HOUSE BILL No. 6132


     November 9, 2000, Introduced by Rep. Reeves and referred to the Committee on Insurance and Financial Services.


        A bill to amend 1939 PA 280, entitled

   "The social welfare act,"

   by amending section 109 (MCL 400.109), as amended by 2000 PA

   168.

               THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

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

 2
      vided under this act:

 3
           (a) Hospital services that an eligible person may receive

 4
      consist of medical, surgical, or obstetrical care, together with

 5
      necessary drugs, X-rays, physical therapy, prosthesis, transpor-

 6
      tation, and nursing care incident to the medical, surgical, or

 7
      obstetrical care.  The period of inpatient hospital service shall

 8
      be the minimum period necessary in this type of facility for the

 9
      proper care and treatment of the individual.  Necessary

10
      hospitalization to provide dental care shall be provided if


   06812'00                                                 LTB
                                              2

 1
      certified by the attending dentist with the approval of the

 2
      department of community health.  A person who is receiving medi-

 3
      cal treatment as an inpatient because of a diagnosis of tubercu-

 4
      losis or mental disease may receive service under this section,

 5
      notwithstanding the mental health code, 1974 PA 258, MCL 330.1001

 6
      to 330.2106, and 1925 PA 177, MCL 332.151 to 332.164.  The

 7
      department of community health shall pay for hospital services

 8
       in accordance with  ACCORDING TO the state plan for medical

 9
      assistance adopted  pursuant to  UNDER section 10 and approved by

10
      the United States department of health and human services.

11
           (b) An eligible person may receive physician services autho-

12
      rized by the department of community health.  The service may be

13
      furnished in the office of the physician, the eligible person's

14
      home, a medical institution, or elsewhere in case of emergency.

15
      A physician shall be paid a reasonable charge for the service

16
      rendered.  Reasonable charges shall be determined by the depart-

17
      ment of community health and shall not be more than  those 

18
      CHARGES paid in this state for services rendered under title

19
      XVIII.

20
           (c) An eligible person may receive nursing home services in

21
      a state licensed nursing home, a medical care facility, or other

22
      facility or identifiable unit of that facility, certified by the

23
      appropriate authority as meeting established standards for a

24
      nursing home under the laws and rules of this state and the

25
      United States department of health and human services, to the

26
      extent found necessary by the attending physician, dentist, or

27
      certified Christian Science practitioner.  An eligible person may



   06812'00                                    3

 1
      receive nursing services in a short-term nursing care program

 2
      established under section 22210 of the public health code, 1978

 3
      PA 368, MCL 333.22210, to the extent found necessary by the

 4
      attending physician when the combined length of stay in the acute

 5
      care bed and short-term nursing care bed exceeds the average

 6
      length of stay for medicaid hospital diagnostic related group

 7
      reimbursement.  The department of community health shall not make

 8
      a final payment  pursuant to  UNDER title XIX for benefits avail-

 9
      able under title XVIII without documentation that title XVIII

10
      claims have been filed and denied.  The department of community

11
      health shall pay for nursing home services  in accordance with 

12
      ACCORDING TO the state plan for medical assistance adopted

13
       pursuant to  UNDER section 10 and approved by the United States

14
      department of health and human services.  A county shall reim-

15
      burse a county maintenance of effort rate determined on an annual

16
      basis for each patient day of medicaid nursing home services pro-

17
      vided to eligible persons in long-term care facilities owned by

18
      the county and licensed to provide nursing home services.  For

19
      purposes of determining rates and costs described in this subdi-

20
      vision, all of the following apply:

21
           (i) For A county owned  facilities  FACILITY with per

22
      patient day updated variable costs exceeding the variable cost

23
      limit for the county facility, county maintenance of effort rate

24
      means 45% of the difference between per patient day updated vari-

25
      able cost and the concomitant nursing home-class variable cost

26
      limit, the quantity offset by the difference between per patient

27
      day updated variable cost and the concomitant variable cost limit



   06812'00
                                   4

 1
      for the county facility.  The county rate shall not be less than

 2
      zero.

 3
           (ii) For A county owned  facilities  FACILITY with per

 4
      patient day updated variable costs not exceeding the variable

 5
      cost limit for the county facility, county maintenance of effort

 6
      rate means 45% of the difference between per patient day updated

 7
      variable cost and the concomitant nursing home class variable

 8
      cost limit.

 9
           (iii) For A county owned  facilities  FACILITY with per

10
      patient day updated variable costs not exceeding the concomitant

11
      nursing home class variable cost limit, the county maintenance of

12
      effort rate  shall equal  EQUALS zero.

13
           (iv) For the purposes of this section:  "per patient day

14
      updated variable costs and the variable cost limit for the county

15
      facility"  shall be  IS determined  pursuant  ACCORDING to
   the

16
      state plan for medical assistance; for A freestanding county

17
       facilities  FACILITY the "nursing home class variable cost

18
      limit"  shall be  IS determined  pursuant  ACCORDING to the
   state

19
      plan for medical assistance and for A hospital attached county

20
       facilities  FACILITY the "nursing class variable cost limit"

21
       shall be  IS determined  pursuant  ACCORDING to the state
   plan

22
      for medical assistance plus $5.00 per patient day; and

23
      "freestanding" and "hospital attached"  shall be  ARE determined

24
       in accordance with  ACCORDING TO the federal regulations.

25
           (v) If the county maintenance of effort rate computed  in

26
      accordance with  ACCORDING TO this section exceeds the county

27
      maintenance of effort rate in effect as of September 30, 1984,



   06812'00
                                   5

 1
      the rate in effect as of September 30, 1984  shall remain 

 2
      REMAINS in effect until a time that the rate computed  in accord-

 3
      ance with  ACCORDING TO this section is less than the

 4
      September 30, 1984 rate.  This limitation remains in effect until

 5
      December 31, 2003.  For each subsequent county fiscal year the

 6
      maintenance of effort  may  SHALL not increase by more than $1.00

 7
      per patient day each year.

 8
           (vi) For A county owned  facilities  FACILITY, reimbursement

 9
      for plant costs will continue to be based on interest expense and

10
      depreciation allowance unless otherwise provided by law.

11
           (d) An eligible person may receive pharmaceutical services

12
      from a licensed pharmacist of the person's choice as prescribed

13
      by a licensed physician or dentist and approved by the department

14
      of community health.  In an emergency, but not routinely, the

15
      person may receive pharmaceutical services rendered personally by

16
      a licensed physician or dentist on the same basis as approved for

17
      pharmacists.

18
           (e) An eligible person may receive other medical and health

19
      services as authorized by the department of community health.

20
           (f) Psychiatric care may also be provided  pursuant 

21
      ACCORDING to the guidelines established by the department of com-

22
      munity health to the extent of appropriations made available by

23
      the legislature for the fiscal year.

24
           (2) The director shall provide notice to the public,  in

25
      accordance with  ACCORDING TO applicable federal regulations, and

26
      shall obtain the approval of the committees on appropriations of

27
      the house of representatives and senate of the legislature of



   06812'00
                                   6

 1
      this state, of any proposed change in the statewide method or

 2
      level of reimbursement for a service, if the proposed change is

 3
      expected to increase or decrease  payments  PAYMENT for that

 4
      service by 1% or more during the 12 months after the effective

 5
      date of the change.

 6
           (3) As used in this act:

 7
           (A) "CERTIFIED NURSE MIDWIFE" MEANS AN INDIVIDUAL LICENSED

 8
      AS A REGISTERED PROFESSIONAL NURSE UNDER PART 172 OF THE PUBLIC

 9
      HEALTH CODE, 1978 PA 368, MCL 333.17201 TO 333.17242, WHO HAS

10
      BEEN ISSUED A SPECIALTY CERTIFICATION IN THE PRACTICE OF NURSE

11
      MIDWIFERY BY THE BOARD OF NURSING UNDER SECTION 17210 OF THE

12
      PUBLIC HEALTH CODE, 1978 PA 368, MCL 333.17210.

13
           (B) "OBSTETRICAL CARE" INCLUDES THE PROVISION OF PRENATAL

14
      AND PREGNANCY RELATED HEALTH CARE PROVIDED BY A CERTIFIED NURSE

15
      MIDWIFE.

16
           (C)  (a)  "Title XVIII" means title XVIII of the social

17
      security act, chapter 531, 49 Stat. 620, 42 U.S.C. 1395 to 1395b,

18
      1395b-2, 1395b-6 to 1395b-7, 1395c to 1395i, 1395i-2 to 1395i-5,

19
      1395j to 1395t, 1395u to 1395w, 1395w-2 to 1395w-4, 1395w-21 to

20
      1395w-28, 1395x to 1395yy, and 1395bbb to 1395ggg.

21
           (D)  (b)  "Title XIX" means title XIX of the social security

22
      act, chapter 531, 49 Stat. 620, 42 U.S.C. 1396 to 1396f, 1396g-1

23
      to 1396r-6, and 1396r-8 to 1396v.

24
           (E)  (c)  "Title XX" means title XX of the social security

25
      act, chapter 531, 49 Stat. 620, 42 U.S.C. 1397 to 1397f.







   06812'00          Final page.                            LTB