COMMUNITY HEALTH FY 2009-10 Appropriations

Summary: As Reported from House Appropriations

HB 4436 (H-1)

Analysts: Margaret Alston, Susan Frey, and Steve Stauff

	FY 2008-09 YTD	FY 2009-10	FY 2009-10	FY 2009-10	FY 2009-10	*Difference: House* *From FY 2008-09 YTD*
	as of2/12/09	Executive	House	Senate	Enacted	*Amount*	%
IDG/IDT	$40,883,900	$48,677,000	$47,177,000	$0	$0	$6,293,100	15.4
Federal	7,219,405,800	8,323,404,700	8,926,554,300	0	0	1,707,148,500	23.7
Local	241,578,600	229,677,200	227,986,700	0	0	(13,591,900)	(5.6)
Private	66,686,800	70,208,500	72,608,500	0	0	5,921,700	8.9
Restricted	1,862,478,400	1,493,425,200	1,512,437,500	0	0	(350,040,900)	(18.8)
GF/GP	3,057,671,800	2,801,574,300	2,646,009,700	0	0	(411,662,100)	(13.5)
Gross	$12,488,705,300	$12,966,966,900	$13,432,773,700	$0	$0	*$944,068,400*	*7.6*
FTEs	4,608.7	4,386.1	4,384.6			(224.1)	(4.9)

Note: FY 2008-09 figures reflect supplementals and Executive Order (EO) actions throughFebruary 12, 2009.

Overview

The Department of Community Health (DCH) budget provides funding for a wide range of mental health, substance abuse, public health, and medical services programs including Medicaid. Established in 1996, the Department also includes the Office of Drug Control Policy, the Office of Services to the Aging, the Crime Victim Services Commission, and health regulatory functions.

Major Budget Changes From FY 2008-09 YTD Appropriations	FY 2008-09 YTD (as of2/12/09)	House Change From YTD
*1. Economic Adjustments* The House concurs with the Executive to include $13.4 million gross ($5.9 million GF/GP) for 1.0% salary/wage increase for non-bargaining and unionized employees and economic adjustments for defined benefit/ contribution retirement, insurance, worker's compensation, building occupancy, food, and gas, fuel, and utility costs for FY 2009-10.	Gross IDG Federal Restricted Local Private GF/GP	N/A N/A N/A N/A N/A N/A N/A	$13,407,300 843,200 2,745,400 762,700 3,159,700 1,800 $5,894,500
*2. Office of Long-Term Care Supports and Services* The House concurs with the Executive to abolish the Office of Long-Term Care Supports and Services, effectiveOctober 1, 2009, in accordance with Executive Order 2009-3, and to integrate functions of this Office within the DCH.	Gross Federal Private GF/GP	$3,882,000 3,048,300 40,100 $793,600	($2,453,800) (1,660,200) 0 ($793,600)
*3. Actuarially Sound Capitation Payment Rates* Concurring with the Executive, the House increases capitation payment rates for Health Plan Services by 4.5% and Medicaid Mental Health and Substance Abuse Services by 4.0% ($197.7 million gross, $72.8 million GF/GP) to ensure rates are actuarially sound in FY 2009-10.	Gross Federal Local Restricted GF/GP	$5,293,292,900 3,214,084,100 30,030,200 971,726,200 $1,077,452,400	$197,711,000 124,933,500 0 0 $72,777,500
*4. MentalHealth Court* Pilot Programs** The House does not concur with the Executive to eliminate $1.1 million GF/GP for nine mental health court pilot programs. Instead, the House proposes a $100 placeholder anticipating that Byrne Justice Assistance Grant funding will be available for financing these programs. Services included in the programs are psychiatric counseling, case management, vocational training, housing assistance, program adherence monitoring, and training court and law enforcement personnel.	Gross GF/GP	$1,126,900 $1,126,900	($1,126,800) ($1,126,800)
*5. Wage Increase for Direct Care Workers* The House concurs with the Executive to add $3.0 million gross ($1.3 million GF/GP) to annualize the cost of a 1.0% wage increase, effectiveFebruary 1, 2009, for direct care workers in mental health settings. Also, the House adds $32.2 million gross ($10.9 million GF/GP) for a $.50 wage increase, effective October 1, 2009, for direct care workers. (Sec. 405)	Gross Federal Restricted Local GF/GP	$2,092,155,700 1,067,036,500 97,074,300 25,228,900 $902,816,000	$35,226,600 23,057,400 0 0 $12,169,200
*6. CMH Non-Medicaid Services Reduction* The House does not concur with the Executive to reduce funding for CMH Non-Medicaid Services by $7.6 million GF/GP. Instead, the House increases funding for this line item by 2.0% ($6.5 million GF/GP)	Gross GF/GP	$322,027,700 $322,027,700	$6,549,400 $6,549,400
*7. Multicultural Services* The House does not concur with the Executive to eliminate $6.8 million GF/GP for multicultural services in which the funds are distributed to the following populations and groups: Chinese American, Asian American, Hispanics, Arab/Chaldean Council, Michigan Inter-Tribal Council, Jewish Federation, Chaldean Culture Center, ACCESS, and Vietnam Veterans.	Gross GF/GP	$6,823,800 $6,823,800	$0 $0
*8. Hospital Rate Adjustor for PIHPs* Concurring with the Executive, the House adds $30.0 million gross ($0 GF/GP) to Medicaid Mental Health Services due to the establishment of hospital rate adjustor for Prepaid Inpatient Health Plans (PIHPs). As is the case for Medicaid Health Plans, estimated payments from private inpatient hospitals for mental health services would be passed through PIHPs.	Gross Federal Restricted Local GF/GP	$1,770,128,000 1,067,036,500 97,074,300 25,228,900 $580,788,300	$30,000,000 18,957,000 11,043,000 0 $0
*9. Mt. Pleasant Center Closure* The House and Executive includes a net reduction of $15.4 million gross ($3.1 million GF/GP) due to the proposed closure ofMt.PleasantCenter for Persons with Developmental Disabilities in October of this year. The reduction reflects the shifting of funds to Medicaid Mental Health Services and other closure-related adjustments.	Gross Federal Restricted Local GF/GP	$0 0 0 0 $0	($15,409,700) (2,199,100) (880,000) (9,248,800) ($3,081,800)
*10. Forensic Mental Health Services to DOC* The House concurs with the Executive to add $5.3 million to the interdepartmental grant from the Department of Corrections (DOC) to reflect the increased demand for DOC mental health services.	Gross IDG	$39,344,800 $39,344,800	$5,318,300 $5,318,300
*11. Criminal Background Check Program* The House and Executive partially replace health systems fees/collections and matching federal Medicaid revenue with GF/GP for the Criminal Background Check Program for employees of health facilities due to lack of available fee revenue.	Gross Federal Restricted GF/GP	$3,956,400 782,500 3,173,900 $0	($1,277,600) (246,700) (3,173,900) $2,143,000
*12. State Disability Assistance Program* The House increases funding for the State Disability Assistance Program Substance Abuse Services by $4.0 million gross (all GF/GP). The funds are to be distributed based on local needs as determined by the department, in consultation with coordinating agencies. (Sec. 406)	Gross GF/GP	$2,509,800 $2,509,800	$4,000,000 $4,000,000
*13. Community Substance Abuse Prevention, Education, and Treatment Programs* The House establishes a $100 GF/GP placeholder for medically necessary medications for the treatment of alcoholism and other substance abuse disorders; allocates $300,000 GF/GP for methandone/buprenorphine clinic to serve 25 counties; adds $15.0 million GF/GP for coordinating agencies; and allocates $9.0 million GF/GP for 90-day intensive substance treatment services for certain offenders. (Secs. 407 and 487)	Gross Federal Restricted GF/GP	$84,968,000 65,777,500 1,784,200 $17,406,300	$24,300,100 0 0 $24,300,100
*14. Primary Care Services* The House increases free health clinics funding by $250,000 GF/GP. Also, the House allocates $100,000 GF/GP for Beaver, Drummond, andMackinac Island clinics. (Sec. 712.)	Gross Federal GF/GP	$4,241,700 2,970,200 $1,271,500	$350,000 0 $350,000
*15. HealthyMichigan* Funded (HMF) Projects and Poison Control** The House retains projects funded by HMF at FY 2008-09 funding levels, and does not concur with selective project reductions proposed by the Executive. HMF funding for poison control is increased from $300,000 to $401,000, generating federal Medicaid match to fund poison control at $1.5 million Gross. An overall Fund revenue reduction of $3.5 million due to declining cigarette tax revenue is taken from the HMF appropriation for Medicaid, and is offset with GF/GP.	Gross Federal Restricted GF/GP	$41,364,600 395,000 40,969,600 $0	$805,000 704,000 (3,541,400) $3,642,400
*16.* *Public* *HealthProgramState* *Funding Reductions* The House rejects almost all of the $5.0 million of GF/GP and Michigan Health Initiative Fund reductions proposed by the Executive to eliminate or reduce the following: AIDS and risk reduction clearinghouse and media campaign, African-American male health initiative, zero to three early childhood program, nurse family partnership, public health physician practice project, FY 2008-09 sexually transmitted disease targeted initiative for gonorrhea and chlamydia, methamphetamine cleanup fund, laboratory services, and family planning local agreements. Traumatic brain injury pilot funding is restored with a $100 placeholder.	Gross Federal Private Restricted GF/GP	$16,415,600 811,100 300,000 1,351,000 $13,953,500	($299,900) 0 0 0 ($299,900)
*17. Local Public Health Operations Funding Increase* The House provides an increase of $5,000,000 for local public health departments for state-local cost-shared public health services.	Gross Local GF/GP	$40,618,400 5,150,000 35,468,400	$5,000,000 0 $5,000,000
*18. Office of Drug Control Policy Dissolved* House concurs with the Executive to dissolve the Office of Drug Control Policy and transfer the remaining functions within DCH. Executive Order 2009-2 abolishes the Office, effectiveOctober 1, 2009. GF/GP funding is eliminated. Responsibility for the remaining Office functions, $11.7 million Gross ($0 GF/GP), and 10.5 staff are transferred to DCH Mental Health and Substance Abuse Services Administration. Based on recent passage of the federal budget for FY 2008-09, the House does not concur with the Executive regarding federal Byrne Justice Assistance Grant reductions and new state restricted substance abuse licensing fees and fines revenue.	FTEs Gross Federal Restricted GF/GP	15.0 $12,129,300 11,747,000 0 $382,300	(4.5) ($382,300) 0 0 ($382,300)
*19. Aging Program Reductions* The House does not concur with GF/GP reductions of $2.0 million proposed by the Executive to senior community services programs ($955,100), nutrition services ($697,200), and three senior volunteer programs ($347,700). The House concurs with the Executive and eliminates Senior Olympics funding ($100,000), new in FY 2008-09. Tribal Elders program funding is retained at $120,000.	Gross Federal Private Restricted GF/GP	$79,751,600 46,873,100 132,000 167,000 $32,579,500	($100,000) 0 0 0 ($100,000)
*20.* *Health Care Coverage Expansion for Disabled Children* The House concurs with the Executive increasing by $11.4 million federal Title XIX Medicaid in the Children's Special Health Care Services program expanding primary care coverage for disabled children in households with income between 200% and 300% of the federal poverty level. This would cover an estimated 4,000 more children.	Gross Federal GF/GP	N/A N/A N/A	$11,373,200 11,373,200 $0
*21. Medicaid Caseload, Utilization and Inflation Increase* The House concurs with the Executive to include an increase of $357.9 million Goss ($129.0 million GF/GP) to cover caseload/utilization/inflation changes within Medicaid, Mental Health/Substance Abuse, Children's Special Health Care Services, Adult Benefits waiver and Federal Medicare Prescription programs.	Gross Federal Local Merit Awd Restricted GF/GP	$9,996,061,200 6,127,686,700 43,567,800 55,856,200 1,600,165,000 $2,168,785,500	$357,927,800 228,969,600 0 0 0 $128,958,200
*22.* *Medicaid FMAP Federal Stimulus Bill Adjustment* The House and Executive concur on an anticipated increase of federal Medicaid funds resulting from the American Recovery and Reinvestment Act that would offset $929.5 million of GF/GP due to a temporary increase in the federal match rate.	Gross Federal Local Merit Awd Restricted GF/GP	$9,996,061,200 6,127,686,700 43,567,800 55,856,200 1,600,165,000 $2,168,785,500	($3,383,200) 961,849,700 (3,382,200) 0 (32,313,000) ($929,536,700)
*23. GME and DSH Increases* The House increases funding for the Graduate Medical Education (GME) program by $82,170,200 Gross ($21,964,100 GF/GP). Funding for Disproportionate Share Hospital (DSH) payments are increased by $1.0 million Gross ($267,300 GF/GP). (Sec. 1647 and Sec. 1717 respectively)	Gross Federal GF/GP	$218,954,800 131,964,100 $80,875,800	$83,170,200 60,938,800 $22,231,400
*24. Physician Increase and Pharmacy Dispensing Fee Increase* A 1% increase by the House of certain primary care physician procedure codes increases the Physician Services line by $4,830,200 Gross ($1,291,100 GF/GP). The Pharmaceutical Services line is increased by $432,000 Gross ($115,500 GF/GP) to fund an additional 30¢ per script for the use of e-prescribing. (Sec. 1620.)	Gross Federal GF/GP	N/A N/A N/A	$5,262,200 3,855,600 $1,406,600
*25. Healthy Kids Dental Expansion* The House expands the Healthy Kids Dental program to all counties inMichigan, an additional 22 counties, resulting in an increase of $76.1 million Gross ($20.3 million GF/GP).	Gross Federal GF/GP	$35,280,000 21,263,300 $559,100	$76,046,700 55,719,400 $20,327,300
*26. Nursing Home Transition Savings* The House concurs with Executive savings of $15.3 million Gross ($6.2 million GF/GP) resulting from $34.1 million Gross ($12.5 million GF/GP) of nursing home transition savings in the Long-Term Care Services line offset by $12.3 million Gross ($3.7 million GF/GP) of increases in other long-term care services lines.	Gross Federal Local Merit Awd Restricted GF/GP	$1,928,347,300 1,182,871,100 6,883,800 55,856,200 219,536,400 $463,199,800	($15,279,400) (9,054,100) 0 0 0 ($6,225,300)
*27. Adult Home Help Worker Wage Increase* An increase by the House in the Adult Home Help Services line of $16.6 million Gross ($4.4 million GF/GP) will fund a 50¢ per hour wage increase for all adult home help workers in all counties. (Sec. 1691)	Gross Federal GF/GP	$258,789,300 155,972,300 $102,817,000	$16,584,000 12,151,100 $4,432,900
*28.* *Medicaid HMO Federal Pharmaceutical Rebates* The House concurs with the Executive reduction of $120.0 million Gross ($44.2 million GF/GP) which represents anticipated savings from allowing health plans to receive federal pharmaceutical rebates for prescription drugs provided to managed care Medicaid enrollees. This would require a change in federal law.	Gross Federal GF/GP	$0 0 $0	($120,000,000) (75,828,000) ($44,172,000)
*29.* *County* *Health* *Plans* The House includes $98,165,400 GF/GP to provide preventative and ambulatory health care services through county health plans. Also included is $5.0 million GF/GP million to cover half of the remaining 35% of COBRA costs for those workers who are eligible for the 65% subsidy of health coverage authorized by the American Recovery and Reinvestment Act. (Sec. 1806 and Sec. 1810 respectively)	Gross GF/GP	N/A N/A	$103,165,400 $103,165,400
*30.* *Adult* *Benefits* *Waiver* *Hospital* *Benefit* The House includes $45.0 million Gross ($23.7 GF/GP) to provide startingOctober 1, 2009, a hospital benefit to those enrolled in the Medicaid adult benefits waiver program. (Sec. 1814)	Gross Federal Local Restricted GF/GP	$134,837,900 97,399,500 6,653,800 6,100,000 $24,744,600	$45,000,000 21,326,600 0 0 $23,673,400

Major Budget Changes From FY 2008-09 YTD Appropriations

FY 2008-09 YTD

(as of2/12/09)

House Change

From YTD

1. Economic Adjustments

The House concurs with the Executive to include $13.4 million gross ($5.9 million GF/GP) for 1.0% salary/wage increase for non-bargaining and unionized employees and economic adjustments for defined benefit/ contribution retirement, insurance, worker's compensation, building occupancy, food, and gas, fuel, and utility costs for FY 2009-10.

Gross

IDG

Federal

Restricted

Local
Private

GF/GP

N/A

N/A

$13,407,300

843,200

2,745,400

762,700

3,159,700

1,800

$5,894,500

2. Office of Long-Term Care Supports and Services

The House concurs with the Executive to abolish the Office of Long-Term Care Supports and Services, effectiveOctober 1, 2009, in accordance with Executive Order 2009-3, and to integrate functions of this Office within the DCH.

Gross

Federal

Private

GF/GP

$3,882,000

3,048,300

40,100

$793,600

($2,453,800)

(1,660,200)

($793,600)

3. Actuarially Sound Capitation Payment Rates

Concurring with the Executive, the House increases capitation payment rates for Health Plan Services by 4.5% and Medicaid Mental Health and Substance Abuse Services by 4.0% ($197.7 million gross, $72.8 million GF/GP) to ensure rates are actuarially sound in FY 2009-10.

Gross

Federal

Local

Restricted

GF/GP

$5,293,292,900

3,214,084,100

30,030,200

971,726,200

$1,077,452,400

$197,711,000

124,933,500

$72,777,500

4. MentalHealth Court Pilot Programs

The House does not concur with the Executive to eliminate $1.1 million GF/GP for nine mental health court pilot programs. Instead, the House proposes a $100 placeholder anticipating that Byrne Justice Assistance Grant funding will be available for financing these programs. Services included in the programs are psychiatric counseling, case management, vocational training, housing assistance, program adherence monitoring, and training court and law enforcement personnel.

Gross

GF/GP

$1,126,900

$1,126,900

($1,126,800)

($1,126,800)

5. Wage Increase for Direct Care Workers

The House concurs with the Executive to add $3.0 million gross ($1.3 million GF/GP) to annualize the cost of a 1.0% wage increase, effectiveFebruary 1, 2009, for direct care workers in mental health settings. Also, the House adds $32.2 million gross ($10.9 million GF/GP) for a $.50 wage increase, effective October 1, 2009, for direct care workers. (Sec. 405)

Gross

Federal

Restricted

Local

GF/GP

$2,092,155,700

1,067,036,500

97,074,300

25,228,900

$902,816,000

$35,226,600

23,057,400

$12,169,200

6. CMH Non-Medicaid Services Reduction

The House does not concur with the Executive to reduce funding for CMH Non-Medicaid Services by $7.6 million GF/GP. Instead, the House increases funding for this line item by 2.0% ($6.5 million GF/GP)

Gross

GF/GP

$322,027,700

$322,027,700

$6,549,400

$6,549,400

7. Multicultural Services

The House does not concur with the Executive to eliminate $6.8 million GF/GP for multicultural services in which the funds are distributed to the following populations and groups: Chinese American, Asian American, Hispanics, Arab/Chaldean Council, Michigan Inter-Tribal Council, Jewish Federation, Chaldean Culture Center, ACCESS, and Vietnam Veterans.

Gross

GF/GP

$6,823,800

$6,823,800

8. Hospital Rate Adjustor for PIHPs

Concurring with the Executive, the House adds $30.0 million gross ($0 GF/GP) to Medicaid Mental Health Services due to the establishment of hospital rate adjustor for Prepaid Inpatient Health Plans (PIHPs). As is the case for Medicaid Health Plans, estimated payments from private inpatient hospitals for mental health services would be passed through PIHPs.

Gross

Federal

Restricted

Local

GF/GP

$1,770,128,000

1,067,036,500

97,074,300

25,228,900

$580,788,300

$30,000,000

18,957,000

11,043,000

9. Mt. Pleasant Center Closure

The House and Executive includes a net reduction of $15.4 million gross ($3.1 million GF/GP) due to the proposed closure ofMt.PleasantCenter for Persons with Developmental Disabilities in October of this year. The reduction reflects the shifting of funds to Medicaid Mental Health Services and other closure-related adjustments.

Gross

Federal

Restricted

Local

GF/GP

($15,409,700)

(2,199,100)

(880,000)

(9,248,800)

($3,081,800)

10. Forensic Mental Health Services to DOC

The House concurs with the Executive to add $5.3 million to the interdepartmental grant from the Department of Corrections (DOC) to reflect the increased demand for DOC mental health services.

Gross

IDG

$39,344,800

$39,344,800

$5,318,300

$5,318,300

11. Criminal Background Check Program

The House and Executive partially replace health systems fees/collections and matching federal Medicaid revenue with GF/GP for the Criminal Background Check Program for employees of health facilities due to lack of available fee revenue.

Gross

Federal

Restricted

GF/GP

$3,956,400

782,500

3,173,900

($1,277,600)

(246,700)

(3,173,900)

$2,143,000

12. State Disability Assistance Program

The House increases funding for the State Disability Assistance Program Substance Abuse Services by $4.0 million gross (all GF/GP). The funds are to be distributed based on local needs as determined by the department, in consultation with coordinating agencies. (Sec. 406)

Gross

GF/GP

$2,509,800

$2,509,800

$4,000,000

$4,000,000

13. Community Substance Abuse Prevention, Education, and Treatment Programs

The House establishes a $100 GF/GP placeholder for medically necessary medications for the treatment of alcoholism and other substance abuse disorders; allocates $300,000 GF/GP for methandone/buprenorphine clinic to serve 25 counties; adds $15.0 million GF/GP for coordinating agencies; and allocates $9.0 million GF/GP for 90-day intensive substance treatment services for certain offenders. (Secs. 407 and 487)

Gross

Federal

Restricted

GF/GP

$84,968,000

65,777,500

1,784,200

$17,406,300

$24,300,100

$24,300,100

14. Primary Care Services

The House increases free health clinics funding by $250,000 GF/GP. Also, the House allocates $100,000 GF/GP for Beaver, Drummond, andMackinac Island clinics. (Sec. 712.)

Gross

Federal

GF/GP

$4,241,700

2,970,200

$1,271,500

$350,000

$350,000

15. HealthyMichigan Funded (HMF) Projects and Poison Control

The House retains projects funded by HMF at FY 2008-09 funding levels, and does not concur with selective project reductions proposed by the Executive. HMF funding for poison control is increased from $300,000 to $401,000, generating federal Medicaid match to fund poison control at $1.5 million Gross. An overall Fund revenue reduction of $3.5 million due to declining cigarette tax revenue is taken from the HMF appropriation for Medicaid, and is offset with GF/GP.

Gross

Federal

Restricted

GF/GP

$41,364,600

395,000

40,969,600

$805,000

704,000

(3,541,400)

$3,642,400

16. Public HealthProgramState Funding Reductions

The House rejects almost all of the $5.0 million of GF/GP and Michigan Health Initiative Fund reductions proposed by the Executive to eliminate or reduce the following: AIDS and risk reduction clearinghouse and media campaign, African-American male health initiative, zero to three early childhood program, nurse family partnership, public health physician practice project, FY 2008-09 sexually transmitted disease targeted initiative for gonorrhea and chlamydia, methamphetamine cleanup fund, laboratory services, and family planning local agreements. Traumatic brain injury pilot funding is restored with a $100 placeholder.

Gross

Federal

Private

Restricted

GF/GP

$16,415,600

811,100

300,000

1,351,000

$13,953,500

($299,900)

($299,900)

17. Local Public Health Operations Funding Increase

The House provides an increase of $5,000,000 for local public health departments for state-local cost-shared public health services.

Gross

Local

GF/GP

$40,618,400

5,150,000

35,468,400

$5,000,000

$5,000,000

18. Office of Drug Control Policy Dissolved

House concurs with the Executive to dissolve the Office of Drug Control Policy and transfer the remaining functions within DCH. Executive Order 2009-2 abolishes the Office, effectiveOctober 1, 2009. GF/GP funding is eliminated. Responsibility for the remaining Office functions, $11.7 million Gross ($0 GF/GP), and 10.5 staff are transferred to DCH Mental Health and Substance Abuse Services Administration. Based on recent passage of the federal budget for FY 2008-09, the House does not concur with the Executive regarding federal Byrne Justice Assistance Grant reductions and new state restricted substance abuse licensing fees and fines revenue.

FTEs

Gross

Federal

Restricted

GF/GP

15.0

$12,129,300

11,747,000

$382,300

(4.5)

($382,300)

($382,300)

19. Aging Program Reductions

The House does not concur with GF/GP reductions of $2.0 million proposed by the Executive to senior community services programs ($955,100), nutrition services ($697,200), and three senior volunteer programs ($347,700). The House concurs with the Executive and eliminates Senior Olympics funding ($100,000), new in FY 2008-09. Tribal Elders program funding is retained at $120,000.

Gross

Federal

Private

Restricted

GF/GP

$79,751,600

46,873,100

132,000

167,000

$32,579,500

($100,000)

($100,000)

20. Health Care Coverage Expansion for Disabled Children

The House concurs with the Executive increasing by $11.4 million federal Title XIX Medicaid in the Children's Special Health Care Services program expanding primary care coverage for disabled children in households with income between 200% and 300% of the federal poverty level. This would cover an estimated 4,000 more children.

Gross

Federal

GF/GP

N/A

N/A

$11,373,200

11,373,200

21. Medicaid Caseload, Utilization and Inflation Increase

The House concurs with the Executive to include an increase of $357.9 million Goss ($129.0 million GF/GP) to cover caseload/utilization/inflation changes within Medicaid, Mental Health/Substance Abuse, Children's Special Health Care Services, Adult Benefits waiver and Federal Medicare Prescription programs.

Gross

Federal

Local

Merit Awd

Restricted

GF/GP

$9,996,061,200

6,127,686,700

43,567,800

55,856,200

1,600,165,000

$2,168,785,500

$357,927,800

228,969,600

$128,958,200

22. Medicaid FMAP Federal Stimulus Bill Adjustment

The House and Executive concur on an anticipated increase of federal Medicaid funds resulting from the American Recovery and Reinvestment Act that would offset $929.5 million of GF/GP due to a temporary increase in the federal match rate.

Gross

Federal

Local

Merit Awd

Restricted

GF/GP

$9,996,061,200

6,127,686,700

43,567,800

55,856,200

1,600,165,000

$2,168,785,500

($3,383,200)

961,849,700

(3,382,200)

(32,313,000)

($929,536,700)

23. GME and DSH Increases

The House increases funding for the Graduate Medical Education (GME) program by $82,170,200 Gross ($21,964,100 GF/GP). Funding for Disproportionate Share Hospital (DSH) payments are increased by $1.0 million Gross ($267,300 GF/GP). (Sec. 1647 and Sec. 1717 respectively)

Gross

Federal

GF/GP

$218,954,800

131,964,100

$80,875,800

$83,170,200

60,938,800

$22,231,400

24. Physician Increase and Pharmacy Dispensing Fee Increase

A 1% increase by the House of certain primary care physician procedure codes increases the Physician Services line by $4,830,200 Gross ($1,291,100 GF/GP). The Pharmaceutical Services line is increased by $432,000 Gross ($115,500 GF/GP) to fund an additional 30¢ per script for the use of e-prescribing. (Sec. 1620.)

Gross

Federal

GF/GP

N/A

N/A

$5,262,200

3,855,600

$1,406,600

25. Healthy Kids Dental Expansion

The House expands the Healthy Kids Dental program to all counties inMichigan, an additional 22 counties, resulting in an increase of $76.1 million Gross ($20.3 million GF/GP).

Gross

Federal

GF/GP

$35,280,000

21,263,300

$559,100

$76,046,700

55,719,400

$20,327,300

26. Nursing Home Transition Savings

The House concurs with Executive savings of $15.3 million Gross ($6.2 million GF/GP) resulting from $34.1 million Gross ($12.5 million GF/GP) of nursing home transition savings in the Long-Term Care Services line offset by $12.3 million Gross ($3.7 million GF/GP) of increases in other long-term care services lines.

Gross

Federal

Local

Merit Awd

Restricted

GF/GP

$1,928,347,300

1,182,871,100

6,883,800

55,856,200

219,536,400

$463,199,800

($15,279,400)

(9,054,100)

($6,225,300)

27. Adult Home Help Worker Wage Increase

An increase by the House in the Adult Home Help Services line of $16.6 million Gross ($4.4 million GF/GP) will fund a 50¢ per hour wage increase for all adult home help workers in all counties. (Sec. 1691)

Gross

Federal

GF/GP

$258,789,300

155,972,300

$102,817,000

$16,584,000

12,151,100

$4,432,900

28. Medicaid HMO Federal Pharmaceutical Rebates

The House concurs with the Executive reduction of $120.0 million Gross ($44.2 million GF/GP) which represents anticipated savings from allowing health plans to receive federal pharmaceutical rebates for prescription drugs provided to managed care Medicaid enrollees. This would require a change in federal law.

Gross

Federal

GF/GP

($120,000,000)

(75,828,000)

($44,172,000)

29. County Health Plans

The House includes $98,165,400 GF/GP to provide preventative and ambulatory health care services through county health plans. Also included is $5.0 million GF/GP million to cover half of the remaining 35% of COBRA costs for those workers who are eligible for the 65% subsidy of health coverage authorized by the American Recovery and Reinvestment Act. (Sec. 1806 and Sec. 1810 respectively)

Gross

GF/GP

N/A

N/A

$103,165,400

$103,165,400

30. Adult Benefits Waiver Hospital Benefit

The House includes $45.0 million Gross ($23.7 GF/GP) to provide startingOctober 1, 2009, a hospital benefit to those enrolled in the Medicaid adult benefits waiver program. (Sec. 1814)

Gross

Federal

Local

Restricted

GF/GP

$134,837,900

97,399,500

6,653,800

6,100,000

$24,744,600

$45,000,000

21,326,600

$23,673,400

Sec. 205. Hiring Freeze –REVISED

Imposes hiring freeze on full-time state classified civil service employees, except internal transfers of classified employees from one position to another in a department or when freeze will render DCH unable to deliver basic services, cause loss of revenue to the state, result in inability of the state to receive federal funds, and necessitate additional expenditures that exceed vacancy savings. Also, requires an annual report on the number of approved exceptions to the hiring freeze.

Major Boilerplate Changes From FY 2008-09
**Sec. 282. Administrative Costs for Coordinating Agencies and Area Agencies on Aging– DELETE** Requires DCH to establish uniform definitions, standards, and instructions for the classification, allocation, assignment, calculation, recording, and reporting of administrative costs by the following entities: coordinating agencies on substance abuse, Salvation Army Harbor Light program, and their subcontractors; and area agencies on aging and local providers and their subcontractors.
**Sec. 286. Financial Transparency Information- NEW** Directs DCH to provide financial information on its website that details expenditures for the current fiscal year. Prohibits DCH from using funds to create financial transparency information if the use of those funds would affect direct services or DCH's ability to perform its mission.
COMMUNITY MENTAL HEALTH/SUBSTANCE ABUSE SERVICES PROGRAMS **Sec. 407(3). Substance Abuse Prevention, Education, and Treatment Grants– DELETED** Requires DCH to develop a feasibility study on a payment methodology that increases allotments to coordinating agencies that are CMH providers.
STATEPSYCHIATRIC HOSPITALS, CENTERS FOR PERSONS WITH DEVELOPMENTAL DISABILITIES, AND FORENSIC AND PRISON MENTAL HEALTH SERVICES *Sec. 608. Privatization of Food and Custodial Services* – DELETED Requires DCH to evaluate the privatization of food and custodial services at state hospitals.
**Sec. 610. Closure of State Facilities- NEW** Requires DCH to make every effort to minimize job losses due to any reductions in force or closing of facilities by placing those employees displaced by the reduction or closure within other state positions and encouraging CMHSPs to hire those displaced employees.
PUBLIC HEALTH *Sec. 804. HIV and Hepatitis C Program Report* – REVISED Eliminates report requirement for cooperative data sharing program with Corrections regarding prisoners being released who have HIV or Hepatitis C, related to theMichigan prisoner reentry initiative.
**Sec. 1116. Coordinated Regional Perinatal System– DELETED** Directs DCH to convene a discussion regarding a statewide coordinated regional perinatal system, and report byApril 1, 2009, including policy and funding recommendations.
CRIME VICTIM SERVICES COMMISSION **Sec. 1304. Sexual Assault Evidence Collection Procedures– DELETED** Requires DCH to work with State Police and other agencies to ensure that recommended procedures for emergency treatment of victims are followed in the collection of evidence in cases of sexual assault.
OFFICE OF SERVICES TO THE AGING *Sec. 1413. Support of Locally-Based Community Senior Services and Area Agencies on Aging* - REVISED Eliminates legislative intent language from this section, including support of locally-based services and prohibiting area agencies on aging from providing direct services except access services, unless a waiver is obtained.
**Sec. 1416. Support for In-Home Services for Non-Medicaid Seniors- DELETED** Establishes legislative commitment to provide in-home services, resources, and assistance for the frail elderly who are not being served by the Medicaid home- and community-based services waiver program.
MEDICAL SERVICES *Sec. 1678. MIChild/School Lunch Act Eligibility* - NEW Requires a child to be automatically enrolled in the MIChild program if the child meets the income eligibility criteria for free breakfast, lunch, or milk as determined under the Richard B. Russell National School Lunch Act.
*Sec. 1687. Health Insurance Study for Long-Term Care Direct Care Workers* - NEW Requires the Department to conduct a study on the feasibility of a rate enhancement for long-term care direct care workers to fund health insurance for these workers.
*Sec. 1753. Auto Insurer Third Party Liability Information* - DELETED Requires Department, upon passage of legislation, to collect medical expense information from auto insurers to allow the State to make third party liability claims for Medicaid recipients.
*Sec. 1775. Medicaid Managed Long-Term Care Study* - DELETED Requires Department to conduct a study and publish a report regarding the feasibility of providing long-term care services through managed care and to implement two long-term care pilots, one in a county with a population over 750,000 and the other in a county with a population under 250,000.
*Sec. 1776. Outpatient Prospective Payment System (OPPS) Methodology* - DELETED If the OPPS reimbursement methodology is continued, the applied Medicaid reduction factor must be revenue neutral and actuarially sound.
*Sec. 1783. Medicare Advantage Special Needs Plans* - NEW Requires the department to develop rates byJanuary 1, 2010 for the enrollment of individuals who are dually eligible for Medicare and Medicaid into Medicaid health plans if the health plans also maintain a Medicare Advantage Special Needs Plan (SNP) certification. The Department is to report quarterly on the number of enrollees with these plans.
*Sec. 1785. Emergency Department Diagnosis Codes* - DELETED Requires Department to convene a workgroup to develop and maintain a list of hospital reimbursement emergency department diagnosis codes for services provided to Medicaid recipients at a defined triage or stabilization rate; the rate shall be equal to the triage rate in place prior to the implementation of the outpatient prospective payment system; defines the workgroup representation; and that implementation of this policy will occur by January 1, 2009.
*Sec. 1789. Nursing Home Occupancy Ceiling Study* - DELETED Requires Department to study whether the current nursing home ceiling of 85% is adequate and to report its findings byApril 1, 2009.
*Sec. 1793. Preventable Hospitalizations from Nursing Homes* - DELETED Department shall consider the development of a pilot project that focuses on preventable hospitalizations from nursing homes.
*Sec. 1807. Medicaid Reimbursement of Primary Care Physicians Providing Mental Health Services* – DELETED Allows the Department to convene a workgroup and provide a report evaluating the feasibility of establishing a Medicaid payment mechanism for the reimbursement of mental health services by primary care physicians.
**Sec. 1808. Medicaid Ambulance Quality Assurance Assessment Program– DELETED** Requires the Department to implement an ambulance quality assurance assessment program with the State to retain a portion of the assessment, if legislation is enacted allowing the ambulance QAAP.
**Sec. 1811. Medicaid Recoveries from Pharmaceutical Drug Damage Suits– NEW** Conditions that if statute is amended to allowMichigan citizens to file product liability suits against pharmaceutical manufacturers related to defective drugs, the Department shall make efforts to recover Medicaid funds paid for in the treatment of injuries resulting from the use of these drugs.
**Sec. 1812. Regional Healthcare Resource Sharing Network Pilot Project– NEW** The Department may allocate funds to support a pilot project to develop a regional healthcare resource sharing network.
*Sec. 1813. Offset Prior Year Executive Order Hospital Payment Reductions* – NEW The Department shall allocate $12.3 million to prevent the implementation of EOs 2001-09, 2002-22 and 2005-07 which reduced certain hospital payments.

Major Boilerplate Changes From FY 2008-09

GENERAL

Sec. 282. Administrative Costs for Coordinating Agencies and Area Agencies on Aging– DELETE

Requires DCH to establish uniform definitions, standards, and instructions for the classification, allocation, assignment, calculation, recording, and reporting of administrative costs by the following entities: coordinating agencies on substance abuse, Salvation Army Harbor Light program, and their subcontractors; and area agencies on aging and local providers and their subcontractors.

Sec. 286. Financial Transparency Information- NEW

Directs DCH to provide financial information on its website that details expenditures for the current fiscal year. Prohibits DCH from using funds to create financial transparency information if the use of those funds would affect direct services or DCH's ability to perform its mission.

COMMUNITY MENTAL HEALTH/SUBSTANCE ABUSE SERVICES PROGRAMS

Sec. 407(3). Substance Abuse Prevention, Education, and Treatment Grants– DELETED

Requires DCH to develop a feasibility study on a payment methodology that increases allotments to coordinating agencies that are CMH providers.

STATEPSYCHIATRIC HOSPITALS, CENTERS FOR PERSONS WITH DEVELOPMENTAL DISABILITIES,

AND FORENSIC AND PRISON MENTAL HEALTH SERVICES

Sec. 608. Privatization of Food and Custodial Services – DELETED

Requires DCH to evaluate the privatization of food and custodial services at state hospitals.

Sec. 610. Closure of State Facilities- NEW

Requires DCH to make every effort to minimize job losses due to any reductions in force or closing of facilities by placing those employees displaced by the reduction or closure within other state positions and encouraging CMHSPs to hire those displaced employees.

PUBLIC HEALTH

Sec. 804. HIV and Hepatitis C Program Report – REVISED

Eliminates report requirement for cooperative data sharing program with Corrections regarding prisoners being released who have HIV or Hepatitis C, related to theMichigan prisoner reentry initiative.

Sec. 1116. Coordinated Regional Perinatal System– DELETED

Directs DCH to convene a discussion regarding a statewide coordinated regional perinatal system, and report byApril 1, 2009, including policy and funding recommendations.

CRIME VICTIM SERVICES COMMISSION

Sec. 1304. Sexual Assault Evidence Collection Procedures– DELETED

Requires DCH to work with State Police and other agencies to ensure that recommended procedures for emergency treatment of victims are followed in the collection of evidence in cases of sexual assault.

OFFICE OF SERVICES TO THE AGING

Sec. 1413. Support of Locally-Based Community Senior Services and Area Agencies on Aging - REVISED

Eliminates legislative intent language from this section, including support of locally-based services and prohibiting area agencies on aging from providing direct services except access services, unless a waiver is obtained.

Sec. 1416. Support for In-Home Services for Non-Medicaid Seniors- DELETED

Establishes legislative commitment to provide in-home services, resources, and assistance for the frail elderly who are not being served by the Medicaid home- and community-based services waiver program.

MEDICAL SERVICES

Sec. 1678. MIChild/School Lunch Act Eligibility - NEW

Requires a child to be automatically enrolled in the MIChild program if the child meets the income eligibility criteria for free breakfast, lunch, or milk as determined under the Richard B. Russell National School Lunch Act.

Sec. 1687. Health Insurance Study for Long-Term Care Direct Care Workers - NEW

Requires the Department to conduct a study on the feasibility of a rate enhancement for long-term care direct care workers to fund health insurance for these workers.

Sec. 1753. Auto Insurer Third Party Liability Information - DELETED

Requires Department, upon passage of legislation, to collect medical expense information from auto insurers to allow the State to make third party liability claims for Medicaid recipients.

Sec. 1775. Medicaid Managed Long-Term Care Study - DELETED

Requires Department to conduct a study and publish a report regarding the feasibility of providing long-term care services through managed care and to implement two long-term care pilots, one in a county with a population over 750,000 and the other in a county with a population under 250,000.

Sec. 1776. Outpatient Prospective Payment System (OPPS) Methodology - DELETED

If the OPPS reimbursement methodology is continued, the applied Medicaid reduction factor must be revenue neutral and actuarially sound.

Sec. 1783. Medicare Advantage Special Needs Plans - NEW

Requires the department to develop rates byJanuary 1, 2010 for the enrollment of individuals who are dually eligible for Medicare and Medicaid into Medicaid health plans if the health plans also maintain a Medicare Advantage Special Needs Plan (SNP) certification. The Department is to report quarterly on the number of enrollees with these plans.

Sec. 1785. Emergency Department Diagnosis Codes - DELETED

Requires Department to convene a workgroup to develop and maintain a list of hospital reimbursement emergency department diagnosis codes for services provided to Medicaid recipients at a defined triage or stabilization rate; the rate shall be equal to the triage rate in place prior to the implementation of the outpatient prospective payment system; defines the workgroup representation; and that implementation of this policy will occur by January 1, 2009.

Sec. 1789. Nursing Home Occupancy Ceiling Study - DELETED

Requires Department to study whether the current nursing home ceiling of 85% is adequate and to report its findings byApril 1, 2009.

Sec. 1793. Preventable Hospitalizations from Nursing Homes - DELETED

Department shall consider the development of a pilot project that focuses on preventable hospitalizations from nursing homes.

Sec. 1807. Medicaid Reimbursement of Primary Care Physicians Providing Mental Health Services – DELETED

Allows the Department to convene a workgroup and provide a report evaluating the feasibility of establishing a Medicaid payment mechanism for the reimbursement of mental health services by primary care physicians.

Sec. 1808. Medicaid Ambulance Quality Assurance Assessment Program– DELETED

Requires the Department to implement an ambulance quality assurance assessment program with the State to retain a portion of the assessment, if legislation is enacted allowing the ambulance QAAP.

Sec. 1811. Medicaid Recoveries from Pharmaceutical Drug Damage Suits– NEW

Conditions that if statute is amended to allowMichigan citizens to file product liability suits against pharmaceutical manufacturers related to defective drugs, the Department shall make efforts to recover Medicaid funds paid for in the treatment of injuries resulting from the use of these drugs.

Sec. 1812. Regional Healthcare Resource Sharing Network Pilot Project– NEW

The Department may allocate funds to support a pilot project to develop a regional healthcare resource sharing network.

Sec. 1813. Offset Prior Year Executive Order Hospital Payment Reductions – NEW

The Department shall allocate $12.3 million to prevent the implementation of EOs 2001-09, 2002-22 and 2005-07 which reduced certain hospital payments.