Bill Text: MI HB4831 | 2009-2010 | 95th Legislature | Introduced

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Bill Title: Human services; medical services; service providers eligible for reimbursement under medicaid; expand to include psychiatric treatment outside of community mental health services programs or specialty prepaid medical programs. Amends sec. 109 of 1939 PA 280 (MCL 400.109).

Spectrum: Strong Partisan Bill (Democrat 12-1)

Status: (Introduced - Dead) 2009-04-28 - Printed Bill Filed 04/24/2009 [HB4831 Detail]

Download: Michigan-2009-HB4831-Introduced.html

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HOUSE BILL No. 4831

 

April 23, 2009, Introduced by Reps. McDowell, Haugh, Polidori, Smith, Jackson, Sheltrown, Lahti, Liss, Roy Schmidt, Barnett, Miller, Neumann and Haines and referred to the Committee on Health Policy.

 

     A bill to amend 1939 PA 280, entitled

 

"The social welfare act,"

 

by amending section 109 (MCL 400.109), as amended by 2006 PA 576.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

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

 

under this act:

 

     (a) Hospital services that an eligible individual may receive

 

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

 

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

 

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

 

or obstetrical care. The period of inpatient hospital service shall

 

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

 

proper care and treatment of the individual. Necessary

 

hospitalization to provide dental care shall be provided if

 

certified by the attending dentist with the approval of the

 

department of community health. An individual who is receiving

 

medical treatment as an inpatient because of a diagnosis of

 

tuberculosis or mental disease may receive service under this

 

section, notwithstanding the mental health code, 1974 PA 258, MCL

 

330.1001 to 330.2106, and 1925 PA 177, MCL 332.151 to 332.164. The

 

department of community health shall pay for hospital services in

 

accordance with 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 of community health. The service may

 

be furnished in the physician's office, the eligible individual's

 

home, a medical institution, or elsewhere in case of emergency. A

 

physician shall be paid a reasonable charge for the service

 

rendered. Reasonable charges shall be determined by the department

 

of community health and shall not be more than those paid in this

 

state for services rendered under title XVIII.

 

     (c) An eligible individual may receive nursing home services

 

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

 

facility or identifiable unit of that facility, certified by the

 

appropriate authority as meeting established standards for a

 

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

 

States department of health and human services, to the extent found

 

necessary by the attending physician, dentist, or certified

 

Christian Science practitioner. An eligible individual may receive

 

nursing services in a short-term nursing care 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 of community health shall not make a final payment

 

pursuant to under title XIX for benefits available under title

 

XVIII without documentation that title XVIII claims have been filed

 

and denied. The department of community health shall pay for

 

nursing home services in accordance with 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 facilities with per patient day updated

 

variable costs exceeding the variable cost limit for the county

 

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

 

difference between per patient day updated variable cost and the

 

concomitant nursing home-class variable cost limit, the quantity

 

offset by the difference between per patient day updated variable

 

cost and the concomitant variable cost limit for the county

 

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

 

     (ii) For county owned facilities with per patient day updated

 

variable costs not exceeding the variable cost limit for the county

 

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

 

difference between per patient day updated variable cost and the

 

concomitant nursing home class variable cost limit.

 

     (iii) For county owned facilities with per patient day updated

 

variable costs not exceeding the concomitant nursing home class

 

variable cost limit, the county maintenance of effort rate shall

 

equal zero.

 

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

 

variable costs and the variable cost limit for the county facility"

 

shall be determined pursuant according to the state plan for

 

medical assistance; for freestanding county facilities the "nursing

 

home class variable cost limit" shall be determined pursuant

 

according to the state plan for medical assistance and for hospital

 

attached county facilities the "nursing class variable cost limit"

 

shall be determined pursuant according to the state plan for

 

medical assistance plus $5.00 per patient day; and "freestanding"

 

and "hospital attached" shall be determined in accordance with the

 

federal regulations.

 

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

 

accordance with 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 in accordance with this section is less than the

 

September 30, 1984 rate. This limitation remains in effect until

 

December 31, 2012. For each subsequent county fiscal year the

 

maintenance of effort may not increase by more than $1.00 per

 

patient day each year.

 

     (vi) For county owned facilities, reimbursement for plant costs

 

will continue to be based on interest expense and depreciation

 

allowance unless otherwise provided by law.

 

     (d) An eligible individual may receive pharmaceutical services

 

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

 

a licensed physician or dentist and approved by the department of

 

community health. In an emergency, but not routinely, the

 

individual may receive pharmaceutical services rendered personally

 

by a licensed physician or dentist on the same basis as approved

 

for pharmacists.

 

     (e) An eligible individual may receive other medical and

 

health services as authorized by the department of community

 

health.

 

     (f) Psychiatric care may also be provided pursuant to under

 

the guidelines established by the department of community health to

 

the extent of appropriations made available by the legislature for

 

the fiscal year. The guidelines established under this subdivision

 

shall allow for payment of psychiatric care, including, but not

 

limited to, early and periodic screening and diagnostic and

 

treatment benefits provided by psychologists practicing

 

independently from community mental health services programs or

 

specialty prepaid health plans.

 

     (g) An eligible individual may receive screening, laboratory

 

services, diagnostic services, early intervention services, and

 

treatment for chronic kidney disease pursuant to under guidelines

 

established by the department of community health. A clinical

 

laboratory performing a creatinine test on an eligible individual

 

pursuant to under this subdivision shall include in the lab report

 

the glomerular filtration rate (eGFR) of the individual and shall

 

report it as a percent of kidney function remaining.

 

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

 

accordance with applicable federal regulations, and shall obtain

 

the approval of the committees on appropriations of the house of

 

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

 

proposed change in the statewide method or level of reimbursement

 

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

 

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

 

months after the effective date of the change.

 

     (3) As used in this act:

 

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

 

act, 42 USC 1395 to 1395b, 1395b-2, 1395b-6 to 1395b-7, 1395c to

 

1395i, 1395i-2 to 1395i-5, 1395j to 1395t, 1395u to 1395w, 1395w-2

 

to 1395w-4, 1395w-21 to 1395w-28, 1395x to 1395yy, and 1395bbb to

 

1395ggg.

 

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

 

USC 1396 to 1396r-6 and 1396r-8 to 1396v.

 

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

 

USC 1397 to 1397f.