Bill Text: MI SB0444 | 2019-2020 | 100th Legislature | Introduced
Bill Title: Health facilities; other; certain fees under the public health code; extend sunset. Amends sec. 20161 of 1978 PA 368 (MCL 333.20161).
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Passed) 2019-10-02 - Assigned Pa 0074'19 With Immediate Effect [SB0444 Detail]
Download: Michigan-2019-SB0444-Introduced.html
SENATE BILL No. 444
August 20, 2019, Introduced by Senator HERTEL and referred to the Committee on Appropriations.
A bill to amend 1978 PA 368, entitled
"Public health code,"
by amending section 20161 (MCL 333.20161), as amended by 2018 PA
245.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
1 Sec. 20161. (1) The department shall assess fees and other
2 assessments for health facility and agency licenses and
3 certificates of need on an annual basis as provided in this
4 article. Until October 1, 2019, 2023, except as otherwise
provided
5 in this article, fees and assessments must be paid as provided in
6 the following schedule:
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7 |
(a) Freestanding surgical |
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8 |
outpatient facilities................$500.00 per facility |
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9 |
license. |
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10 |
(b) Hospitals...................$500.00 per facility |
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11 |
license and $10.00 per |
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1 |
licensed bed. |
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2 |
(c) Nursing homes, county |
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3 |
medical care facilities, and |
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4 |
hospital long-term care units........$500.00 per facility |
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5 |
license and $3.00 per |
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6 |
licensed bed over 100 |
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7 |
licensed beds. |
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8 |
(d) Homes for the aged..........$6.27 per licensed bed. |
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9 |
(e) Hospice agencies............$500.00 per agency license. |
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10 |
(f) Hospice residences..........$500.00 per facility |
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11 |
license and $5.00 per |
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12 |
licensed bed. |
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13 |
(g) Subject to subsection |
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14 |
(11), quality assurance assessment |
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15 |
for nursing homes and hospital |
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16 |
long-term care units.................an amount resulting |
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17 |
in not more than 6% |
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18 |
of total industry |
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19 |
revenues. |
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20 |
(h) Subject to subsection |
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21 |
(12), quality assurance assessment |
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22 |
for hospitals........................at a fixed or variable |
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23 |
rate that generates |
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24 |
funds not more than the |
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25 |
maximum allowable under |
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26 |
the federal matching |
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27 |
requirements, after |
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1 |
consideration for the |
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2 |
amounts in subsection |
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3 |
(12)(a) and (i). |
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4 |
(i) Initial licensure |
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5 |
application fee for subdivisions |
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6 |
(a), (b), (c), (e), and (f)..........$2,000.00 per initial |
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7 |
license. |
8 (2) If a hospital requests the department to conduct a
9 certification survey for purposes of title XVIII or title XIX, the
10 hospital shall pay a license fee surcharge of $23.00 per bed. As
11 used in this subsection, "title XVIII" and "title XIX" mean those
12 terms as defined in section 20155.
13 (3) All of the following apply to the assessment under this
14 section for certificates of need:
15 (a) The base fee for a certificate of need is $3,000.00 for
16 each application. For a project requiring a projected capital
17 expenditure of more than $500,000.00 but less than $4,000,000.00,
18 an additional fee of $5,000.00 is added to the base fee. For a
19 project requiring a projected capital expenditure of $4,000,000.00
20 or more but less than $10,000,000.00, an additional fee of
21 $8,000.00 is added to the base fee. For a project requiring a
22 projected capital expenditure of $10,000,000.00 or more, an
23 additional fee of $12,000.00 is added to the base fee.
24 (b) In addition to the fees under subdivision (a), the
25 applicant shall pay $3,000.00 for any designated complex project
26 including a project scheduled for comparative review or for a
27 consolidated licensed health facility application for acquisition
1 or replacement.
2 (c) If required by the department, the applicant shall pay
3 $1,000.00 for a certificate of need application that receives
4 expedited processing at the request of the applicant.
5 (d) The department shall charge a fee of $500.00 to review any
6 letter of intent requesting or resulting in a waiver from
7 certificate of need review and any amendment request to an approved
8 certificate of need.
9 (e) A health facility or agency that offers certificate of
10 need covered clinical services shall pay $100.00 for each
11 certificate of need approved covered clinical service as part of
12 the certificate of need annual survey at the time of submission of
13 the survey data.
14 (f) The department shall use the fees collected under this
15 subsection only to fund the certificate of need program. Funds
16 remaining in the certificate of need program at the end of the
17 fiscal year do not lapse to the general fund but remain available
18 to fund the certificate of need program in subsequent years.
19 (4) A license issued under this part is effective for no
20 longer than 1 year after the date of issuance.
21 (5) Fees described in this section are payable to the
22 department at the time an application for a license, permit, or
23 certificate is submitted. If an application for a license, permit,
24 or certificate is denied or if a license, permit, or certificate is
25 revoked before its expiration date, the department shall not refund
26 fees paid to the department.
27 (6) The fee for a provisional license or temporary permit is
1 the same as for a license. A license may be issued at the
2 expiration date of a temporary permit without an additional fee for
3 the balance of the period for which the fee was paid if the
4 requirements for licensure are met.
5 (7) The cost of licensure activities must be supported by
6 license fees.
7 (8) The application fee for a waiver under section 21564 is
8 $200.00 plus $40.00 per hour for the professional services and
9 travel expenses directly related to processing the application. The
10 travel expenses must be calculated in accordance with the state
11 standardized travel regulations of the department of technology,
12 management, and budget in effect at the time of the travel.
13 (9) An applicant for licensure or renewal of licensure under
14 part 209 shall pay the applicable fees set forth in part 209.
15 (10) Except as otherwise provided in this section, the fees
16 and assessments collected under this section must be deposited in
17 the state treasury, to the credit of the general fund. The
18 department may use the unreserved fund balance in fees and
19 assessments for the criminal history check program required under
20 this article.
21 (11) The quality assurance assessment collected under
22 subsection (1)(g) and all federal matching funds attributed to that
23 assessment must be used only for the following purposes and under
24 the following specific circumstances:
25 (a) The quality assurance assessment and all federal matching
26 funds attributed to that assessment 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, must be 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, must be
21 assessed in the first quarter after federal approval of the waiver
22 and must be subsequently assessed on October 1 of each following
23 year, and is payable on a quarterly basis, with the first payment
24 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) must be prorated on a quarterly basis for any
11 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 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) must be equal to 13.2%
22 of the federal funds generated by the nursing homes and hospital
23 long-term care units quality assurance assessment, including the
24 state retention amount. The state retention amount must be
25 appropriated each fiscal year to the department to support Medicaid
26 expenditures for long-term care services. These funds must offset
27 an identical amount of general fund/general purpose revenue
1 originally appropriated for that purpose.
2 (l) Beginning
October 1, 2019, 2023, the department shall not
3 assess or collect the quality assurance assessment or apply for
4 federal matching funds. The quality assurance assessment collected
5 under subsection (1)(g) 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 must be returned to the nursing home or hospital long-term care
11 unit.
12 (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 must be
15 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 must be assessed on all
20 net patient revenue, before deduction of expenses, less Medicare
21 net revenue, as reported in the most recently available Medicare
22 cost report and is payable on a quarterly basis, with the first
23 payment due 90 days after the date the assessment is assessed. As
24 used in this subdivision, "Medicare net revenue" includes Medicare
25 payments and amounts collected for coinsurance and deductibles.
26 (c) Beginning October 1, 2002, the department shall increase
27 the hospital Medicaid reimbursement rates for the balance of that
1 year. For each subsequent year in which the quality assurance
2 assessment is assessed and collected, the department shall maintain
3 the hospital Medicaid reimbursement rate increase financed by the
4 quality assurance assessments.
5 (d) The department shall implement this section in a manner
6 that complies with federal requirements necessary to ensure that
7 the quality assurance assessment qualifies for federal matching
8 funds.
9 (e) If a hospital fails to pay the assessment required by
10 subsection (1)(h), the department may assess the hospital a penalty
11 of 5% of the assessment for each month that the assessment and
12 penalty are not paid up to a maximum of 50% of the assessment. The
13 department may also refer for collection to the department of
14 treasury past due amounts consistent with section 13 of 1941 PA
15 122, MCL 205.13.
16 (f) The hospital quality assurance assessment fund is
17 established in the state treasury. The department shall deposit the
18 revenue raised through the quality assurance assessment with the
19 state treasurer for deposit in the hospital quality assurance
20 assessment fund.
21 (g) In each fiscal year governed by this subsection, the
22 quality assurance assessment must only be collected and expended if
23 Medicaid hospital inpatient DRG and outpatient reimbursement rates
24 and disproportionate share hospital and graduate medical education
25 payments are not below the level of rates and payments in effect on
26 April 1, 2002 as a direct result of the quality assurance
27 assessment collected under subsection (1)(h), except as provided in
1 subdivision (h).
2 (h) The quality assurance assessment collected under
3 subsection (1)(h) must not be assessed or collected after September
4 30, 2011 if the quality assurance assessment is not eligible for
5 federal matching funds. Any portion of the quality assurance
6 assessment collected from a hospital that is not eligible for
7 federal matching funds must be returned to the hospital.
8 (i) The state retention amount of the quality assurance
9 assessment collected under subsection (1)(h) must be equal to 13.2%
10 of the federal funds generated by the hospital quality assurance
11 assessment, including the state retention amount. The 13.2% state
12 retention amount described in this subdivision does not apply to
13 the Healthy Michigan plan. In the fiscal year ending September 30,
14 2016, there is a 1-time additional retention amount of up to
15 $92,856,100.00. In the fiscal year ending September 30, 2017, there
16 is a retention amount of $105,000,000.00 for the Healthy Michigan
17 plan. Beginning in the fiscal year ending September 30, 2018, and
18 for each fiscal year thereafter, there is a retention amount of
19 $118,420,600.00 for each fiscal year for the Healthy Michigan Plan.
20 The state retention percentage must be applied proportionately to
21 each hospital quality assurance assessment program to determine the
22 retention amount for each program. The state retention amount must
23 be appropriated each fiscal year to the department to support
24 Medicaid expenditures for hospital services and therapy. These
25 funds must offset an identical amount of general fund/general
26 purpose revenue originally appropriated for that purpose. By May
27 31, 2019, the department, the state budget office, and the Michigan
1 Health and Hospital Association shall identify an appropriate
2 retention amount for the fiscal year ending September 30, 2020 and
3 each fiscal year thereafter.
4 (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 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 must not exceed $20,000,000.00.
17 (d) The quality assurance assessment authorized under this
18 subsection must not be collected after October 1, 2019. 2023. The
19 quality assurance assessment authorized under this subsection must
20 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 (14) The quality assurance assessment provided for under this
24 section is a tax that is levied on a health facility or agency.
25 (15) As used in this section:
26 (a) "Healthy Michigan plan" means the medical assistance
27 program described in section 105d of the social welfare act, 1939
1 PA 280, MCL 400.105d, that has a federal matching fund rate of not
2 less than 90%.
3 (b) "Medicaid" means that term as defined in section 22207.
