Bill Text: MI HB5674 | 2017-2018 | 99th Legislature | Introduced

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Bill Title: Human services; medical services; Healthy Michigan; eliminate language related to cost exceeding savings. Amends sec. 105d of 1939 PA 280 (MCL 400.105d).

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2018-03-06 - Bill Electronically Reproduced 03/01/2018 [HB5674 Detail]

Download: Michigan-2017-HB5674-Introduced.html

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HOUSE BILL No. 5674

 

 

March 1, 2018, Introduced by Reps. Sowerby, Ellison, Moss, Clemente, Sneller, Neeley, Zemke, Hertel, Pagan, Rabhi, Yanez, Camilleri, Elder, Greig, LaGrand, Greimel, Liberati, Wittenberg, Sabo, Green, Hoadley, Lasinski, Geiss, Cambensy, Hammoud and Gay-Dagnogo and referred to the Committee on Health Policy.

 

     A bill to amend 1939 PA 280, entitled

 

"The social welfare act,"

 

by amending section 105d (MCL 400.105d), as added by 2013 PA 107.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

     Sec. 105d. (1) The department of community health shall seek a

 

waiver from the United States department Department of health

 

Health and human services Human Services to do, without

 

jeopardizing federal match dollars or otherwise incurring federal

 

financial penalties, and upon approval of the waiver shall do, all

 

of the following:

 

     (a) Enroll individuals eligible under section

 

1396a(a)(10)(A)(i)(VIII) of title XIX who meet the citizenship

 

provisions of 42 CFR 435.406 and who are otherwise eligible for the

 

medical assistance program under this act into a contracted health

plan that provides for an account into which money from any source,

 

including, but not limited to, the enrollee, the enrollee's

 

employer, and private or public entities on the enrollee's behalf,

 

can be deposited to pay for incurred health expenses, including,

 

but not limited to, co-pays. The account shall be administered by

 

the department of community health and can be delegated to a

 

contracted health plan or a third party administrator, as

 

considered necessary. The department of community health shall not

 

begin enrollment of individuals eligible under this subdivision

 

until January 1, 2014 or until the waiver requested in this

 

subsection is approved by the United States department of health

 

and human services, whichever is later.

 

     (b) Ensure that contracted health plans track all enrollee co-

 

pays incurred for the first 6 months that an individual is enrolled

 

in the program described in subdivision (a) and calculate the

 

average monthly co-pay experience for the enrollee. The average co-

 

pay amount shall be adjusted at least annually to reflect changes

 

in the enrollee's co-pay experience. The department of community

 

health shall ensure that each enrollee receives quarterly

 

statements for his or her account that include expenditures from

 

the account, account balance, and the cost-sharing amount due for

 

the following 3 months. The Each month, the enrollee shall be

 

required to remit each month the average co-pay amount calculated

 

by the contracted health plan into the enrollee's account. The

 

department of community health shall pursue a range of consequences

 

for enrollees who consistently fail to meet their cost-sharing

 

requirements, including, but not limited to, using the MIChild

program as a template and closer oversight by health plans in

 

access to providers. The department of community health shall

 

report its plan of action for enrollees who consistently fail to

 

meet their cost-sharing requirements to the legislature. by June 1,

 

2014.

 

     (c) Give enrollees described in subdivision (a) a choice in

 

choosing among contracted health plans.

 

     (d) Ensure that all enrollees described in subdivision (a)

 

have access to a primary care practitioner who is licensed,

 

registered, or otherwise authorized to engage in his or her health

 

care profession in this state and access to preventive services.

 

The department of community health shall require that all new

 

enrollees be assigned and have scheduled an initial appointment

 

with their primary care practitioner within 60 days of initial

 

enrollment. The department of community health shall monitor and

 

track contracted health plans for compliance in this area and

 

consider that compliance in any health plan incentive programs. The

 

department of community health shall ensure that the contracted

 

health plans have procedures to ensure that the privacy of the

 

enrollees' personal information is protected in accordance with the

 

health insurance portability and accountability act of 1996, Public

 

Law 104-191.

 

     (e) Require enrollees described in subdivision (a) with annual

 

incomes between 100% and 133% of the federal poverty guidelines to

 

contribute not more than 5% of income annually for cost-sharing

 

requirements. Cost-sharing includes co-pays and required

 

contributions made into the accounts authorized under subdivision

(a). Contributions required in this subdivision do not apply for

 

the first 6 months an individual described in subdivision (a) is

 

enrolled. Required contributions to an account used to pay for

 

incurred health expenses shall be 2% of income annually.

 

Notwithstanding this minimum, required contributions may be reduced

 

by the contracting health plan. The reductions may occur only if

 

healthy behaviors are being addressed as attested to by the

 

contracted health plan based on uniform standards developed by the

 

department of community health in consultation with the contracted

 

health plans. The uniform standards shall include healthy behaviors

 

that must include, but are not limited to, completing a department

 

of community health approved department-approved annual health risk

 

assessment to identify unhealthy characteristics, including alcohol

 

use, substance use disorders, tobacco use, obesity, and

 

immunization status. Co-pays can be reduced if healthy behaviors

 

are met, but not until annual accumulated co-pays reach 2% of

 

income except co-pays for specific services may be waived by the

 

contracted health plan if the desired outcome is to promote greater

 

access to services that prevent the progression of and

 

complications related to chronic diseases. If the enrollee

 

described in subdivision (a) becomes ineligible for medical

 

assistance under the program described in this section, the

 

remaining balance in the account described in subdivision (a) shall

 

be returned to that enrollee in the form of a voucher for the sole

 

purpose of purchasing and paying for private insurance.

 

     (f) By July 1, 2014, design and implement Implement and

 

maintain a co-pay structure that encourages use of high-value

services, while discouraging low-value services such as nonurgent

 

emergency department use.

 

     (g) During the enrollment process, inform enrollees described

 

in subdivision (a) about advance directives and require the

 

enrollees to complete a department of community health-approved

 

department-approved advance directive on a form that includes an

 

option to decline. The An advance directives directive received

 

from enrollees an enrollee as provided in this subdivision shall be

 

transmitted to the peace of mind registry organization to be placed

 

on the peace of mind registry.

 

     (h) By April 1, 2015, develop Maintain incentives for

 

enrollees and providers who assist the department of community

 

health in detecting fraud and abuse in the medical assistance

 

program. The department of community health shall provide an annual

 

report that includes the type of fraud detected, the amount saved,

 

and the outcome of the investigation to the legislature.

 

     (i) Allow for services provided by telemedicine from a

 

practitioner who is licensed, registered, or otherwise authorized

 

under section 16171 of the public health code, 1978 PA 368, MCL

 

333.16171, to engage in his or her health care profession in the

 

state where the patient is located.

 

     (2) For services rendered to an uninsured individual, a

 

hospital that participates in the medical assistance program under

 

this act shall accept 115% of medicare Medicare rates as payments

 

in full from an uninsured individual with an annual income level up

 

to 250% of the federal poverty guidelines. This subsection applies

 

whether or not either or both of the waivers requested under this

section are approved, the patient protection and affordable care

 

act is repealed, or the state terminates or opts out of the program

 

established under this section.

 

     (3) Not more than 7 calendar days after receiving each of the

 

official waiver-related written correspondence from the United

 

States department of health and human services Department of Health

 

and Human Services to implement the provisions of this section, the

 

department of community health shall submit a written copy of the

 

approved waiver provisions to the legislature for review.

 

     (4) By September 30, 2015, the department of community health

 

shall develop and The department shall develop, implement, and

 

maintain a plan to enroll all existing fee-for-service enrollees

 

into contracted health plans if allowable by law, if the medical

 

assistance program is the primary payer and if that enrollment is

 

cost-effective. This includes all newly eligible enrollees as

 

described in subsection (1)(a). The department of community health

 

shall include contracted health plans as the mandatory delivery

 

system in its waiver request. The department of community health

 

also shall pursue any and all necessary waivers to enroll persons

 

eligible for both medicaid and medicare Medicaid and Medicare into

 

the 4 integrated care demonstration regions beginning July 1, 2014.

 

By September 30, 2015, the department of community health shall

 

identify all remaining populations eligible for managed care,

 

develop plans for their integration into managed care, and provide

 

recommendations for a performance bonus incentive plan mechanism

 

for long-term care managed care providers that are consistent with

 

other managed care performance bonus incentive plans. By September

30, 2015, the department of community health shall make

 

recommendations for a performance bonus incentive plan for long-

 

term care managed care providers of up to 3% of their medicaid

 

Medicaid capitation payments, consistent with other managed care

 

performance bonus incentive plans. These payments shall comply with

 

federal requirements and shall be based on measures that identify

 

the appropriate use of long-term care services and that focus on

 

consumer satisfaction, consumer choice, and other appropriate

 

quality measures applicable to community-based and nursing home

 

services. Where appropriate, these quality measures shall be

 

consistent with quality measures used for similar services

 

implemented by the integrated care for duals demonstration project.

 

This subsection applies whether or not either or both of the

 

waivers requested under this section are approved, the patient

 

protection and affordable care act is repealed, or the state

 

terminates or opts out of the program established under this

 

section.

 

     (5) By September 30, 2016, the department of community health

 

shall implement a pharmaceutical benefit that utilizes co-pays at

 

appropriate levels allowable by the centers for medicare and

 

medicaid services Centers for Medicare and Medicaid Services to

 

encourage the use of high-value, low-cost prescriptions, such as

 

generic prescriptions when such an alternative exists for a branded

 

product and 90-day prescription supplies, as recommended by the

 

enrollee's prescribing provider and as is consistent with section

 

109h and sections 9701 to 9709 of the public health code, 1978 PA

 

368, MCL 333.9701 to 333.9709. This subsection applies whether or

not either or both of the waivers requested under this section are

 

approved, the patient protection and affordable care act is

 

repealed, or the state terminates or opts out of the program

 

established under this section.

 

     (6) The department of community health shall work with

 

providers, contracted health plans, and other departments as

 

necessary to create processes that reduce the amount of uncollected

 

cost-sharing and reduce the administrative cost of collecting cost-

 

sharing. To this end, a minimum 0.25% of payments to contracted

 

health plans shall be withheld for the purpose of establishing a

 

cost-sharing compliance bonus pool. beginning October 1, 2015. The

 

distribution of funds from the cost-sharing compliance pool shall

 

be based on the contracted health plans' success in collecting

 

cost-sharing payments. The department of community health shall

 

develop the methodology for distribution of these funds. This

 

subsection applies whether or not either or both of the waivers

 

requested under this section are approved, the patient protection

 

and affordable care act is repealed, or the state terminates or

 

opts out of the program established under this section.

 

     (7) By June 1, 2014, the The department of community health

 

shall develop a methodology that decreases the amount an enrollee's

 

required contribution may be reduced as described in subsection

 

(1)(e) based on, but not limited to, factors such as an enrollee's

 

failure to pay cost-sharing requirements and the enrollee's

 

inappropriate utilization of emergency departments.

 

     (8) The program described in this section is created in part

 

to extend health coverage to the state's low-income citizens and to

provide health insurance cost relief to individuals and to the

 

business community by reducing the cost shift attendant to

 

uncompensated care. Uncompensated care does not include courtesy

 

allowances or discounts given to patients. The medicaid Medicaid

 

hospital cost report shall be part of the uncompensated care

 

definition and calculation. In addition to the medicaid Medicaid

 

hospital cost report, the department of community health shall

 

collect and examine other relevant financial data for all hospitals

 

and evaluate the impact that providing medical coverage to the

 

expanded population of enrollees described in subsection (1)(a) has

 

had on the actual cost of uncompensated care. This shall be

 

reported for all hospitals in the state. By December 31, 2014, the

 

department of community health shall make an initial baseline

 

uncompensated care report containing at least the data described in

 

this subsection to the legislature and each December 31 after that

 

shall make a report regarding the preceding fiscal year's evidence

 

of the reduction in the amount of the actual cost of uncompensated

 

care compared to the initial baseline report. The baseline report

 

shall use fiscal year 2012-2013 data. Based on the evidence of the

 

reduction in the amount of the actual cost of uncompensated care

 

borne by the hospitals in this state, beginning April 1, 2015, the

 

department of community health shall proportionally reduce the

 

disproportionate share payments to all hospitals and hospital

 

systems for the purpose of producing general fund savings. The

 

department of community health shall recognize any savings from

 

this reduction by September 30, 2016. All the reports required

 

under this subsection shall be made available to the legislature

and shall be easily accessible on the department of community

 

health's department's website.

 

     (9) The department of insurance and financial services shall

 

examine the financial reports of health insurers and evaluate the

 

impact that providing medical coverage to the expanded population

 

of enrollees described in subsection (1)(a) has had on the cost of

 

uncompensated care as it relates to insurance rates and insurance

 

rate change filings, as well as its resulting net effect on rates

 

overall. The department of insurance and financial services shall

 

consider the evaluation described in this subsection in the annual

 

approval of rates. By December 31, 2014, the department of

 

insurance and financial services shall make an initial baseline

 

report to the legislature regarding rates and each December 31

 

after that shall make a report regarding the evidence of the change

 

in rates compared to the initial baseline report. All the reports

 

required under this subsection shall be made available to the

 

legislature and shall be made available and easily accessible on

 

the department of community health's department's website.

 

     (10) The department of community health shall explore and

 

develop a range of innovations and initiatives to improve the

 

effectiveness and performance of the medical assistance program and

 

to lower overall health care costs in this state. The department of

 

community health shall report the results of the efforts described

 

in this subsection to the legislature and to the house and senate

 

fiscal agencies by September 30, 2015. The report required under

 

this subsection shall also be made available and easily accessible

 

on the department of community health's department's website. The

department of community health shall pursue a broad range of

 

innovations and initiatives as time and resources allow that shall

 

include, at a minimum, all of the following:

 

     (a) The value and cost-effectiveness of optional medicaid

 

Medicaid benefits as described in federal statute.

 

     (b) The identification of private sector, primarily small

 

business, health coverage benefit differences compared to the

 

medical assistance program services and justification for the

 

differences.

 

     (c) The minimum measures and data sets required to effectively

 

measure the medical assistance program's return on investment for

 

taxpayers.

 

     (d) Review and evaluation of the effectiveness of current

 

incentives for contracted health plans, providers, and

 

beneficiaries with recommendations for expanding and refining

 

incentives to accelerate improvement in health outcomes, healthy

 

behaviors, and cost-effectiveness and review of the compliance of

 

required contributions and co-pays.

 

     (e) Review and evaluation of the current design principles

 

that serve as the foundation for the state's medical assistance

 

program to ensure the program is cost-effective and that

 

appropriate incentive measures are utilized. The review shall

 

include, at a minimum, the auto-assignment algorithm and

 

performance bonus incentive pool. This subsection applies whether

 

or not either or both of the waivers requested under this section

 

are approved, the patient protection and affordable care act is

 

repealed, or the state terminates or opts out of the program

established under this section.

 

     (f) The identification of private sector initiatives used to

 

incent individuals to comply with medical advice.

 

     (11) By December 31, 2015, the department of community health

 

shall review and report to the legislature the feasibility of

 

programs recommended by multiple national organizations that

 

include, but are not limited to, the council Council of state

 

governments, State Governments, the national conference National

 

Conference of state legislatures, State Legislatures, and the

 

American legislative exchange council, Legislative Exchange

 

Council, on improving the cost-effectiveness of the medical

 

assistance program.

 

     (12) By January 1, 2014, the The department of community

 

health in collaboration with the contracted health plans and

 

providers shall create and implement financial incentives for all

 

of the following:

 

     (a) Contracted health plans that meet specified population

 

improvement goals.

 

     (b) Providers who meet specified quality, cost, and

 

utilization targets.

 

     (c) Enrollees who demonstrate improved health outcomes or

 

maintain healthy behaviors as identified in a health risk

 

assessment as identified by their primary care practitioner who is

 

licensed, registered, or otherwise authorized to engage in his or

 

her health care profession in this state. This subsection applies

 

whether or not either or both of the waivers requested under this

 

section are approved, the patient protection and affordable care

act is repealed, or the state terminates or opts out of the program

 

established under this section.

 

     (13) By October 1, 2015, the The performance bonus incentive

 

pool for contracted health plans that are not specialty prepaid

 

health plans shall include inappropriate utilization of emergency

 

departments, ambulatory care, contracted health plan all-cause

 

acute 30-day readmission rates, and generic drug utilization when

 

such an alternative exists for a branded product and consistent

 

with section 109h and sections 9701 to 9709 of the public health

 

code, 1978 PA 368, MCL 333.9701 to 333.9709, as a percentage of

 

total. These measurement tools shall be considered and weighed

 

within the 6 highest factors used in the formula. This subsection

 

applies whether or not either or both of the waivers requested

 

under this section are approved, the patient protection and

 

affordable care act is repealed, or the state terminates or opts

 

out of the program established under this section.

 

     (14) The department of community health shall ensure that all

 

capitated payments made to contracted health plans are actuarially

 

sound. This subsection applies whether or not either or both of the

 

waivers requested under this section are approved, the patient

 

protection and affordable care act is repealed, or the state

 

terminates or opts out of the program established under this

 

section.

 

     (15) The department of community health shall maintain

 

administrative costs at a level of not more than 1% of the

 

department of community health's department's appropriation of the

 

state medical assistance program. These administrative costs shall

be capped at the total administrative costs for the fiscal year

 

ending September 30, 2016, except for inflation and project-related

 

costs required to achieve medical assistance net general fund

 

savings. This subsection applies whether or not either or both of

 

the waivers requested under this section are approved, the patient

 

protection and affordable care act is repealed, or the state

 

terminates or opts out of the program established under this

 

section.

 

     (16) By October 1, 2015, the The department of community

 

health shall establish uniform procedures and compliance metrics

 

for utilization by the contracted health plans to ensure that cost-

 

sharing requirements are being met. This shall include

 

ramifications for the contracted health plans' failure to comply

 

with performance or compliance metrics. This subsection applies

 

whether or not either or both of the waivers requested under this

 

section are approved, the patient protection and affordable care

 

act is repealed, or the state terminates or opts out of the program

 

established under this section.

 

     (17) Beginning October 1, 2015, the The department of

 

community health shall withhold, at a minimum, 0.75% of payments to

 

contracted health plans, except for specialty prepaid health plans,

 

for the purpose of expanding the existing performance bonus

 

incentive pool. Distribution of funds from the performance bonus

 

incentive pool is contingent on the contracted health plan's

 

completion of the required performance or compliance metrics. This

 

subsection applies whether or not either or both of the waivers

 

requested under this section are approved, the patient protection

and affordable care act is repealed, or the state terminates or

 

opts out of the program established under this section.

 

     (18) By October 1, 2015, the The department of community

 

health shall withhold, at a minimum, 0.75% of payments to specialty

 

prepaid health plans for the purpose of establishing a performance

 

bonus incentive pool. Distribution of funds from the performance

 

bonus incentive pool is contingent on the specialty prepaid health

 

plan's completion of the required performance of compliance metrics

 

, which shall that must include, at a minimum, partnering with

 

other contracted health plans to reduce nonemergent emergency

 

department utilization, increased participation in patient-centered

 

medical homes, increased use of electronic health records and data

 

sharing with other providers, and identification of enrollees who

 

may be eligible for services through the veterans administration.

 

This subsection applies whether or not either or both of the

 

waivers requested under this section are approved, the patient

 

protection and affordable care act is repealed, or the state

 

terminates or opts out of the program established under this

 

section.

 

     (19) The department of community health shall measure

 

contracted health plan or specialty prepaid health plan performance

 

metrics, as applicable, on application of standards of care as that

 

relates to appropriate treatment of substance use disorders and

 

efforts to reduce substance use disorders. This subsection applies

 

whether or not either or both of the waivers requested under this

 

section are approved, the patient protection and affordable care

 

act is repealed, or the state terminates or opts out of the program

established under this section.

 

     (20) By September 1, 2015, in addition to the waiver requested

 

in subsection (1), the department of community health shall seek an

 

additional waiver from the United States department Department of

 

health Health and human services Human Services that requires

 

individuals who are between 100% and 133% of the federal poverty

 

guidelines and who have had medical assistance coverage for 48

 

cumulative months beginning on the date of their enrollment into

 

the program described in subsection (1) to choose 1 of the

 

following options:

 

     (a) Change their medical assistance program eligibility

 

status, in accordance with federal law, to be considered eligible

 

for federal advance premium tax credit and cost-sharing subsidies

 

from the federal government to purchase private insurance coverage

 

through an American health benefit exchange without financial

 

penalty to the state.

 

     (b) Remain in the medical assistance program but increase

 

cost-sharing requirements up to 7% of income. Required

 

contributions shall be deposited into an account used to pay for

 

incurred health expenses for covered benefits and shall be 3.5% of

 

income but may be reduced as provided in subsection (1)(e). The

 

department of community health may reduce co-pays as provided in

 

subsection (1)(e), but not until annual accumulated co-pays reach

 

3% of income.

 

     (21) The department of community health shall notify enrollees

 

60 days before the end of the enrollee's forty-eighth month that

 

coverage under the current program is no longer available to them

and that, in order to continue coverage, the enrollee must choose

 

between the options described in subsection (20)(a) or (b).

 

     (22) The department of community health shall implement a

 

system for individuals who fail to choose an option described under

 

subsection (20)(a) or (b) within a specified time determined by the

 

department of community health that enrolls those individuals into

 

the option described in subsection (20)(b).

 

     (23) If the waiver requested under subsection (20) is not

 

approved by the United States department Department of health

 

Health and human services Human Services by December 31, 2015,

 

medical coverage for individuals described in subsection (1)(a)

 

shall no longer be provided. If the waiver is not approved by

 

December 31, 2015, then by January 31, 2016, the department of

 

community health shall notify enrollees that the program described

 

in subsection (1) shall be terminated on April 30, 2016. If a

 

waiver requested under subsection (1) or (20) is approved and is

 

required to be renewed at any time after approval, medical coverage

 

for individuals described in subsection (1)(a) shall no longer be

 

provided if either renewal request is not approved by the United

 

States department Department of health Health and human services

 

Human Services or if a waiver is canceled after approval. The

 

department of community health shall give enrollees 4 months'

 

advance notice before termination of coverage based on a renewal

 

request not being approved as described in this subsection. A

 

notification described in this subsection shall state that the

 

enrollment was terminated due to the failure of the United States

 

department Department of health Health and human services Human

Services to approve the waiver requested under subsection (20) or

 

renewal of a waiver described in this subsection.

 

     (24) Individuals described in 42 CFR 440.315 are not subject

 

to the provisions of the waiver described in subsection (20).

 

     (25) The department of community health shall make available

 

at least 3 years of state medical assistance program data, without

 

charge, to any vendor considered qualified by the department of

 

community health who indicates interest in submitting proposals to

 

contracted health plans in order to implement cost savings and

 

population health improvement opportunities through the use of

 

innovative information and data management technologies. Any

 

program or proposal to the contracted health plans must be

 

consistent with the state's goals of improving health, increasing

 

the quality, reliability, availability, and continuity of care, and

 

reducing the cost of care of the eligible population of enrollees

 

described in subsection (1)(a). The use of the data described in

 

this subsection for the purpose of assessing the potential

 

opportunity and subsequent development and submission of formal

 

proposals to contracted health plans is not a cost or contractual

 

obligation to the department of community health or the state.

 

     (26) If the department of community health does not receive

 

approval for both of the waivers required under this section before

 

December 31, 2015, the program described in this section is

 

terminated. The department of community health shall request

 

written documentation from the United States department Department

 

of health Health and human services Human Services that if the

 

waivers described in this section are rejected causing the medical

assistance program to revert back to the eligibility requirements

 

in effect on the effective date of the amendatory act that added

 

this section, March 14, 2014, excluding any waivers that have not

 

been renewed, there shall be no financial federal funding penalty

 

to the state associated with the implementation and subsequent

 

cancellation of the program created in this section. If the

 

department of community health does not receive this documentation

 

by December 31, 2013, the department of community health shall not

 

implement the program described in this section.

 

     (27) This section does not apply if either of the following

 

occurs:

 

     (a) If the department of community health is unable to obtain

 

either of the federal waivers requested in subsection (1) or (20).

 

     (b) If federal government matching funds for the program

 

described in this section are reduced below 100% and annual state

 

savings and other nonfederal net savings associated with the

 

implementation of that program are not sufficient to cover the

 

reduced federal match. The department of community health shall

 

determine and the state budget office shall approve how annual

 

state savings and other nonfederal net savings shall be calculated

 

by June 1, 2014. By September 1, 2014, the calculations and

 

methodology used to determine the state and other nonfederal net

 

savings shall be submitted to the legislature.

 

     (27) (28) The department of community health shall develop,

 

administer, and coordinate with the department of treasury a

 

procedure for offsetting the state tax refunds of an enrollee who

 

owes a liability to the state of past due uncollected cost-sharing,

as allowable by the federal government. The procedure shall include

 

a guideline that the department of community health submit to the

 

department of treasury, not later than November 1 of each year, all

 

requests for the offset of state tax refunds claimed on returns

 

filed or to be filed for that tax year. For the purpose of this

 

subsection, any nonpayment of the cost-sharing required under this

 

section owed by the enrollee is considered a liability to the state

 

under section 30a(2)(b) of 1941 PA 122, MCL 205.30a.

 

     (28) (29) For the purpose of this subsection, any nonpayment

 

of the cost-sharing required under this section owed by the

 

enrollee is considered a current liability to the state under

 

section 32 of the McCauley-Traxler-Law-Bowman-McNeely lottery act,

 

1972 PA 239, MCL 432.32, and shall be handled in accordance with

 

the procedures for handling a liability to the state under that

 

section, as allowed by the federal government.

 

     (29) (30) By November 30, 2013, the department of community

 

health shall convene a symposium to examine the issues of emergency

 

department overutilization and improper usage. By December 31,

 

2014, the department of community health shall submit a report to

 

the legislature that identifies the causes of overutilization and

 

improper emergency service usage that includes specific best

 

practice recommendations for decreasing overutilization of

 

emergency departments and improper emergency service usage, as well

 

as how those best practices are being implemented. Both broad

 

recommendations and specific recommendations related to the

 

medicaid Medicaid program, enrollee behavior, and health plan

 

access issues shall be included.

     (30) (31) The department of community health shall contract

 

with an independent third party vendor to review the reports

 

required in subsections (8) and (9) and other data as necessary, in

 

order to develop a methodology for measuring, tracking, and

 

reporting medical cost and uncompensated care cost reduction or

 

rate of increase reduction and their effect on health insurance

 

rates along with recommendations for ongoing annual review. The

 

final report and recommendations shall be submitted to the

 

legislature by September 30, 2015.

 

     (31) (32) For the purposes of submitting reports and other

 

information or data required under this section only, "legislature"

 

means the senate majority leader, the speaker of the house of

 

representatives, the chairs of the senate and house of

 

representatives appropriations committees, the chairs of the senate

 

and house of representatives appropriations subcommittees on the

 

department of community health budget, and the chairs of the senate

 

and house of representatives standing committees on health policy.

 

     (32) (33) As used in this section:

 

     (a) "Patient protection and affordable care act" means the

 

patient protection and affordable care act, Public Law 111-148, as

 

amended by the federal health care and education reconciliation act

 

of 2010, Public Law 111-152.

 

     (b) "Peace of mind registry" and "peace of mind registry

 

organization" mean those terms as defined in section 10301 of the

 

public health code, 1978 PA 368, MCL 333.10301.

 

     (c) "State savings" means any state fund net savings,

 

calculated as of the closing of the financial books for the

department of community health at the end of each fiscal year, that

 

result from the program described in this section. The savings

 

shall result in a reduction in spending from the following state

 

fund accounts: adult benefit waiver, non-medicaid non-Medicaid

 

community mental health, and prisoner health care. Any identified

 

savings from other state fund accounts shall be proposed to the

 

house of representatives and senate appropriations committees for

 

approval to include in that year's state savings calculation. It is

 

the intent of the legislature that for fiscal year ending September

 

30, 2014 only, $193,000,000.00 of the state savings shall be

 

deposited in the roads and risks reserve fund created in section

 

211b of article VIII of 2013 PA 59.

 

     (d) "Telemedicine" means that term as defined in section 3476

 

of the insurance code of 1956, 1956 PA 218, MCL 500.3476.

 

     Enacting section 1. This amendatory act takes effect 90 days

 

after the date it is enacted into law.