HOUSE BILL No. 4404

 

 

March 23, 2017, Introduced by Reps. Singh, Schor, Green, Pagan, Jones, Hertel, Ellison and Lucido and referred to the Committee on Health Policy.

 

      A bill to amend 1978 PA 368, entitled

 

"Public health code,"

 

by amending sections 20106, 20109, 20115, 20142, and 20161 (MCL

 

333.20106, 333.20109, 333.20115, 333.20142, and 333.20161), section

 

20106 as amended by 2015 PA 104, section 20109 as amended by 2015

 

PA 156, section 20115 as amended by 2012 PA 499, and section 20161

 

as amended by 2016 PA 189, and by adding part 218.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

 1        Sec. 20106. (1) "Health facility or agency", except as

 

 2  provided in section 20115, means:

 

 3        (a) An ambulance operation, aircraft transport operation,

 

 4  nontransport prehospital life support operation, or medical first

 

 5  response service.

 

 6        (b) A county medical care facility.

 


 1        (c) A freestanding surgical outpatient facility.

 

 2        (d) A health maintenance organization.

 

 3        (e) A home for the aged.

 

 4        (f) A hospital.

 

 5        (g) A nursing home.

 

 6        (h) A hospice.

 

 7        (i) A hospice residence.

 

 8        (j) A facility or agency listed in subdivisions (a) to (g)

 

 9  located in a university, college, or other educational institution.

 

10        (k) A pain management facility.

 

11        (2) "Health maintenance organization" means that term as

 

12  defined in section 3501 of the insurance code of 1956, 1956 PA 218,

 

13  MCL 500.3501.

 

14        (3) "Home for the aged" means a supervised personal care

 

15  facility, other than a hotel, adult foster care facility, hospital,

 

16  nursing home, or county medical care facility that provides room,

 

17  board, and supervised personal care to 21 or more unrelated,

 

18  nontransient, individuals 60 years of age or older. Home for the

 

19  aged includes a supervised personal care facility for 20 or fewer

 

20  individuals 60 years of age or older if the facility is operated in

 

21  conjunction with and as a distinct part of a licensed nursing home.

 

22  Home for the aged does not include an area excluded from this

 

23  definition by section 17(3) of the continuing care community

 

24  disclosure act, 2014 PA 448, MCL 554.917.

 

25        (4) "Hospice" means a health care program that provides a

 

26  coordinated set of services rendered at home or in outpatient or

 

27  institutional settings for individuals suffering from a disease or


 1  condition with a terminal prognosis.

 

 2        (5) "Hospital" means a facility offering inpatient, overnight

 

 3  care, and services for observation, diagnosis, and active treatment

 

 4  of an individual with a medical, surgical, obstetric, chronic, or

 

 5  rehabilitative condition requiring the daily direction or

 

 6  supervision of a physician. Hospital does not include a mental

 

 7  health hospital licensed or operated by the department of community

 

 8  health and human services or a hospital operated by the department

 

 9  of corrections.

 

10        (6) "Hospital long-term care unit" means a nursing care

 

11  facility, owned and operated by and as part of a hospital,

 

12  providing organized nursing care and medical treatment to 7 or more

 

13  unrelated individuals suffering or recovering from illness, injury,

 

14  or infirmity.

 

15        Sec. 20109. (1) "Nursing home" means a nursing care facility,

 

16  including a county medical care facility, that provides organized

 

17  nursing care and medical treatment to 7 or more unrelated

 

18  individuals suffering or recovering from illness, injury, or

 

19  infirmity. As used in this subsection, "medical treatment" includes

 

20  treatment by an employee or independent contractor of the nursing

 

21  home who is an individual licensed or otherwise authorized to

 

22  engage in a health profession under part 170 or 175. Nursing home

 

23  does not include any of the following:

 

24        (a) A unit in a state correctional facility.

 

25        (b) A hospital.

 

26        (c) A veterans facility created under 1885 PA 152, MCL 36.1 to

 

27  36.12.


 1        (d) A hospice residence that is licensed under this article.

 

 2        (e) A hospice that is certified under 42 CFR 418.100.

 

 3        (2) "Pain management facility" means that term as defined in

 

 4  section 21805.

 

 5        (3) (2) "Person" means that term as defined in section 1106 or

 

 6  a governmental entity.

 

 7        (4) (3) "Public member" means a member of the general public

 

 8  who is not a provider; who does not have an ownership interest in

 

 9  or contractual relationship with a nursing home other than a

 

10  resident contract; who does not have a contractual relationship

 

11  with a person who does substantial business with a nursing home;

 

12  and who is not the spouse, parent, sibling, or child of an

 

13  individual who has an ownership interest in or contractual

 

14  relationship with a nursing home, other than a resident contract.

 

15        (5) (4) "Skilled nursing facility" means a hospital long-term

 

16  care unit, nursing home, county medical care facility, or other

 

17  nursing care facility, or a distinct part thereof, certified by the

 

18  department to provide skilled nursing care.

 

19        Sec. 20115. (1) The department may promulgate rules to further

 

20  define the term "health facility or agency" and the definition of a

 

21  health facility or agency listed in section 20106 as required to

 

22  implement this article. The department may define a specific

 

23  organization as a health facility or agency for the sole purpose of

 

24  certification authorized under this article. For purpose of

 

25  certification only, an organization defined in section 20106(5),

 

26  20108(1), or 20109(4) 20109(5) is considered a health facility or

 

27  agency. The term "health facility or agency" does not mean a


 1  visiting nurse service or home aide service conducted by and for

 

 2  the adherents of a church or religious denomination for the purpose

 

 3  of providing service for those who depend upon spiritual means

 

 4  through prayer alone for healing.

 

 5        (2) The department shall promulgate rules to differentiate a

 

 6  freestanding surgical outpatient facility from a private office of

 

 7  a physician, dentist, podiatrist, or other health professional. The

 

 8  department shall specify in the rules that a facility including,

 

 9  but not limited to, a private practice office described in this

 

10  subsection must be licensed under this article as a freestanding

 

11  surgical outpatient facility if that facility performs 120 or more

 

12  surgical abortions per year and publicly advertises outpatient

 

13  abortion services.

 

14        (3) The department shall promulgate rules that in effect

 

15  republish R 325.3826, R 325.3832, R 325.3835, R 325.3857, R

 

16  325.3866, R 325.3867, and R 325.3868 of the Michigan administrative

 

17  code, Administrative Code, but shall include in the rules standards

 

18  for a freestanding surgical outpatient facility or private practice

 

19  office that performs 120 or more surgical abortions per year and

 

20  that publicly advertises outpatient abortion services. The

 

21  department shall assure ensure that the standards are consistent

 

22  with the most recent United States supreme court Supreme Court

 

23  decisions regarding state regulation of abortions.

 

24        (4) Subject to section 20145 and part 222, the department may

 

25  modify or waive 1 or more of the rules contained in R 325.3801 to R

 

26  325.3877 of the Michigan administrative code Administrative Code

 

27  regarding construction or equipment standards, or both, for a


 1  freestanding surgical outpatient facility that performs 120 or more

 

 2  surgical abortions per year and that publicly advertises outpatient

 

 3  abortion services, if both of the following conditions are met:

 

 4        (a) The freestanding surgical outpatient facility was in

 

 5  existence and operating on December 31, 2012.

 

 6        (b) The department makes a determination that the existing

 

 7  construction or equipment conditions, or both, within the

 

 8  freestanding surgical outpatient facility are adequate to preserve

 

 9  the health and safety of the patients and employees of the

 

10  freestanding surgical outpatient facility or that the construction

 

11  or equipment conditions, or both, can be modified to adequately

 

12  preserve the health and safety of the patients and employees of the

 

13  freestanding surgical outpatient facility without meeting the

 

14  specific requirements of the rules.

 

15        (5) By January 15 each year, the department of community

 

16  health and human services shall provide the following information

 

17  to the department: of licensing and regulatory affairs:

 

18        (a) From data received by the department of community health

 

19  and human services through the abortion reporting requirements of

 

20  section 2835, all of the following:

 

21        (i) The name and location of each facility at which abortions

 

22  were performed during the immediately preceding calendar year.

 

23        (ii) The total number of abortions performed at that facility

 

24  location during the immediately preceding calendar year.

 

25        (iii) The total number of surgical abortions performed at that

 

26  facility location during the immediately preceding calendar year.

 

27        (b) Whether a facility at which surgical abortions were


 1  performed in the immediately preceding calendar year publicly

 

 2  advertises abortion services.

 

 3        (6) As used in this section:

 

 4        (a) "Abortion" means that term as defined in section 17015.

 

 5        (b) "Publicly advertises" means to advertise using directory

 

 6  or internet advertising including yellow pages, white pages, banner

 

 7  advertising, or electronic publishing.

 

 8        (c) "Surgical abortion" means an abortion that is not a

 

 9  medical abortion as that term is defined in section 17017.

 

10        Sec. 20142. (1) A health facility or agency shall apply for

 

11  licensure or certification on a form authorized and provided by the

 

12  department. The application shall must include attachments,

 

13  additional data, and information required under this article and by

 

14  the department.

 

15        (2) An applicant shall certify the accuracy of information

 

16  supplied in the application and supplemental statements.

 

17        (3) An applicant or a licensee under part 213, or 217, or 218

 

18  shall disclose the names, addresses, principal occupations, and

 

19  official positions of all persons who have an ownership interest in

 

20  the health facility or agency. If the health facility or agency is

 

21  located on or in leased real estate, the applicant or licensee

 

22  shall disclose the name of the lessor and any direct or indirect

 

23  interest the applicant or licensee has in the lease other than as

 

24  lessee. A change in ownership shall must be reported to the

 

25  director not less than 15 days before the change occurs, except

 

26  that a person purchasing stock of a company registered pursuant to

 

27  the securities exchange act of 1934, 15 U.S.C. 78a to 78kk, USC 78a


 1  to 78qq, is exempt from disclosing ownership in the facility. A

 

 2  person required to file a beneficial ownership report pursuant to

 

 3  section 16(a) 78p of the securities exchange act of 1934, 15 U.S.C.

 

 4  78p USC 78p, shall file with the department information relating to

 

 5  securities ownership required by the department rule or order. An

 

 6  applicant or licensee proposing a sale of a nursing home to another

 

 7  person shall provide the department with written, advance notice of

 

 8  the proposed sale. The applicant or licensee and the other parties

 

 9  to the sale shall arrange to meet with specified department

 

10  representatives and shall obtain before the sale a determination of

 

11  the items of noncompliance with applicable law and rules which

 

12  shall that must be corrected. The department shall notify the

 

13  respective parties of the items of noncompliance prior to before

 

14  the change of ownership and shall indicate that the items of

 

15  noncompliance must be corrected as a condition of issuance of a

 

16  license to the new owner. The department may accept reports filed

 

17  with the securities and exchange commission United States

 

18  Securities and Exchange Commission relating to the filings. A

 

19  person who violates this subsection is guilty of a misdemeanor,

 

20  punishable by a fine of not more than $1,000.00 for each violation.

 

21        (4) An applicant or licensee under part 217 shall disclose the

 

22  names and business addresses of suppliers who furnish goods or

 

23  services to an individual nursing home or a group of nursing homes

 

24  under common ownership, the aggregate charges for which exceed

 

25  $5,000.00 in a 12-month period which that includes a month in a

 

26  nursing home's current fiscal year. An applicant or licensee shall

 

27  disclose the names, addresses, principal occupations, and official


 1  positions of all persons individuals who have an ownership interest

 

 2  in a business which that furnishes goods or services to an

 

 3  individual nursing home or to a group of nursing homes under common

 

 4  ownership, if both of the following apply:

 

 5        (a) The person, individual, or the person's individual's

 

 6  spouse, parent, sibling, or child, has an ownership interest in the

 

 7  nursing home purchasing the goods or services.

 

 8        (b) The aggregate charges for the goods or services purchased

 

 9  exceeds $5,000.00 in a 12-month period which that includes a month

 

10  in the nursing home's current fiscal year.

 

11        (5) An applicant or licensee who makes a false statement in an

 

12  application or statement required by the department pursuant to

 

13  under this article is guilty of a felony , punishable by

 

14  imprisonment for not more than 4 years , or a fine of not more than

 

15  $30,000.00, or both.

 

16        Sec. 20161. (1) The department shall assess fees and other

 

17  assessments for health facility and agency licenses and

 

18  certificates of need on an annual basis as provided in this

 

19  article. Until October 1, 2019, except as otherwise provided in

 

20  this article, fees and assessments shall must be paid as provided

 

21  in the following schedule:

 

 

22

     (a) Freestanding surgical

23

outpatient facilities................$500.00 per facility

24

                                     license.

25

     (b) Hospitals...................$500.00 per facility

26

                                     license and $10.00 per


 1

                                     licensed bed.

 2

     (c) Nursing homes, county

 3

medical care facilities, and

 4

hospital long-term care units........$500.00 per facility

 5

                                     license and $3.00 per

 6

                                     licensed bed over 100

 7

                                     licensed beds.

 8

     (d) Homes for the aged..........$6.27 per licensed bed.

 9

     (e) Hospice agencies............$500.00 per agency license.

10

     (f) Hospice residences..........$500.00 per facility

11

                                     license and $5.00 per

12

                                     licensed bed.

13

     (g) Pain management facilities..$1,000.00 per facility

14

                                     license.

15

     (h) (g) Subject to subsection

16

(11), quality assurance assessment

17

for nursing homes and hospital

18

long-term care units.................an amount resulting

19

                                     in not more than 6%

20

                                     of total industry

21

                                     revenues.

22

     (i) (h) Subject to subsection

23

(12), quality assurance assessment

24

for hospitals........................at a fixed or variable

25

                                     rate that generates


 1

                                     funds not more than the

 2

                                     maximum allowable under

 3

                                     the federal matching

 4

                                     requirements, after

 5

                                     consideration for the

 6

                                     amounts in subsection

 7

                                     (12)(a) and (i).

 8

     (j) (i) Initial licensure

 9

application fee for subdivisions

10

(a), (b), (c), (e), and (f), and (g)..$2,000.00 per initial

11

                                     license.

 

 

12        (2) If a hospital requests the department to conduct a

 

13  certification survey for purposes of title XVIII or title XIX, of

 

14  the social security act, the hospital shall pay a license fee

 

15  surcharge of $23.00 per bed. As used in this subsection, "title

 

16  XVIII" and "title XIX" mean those terms as defined in section

 

17  20155.

 

18        (3) All of the following apply to the assessment under this

 

19  section for certificates of need:

 

20        (a) The base fee for a certificate of need is $3,000.00 for

 

21  each application. For a project requiring a projected capital

 

22  expenditure of more than $500,000.00 but less than $4,000,000.00,

 

23  an additional fee of $5,000.00 is added to the base fee. For a

 

24  project requiring a projected capital expenditure of $4,000,000.00

 

25  or more but less than $10,000,000.00, an additional fee of

 

26  $8,000.00 is added to the base fee. For a project requiring a

 

27  projected capital expenditure of $10,000,000.00 or more, an


 1  additional fee of $12,000.00 is added to the base fee.

 

 2        (b) In addition to the fees under subdivision (a), the

 

 3  applicant shall pay $3,000.00 for any designated complex project

 

 4  including a project scheduled for comparative review or for a

 

 5  consolidated licensed health facility application for acquisition

 

 6  or replacement.

 

 7        (c) If required by the department, the applicant shall pay

 

 8  $1,000.00 for a certificate of need application that receives

 

 9  expedited processing at the request of the applicant.

 

10        (d) The department shall charge a fee of $500.00 to review any

 

11  letter of intent requesting or resulting in a waiver from

 

12  certificate of need review and any amendment request to an approved

 

13  certificate of need.

 

14        (e) A health facility or agency that offers certificate of

 

15  need covered clinical services shall pay $100.00 for each

 

16  certificate of need approved covered clinical service as part of

 

17  the certificate of need annual survey at the time of submission of

 

18  the survey data.

 

19        (f) The department shall use the fees collected under this

 

20  subsection only to fund the certificate of need program. Funds

 

21  remaining in the certificate of need program at the end of the

 

22  fiscal year shall do not lapse to the general fund but shall remain

 

23  available to fund the certificate of need program in subsequent

 

24  years.

 

25        (4) A license issued under this part is effective for no

 

26  longer than 1 year after the date of issuance.

 

27        (5) Fees described in this section are payable to the


 1  department at the time an application for a license, permit, or

 

 2  certificate is submitted. If an application for a license, permit,

 

 3  or certificate is denied or if a license, permit, or certificate is

 

 4  revoked before its expiration date, the department shall not refund

 

 5  fees paid to the department.

 

 6        (6) The fee for a provisional license or temporary permit is

 

 7  the same as for a license. A license may be issued at the

 

 8  expiration date of a temporary permit without an additional fee for

 

 9  the balance of the period for which the fee was paid if the

 

10  requirements for licensure are met.

 

11        (7) The cost of licensure activities shall must be supported

 

12  by license fees.

 

13        (8) The application fee for a waiver under section 21564 is

 

14  $200.00 plus $40.00 per hour for the professional services and

 

15  travel expenses directly related to processing the application. The

 

16  travel expenses shall be are calculated in accordance with the

 

17  state standardized travel regulations of the department of

 

18  technology, management, and budget in effect at the time of the

 

19  travel.

 

20        (9) An applicant for licensure or renewal of licensure under

 

21  part 209 shall pay the applicable fees set forth in part 209.

 

22        (10) Except as otherwise provided in this section, the

 

23  department shall deposit the fees and assessments collected under

 

24  this section shall be deposited in the state treasury, to the

 

25  credit of the general fund. The department may use the unreserved

 

26  fund balance in fees and assessments for the criminal history check

 

27  program required under this article.


 1        (11) The quality assurance assessment collected under

 

 2  subsection (1)(g) (1)(h) and all federal matching funds attributed

 

 3  to that assessment shall must be used only for the following

 

 4  purposes and under the following specific circumstances:

 

 5        (a) The quality assurance assessment and all federal matching

 

 6  funds attributed to that assessment shall must be used to finance

 

 7  Medicaid nursing home reimbursement payments. Only licensed nursing

 

 8  homes and hospital long-term care units that are assessed the

 

 9  quality assurance assessment and participate in the Medicaid

 

10  program are eligible for increased per diem Medicaid reimbursement

 

11  rates under this subdivision. A nursing home or long-term care unit

 

12  that is assessed the quality assurance assessment and that does not

 

13  pay the assessment required under subsection (1)(g) (1)(h) in

 

14  accordance with subdivision (c)(i) or in accordance with a written

 

15  payment agreement with this state shall not receive the increased

 

16  per diem Medicaid reimbursement rates under this subdivision until

 

17  all of its outstanding quality assurance assessments and any

 

18  penalties assessed under subdivision (f) have been paid in full.

 

19  This subdivision does not authorize or require the department to

 

20  overspend tax revenue in violation of the management and budget

 

21  act, 1984 PA 431, MCL 18.1101 to 18.1594.

 

22        (b) Except as otherwise provided under subdivision (c),

 

23  beginning October 1, 2005, the quality assurance assessment is

 

24  based on the total number of patient days of care each nursing home

 

25  and hospital long-term care unit provided to non-Medicare patients

 

26  within the immediately preceding year, shall must be assessed at a

 

27  uniform rate on October 1, 2005 and subsequently on October 1 of


 1  each following year, and is payable on a quarterly basis, with the

 

 2  first payment due 90 days after the date the assessment is

 

 3  assessed.

 

 4        (c) Within 30 days after September 30, 2005, the department

 

 5  shall submit an application to the federal Centers for Medicare and

 

 6  Medicaid Services to request a waiver according to 42 CFR 433.68(e)

 

 7  to implement this subdivision as follows:

 

 8        (i) If the waiver is approved, the quality assurance

 

 9  assessment rate for a nursing home or hospital long-term care unit

 

10  with less than 40 licensed beds or with the maximum number, or more

 

11  than the maximum number, of licensed beds necessary to secure

 

12  federal approval of the application is $2.00 per non-Medicare

 

13  patient day of care provided within the immediately preceding year

 

14  or a rate as otherwise altered on the application for the waiver to

 

15  obtain federal approval. If the waiver is approved, for all other

 

16  nursing homes and long-term care units the quality assurance

 

17  assessment rate is to be calculated by dividing the total statewide

 

18  maximum allowable assessment permitted under subsection (1)(g)

 

19  (1)(h) less the total amount to be paid by the nursing homes and

 

20  long-term care units with less than 40 licensed beds or with the

 

21  maximum number, or more than the maximum number, of licensed beds

 

22  necessary to secure federal approval of the application by the

 

23  total number of non-Medicare patient days of care provided within

 

24  the immediately preceding year by those nursing homes and long-term

 

25  care units with more than 39 licensed beds, but less than the

 

26  maximum number of licensed beds necessary to secure federal

 

27  approval. The quality assurance assessment, as provided under this


 1  subparagraph, shall must be assessed in the first quarter after

 

 2  federal approval of the waiver and shall must be subsequently

 

 3  assessed on October 1 of each following year, and is payable on a

 

 4  quarterly basis, with the first payment due 90 days after the date

 

 5  the assessment is assessed.

 

 6        (ii) If the waiver is approved, continuing care retirement

 

 7  centers are exempt from the quality assurance assessment if the

 

 8  continuing care retirement center requires each center resident to

 

 9  provide an initial life interest payment of $150,000.00, on

 

10  average, per resident to ensure payment for that resident's

 

11  residency and services and the continuing care retirement center

 

12  utilizes all of the initial life interest payment before the

 

13  resident becomes eligible for medical assistance under the state's

 

14  Medicaid plan. As used in this subparagraph, "continuing care

 

15  retirement center" means a nursing care facility that provides

 

16  independent living services, assisted living services, and nursing

 

17  care and medical treatment services, in a campus-like setting that

 

18  has shared facilities or common areas, or both.

 

19        (d) Beginning May 10, 2002, the department shall increase the

 

20  per diem nursing home Medicaid reimbursement rates for the balance

 

21  of that year. For each subsequent year in which the quality

 

22  assurance assessment is assessed and collected, the department

 

23  shall maintain the Medicaid nursing home reimbursement payment

 

24  increase financed by the quality assurance assessment.

 

25        (e) The department shall implement this section in a manner

 

26  that complies with federal requirements necessary to ensure that

 

27  the quality assurance assessment qualifies for federal matching


 1  funds.

 

 2        (f) If a nursing home or a hospital long-term care unit fails

 

 3  to pay the assessment required by subsection (1)(g), (1)(h), the

 

 4  department may assess the nursing home or hospital long-term care

 

 5  unit a penalty of 5% of the assessment for each month that the

 

 6  assessment and penalty are not paid up to a maximum of 50% of the

 

 7  assessment. The department may also refer for collection to the

 

 8  department of treasury past due amounts consistent with section 13

 

 9  of 1941 PA 122, MCL 205.13.

 

10        (g) The Medicaid nursing home quality assurance assessment

 

11  fund is established in the state treasury. The department shall

 

12  deposit the revenue raised through the quality assurance assessment

 

13  with the state treasurer for deposit in the Medicaid nursing home

 

14  quality assurance assessment fund.

 

15        (h) The department shall not implement this subsection in a

 

16  manner that conflicts with 42 USC 1396b(w).

 

17        (i) The department shall prorate the quality assurance

 

18  assessment collected under subsection (1)(g) shall be prorated

 

19  (1)(h) on a quarterly basis for any licensed beds added to or

 

20  subtracted from a nursing home or hospital long-term care unit

 

21  since the immediately preceding July 1. Any adjustments in payments

 

22  are due on the next quarterly installment due date.

 

23        (j) In each fiscal year governed by this subsection, Medicaid

 

24  reimbursement rates shall must not be reduced below the Medicaid

 

25  reimbursement rates in effect on April 1, 2002 as a direct result

 

26  of the quality assurance assessment collected under subsection

 

27  (1)(g).(1)(h).


 1        (k) The state retention amount of the quality assurance

 

 2  assessment collected under subsection (1)(g) shall be (1)(h) is

 

 3  equal to 13.2% of the federal funds generated by the nursing homes

 

 4  and hospital long-term care units quality assurance assessment,

 

 5  including the state retention amount. The state retention amount

 

 6  shall must be appropriated each fiscal year to the department to

 

 7  support Medicaid expenditures for long-term care services. These

 

 8  funds shall must offset an identical amount of general fund/general

 

 9  purpose revenue originally appropriated for that purpose.

 

10        (l) Beginning October 1, 2019, the department shall not assess

 

11  or collect the quality assurance assessment or apply for federal

 

12  matching funds. The department shall not assess or collect the

 

13  quality assurance assessment collected under subsection (1)(g)

 

14  shall not be assessed or collected (1)(h) after September 30, 2011

 

15  if the quality assurance assessment is not eligible for federal

 

16  matching funds. Any portion of the quality assurance assessment

 

17  collected from a nursing home or hospital long-term care unit that

 

18  is not eligible for federal matching funds shall must be returned

 

19  to the nursing home or hospital long-term care unit.

 

20        (12) The quality assurance dedication is an earmarked

 

21  assessment collected under subsection (1)(h). (1)(i). That

 

22  assessment and all federal matching funds attributed to that

 

23  assessment shall must be used only for the following purpose and

 

24  under the following specific circumstances:

 

25        (a) To maintain the increased Medicaid reimbursement rate

 

26  increases as provided for in subdivision (c).

 

27        (b) The quality assurance assessment shall must be assessed on


 1  all net patient revenue, before deduction of expenses, less

 

 2  Medicare net revenue, as reported in the most recently available

 

 3  Medicare cost report and is payable on a quarterly basis, with the

 

 4  first payment due 90 days after the date the assessment is

 

 5  assessed. As used in this subdivision, "Medicare net revenue"

 

 6  includes Medicare payments and amounts collected for coinsurance

 

 7  and deductibles.

 

 8        (c) Beginning October 1, 2002, the department shall increase

 

 9  the hospital Medicaid reimbursement rates for the balance of that

 

10  year. For each subsequent year in which the quality assurance

 

11  assessment is assessed and collected, the department shall maintain

 

12  the hospital Medicaid reimbursement rate increase financed by the

 

13  quality assurance assessments.

 

14        (d) The department shall implement this section in a manner

 

15  that complies with federal requirements necessary to ensure that

 

16  the quality assurance assessment qualifies for federal matching

 

17  funds.

 

18        (e) If a hospital fails to pay the assessment required by

 

19  subsection (1)(h), (1)(i), the department may assess the hospital a

 

20  penalty of 5% of the assessment for each month that the assessment

 

21  and penalty are not paid up to a maximum of 50% of the assessment.

 

22  The department may also refer for collection to the department of

 

23  treasury past due amounts consistent with section 13 of 1941 PA

 

24  122, MCL 205.13.

 

25        (f) The hospital quality assurance assessment fund is

 

26  established in the state treasury. The department shall deposit the

 

27  revenue raised through the quality assurance assessment with the


 1  state treasurer for deposit in the hospital quality assurance

 

 2  assessment fund.

 

 3        (g) In each fiscal year governed by this subsection, the

 

 4  department shall only collect and expend the quality assurance

 

 5  assessment shall only be collected and expended if Medicaid

 

 6  hospital inpatient DRG and outpatient reimbursement rates and

 

 7  disproportionate share hospital and graduate medical education

 

 8  payments are not below the level of rates and payments in effect on

 

 9  April 1, 2002 as a direct result of the quality assurance

 

10  assessment collected under subsection (1)(h), (1)(i), except as

 

11  provided in subdivision (h).

 

12        (h) The department shall not assess or collect the quality

 

13  assurance assessment collected under subsection (1)(h) shall not be

 

14  assessed or collected (1)(i) after September 30, 2011 if the

 

15  quality assurance assessment is not eligible for federal matching

 

16  funds. Any portion of the quality assurance assessment collected

 

17  from a hospital that is not eligible for federal matching funds

 

18  shall must be returned to the hospital.

 

19        (i) The state retention amount of the quality assurance

 

20  assessment collected under subsection (1)(h) shall be (1)(i) is

 

21  equal to 13.2% of the federal funds generated by the hospital

 

22  quality assurance assessment, including the state retention amount.

 

23  The 13.2% state retention amount described in this subdivision does

 

24  not apply to the Healthy Michigan plan. In the fiscal year ending

 

25  September 30, 2016, there is a 1-time additional retention amount

 

26  of up to $92,856,100.00. Beginning in the fiscal year ending

 

27  September 30, 2017, and for each fiscal year thereafter, there is a


 1  retention amount of $105,000,000.00 for each fiscal year for the

 

 2  Healthy Michigan plan. The state retention percentage shall must be

 

 3  applied proportionately to each hospital quality assurance

 

 4  assessment program to determine the retention amount for each

 

 5  program. The state retention amount shall must be appropriated each

 

 6  fiscal year to the department to support Medicaid expenditures for

 

 7  hospital services and therapy. These funds shall must offset an

 

 8  identical amount of general fund/general purpose revenue originally

 

 9  appropriated for that purpose. By May 31, 2019, the department, the

 

10  state budget office, and the Michigan Health and Hospital

 

11  Association shall identify an appropriate retention amount for the

 

12  fiscal year ending September 30, 2020 and each fiscal year

 

13  thereafter.

 

14        (13) The department may establish a quality assurance

 

15  assessment to increase ambulance reimbursement as follows:

 

16        (a) The quality assurance assessment authorized under this

 

17  subsection shall must be used to provide reimbursement to Medicaid

 

18  ambulance providers. The department may promulgate rules to provide

 

19  the structure of the quality assurance assessment authorized under

 

20  this subsection and the level of the assessment.

 

21        (b) The department shall implement this subsection in a manner

 

22  that complies with federal requirements necessary to ensure that

 

23  the quality assurance assessment qualifies for federal matching

 

24  funds.

 

25        (c) The total annual collections by the department under this

 

26  subsection shall not exceed $20,000,000.00.

 

27        (d) The department shall not collect the quality assurance


 1  assessment authorized under this subsection shall not be collected

 

 2  after October 1, 2019. The department shall not collect or assess

 

 3  the quality assurance assessment authorized under this subsection

 

 4  shall no longer be collected or assessed if the quality assurance

 

 5  assessment authorized under this subsection is not eligible for

 

 6  federal matching funds.

 

 7        (14) The quality assurance assessment provided for under this

 

 8  section is a tax that is levied on a health facility or agency.

 

 9        (15) As used in this section:

 

10        (a) "Healthy Michigan plan" means the medical assistance plan

 

11  described in section 105d of the social welfare act, 1939 PA 280,

 

12  MCL 400.105d, that has a federal matching fund rate of not less

 

13  than 90%.

 

14        (b) "Medicaid" means that term as defined in section 22207.

 

15                             PART 218

 

16        Sec. 21801. (1) For purposes of this part, the words and

 

17  phrases defined in sections 21803 to 21805 have the meanings

 

18  ascribed to them in those sections.

 

19        (2) In addition, article 1 contains general definitions and

 

20  principles of construction applicable to all articles in this code

 

21  and part 201 contains definitions applicable to this part.

 

22        Sec. 21803. "Controlled substance" means that term as defined

 

23  in section 7104.

 

24        Sec. 21805. (1) "Pain management facility" means a facility

 

25  where a majority of the patients are provided treatment for pain

 

26  through the use of a controlled substance and either the facility's

 

27  primary practice is the treatment of pain or the facility


 1  advertises for any type of pain management service. Pain management

 

 2  facility does not include any of the following:

 

 3        (a) An ambulance operation, aircraft transport operation,

 

 4  nontransport prehospital life support operation, or medical first

 

 5  response service.

 

 6        (b) A county medical care facility.

 

 7        (c) A freestanding surgical outpatient facility.

 

 8        (d) A home for the aged.

 

 9        (e) A hospital.

 

10        (f) A nursing home.

 

11        (g) A hospice.

 

12        (h) A hospice residence.

 

13        (i) A hospital long-term care unit.

 

14        (j) The private office of a physician who is employed by a

 

15  hospital.

 

16        (k) A health facility or agency listed in subdivisions (a) to

 

17  (f) located in a university, college, or other educational

 

18  institution.

 

19        (l) An educational institution to the extent that it provides

 

20  instruction to individuals preparing to practice as a physician,

 

21  podiatrist, dentist, nurse, physician's assistant, optometrist, or

 

22  veterinarian.

 

23        (2) "Pain management service" means medical care specializing

 

24  in managing chronic or acute pain.

 

25        (3) "Physician" means that term as defined in section 17001 or

 

26  17501.

 

27        (4) "Practice of medicine" means that term as defined in


 1  section 17001.

 

 2        (5) "Practice of osteopathic medicine and surgery" means that

 

 3  term as defined in section 17501.

 

 4        Sec. 21807. Notwithstanding section 20141, beginning January

 

 5  1, 2018, a person shall not establish or maintain and operate a

 

 6  pain management facility without having submitted a completed

 

 7  application for licensure as a pain management facility. Beginning

 

 8  June 1, 2018, a person shall not establish or maintain and operate

 

 9  a pain management facility without having obtained a license from

 

10  the department.

 

11        Sec. 21809. (1) Except as otherwise provided in this

 

12  subsection, an individual who is not a physician shall not have an

 

13  ownership interest in a pain management facility. This subsection

 

14  does not apply to a pain management facility established and

 

15  operating in this state on the effective date of the amendatory act

 

16  that added this part unless 1 or more of the following have

 

17  occurred:

 

18        (a) An individual employed by the facility has been sanctioned

 

19  by a disciplinary subcommittee under this act for an act or

 

20  omission involving a controlled substance or has a conviction

 

21  involving a controlled substance.

 

22        (b) The pain management facility has been sanctioned under

 

23  this act for an act or omission involving a controlled substance.

 

24        (2) If 1 of the owners of a pain management facility that is

 

25  established and operating in this state on the effective date of

 

26  the amendatory act that added this part is not a physician, the

 

27  owners of the facility shall designate a physician who is employed


 1  by the pain management facility to meet the requirements of

 

 2  subsection (3).

 

 3        (3) Beginning 1 year after the effective date of the

 

 4  amendatory act that added this part, the owners of a pain

 

 5  management facility shall ensure that a physician designated under

 

 6  subsection (2) or at least 1 physician who has an ownership

 

 7  interest in the pain management facility shall, for at least 50% of

 

 8  the time that a patient is present in the pain management facility,

 

 9  be physically present in the facility and engaging in the practice

 

10  of medicine or the practice of osteopathic medicine and surgery.

 

11  The physicians described in this subsection must also meet 1 of the

 

12  following:

 

13        (a) Hold a subspecialty certification in pain management

 

14  issued by the American Board of Medical Specialties, a certificate

 

15  of added qualification in pain management issued by the American

 

16  Osteopathic Association Bureau of Osteopathic Specialists, or an

 

17  equivalent certification or certificate as determined by the

 

18  department.

 

19        (b) Hold a subspecialty certification in hospice and

 

20  palliative medicine issued by the American Board of Medical

 

21  Specialties, a certificate of added qualification in hospice and

 

22  palliative medicine issued by the American Osteopathic Association

 

23  Bureau of Osteopathic Specialists, or an equivalent certification

 

24  or certificate as determined by the department.

 

25        (c) Hold a board certification issued by the American Board of

 

26  Pain Management, the American Board of Interventional Pain

 

27  Physicians, or an equivalent certification as determined by the


 1  department.

 

 2        (d) Have completed a residency or fellowship in pain

 

 3  management approved by the department or meet any other educational

 

 4  standard as determined by the department.

 

 5        Sec. 21811. (1) Subject to subsection (2), a pain management

 

 6  facility shall accept private health insurance as a source of

 

 7  payment for a good or service provided to a patient.

 

 8        (2) Subject to section 20201, a pain management facility shall

 

 9  only accept payment for a good or service provided to a patient

 

10  from the patient or the patient's insurer, guarantor, spouse,

 

11  parent, legal guardian, or legal custodian.

 

12        Enacting section 1. This amendatory act takes effect 90 days

 

13  after the date it is enacted into law.