Bill Text: MI HB4357 | 2017-2018 | 99th Legislature | Introduced

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Bill Title: Human services; medical services; coverage for cranial hair prosthesis; provide for under certain circumstances. Amends sec. 109 of 1939 PA 280 (MCL 400.109).

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2017-03-15 - Bill Electronically Reproduced 03/14/2017 [HB4357 Detail]

Download: Michigan-2017-HB4357-Introduced.html

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HOUSE BILL No. 4357

 

 

March 14, 2017, Introduced by Reps. Hoadley, Lucido, Hammoud, Pagan, Chang, Ellison, Wittenberg, Geiss, Camilleri, Chirkun, Yanez, Moss, Phelps, Love and Lasinski and referred to the Committee on Insurance.

 

     A bill to amend 1939 PA 280, entitled

 

"The social welfare act,"

 

by amending section 109 (MCL 400.109), as amended by 2016 PA 551.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

     Sec. 109. (1) The following medical services may be provided

 

under this act:

 

     (a) Hospital services that an eligible individual may receive

 

consist of medical, surgical, or obstetrical care, together with

 

necessary drugs, X-rays, physical therapy, prosthesis,

 

transportation, and nursing care incident to the medical, surgical,

 

or obstetrical care. The period of inpatient hospital service shall

 

be the minimum period necessary in this type of facility for the

 

proper care and treatment of the individual. Necessary

 

hospitalization to provide dental care shall be provided if

certified by the attending dentist with the approval of the

 

department. An individual who is receiving medical treatment as an

 

inpatient because of a diagnosis of tuberculosis or mental disease

 

may receive service under this section, notwithstanding the mental

 

health code, 1974 PA 258, MCL 330.1001 to 330.2106, and 1925 PA

 

177, MCL 332.151 to 332.164. The department shall pay for hospital

 

services according to the state plan for medical assistance adopted

 

under section 10 and approved by the United States Department of

 

Health and Human Services.

 

     (b) An eligible individual may receive physician services

 

authorized by the department. The service may be furnished in the

 

physician's office, the eligible individual's home, a medical

 

institution, or elsewhere in case of emergency. A physician shall

 

be paid a reasonable charge for the service rendered. Reasonable

 

charges shall be determined by the department and shall not be more

 

than those paid in this state for services rendered under title

 

XVIII.

 

     (c) An eligible individual may receive nursing home services

 

in a state licensed nursing home, a medical care facility, or other

 

facility or identifiable unit of that facility, certified by the

 

appropriate authority as meeting established standards for a

 

nursing home under the laws and rules of this state and the United

 

States Department of Health and Human Services, to the extent found

 

necessary by the attending physician, dentist, or certified

 

Christian Science practitioner. An eligible individual may receive

 

nursing services in an extended care services program established

 

under section 22210 of the public health code, 1978 PA 368, MCL

333.22210, to the extent found necessary by the attending physician

 

when the combined length of stay in the acute care bed and short-

 

term nursing care bed exceeds the average length of stay for

 

Medicaid hospital diagnostic related group reimbursement. The

 

department shall not make a final payment under title XIX for

 

benefits available under title XVIII without documentation that

 

title XVIII claims have been filed and denied. The department shall

 

pay for nursing home services according to the state plan for

 

medical assistance adopted according to section 10 and approved by

 

the United States Department of Health and Human Services. A county

 

shall reimburse a county maintenance of effort rate determined on

 

an annual basis for each patient day of Medicaid nursing home

 

services provided to eligible individuals in long-term care

 

facilities owned by the county and licensed to provide nursing home

 

services. For purposes of determining rates and costs described in

 

this subdivision, all of the following apply:

 

     (i) For county owned county-owned facilities with per patient

 

day updated variable costs exceeding the variable cost limit for

 

the county facility, county maintenance of effort rate means 45% of

 

the difference between per patient day updated variable cost and

 

the concomitant nursing home-class variable cost limit, the

 

quantity offset by the difference between per patient day updated

 

variable cost and the concomitant variable cost limit for the

 

county facility. The county rate shall not be less than zero.

 

     (ii) For county owned county-owned facilities with per patient

 

day updated variable costs not exceeding the variable cost limit

 

for the county facility, county maintenance of effort rate means

45% of the difference between per patient day updated variable cost

 

and the concomitant nursing home class variable cost limit.

 

     (iii) For county owned county-owned facilities with per

 

patient day updated variable costs not exceeding the concomitant

 

nursing home class variable cost limit, the county maintenance of

 

effort rate shall equal zero.

 

     (iv) For the purposes of this section: "per patient day

 

updated variable costs and the variable cost limit for the county

 

facility" shall be determined according to the state plan for

 

medical assistance; for freestanding county facilities the "nursing

 

home class variable cost limit" shall be determined according to

 

the state plan for medical assistance and for hospital attached

 

county facilities the "nursing class variable cost limit" shall be

 

determined according to the state plan for medical assistance plus

 

$5.00 per patient day; and "freestanding" and "hospital attached"

 

shall be determined according to the federal regulations.

 

     (v) If the county maintenance of effort rate computed under

 

this section exceeds the county maintenance of effort rate in

 

effect as of September 30, 1984, the rate in effect as of September

 

30, 1984 shall remain in effect until a time that the rate computed

 

under this section is less than the September 30, 1984 rate. This

 

limitation remains in effect until December 31, 2022. For each

 

subsequent county fiscal year, the maintenance of effort rate may

 

not increase by more than $1.00 per patient day each year.

 

     (vi) For county owned county-owned facilities, reimbursement

 

for plant costs will continue to be based on interest expense and

 

depreciation allowance unless otherwise provided by law.

     (d) An eligible individual may receive pharmaceutical services

 

from a licensed pharmacist of the person's choice as prescribed by

 

a licensed physician or dentist and approved by the department. In

 

an emergency, but not routinely, the individual may receive

 

pharmaceutical services rendered personally by a licensed physician

 

or dentist on the same basis as approved for pharmacists.

 

     (e) An eligible individual may receive other medical and

 

health services as authorized by the department.

 

     (f) Psychiatric care may also be provided according to the

 

guidelines established by the department to the extent of

 

appropriations made available by the legislature for the fiscal

 

year.

 

     (g) An eligible individual may receive screening, laboratory

 

services, diagnostic services, early intervention services, and

 

treatment for chronic kidney disease under guidelines established

 

by the department. A clinical laboratory performing a creatinine

 

test on an eligible individual under this subdivision shall include

 

in the lab report the glomerular filtration rate (eGFR) of the

 

individual and shall report it as a percent percentage of kidney

 

function remaining.

 

     (2) The department shall provide medical assistance benefits

 

under this act for a cranial hair prosthesis to an eligible

 

individual who is less than 19 years of age and has cranial hair

 

loss as a result of a medical condition or as a result of treatment

 

for a medical condition. The coverage required by this subsection

 

is not subject to a dollar limit, a deductible, or a coinsurance

 

provision that is less favorable than coverage applied to any other

prosthesis. As used in this subsection, "cranial hair prosthesis"

 

includes any human or synthetic substitute for cranial hair.

 

     (3) (2) The director shall provide notice to the public,

 

according to applicable federal regulations, and shall obtain the

 

approval of the committees on appropriations of the house of

 

representatives and senate of the legislature of this state, of a

 

proposed change in the statewide method or level of reimbursement

 

for a service, if the proposed change is expected to increase or

 

decrease payments for that service by 1% or more during the 12

 

months after the effective date of the change.

 

     (4) (3) As used in this act:

 

     (a) "Title XVIII" means title XVIII of the social security

 

act, 42 USC 1395 to 1395lll.

 

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

 

USC 1396 to 1396w-5.

 

     (c) "Title XX" means title XX of the social security act, 42

 

USC 1397 to 1397m-5.

 

     Enacting section 1. This amendatory act takes effect 90 days

 

after the date it is enacted into law.