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.