

 

19        (16) The department shall maintain a record indicating whether

 

20  a visit and inspection is announced or unannounced. Survey findings

 

21  gathered at each health facility or agency during each visit and

 

22  inspection, whether announced or unannounced, shall must be taken

 

23  into account in licensure decisions.

 

24        (17) The department shall require periodic reports and a

 

25  health facility or agency shall give the department access to

 

26  books, records, and other documents maintained by a health facility

 

27  or agency to the extent necessary to carry out the purpose of this


 1  article and the rules promulgated under this article. The

 

 2  department shall not divulge or disclose the contents of the

 

 3  patient's clinical records in a manner that identifies an

 

 4  individual except under court order. The department may copy health

 

 5  facility or agency records as required to document findings.

 

 6  Surveyors shall use electronic resident information, whenever

 

 7  available, as a source of survey-related data and shall request

 

 8  facility assistance to access the system to maximize data export.

 

 9        (18) The department may delegate survey, evaluation, or

 

10  consultation functions to another state agency or to a local health

 

11  department qualified to perform those functions. The department

 

12  shall not delegate survey, evaluation, or consultation functions to

 

13  a local health department that owns or operates a hospice or

 

14  hospice residence licensed under this article. The department shall

 

15  delegate under this subsection by cost reimbursement contract

 

16  between the department and the state agency or local health

 

17  department. The department shall not delegate survey, evaluation,

 

18  or consultation functions to nongovernmental agencies, except as

 

19  provided in this section. The voluntary inspection described in

 

20  this subsection must be agreed upon by both the licensee and the

 

21  department.

 

22        (19) If, upon investigation, the department or a state agency

 

23  determines that an individual licensed to practice a profession in

 

24  this state has violated the applicable licensure statute or the

 

25  rules promulgated under that statute, the department, state agency,

 

26  or local health department shall forward the evidence it has to the

 

27  appropriate licensing agency.


 1        (20) The department may consolidate all information provided

 

 2  for any report required under this section and section 20155a into

 

 3  a single report. The department shall report to the appropriations

 

 4  subcommittees, the senate and house of representatives standing

 

 5  committees having jurisdiction over issues involving senior

 

 6  citizens, and the fiscal agencies on March 1 of each year on the

 

 7  initial and follow-up surveys conducted on all nursing homes in

 

 8  this state. The department shall include all of the following

 

 9  information in the report:

 

10        (a) The number of surveys conducted.

 

11        (b) The number requiring follow-up surveys.

 

12        (c) The average number of citations per nursing home for the

 

13  most recent calendar year.

 

14        (d) The number of night and weekend complaints filed.

 

15        (e) The number of night and weekend responses to complaints

 

16  conducted by the department.

 

17        (f) The average length of time for the department to respond

 

18  to a complaint filed against a nursing home.

 

19        (g) The number and percentage of citations disputed through

 

20  informal dispute resolution and independent informal dispute

 

21  resolution.

 

22        (h) The number and percentage of citations overturned or

 

23  modified, or both.

 

24        (i) The review of citation patterns developed under subsection

 

25  (8).

 

26        (j) Information regarding the progress made on implementing

 

27  the administrative and electronic support structure to efficiently


 1  coordinate all nursing home licensing and certification functions.

 

 2        (k) The number of annual standard surveys of nursing homes

 

 3  that were conducted during a period of open survey or enforcement

 

 4  cycle.

 

 5        (l) The number of abbreviated complaint surveys that were not

 

 6  conducted on consecutive surveyor workdays.

 

 7        (m) The percent of all form CMS-2567 reports of findings that

 

 8  were released to the nursing home within the 10-working-day

 

 9  requirement.

 

10        (n) The percent of provider notifications of acceptance or

 

11  rejection of a plan of correction that were released to the nursing

 

12  home within the 10-working-day requirement.

 

13        (o) The percent of first revisits that were completed within

 

14  60 days from the date of survey completion.

 

15        (p) The percent of second revisits that were completed within

 

16  85 days from the date of survey completion.

 

17        (q) The percent of letters of compliance notification to the

 

18  nursing home that were released within 10 working days of the date

 

19  of the completion of the revisit.

 

20        (r) A summary of the discussions from the meetings required in

 

21  subsection (24).

 

22        (s) The number of nursing homes that participated in a

 

23  recognized quality improvement program as described under section

 

24  20155a(3).

 

25        (21) The department shall report on March 1 of each year to

 

26  the standing committees on appropriations and the standing

 

27  committees having jurisdiction over issues involving senior


 1  citizens in the senate and the house of representatives on all of

 

 2  the following:

 

 3        (a) The percentage of nursing home citations that are appealed

 

 4  through the informal dispute resolution process.

 

 5        (b) The number and percentage of nursing home citations that

 

 6  are appealed and supported, amended, or deleted through the

 

 7  informal dispute resolution process.

 

 8        (c) A summary of the quality assurance review of the amended

 

 9  citations and related survey retraining efforts to improve

 

10  consistency among surveyors and across the survey administrative

 

11  unit that occurred in the year being reported.

 

12        (22) Subject to subsection (23), a clarification work group

 

13  comprised of the department in consultation with a nursing home

 

14  resident or a member of a nursing home resident's family, nursing

 

15  home provider groups, the American Medical Directors Association,

 

16  the state long-term care ombudsman, and the federal Centers for

 

17  Medicare and Medicaid Services shall clarify the following terms as

 

18  those terms are used in title XVIII and title XIX and applied by

 

19  the department to provide more consistent regulation of nursing

 

20  homes in this state:

 

21        (a) Immediate jeopardy.

 

22        (b) Harm.

 

23        (c) Potential harm.

 

24        (d) Avoidable.

 

25        (e) Unavoidable.

 

26        (23) All of the following clarifications developed under

 

27  subsection (22) apply for purposes of subsection (22):


 1        (a) Specifically, the term "immediate jeopardy" means a

 

 2  situation in which immediate corrective action is necessary because

 

 3  the nursing home's noncompliance with 1 or more requirements of

 

 4  participation has caused or is likely to cause serious injury,

 

 5  harm, impairment, or death to a resident receiving care in a

 

 6  nursing home.

 

 7        (b) The likelihood of immediate jeopardy is reasonably higher

 

 8  if there is evidence of a flagrant failure by the nursing home to

 

 9  comply with a peer-reviewed, evidence-based, nationally recognized

 

10  clinical process guideline than if the nursing home has

 

11  substantially and continuously complied with peer-reviewed,

 

12  evidence-based, nationally recognized guidelines. If federal

 

13  regulations and guidelines are not clear, and if the clinical

 

14  process guidelines have been recognized, a process failure giving

 

15  rise to an immediate jeopardy may involve an egregious widespread

 

16  or repeated process failure and the absence of reasonable efforts

 

17  to detect and prevent the process failure.

 

18        (c) In determining whether or not there is immediate jeopardy,

 

19  the survey agency should consider at least all of the following:

 

20        (i) Whether the nursing home could reasonably have been

 

21  expected to know about the deficient practice and to stop it, but

 

22  did not stop the deficient practice.

 

23        (ii) Whether the nursing home could reasonably have been

 

24  expected to identify the deficient practice and to correct it, but

 

25  did not correct the deficient practice.

 

26        (iii) Whether the nursing home could reasonably have been

 

27  expected to anticipate that serious injury, serious harm,


 1  impairment, or death might result from continuing the deficient

 

 2  practice, but did not so anticipate.

 

 3        (iv) Whether the nursing home could reasonably have been

 

 4  expected to know that a widely accepted high-risk practice is or

 

 5  could be problematic, but did not know.

 

 6        (v) Whether the nursing home could reasonably have been

 

 7  expected to detect the process problem in a more timely fashion,

 

 8  but did not so detect.

 

 9        (d) The existence of 1 or more of the factors described in

 

10  subdivision (c), and especially the existence of 3 or more of those

 

11  factors simultaneously, may lead to a conclusion that the situation

 

12  is one in which the nursing home's practice makes adverse events

 

13  likely to occur if immediate intervention is not undertaken, and

 

14  therefore constitutes immediate jeopardy. If none of the factors

 

15  described in subdivision (c) is present, the situation may involve

 

16  harm or potential harm that is not immediate jeopardy.

 

17        (e) Specifically, "actual harm" means a negative outcome to a

 

18  resident that has compromised the resident's ability to maintain or

 

19  reach, or both, his or her highest practicable physical, mental,

 

20  and psychosocial well-being as defined by an accurate and

 

21  comprehensive resident assessment, plan of care, and provision of

 

22  services. Harm does not include a deficient practice that only may

 

23  cause or has caused limited consequences to the resident.

 

24        (f) For purposes of subdivision (e), in determining whether a

 

25  negative outcome is of limited consequence, if the "state

 

26  operations manual" "State Operations Manual" or "the guidance to

 

27  surveyors" "The Guidance to Surveyors" published by the federal


 1  Centers for Medicare and Medicaid Services does not provide

 

 2  specific guidance, the department may consider whether most people

 

 3  in similar circumstances would feel that the damage was of such

 

 4  short duration or impact as to be inconsequential or trivial. In

 

 5  such a case, the consequence of a negative outcome may be

 

 6  considered more limited if it occurs in the context of overall

 

 7  procedural consistency with a peer-reviewed, evidence-based,

 

 8  nationally recognized clinical process guideline, as compared to a

 

 9  substantial inconsistency with or variance from the guideline.

 

10        (g) For purposes of subdivision (e), if the publications

 

11  described in subdivision (f) do not provide specific guidance, the

 

12  department may consider the degree of a nursing home's adherence to

 

13  a peer-reviewed, evidence-based, nationally recognized clinical

 

14  process guideline in considering whether the degree of compromise

 

15  and future risk to the resident constitutes actual harm. The risk

 

16  of significant compromise to the resident may be considered greater

 

17  in the context of substantial deviation from the guidelines than in

 

18  the case of overall adherence.

 

19        (h) To improve consistency and to avoid disputes over

 

20  avoidable and unavoidable negative outcomes, nursing homes and

 

21  survey agencies must have a common understanding of accepted

 

22  process guidelines and of the circumstances under which it can

 

23  reasonably be said that certain actions or inactions will lead to

 

24  avoidable negative outcomes. If the "state operations manual"

 

25  "State Operations Manual" or "the guidance to surveyors" "The

 

26  Guidance to Surveyors" published by the federal Centers for

 

27  Medicare and Medicaid Services is not specific, a nursing home's


 1  overall documentation of adherence to a peer-reviewed, evidence-

 

 2  based, nationally recognized clinical process guideline with a

 

 3  process indicator is relevant information in considering whether a

 

 4  negative outcome was avoidable or unavoidable and may be considered

 

 5  in the application of that term.

 

 6        (24) The department shall conduct a quarterly meeting and

 

 7  invite appropriate stakeholders. The department shall invite as

 

 8  appropriate stakeholders under this subsection at least 1

 

 9  representative from each nursing home provider organization that

 

10  does not own or operate a nursing home representing 30 or more

 

11  nursing homes statewide, the state long-term care ombudsman or his

 

12  or her designee, and any other clinical experts. Individuals who

 

13  participate in these quarterly meetings, jointly with the

 

14  department, may designate advisory workgroups to develop

 

15  recommendations on the discussion topics that should include, at a

 

16  minimum, all of the following:

 

17        (a) Opportunities for enhanced promotion of nursing home

 

18  performance, including, but not limited to, programs that encourage

 

19  and reward providers that strive for excellence.

 

20        (b) Seeking quality improvement to the survey and enforcement

 

21  process, including clarifications to process-related policies and

 

22  protocols that include, but are not limited to, all of the

 

23  following:

 

24        (i) Improving the surveyors' quality and preparedness.

 

25        (ii) Enhanced communication between regulators, surveyors,

 

26  providers, and consumers.

 

27        (iii) Ensuring fair enforcement and dispute resolution by


 1  identifying methods or strategies that may resolve identified

 

 2  problems or concerns.

 

 3        (c) Promoting transparency across provider and surveyor

 

 4  communities, including, but not limited to, all of the following:

 

 5        (i) Applying regulations in a consistent manner and evaluating

 

 6  changes that have been implemented to resolve identified problems

 

 7  and concerns.

 

 8        (ii) Providing consumers with information regarding changes in

 

 9  policy and interpretation.

 

10        (iii) Identifying positive and negative trends and factors

 

11  contributing to those trends in the areas of resident care,

 

12  deficient practices, and enforcement.

 

13        (d) Clinical process guidelines.

 

14        (25) A nursing home shall use peer-reviewed, evidence-based,

 

15  nationally recognized clinical process guidelines or peer-reviewed,

 

16  evidence-based, best-practice resources to develop and implement

 

17  resident care policies and compliance protocols with measurable

 

18  outcomes specifically in the following clinical practice areas:

 

19        (a) Use of bed rails.

 

20        (b) Adverse drug effects.

 

21        (c) Prevention of falls.

 

22        (d) Prevention of pressure ulcers.

 

23        (e) Nutrition and hydration.

 

24        (f) Pain management.

 

25        (g) Depression and depression pharmacotherapy.

 

26        (h) Heart failure.

 

27        (i) Urinary incontinence.


 1        (j) Dementia care.

 

 2        (k) Osteoporosis.

 

 3        (l) Altered mental states.

 

 4        (m) Physical and chemical restraints.

 

 5        (n) Person-centered care principles.

 

 6        (26) In an area of clinical practice that is not listed in

 

 7  subsection (25), a nursing home may use peer-reviewed, evidence-

 

 8  based, nationally recognized clinical process guidelines or peer-

 

 9  reviewed, evidence-based, best-practice resources to develop and

 

10  implement resident care policies and compliance protocols with

 

11  measurable outcomes to promote performance excellence.

 

12        (27) The department shall consider recommendations from an

 

13  advisory workgroup created under subsection (24). The department

 

14  may include training on new and revised peer-reviewed, evidence-

 

15  based, nationally recognized clinical process guidelines or peer-

 

16  reviewed, evidence-based, best-practice resources, which contain

 

17  measurable outcomes, in the joint provider and surveyor training

 

18  sessions to assist provider efforts toward improved regulatory

 

19  compliance and performance excellence and to foster a common

 

20  understanding of accepted peer-reviewed, evidence-based, best-

 

21  practice resources between providers and the survey agency. The

 

22  department shall post on its website all peer-reviewed, evidence-

 

23  based, nationally recognized clinical process guidelines and peer-

 

24  reviewed, evidence-based, best-practice resources used in a

 

25  training session under this subsection for provider, surveyor, and

 

26  public reference.

 

27        (28) Representatives from each nursing home provider


 1  organization that does not own or operate a nursing home

 

 2  representing 30 or more nursing homes statewide and the state long-

 

 3  term care ombudsman or his or her designee are permanent members of

 

 4  a clinical advisory workgroup created under subsection (24). The

 

 5  department shall issue survey certification memorandums to

 

 6  providers to announce or clarify changes in the interpretation of

 

 7  regulations.

 

 8        (29) The department shall maintain the process by which the

 

 9  director of the long-term care division or his or her designee

 

10  reviews and authorizes the issuance of a citation for immediate

 

11  jeopardy or substandard quality of care before the statement of

 

12  deficiencies is made final. The review must assure ensure the

 

13  consistent and accurate application of federal and state survey

 

14  protocols and defined regulatory standards. As used in this

 

15  subsection, "immediate jeopardy" and "substandard quality of care"

 

16  mean those terms as defined by the federal Centers for Medicare and

 

17  Medicaid Services.

 

18        (30) Upon availability of funds, the department shall give

 

19  grants, awards, or other recognition to nursing homes to encourage

 

20  the rapid development and implementation of resident care policies

 

21  and compliance protocols that are created from peer-reviewed,

 

22  evidence-based, nationally recognized clinical process guidelines

 

23  or peer-reviewed, evidence-based, best-practice resources with

 

24  measurable outcomes to promote performance excellence.

 

25        (31) A nursing home shall post the nursing home's survey

 

26  report in a conspicuous place within the nursing home for public

 

27  review.


 1        (32) Nothing in this section limits the requirements of

 

 2  related state and federal law.

 

 3        (33) As used in this section:

 

 4        (a) "Consecutive days" means calendar days, but does not

 

 5  include Saturday, Sunday, or state- or federally-recognized

 

 6  holidays.

 

 7        (b) "Form CMS-2567" means the federal Centers for Medicare and

 

 8  Medicaid Services' form for the statement of deficiencies and plan

 

 9  of correction or a successor form serving the same purpose.

 

10        (c) "Title XVIII" means title XVIII of the social security

 

11  act, 42 USC 1395 to 1395lll.

 

12        (d) "Title XIX" means title XIX of the social security act, 42

 

13  USC 1396 to 1396w-5.

 

14        Sec. 20161. (1) The department shall assess fees and other

 

15  assessments for health facility and agency licenses and

 

16  certificates of need on an annual basis as provided in this

 

17  article. Until October 1, 2019, except as otherwise provided in

 

18  this article, fees and assessments shall must be paid as provided

 

19  in the following schedule:

 

 

20

     (a) Freestanding surgical

21

outpatient facilities................$500.00 per facility

22

                                     license.

23

     (b) Hospitals...................$500.00 per facility

24

                                     license and $10.00 per

25

                                     licensed bed.

26

     (c) Nursing homes, county

27

medical care facilities, and


 1

hospital long-term care units........$500.00 per facility

 2

                                     license and $3.00 per

 3

                                     licensed bed over 100

 4

                                     licensed beds.

 5

     (d) Homes for the aged..........$6.27 per licensed bed.

 6

     (e) Hospice agencies............$500.00 per agency license.

 7

     (f) Hospice residences..........$500.00 per facility

 8

                                     license and $5.00 per

 9

                                     licensed bed.

10

     (g) Subject to subsection

11

(11), (10), quality assurance assessment

12

for nursing homes and hospital

13

long-term care units.................an amount resulting

14

                                     in not more than 6%

15

                                     of total industry

16

                                     revenues.

17

     (h) Subject to subsection

18

(12), (11), quality assurance assessment

19

for hospitals........................at a fixed or variable

20

                                     rate that generates

21

                                     funds not more than the

22

                                     maximum allowable under

23

                                     the federal matching

24

                                     requirements, after

25

                                     consideration for the

26

                                     amounts in subsection

27

                                     (12)(a) (11)(a) and (i).


 1

     (i) Initial licensure

 2

application fee for subdivisions

 3

(a), (b), (c), (e), and (f)..........$2,000.00 per initial

 4

                                     license.

 

 

 5        (2) If a hospital requests the department to conduct a

 

 6  certification survey for purposes of title XVIII or title XIX, of

 

 7  the social security act, the hospital shall pay a license fee

 

 8  surcharge of $23.00 per bed. As used in this subsection, "title

 

 9  XVIII" and "title XIX" mean those terms as defined in section

 

10  20155.

 

11        (3) All of the following apply to the assessment under this

 

12  section for certificates of need:

 

13        (a) The base fee for a certificate of need is $3,000.00 for

 

14  each application. For a project requiring a projected capital

 

15  expenditure of more than $500,000.00 but less than $4,000,000.00,

 

16  an additional fee of $5,000.00 is added to the base fee. For a

 

17  project requiring a projected capital expenditure of $4,000,000.00

 

18  or more but less than $10,000,000.00, an additional fee of

 

19  $8,000.00 is added to the base fee. For a project requiring a

 

20  projected capital expenditure of $10,000,000.00 or more, an

 

21  additional fee of $12,000.00 is added to the base fee.

 

22        (b) In addition to the fees under subdivision (a), the

 

23  applicant shall pay $3,000.00 for any designated complex project

 

24  including a project scheduled for comparative review or for a

 

25  consolidated licensed health facility application for acquisition

 

26  or replacement.

 

27        (c) If required by the department, the applicant shall pay


 1  $1,000.00 for a certificate of need application that receives

 

 2  expedited processing at the request of the applicant.

 

 3        (d) The department shall charge a fee of $500.00 to review any

 

 4  letter of intent requesting or resulting in a waiver from

 

 5  certificate of need review and any amendment request to an approved

 

 6  certificate of need.

 

 7        (e) A health facility or agency that offers certificate of

 

 8  need covered clinical services shall pay $100.00 for each

 

 9  certificate of need approved covered clinical service as part of

 

10  the certificate of need annual survey at the time of submission of

 

11  the survey data.

 

12        (f) The department shall use the fees collected under this

 

13  subsection only to fund the certificate of need program. Funds

 

14  remaining in the certificate of need program at the end of the

 

15  fiscal year shall not lapse to the general fund but shall remain

 

16  available to fund the certificate of need program in subsequent

 

17  years.

 

18        (3) (4) A license issued under this part is effective for no

 

19  longer than 1 year after the date of issuance.

 

20        (4) (5) Fees described in this section are payable to the

 

21  department at the time when an application for a license , or

 

22  permit , or certificate is submitted. If an application for a

 

23  license , or permit , or certificate is denied or if a license , or

 

24  permit , or certificate is revoked before its expiration date, the

 

25  department shall not refund fees paid to the department.

 

26        (5) (6) The fee for a provisional license or temporary permit

 

27  is the same as for a license. A license may be issued at the


 1  expiration date of a temporary permit without an additional fee for

 

 2  the balance of the period for which the fee was paid if the

 

 3  requirements for licensure are met.

 

 4        (6) (7) The cost of licensure activities shall must be

 

 5  supported by license fees.

 

 6        (7) (8) The application fee for a waiver under section 21564

 

 7  is $200.00 plus $40.00 per hour for the professional services and

 

 8  travel expenses directly related to processing the application. The

 

 9  travel expenses shall must be calculated in accordance with the

 

10  state standardized travel regulations of the department of

 

11  technology, management, and budget in effect at the time of the

 

12  travel.

 

13        (8) (9) An applicant for licensure or renewal of licensure

 

14  under part 209 shall pay the applicable fees set forth in part 209.

 

15        (9) (10) Except as otherwise provided in this section, the

 

16  fees and assessments collected under this section shall must be

 

17  deposited in the state treasury, to the credit of the general fund.

 

18  The department may use the unreserved fund balance in fees and

 

19  assessments for the criminal history check program required under

 

20  this article.

 

21        (10) (11) The quality assurance assessment collected under

 

22  subsection (1)(g) and all federal matching funds attributed to that

 

23  assessment shall must be used only for the following purposes and

 

24  under the following specific circumstances:

 

25        (a) The quality assurance assessment and all federal matching

 

26  funds attributed to that assessment shall must be used to finance

 

27  Medicaid nursing home reimbursement payments. Only licensed nursing


 1  homes and hospital long-term care units that are assessed the

 

 2  quality assurance assessment and participate in the Medicaid

 

 3  program are eligible for increased per diem Medicaid reimbursement

 

 4  rates under this subdivision. A nursing home or long-term care unit

 

 5  that is assessed the quality assurance assessment and that does not

 

 6  pay the assessment required under subsection (1)(g) in accordance

 

 7  with subdivision (c)(i) or in accordance with a written payment

 

 8  agreement with this state shall not receive the increased per diem

 

 9  Medicaid reimbursement rates under this subdivision until all of

 

10  its outstanding quality assurance assessments and any penalties

 

11  assessed under subdivision (f) have been paid in full. This

 

12  subdivision does not authorize or require the department to

 

13  overspend tax revenue in violation of the management and budget

 

14  act, 1984 PA 431, MCL 18.1101 to 18.1594.

 

15        (b) Except as otherwise provided under subdivision (c),

 

16  beginning October 1, 2005, the quality assurance assessment is

 

17  based on the total number of patient days of care each nursing home

 

18  and hospital long-term care unit provided to non-Medicare patients

 

19  within the immediately preceding year, shall be is assessed at a

 

20  uniform rate on October 1, 2005 and subsequently on October 1 of

 

21  each following year, and is payable on a quarterly basis, with the

 

22  first payment due 90 days after the date the assessment is

 

23  assessed.

 

24        (c) Within 30 days after September 30, 2005, the department

 

25  shall submit an application to the federal Centers for Medicare and

 

26  Medicaid Services to request a waiver according to 42 CFR 433.68(e)

 

27  to implement this subdivision as follows:


 1        (i) If the waiver is approved, the quality assurance

 

 2  assessment rate for a nursing home or hospital long-term care unit

 

 3  with less than 40 licensed beds or with the maximum number, or more

 

 4  than the maximum number, of licensed beds necessary to secure

 

 5  federal approval of the application is $2.00 per non-Medicare

 

 6  patient day of care provided within the immediately preceding year

 

 7  or a rate as otherwise altered on the application for the waiver to

 

 8  obtain federal approval. If the waiver is approved, for all other

 

 9  nursing homes and long-term care units the quality assurance

 

10  assessment rate is to be calculated by dividing the total statewide

 

11  maximum allowable assessment permitted under subsection (1)(g) less

 

12  the total amount to be paid by the nursing homes and long-term care

 

13  units with less than 40 licensed beds or with the maximum number,

 

14  or more than the maximum number, of licensed beds necessary to

 

15  secure federal approval of the application by the total number of

 

16  non-Medicare patient days of care provided within the immediately

 

17  preceding year by those nursing homes and long-term care units with

 

18  more than 39 licensed beds, but less than the maximum number of

 

19  licensed beds necessary to secure federal approval. The quality

 

20  assurance assessment, as provided under this subparagraph, shall

 

21  must be assessed in the first quarter after federal approval of the

 

22  waiver and shall be subsequently assessed on October 1 of each

 

23  following year, and is payable on a quarterly basis, with the first

 

24  payment due 90 days after the date the assessment is assessed.

 

25        (ii) If the waiver is approved, continuing care retirement

 

26  centers are exempt from the quality assurance assessment if the

 

27  continuing care retirement center requires each center resident to


 1  provide an initial life interest payment of $150,000.00, on

 

 2  average, per resident to ensure payment for that resident's

 

 3  residency and services and the continuing care retirement center

 

 4  utilizes all of the initial life interest payment before the

 

 5  resident becomes eligible for medical assistance under the state's

 

 6  Medicaid plan. As used in this subparagraph, "continuing care

 

 7  retirement center" means a nursing care facility that provides

 

 8  independent living services, assisted living services, and nursing

 

 9  care and medical treatment services, in a campus-like setting that

 

10  has shared facilities or common areas, or both.

 

11        (d) Beginning May 10, 2002, the department shall increase the

 

12  per diem nursing home Medicaid reimbursement rates for the balance

 

13  of that year. For each subsequent year in which the quality

 

14  assurance assessment is assessed and collected, the department

 

15  shall maintain the Medicaid nursing home reimbursement payment

 

16  increase financed by the quality assurance assessment.

 

17        (e) The department shall implement this section in a manner

 

18  that complies with federal requirements necessary to ensure that

 

19  the quality assurance assessment qualifies for federal matching

 

20  funds.

 

21        (f) If a nursing home or a hospital long-term care unit fails

 

22  to pay the assessment required by subsection (1)(g), the department

 

23  may assess the nursing home or hospital long-term care unit a

 

24  penalty of 5% of the assessment for each month that the assessment

 

25  and penalty are not paid up to a maximum of 50% of the assessment.

 

26  The department may also refer for collection to the department of

 

27  treasury past due amounts consistent with section 13 of 1941 PA


 1  122, MCL 205.13.

 

 2        (g) The Medicaid nursing home quality assurance assessment

 

 3  fund is established in the state treasury. The department shall

 

 4  deposit the revenue raised through the quality assurance assessment

 

 5  with the state treasurer for deposit in the Medicaid nursing home

 

 6  quality assurance assessment fund.

 

 7        (h) The department shall not implement this subsection in a

 

 8  manner that conflicts with 42 USC 1396b(w).

 

 9        (i) The quality assurance assessment collected under

 

10  subsection (1)(g) shall must be prorated on a quarterly basis for

 

11  any licensed beds added to or subtracted from a nursing home or

 

12  hospital long-term care unit since the immediately preceding July

 

13  1. Any adjustments in payments are due on the next quarterly

 

14  installment due date.

 

15        (j) In each fiscal year governed by this subsection, Medicaid

 

16  reimbursement rates shall must not be reduced below the Medicaid

 

17  reimbursement rates in effect on April 1, 2002 as a direct result

 

18  of the quality assurance assessment collected under subsection

 

19  (1)(g).

 

20        (k) The state retention amount of the quality assurance

 

21  assessment collected under subsection (1)(g) shall must be equal to

 

22  13.2% of the federal funds generated by the nursing homes and

 

23  hospital long-term care units quality assurance assessment,

 

24  including the state retention amount. The state retention amount

 

25  shall must be appropriated each fiscal year to the department to

 

26  support Medicaid expenditures for long-term care services. These

 

27  funds shall must offset an identical amount of general fund/general


 1  purpose revenue originally appropriated for that purpose.

 

 2        (l) Beginning October 1, 2019, the department shall not assess

 

 3  or collect the quality assurance assessment or apply for federal

 

 4  matching funds. The quality assurance assessment collected under

 

 5  subsection (1)(g) shall must not be assessed or collected after

 

 6  September 30, 2011 if the quality assurance assessment is not

 

 7  eligible for federal matching funds. Any portion of the quality

 

 8  assurance assessment collected from a nursing home or hospital

 

 9  long-term care unit that is not eligible for federal matching funds

 

10  shall must be returned to the nursing home or hospital long-term

 

11  care unit.

 

12        (11) (12) The quality assurance dedication is an earmarked

 

13  assessment collected under subsection (1)(h). That assessment and

 

14  all federal matching funds attributed to that assessment shall must

 

15  be used only for the following purpose and under the following

 

16  specific circumstances:

 

17        (a) To maintain the increased Medicaid reimbursement rate

 

18  increases as provided for in subdivision (c).

 

19        (b) The quality assurance assessment shall must be assessed on

 

20  all net patient revenue, before deduction of expenses, less

 

21  Medicare net revenue, as reported in the most recently available

 

22  Medicare cost report and is payable on a quarterly basis, with the

 

23  first payment due 90 days after the date the assessment is

 

24  assessed. As used in this subdivision, "Medicare net revenue"

 

25  includes Medicare payments and amounts collected for coinsurance

 

26  and deductibles.

 

27        (c) Beginning October 1, 2002, the department shall increase


 1  the hospital Medicaid reimbursement rates for the balance of that

 

 2  year. For each subsequent year in which the quality assurance

 

 3  assessment is assessed and collected, the department shall maintain

 

 4  the hospital Medicaid reimbursement rate increase financed by the

 

 5  quality assurance assessments.

 

 6        (d) The department shall implement this section in a manner

 

 7  that complies with federal requirements necessary to ensure that

 

 8  the quality assurance assessment qualifies for federal matching

 

 9  funds.

 

10        (e) If a hospital fails to pay the assessment required by

 

11  subsection (1)(h), the department may assess the hospital a penalty

 

12  of 5% of the assessment for each month that the assessment and

 

13  penalty are not paid up to a maximum of 50% of the assessment. The

 

14  department may also refer for collection to the department of

 

15  treasury past due amounts consistent with section 13 of 1941 PA

 

16  122, MCL 205.13.

 

17        (f) The hospital quality assurance assessment fund is

 

18  established in the state treasury. The department shall deposit the

 

19  revenue raised through the quality assurance assessment with the

 

20  state treasurer for deposit in the hospital quality assurance

 

21  assessment fund.

 

22        (g) In each fiscal year governed by this subsection, the

 

23  quality assurance assessment shall must only be collected and

 

24  expended if Medicaid hospital inpatient DRG and outpatient

 

25  reimbursement rates and disproportionate share hospital and

 

26  graduate medical education payments are not below the level of

 

27  rates and payments in effect on April 1, 2002 as a direct result of


 1  the quality assurance assessment collected under subsection (1)(h),

 

 2  except as provided in subdivision (h).

 

 3        (h) The quality assurance assessment collected under

 

 4  subsection (1)(h) shall must not be assessed or collected after

 

 5  September 30, 2011 if the quality assurance assessment is not

 

 6  eligible for federal matching funds. Any portion of the quality

 

 7  assurance assessment collected from a hospital that is not eligible

 

 8  for federal matching funds shall must be returned to the hospital.

 

 9        (i) The state retention amount of the quality assurance

 

10  assessment collected under subsection (1)(h) shall must be equal to

 

11  13.2% of the federal funds generated by the hospital quality

 

12  assurance assessment, including the state retention amount. The

 

13  13.2% state retention amount described in this subdivision does not

 

14  apply to the Healthy Michigan plan. In the fiscal year ending

 

15  September 30, 2016, there is a 1-time additional retention amount

 

16  of up to $92,856,100.00. Beginning in the fiscal year ending

 

17  September 30, 2017, and for each fiscal year thereafter, there is a

 

18  retention amount of $105,000,000.00 for each fiscal year for the

 

19  Healthy Michigan plan. The state retention percentage shall must be

 

20  applied proportionately to each hospital quality assurance

 

21  assessment program to determine the retention amount for each

 

22  program. The state retention amount shall must be appropriated each

 

23  fiscal year to the department to support Medicaid expenditures for

 

24  hospital services and therapy. These funds shall must offset an

 

25  identical amount of general fund/general purpose revenue originally

 

26  appropriated for that purpose. By May 31, 2019, the department, the

 

27  state budget office, and the Michigan Health and Hospital


 1  Association shall identify an appropriate retention amount for the

 

 2  fiscal year ending September 30, 2020 and each fiscal year

 

 3  thereafter.

 

 4        (12) (13) The department may establish a quality assurance

 

 5  assessment to increase ambulance reimbursement as follows:

 

 6        (a) The quality assurance assessment authorized under this

 

 7  subsection shall must be used to provide reimbursement to Medicaid

 

 8  ambulance providers. The department may promulgate rules to provide

 

 9  the structure of the quality assurance assessment authorized under

 

10  this subsection and the level of the assessment.

 

11        (b) The department shall implement this subsection in a manner

 

12  that complies with federal requirements necessary to ensure that

 

13  the quality assurance assessment qualifies for federal matching

 

14  funds.

 

15        (c) The total annual collections by the department under this

 

16  subsection shall must not exceed $20,000,000.00.

 

17        (d) The quality assurance assessment authorized under this

 

18  subsection shall must not be collected after October 1, 2019. The

 

19  quality assurance assessment authorized under this subsection shall

 

20  must no longer be collected or assessed if the quality assurance

 

21  assessment authorized under this subsection is not eligible for

 

22  federal matching funds.

 

23        (13) (14) The quality assurance assessment provided for under

 

24  this section is a tax that is levied on a health facility or

 

25  agency.

 

26        (14) (15) As used in this section:

 

27        (a) "Healthy Michigan plan" means the medical assistance plan


 1  program described in section 105d of the social welfare act, 1939

 

 2  PA 280, MCL 400.105d, that has a federal matching fund rate of not

 

 3  less than 90%.

 

 4        (b) "Medicaid" means that term as defined in section 22207.a

 

 5  program for medical assistance established under title XIX of the

 

 6  social security act, 42 USC 1396 to 1396w-5, and administered by

 

 7  the department of health and human services under the social

 

 8  welfare act, 1939 PA 280, MCL 400.1 to 400.119b.

 

 9        Sec. 20164. (1) A license, certification, provisional license,

 

10  or limited license is valid for not more than 1 year after the date

 

11  of issuance, except as provided in section 20511 or part 209. or

 

12  210. A license for a facility licensed under part 215 shall be is

 

13  valid for 2 years, except that provisional and limited licenses may

 

14  be valid for 1 year.

 

15        (2) A license , or certification , or certificate of need is

 

16  not transferable and shall must state the persons, buildings, and

 

17  properties to which it applies. Applications for licensure or

 

18  certification because of transfer of ownership or essential

 

19  ownership interest shall not be acted upon until satisfactory

 

20  evidence is provided of compliance with part 222.

 

21        (3) If ownership is not voluntarily transferred, the

 

22  department shall be notified immediately and the new owner shall

 

23  apply for a license and certification not later than 30 days after

 

24  the transfer.

 

25        Sec. 20165. (1) Except as otherwise provided in this section,

 

26  after notice of intent to an applicant or licensee to deny, limit,

 

27  suspend, or revoke the applicant's or licensee's license or


 1  certification and an opportunity for a hearing, the department may

 

 2  deny, limit, suspend, or revoke the license or certification or

 

 3  impose an administrative fine on a licensee if 1 or more of the

 

 4  following exist:

 

 5        (a) Fraud or deceit in obtaining or attempting to obtain a

 

 6  license or certification or in the operation of the licensed health

 

 7  facility or agency.

 

 8        (b) A violation of this article or a rule promulgated under

 

 9  this article.

 

10        (c) False or misleading advertising.

 

11        (d) Negligence or failure to exercise due care, including

 

12  negligent supervision of employees and subordinates.

 

13        (e) Permitting a license or certificate to be used by an

 

14  unauthorized health facility or agency.

 

15        (f) Evidence of abuse regarding a patient's health, welfare,

 

16  or safety or the denial of a patient's rights.

 

17        (g) Failure to comply with section 10115.

 

18        (h) Failure to comply with former part 222 or a term,

 

19  condition, or stipulation of a certificate of need issued under

 

20  former part 222, or both. This subdivision only applies to a

 

21  failure to comply that occurred before the effective date of the

 

22  amendatory act that repealed part 222.

 

23        (i) A violation of section 20197(1).

 

24        (2) The department may deny an application for a license or

 

25  certification based on a finding of a condition or practice that

 

26  would constitute a violation of this article if the applicant were

 

27  a licensee.


 1        (3) Denial, suspension, or revocation of an individual

 

 2  emergency medical services personnel license under part 209 is

 

 3  governed by section 20958.

 

 4        (4) If the department determines under subsection (1) that a

 

 5  health facility or agency has violated section 20197(1), the

 

 6  department shall impose an administrative fine of $5,000,000.00 on

 

 7  the health facility or agency.

 

 8        Sec. 20166. (1) Notice of intent to deny, limit, suspend, or

 

 9  revoke a license or certification shall must be given by certified

 

10  mail or personal service, shall set forth the particular reasons

 

11  for the proposed action, and shall fix a date, not less that than

 

12  30 days after the date of service, on which the applicant or

 

13  licensee shall be is given the opportunity for a hearing before the

 

14  director or the director's authorized representative. The hearing

 

15  shall must be conducted in accordance with the administrative

 

16  procedures act of 1969 and rules promulgated by the department. A

 

17  full and complete record shall must be kept of the proceeding and

 

18  shall must be transcribed when requested by an interested party,

 

19  who shall pay the cost of preparing the transcript.

 

20        (2) On the basis of a hearing or on the default of the

 

21  applicant or licensee, the department may issue, deny, limit,

 

22  suspend, or revoke a license or certification. A copy of the

 

23  determination shall must be sent by certified mail or served

 

24  personally upon the applicant or licensee. The determination

 

25  becomes final 30 days after it is mailed or served, unless the

 

26  applicant or licensee within the 30 days appeals the decision to

 

27  the circuit court in the county of jurisdiction or to the Ingham


 1  county County circuit court.

 

 2        (3) The department may establish procedures, hold hearings,

 

 3  administer oaths, issue subpoenas, or order testimony to be taken

 

 4  at a hearing or by deposition in a proceeding pending at any stage

 

 5  of the proceeding. A person may be compelled to appear and testify

 

 6  and to produce books, papers, or documents in a proceeding.

 

 7        (4) In case of disobedience of a subpoena, a party to a

 

 8  hearing may invoke the aid of the circuit court of the jurisdiction

 

 9  in which the hearing is held to require the attendance and

 

10  testimony of witnesses. The circuit court may issue an order

 

11  requiring an individual to appear and give testimony. Failure to

 

12  obey the order of the circuit court may be punished by the court as

 

13  a contempt.

 

14        (5) The department shall not deny, limit, suspend, or revoke a

 

15  license on the basis of an applicant's or licensee's failure to

 

16  show a need for a health facility or agency unless the health

 

17  facility or agency has did not obtained obtain a certificate of

 

18  need as required by former part 222.

 

19        Sec. 21551. (1) A hospital licensed under this article and

 

20  located in a nonurbanized area may apply to the department to

 

21  temporarily delicense not more than 50% of its licensed beds for

 

22  not more than 5 years.

 

23        (2) A hospital that is granted a temporary delicensure of beds

 

24  under subsection (1) may apply to the department for an extension

 

25  of temporary delicensure for those beds for up to an additional 5

 

26  years to the extent that the hospital actually met the requirements

 

27  of used the delicensed beds as described in subsection (6) during


 1  the initial period of delicensure granted under subsection (1). The

 

 2  department shall grant an extension under this subsection unless

 

 3  the department determines under part 222 that there is a

 

 4  demonstrated need for the delicensed beds in the subarea in which

 

 5  the hospital is located. If the department does not grant an

 

 6  extension under this subsection, the hospital shall request

 

 7  relicensure of the beds pursuant to under subsection (7) or allow

 

 8  the beds to become permanently delicensed pursuant to under

 

 9  subsection (8).

 

10        (3) Except as otherwise provided in this section, for a period

 

11  of 90 days after January 1, 1991, if a hospital is located in a

 

12  distressed area and has an annual indigent volume consisting of not

 

13  less than 25% indigent patients, the hospital may apply to the

 

14  department to temporarily delicense not more than 50% of its

 

15  licensed beds for a period of not more than 2 years. Upon receipt

 

16  of a complete application under this subsection, the department

 

17  shall temporarily delicense the beds indicated in the application.

 

18  The department shall not grant an extension of temporary

 

19  delicensure under this subsection.

 

20        (4) An application under subsection (1) or (3) shall must be

 

21  on a form provided by the department. The form shall must contain

 

22  all of the following information:

 

23        (a) The number and location of the specific beds to be

 

24  delicensed.

 

25        (b) The period of time during which the beds will be

 

26  delicensed.

 

27        (c) The alternative use proposed for the space occupied by the


 1  beds to be delicensed.

 

 2        (5) A hospital that files an application under subsection (1)

 

 3  or (3) may file an amended application with the department on a

 

 4  form provided by the department. The hospital shall state on the

 

 5  form the purpose of the amendment. If the hospital meets the

 

 6  requirements of this section, the department shall so amend the

 

 7  hospital's original application.

 

 8        (6) An alternative use of space made available by the

 

 9  delicensure of beds under this section shall not result in a

 

10  violation of this article or the rules promulgated under this

 

11  article. Along with the application, an applicant for delicensure

 

12  under subsection (1) or (3) shall submit to the department plans

 

13  that indicate to the satisfaction of the department that the space

 

14  occupied by the beds proposed for temporary delicensure will be

 

15  used for 1 or more of the following:

 

16        (a) An alternative use that over the proposed period of

 

17  temporary delicensure would defray the depreciation and interest

 

18  costs that otherwise would be allocated to the space along with the

 

19  operating expenses related to the alternative use.

 

20        (b) To correct a licensing deficiency previously identified by

 

21  the department.

 

22        (c) Nonhospital purposes including, but not limited to,

 

23  community service projects, if the depreciation and interest costs

 

24  for all capital expenditures that would otherwise be allocated to

 

25  the space, as well as any operating costs related to the proposed

 

26  alternative use, would not be considered as hospital costs for

 

27  purposes of reimbursement.


 1        (7) The department shall relicense beds that are temporarily

 

 2  delicensed under this section if all of the following requirements

 

 3  are met:

 

 4        (a) The hospital files with the department a written request

 

 5  for relicensure not less than 90 days before the earlier of the

 

 6  following:

 

 7        (i) The expiration of the period for which delicensure was

 

 8  granted.

 

 9        (ii) The date upon which the hospital is requesting

 

10  relicensure.

 

11        (iii) The last hospital license renewal date in the

 

12  delicensure period.

 

13        (b) The space to be occupied by the relicensed beds is in

 

14  compliance with this article and the rules promulgated under this

 

15  article, including all licensure standards in effect at the time of

 

16  relicensure, or the hospital has a plan of corrections that has

 

17  been approved by the department.

 

18        (8) If a hospital does not meet all of the requirements of

 

19  subsection (7) or if a hospital decides to allow beds to become

 

20  permanently delicensed as described in subsection (2), then all of

 

21  the temporarily delicensed beds shall must be automatically and

 

22  permanently delicensed effective on the last day of the period for

 

23  which the department granted temporary delicensure.

 

24        (9) The department shall continue to count beds temporarily

 

25  delicensed under this section in the department's bed inventory for

 

26  purposes of determining hospital bed need under part 222 in the

 

27  subarea in which the beds are located. The department shall


 1  indicate in the bed inventory which beds are licensed and which

 

 2  beds are temporary temporarily delicensed under this section. The

 

 3  department shall not include a hospital's temporarily delicensed

 

 4  beds in the hospital's licensed bed count.

 

 5        (10) A hospital that is granted temporary delicensure of beds

 

 6  under this section shall not transfer the beds to another site or

 

 7  hospital without first obtaining a certificate of need.

 

 8        (10) (11) A hospital that has beds that are subject to a

 

 9  hospital bed reduction plan or to a department action to enforce

 

10  this article shall not use beds temporarily delicensed under this

 

11  section to comply with the bed reduction plan.

 

12        (11) (12) As used in this section:

 

13        (a) "Distressed area" means a city that meets all of the

 

14  following criteria:

 

15        (i) Had a negative population change from 1970 to the date of

 

16  the 1980 federal decennial census.

 

17        (ii) From 1972 to 1989, had an increase in its state equalized

 

18  valuation that is less than the statewide average.

 

19        (iii) Has a poverty level that is greater than the statewide

 

20  average, according to the 1980 federal decennial census.

 

21        (iv) Was eligible for an urban development action grant from

 

22  the United States department Department of housing Housing and

 

23  urban development Urban Development in 1984 and was listed in 49

 

24  F.R. FR No. 28 (February 9, 1984) or 49 F.R. FR No. 30 (February

 

25  13, 1984).

 

26        (v) Had an unemployment rate that was higher than the

 

27  statewide average for 3 of the 5 years from 1981 to 1985.


 1        (b) "Indigent volume" means the ratio of a hospital's indigent

 

 2  charges to its total charges expressed as a percentage as

 

 3  determined by the department of social health and human services

 

 4  after November 12, 1990, pursuant to under chapter 8 of the

 

 5  department of social health and human services guidelines entitled

 

 6  "medical assistance program manual"."Medical Assistance Program

 

 7  Manual".

 

 8        (c) "Nonurbanized area" means an area that is not an urbanized

 

 9  area.

 

10        (d) "Urbanized area" means that term as defined by the office

 

11  Office of federal statistical policy Federal Statistical Policy and

 

12  standards Standards of the United States department Department of

 

13  commerce Commerce in the appendix entitled "general procedures and

 

14  definitions", "General Procedures and Definitions", 45 F.R. FR p.

 

15  962 (January 3, 1980), which document is incorporated by reference.

 

16        Sec. 21562. (1) A hospital designated as a rural community

 

17  hospital under section 21561 shall be a limited service hospital

 

18  directed toward the delivery of not more than basic acute care

 

19  services in order to assure ensure appropriate access in the rural

 

20  area.

 

21        (2) The rules promulgated to implement this part shall must

 

22  require that a hospital designated as a rural community hospital

 

23  under section 21561 shall provide no more than the following

 

24  services:

 

25        (a) Emergency care.

 

26        (b) Stabilization care for transfer to another facility.

 

27        (c) Inpatient care.


 1        (d) Radiology and laboratory services.

 

 2        (e) Ambulatory care.

 

 3        (f) Obstetrical services.

 

 4        (g) Outpatient services.

 

 5        (h) Other services determined as appropriate by the ad hoc

 

 6  advisory committee created in subsection (5).

 

 7        (3) A rural community hospital shall enter into an agreement

 

 8  with the department of social health and human services to

 

 9  participate in the medicaid Medicaid program. As used in this

 

10  subsection, "medicaid" "Medicaid" means that term as defined in

 

11  section 22207.a program for medical assistance established under

 

12  title XIX of the social security act, 42 USC 1396 to 1396w-5, and

 

13  administered by the department of health and human services under

 

14  the social welfare act, 1939 PA 280, MCL 400.1 to 400.119b.

 

15        (4) A rural community hospital shall meet the conditions for

 

16  participation in the federal medicare Medicare program under title

 

17  XVIII of the social security act, 42 USC 1395 to 1395lll.

 

18        (5) Not later than 3 months after the effective date of this

 

19  section, the director shall appoint an ad hoc advisory committee to

 

20  develop recommendations for rules to designate the maximum number

 

21  of beds and the services to be provided by a rural community

 

22  hospital. In developing recommendations under this subsection, the

 

23  ad hoc advisory committee shall review the provisions of the code

 

24  pertaining to hospital licensure in order to determine those

 

25  provisions that should apply to rural community hospitals. The

 

26  director shall direct the committee to report its recommendations

 

27  to the department within 12 months after the committee is


 1  appointed. The ad hoc advisory committee shall be appointed as

 

 2  follows:

 

 3        (a) Twenty-five percent of the members shall be

 

 4  representatives from hospitals with fewer than 100 licensed beds.

 

 5        (b) Twenty-five percent of the members shall be

 

 6  representatives from health care provider organizations other than

 

 7  hospitals.

 

 8        (c) Twenty-five percent of the members shall be

 

 9  representatives from organizations whose membership includes

 

10  consumers of rural health care services or members of local

 

11  governmental units located in rural areas.

 

12        (d) Twenty-five percent of the members shall be

 

13  representatives from purchasers or payers of rural health care

 

14  services.

 

15        (5) (6) A hospital designated as a rural community hospital

 

16  under section 21561 shall develop and implement a transfer

 

17  agreement between the rural community hospital and 1 or more

 

18  appropriate referral hospitals.

 

19        Sec. 21563. (1) The department , in consultation with the ad

 

20  hoc advisory committee appointed under section 21562, shall

 

21  promulgate rules for designation of a rural community hospital,

 

22  maximum number of beds, and the services provided by a rural

 

23  community hospital. The director shall submit proposed rules, based

 

24  on the recommendations of the committee, for public hearing not

 

25  later than 6 months after receiving the report under section

 

26  21562(5).

 

27        (2) The designation as a rural community hospital shall must


 1  be shown on a hospital's license and shall must be for the same

 

 2  term as the hospital license. Except as otherwise expressly

 

 3  provided in this part or in rules promulgated under this section, a

 

 4  rural community hospital shall must be licensed and regulated in

 

 5  the same manner as a hospital otherwise licensed under this

 

 6  article. The provisions of part 222 applicable to hospitals also

 

 7  apply to a rural community hospital and to a hospital designated by

 

 8  the department under federal law as an essential access community

 

 9  hospital or a rural primary care hospital. This part and the rules

 

10  promulgated under this part do not preclude the establishment of

 

11  differential reimbursement for rural community hospitals, essential

 

12  access community hospitals, and rural primary care hospitals.

 

13        Enacting section 1. The following acts and parts of acts are

 

14  repealed:

 

15        (a) Section 20143 of the public health code, 1978 PA 368, MCL

 

16  333.20143.

 

17        (b) Section 21420 of the public health code, 1978 PA 368, MCL

 

18  333.21420.

 

19        (c) Part 222 of the public health code, 1978 PA 368, MCL

 

20  333.22201 to 333.22260.

 

21        (d) Section 8t of 1945 PA 47, MCL 331.8t.

 

22        (e) Section 47 of the hospital finance authority act, 1969 PA

 

23  38, MCL 331.77.

 

24        Enacting section 2. This amendatory act takes effect 90 days

 

25  after the date it is enacted into law.

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