HB-4443, As Passed Senate, May 25, 2011

SUBSTITUTE FOR

HOUSE BILL NO. 4443

     A bill to amend 1939 PA 280, entitled

"The social welfare act,"

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

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

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

under this act:

     (a) Hospital services that an eligible individual may receive

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

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

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

or obstetrical care. The period of inpatient hospital service shall

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

proper care and treatment of the individual. Necessary

hospitalization to provide dental care shall be provided if

certified by the attending dentist with the approval of the

department of community health. An individual who is receiving

medical treatment as an inpatient because of a diagnosis of

tuberculosis or mental disease may receive service under this

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

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

department of community health shall pay for hospital services in

accordance with according to the state plan for medical assistance

adopted under section 10 and approved by the United States

department of health and human services.

     (b) An eligible individual may receive physician services

authorized by the department of community health. The service may

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

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

physician shall be paid a reasonable charge for the service

rendered. Reasonable charges shall be determined by the department

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

state for services rendered under title XVIII.

     (c) An eligible individual may receive nursing home services

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

facility or identifiable unit of that facility, certified by the

appropriate authority as meeting established standards for a

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

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

necessary by the attending physician, dentist, or certified

Christian Science practitioner. An eligible individual may receive

nursing services in a short-term nursing an extended care services

program established under section 22210 of the public health code,

1978 PA 368, MCL 333.22210, to the extent found necessary by the

attending physician when the combined length of stay in the acute

care bed and short-term nursing care bed exceeds the average length

of stay for medicaid hospital diagnostic related group

reimbursement. The department of community health shall not make a

final payment pursuant to under title XIX for benefits available

under title XVIII without documentation that title XVIII claims

have been filed and denied. The department of community health

shall pay for nursing home services in accordance with according to

the state plan for medical assistance adopted according to section

10 and approved by the United States department of health and human

services. A county shall reimburse a county maintenance of effort

rate determined on an annual basis for each patient day of medicaid

nursing home services provided to eligible individuals in long-term

care facilities owned by the county and licensed to provide nursing

home services. For purposes of determining rates and costs

described in this subdivision, all of the following apply:

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

variable costs exceeding the variable cost limit for the county

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

difference between per patient day updated variable cost and the

concomitant nursing home-class variable cost limit, the quantity

offset by the difference between per patient day updated variable

cost and the concomitant variable cost limit for the county

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

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

variable costs not exceeding the variable cost limit for the county

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

difference between per patient day updated variable cost and the

concomitant nursing home class variable cost limit.

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

variable costs not exceeding the concomitant nursing home class

variable cost limit, the county maintenance of effort rate shall

equal zero.

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

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

shall be determined pursuant according to the state plan for

medical assistance; for freestanding county facilities the "nursing

home class variable cost limit" shall be determined pursuant

according to the state plan for medical assistance and for hospital

attached county facilities the "nursing class variable cost limit"

shall be determined pursuant to the state plan for medical

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

"hospital attached" shall be determined in accordance with

according to the federal regulations.

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

accordance with under this section exceeds the county maintenance

of effort rate in effect as of September 30, 1984, the rate in

effect as of September 30, 1984 shall remain in effect until a time

that the rate computed in accordance with under this section is

less than the September 30, 1984 rate. This limitation remains in

effect until December 31, 2012. For each subsequent county fiscal

year the maintenance of effort may not increase by more than $1.00

per patient day each year.

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

will continue to be based on interest expense and depreciation

allowance unless otherwise provided by law.

     (d) An eligible individual may receive pharmaceutical services

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

a licensed physician or dentist and approved by the department of

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

individual may receive pharmaceutical services rendered personally

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

for pharmacists.

     (e) An eligible individual may receive other medical and

health services as authorized by the department of community

health.

     (f) Psychiatric care may also be provided pursuant according

to the guidelines established by the department of community health

to the extent of appropriations made available by the legislature

for the fiscal year.

     (g) An eligible individual may receive screening, laboratory

services, diagnostic services, early intervention services, and

treatment for chronic kidney disease pursuant to under guidelines

established by the department of community health. A clinical

laboratory performing a creatinine test on an eligible individual

pursuant to under this subdivision shall include in the lab report

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

report it as a percent of kidney function remaining.

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

accordance with according to applicable federal regulations, and

shall obtain the approval of the committees on appropriations of

the house of representatives and senate of the legislature of this

state, of a proposed change in the statewide method or level of

reimbursement for a service, if the proposed change is expected to

increase or decrease payments for that service by 1% or more during

the 12 months after the effective date of the change.

     (3) As used in this act:

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

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

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

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

1395ggg.42 USC 1395 to 1395kkk-1.

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

USC 1396 to 1396r-6 and 1396r-8 to 1396v.1396w-5.

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

USC 1397 to 1397f.1397m-5.

     Enacting section 1. This amendatory act does not take effect

unless House Bill No. 4441 of the 96th Legislature is enacted into

law.