HOUSE BILL No. 6267 September 17, 2002, Introduced by Reps. Shackleton, Allen, Pumford, DeRossett, Van Woerkom, Meyer, Ehardt, Hager, Stamas and Vander Veen and referred to the Committee on Health Policy. A bill to amend 1978 PA 368, entitled "Public health code," by amending sections 16105, 16106, 16108, 16128, 16163, 16174, 16186, 16261, 16323, 16608, and 20161 (MCL 333.16105, 333.16106, 333.16108, 333.16128, 333.16163, 333.16174, 333.16186, 333.16261, 333.16323, 333.16608, and 333.20161), section 16106 as amended by 1997 PA 153, section 16108 as amended and section 16323 as added by 1993 PA 80, section 16174 as amended by 1998 PA 227, section 16186 as amended by 2002 PA 441, section 16608 as amended by 1990 PA 216, and section 20161 as amended by 2002 PA 303. THE PEOPLE OF THE STATE OF MICHIGAN ENACT: 1 Sec. 16105. (1) "Health occupation" means a health related 2 vocation, calling, occupation, or employment performed by 3individualsAN INDIVIDUAL whether or not THE INDIVIDUAL IS 4 licensed or registered under this article. 07725'02 KAO 2 1 (2) "Health profession" means a vocation, calling, 2 occupation, or employment performed byindividualsAN 3 INDIVIDUAL acting pursuant to a license or registration issued 4 under this article. 5 (3) "Health profession specialty field" means an area of 6 practice established under this articlewhichTHAT is within 7 the scope of activities, functions, and duties of a licensed 8 health profession andwhichTHAT requires advanced education 9 and training beyond that required for initial licensure. 10 (4) "HEALTH PROFESSION SPECIALTY FIELD LICENSE" MEANS AN 11 AUTHORIZATION TO USE A TITLE ISSUED TO A LICENSEE WHO HAS MET 12 QUALIFICATIONS ESTABLISHED BY THE MICHIGAN BOARD OF DENTISTRY FOR 13 REGISTRATION IN A HEALTH PROFESSION SPECIALTY FIELD. AN INDIVID- 14 UAL WHO HOLDS A DENTAL SPECIALTY CERTIFICATION ON THE EFFECTIVE 15 DATE OF THE AMENDATORY ACT THAT ADDED THIS SUBSECTION IS CONSID- 16 ERED TO HOLD A HEALTH PROFESSION SPECIALTY FIELD LICENSE IN THAT 17 SPECIALITY AND MAY OBTAIN RENEWAL OF THE HEALTH PROFESSION SPE- 18 CIALTY FIELD LICENSE IN THAT SPECIALITY ON THE EXPIRATION DATE OF 19 THE SPECIALTY CERTIFICATION. THE HEALTH PROFESSION SPECIALTY 20 FIELD LICENSE IS NOT A LICENSE AS THAT TERM IS DEFINED IN 21 SECTION 16106(2). 22 (5)(4)"Health profession subfield" means an area of 23 practice established under this article which is within the scope 24 of the activities, functions, and duties of a licensed health 25 profession, and requires less comprehensive knowledge and skill 26 than is required to practice the full scope of the health 27 profession. 07725'02 3 1 Sec. 16106. (1) "Incompetence" means a departure from, or 2 failure to conform to, minimal standards of acceptable and pre- 3 vailing practice fortheA health profession, whether or not 4 actual injury to an individual occurs. 5 (2) "License", except as otherwise provided in this subsec- 6 tion, means an authorization issued under this article to prac- 7 tice where practice would otherwise be unlawful. License 8 includes an authorization to use a designated title which use 9 would otherwise be prohibited under this article and may be used 10 to refer to a health profession subfield license, limited 11 license, or a temporary license. For purposes of the definition 12 of "prescriber" contained in section 17708(2) only, license 13 includes an authorization issued under the laws of another state, 14 or the country of Canada,to practice in that state,or IN 15 the country of Canada, where practice would otherwise be unlaw- 16 ful, and is limited to a licensed doctor of medicine, a licensed 17 doctor of osteopathic medicine and surgery, or another licensed 18 health professional acting under the delegation and using, 19 recording, or otherwise indicating the name of the delegating 20 licensed doctor of medicine or licensed doctor of osteopathic 21 medicine and surgery. LICENSE DOES NOT INCLUDE A HEALTH PROFES- 22 SION SPECIALTY FIELD LICENSE. 23 (3) "Licensee", as used in a part that regulates a specific 24 health profession, meansa personAN INDIVIDUAL to whom a 25 license is issued under that part, and as used in this part means 26 each licensee regulated by this article. 07725'02 4 1 (4) "Limitation" means an action by which a board imposes 2 restrictions or conditions, or both, on a license. 3 (5) "Limited license" means a license to which restrictions 4 or conditions, or both, as to scope of practice, place of prac- 5 tice, supervision of practice, duration of licensed status, or 6 type or condition of patient or client served are imposed by a 7 board. 8 Sec. 16108. (1) "Reclassification" means an action by a 9 disciplinary subcommittee by which restrictions or conditions, or 10 both, applicable to a license are added or removed. 11 (2) "Registration" means an authorization only for the use 12 of a designated title which use would otherwise be prohibited 13 under this article.ItREGISTRATION includes specialty certi- 14 fication of a licensee AND A HEALTH PROFESSION SPECIALTY FIELD 15 LICENSE. 16 (3) "Registrant" as used inanyA part that regulates the 17 use of a title means an individual to whom a registration, A SPE- 18 CIALTY CERTIFICATION, or A HEALTH PROFESSION specialty 19certificationFIELD LICENSE is issued under that part, and as 20 used in this part means each registrant regulated by this 21 article. 22 (4) "Reinstatement" means the granting of a license or cer- 23 tificate of registration, with or without limitations or condi- 24 tions, toa personAN INDIVIDUAL whose license or certificate 25 of registration has been suspended or revoked. 07725'02 5 1 (5) "Relicensure" means the granting of a license toa2personAN INDIVIDUAL whose license has lapsed for failure to 3 renew the license within 60 days after the expiration date. 4 (6) "Reregistration" means the granting of a certificate of 5 registration toa personAN INDIVIDUAL whose certificate of 6 registration has lapsed for failure to renew the certificate 7 within 60 days after the expiration date. 8 Sec. 16128. (1) A health profession subfield task force 9 shall be composed of a majority of members licensed in the sub- 10 fields of the health professionwhichTHAT are created by this 11 article and shall include at least 1 licensed member from each of 12 the subfields of the health professionwhichTHAT is created by 13 this article. A health profession subfield task force shall 14 include at least 1 public member and 1 member of that profession 15 who holds a license other than a subfield license in that health 16 profession. 17 (2) A health profession specialty field task force shall be 18 composed of a majority of memberscertifiedREGISTERED in the 19 specialty fields of the health professionwhichTHAT are cre- 20 ated by this article. A health profession specialty field task 21 force shall include at least 1 public member and 1 member of that 22 health profession who is a member of the board. 23 Sec. 16163. A task force shall recommend to the board as 24 to: 25 (a) Determination of standards of education, training, and 26 experience required for practice in a health profession subfield 27 or forcertificationREGISTRATION in a health profession 07725'02 6 1 specialty field, and where appropriate, guidelines for approval 2 of educational programs for the HEALTH PROFESSION subfield or 3 HEALTH PROFESSION specialty field. 4 (b) Qualifications required of applicants for licensure in 5 health profession subfields or forcertificationREGISTRATION 6 in health profession specialty fields. 7 (c) Evaluation of qualifications for initial and continuing 8 licensure of practitioners in health profession subfields or 9 HEALTH PROFESSION specialty fields. The evaluation may cover 10 assessment of educational credentials, work experience and 11 related training, and administration of tests and examinations. 12 (d) Guidelines for utilization of, and standards of practice 13 for, licensees in health profession subfields or REGISTRANTS IN 14 HEALTH PROFESSION specialty fields. 15 Sec. 16174. (1) An individual who is licensed or registered 16 under this article shall meet all of the following requirements: 17 (a) Be 18 or more years of age. 18 (b) Be of good moral character. 19 (c) Have a specific education or experience in the health 20 profession or in a HEALTH PROFESSION subfield or HEALTH 21 PROFESSION specialty field ofaTHE health profession, or 22 training equivalent, or both, as prescribed by this article or 23 rules of a board necessary to promote safe and competent practice 24 and informed consumer choice. 25 (d) Have a working knowledge of the English language as 26 determined in accordance with minimum standards established for 27 that purpose by the department. 07725'02 7 1 (e) Pay the appropriate fees as prescribed in this article. 2 (2) In addition to the requirements of subsection (1), an 3 applicant for licensure, registration,orspecialty 4 certification, OR A HEALTH PROFESSION SPECIALTY SUBFIELD LICENSE 5 under this article shall meet all of the following requirements: 6 (a) Establish that disciplinary proceedings before a similar 7 licensure, registration, or specialty LICENSURE OR SPECIALTY cer- 8 tification board of this or any other state, of the United States 9 military, of the federal government, or of another country are 10 not pending against the applicant. 11 (b) Establish that if sanctions have been imposed against 12 the applicant by a similar licensure, registration, or specialty 13 LICENSURE OR SPECIALTY certification board of this or any other 14 state, of the United States military, of the federal government, 15 or of another country based upon grounds that are substantially 16 similar to those set forth in this article or article 7 or the 17 rules promulgated under this article or article 7, as determined 18 by the board or task force to which the applicant applies, the 19 sanctions are not in force at the time of application. 20 (c) File with the board or task force a written, signed con- 21 sent to the release of information regarding a disciplinary 22 investigation involving the applicant conducted by a similar 23 licensure, registration, or specialty LICENSURE OR SPECIALTY cer- 24 tification board of this or any other state, of the United States 25 military, of the federal government, or of another country. 26 (3) Before licensing, registering,orcertifying, OR 27 ISSUING A HEALTH PROFESSION SPECIALTY FIELD LICENSE TO an 07725'02 8 1 applicant, the board or task force to which the applicant applies 2 may do 1 of the following: 3 (a) Make an independent inquiry into the applicant's compli- 4 ance with the requirements described in subsection (2). If a 5 licensure or registration board or task force determines under 6 subsection (2)(b) that sanctions have been imposed and are in 7 force at the time of application, the board or task force shall 8 not grant a license or registration or specialty certification OR 9 HEALTH PROFESSION SPECIALTY FIELD LICENSE to the applicant. 10 (b) Require the applicant to secure from a national associa- 11 tion or federation of state professional licensing boards certi- 12 fication of compliance with the requirements described in subsec- 13 tion (2). 14 (4) If, after issuing a license, registration,or15 SPECIALTY certification, OR HEALTH PROFESSION SPECIALTY FIELD 16 LICENSE, a board or task force or the department determines that 17 sanctions have been imposed against the licensee or registrant by 18 a similar licensure or registration or SPECIALTY LICENSURE OR 19 SPECIALTY certification board as described in subsection (2)(b), 20 the disciplinary subcommittee may impose appropriate sanctions 21 upon the licensee or registrant. The licensee or registrant may 22 request a show cause hearing before a hearing examiner to demon- 23 strate why the sanctions should not be imposed. 24 (5) An applicant for licensure, registration,orspecialty 25 certification, OR A HEALTH PROFESSION SPECIALTY FIELD LICENSE who 26 is or has been licensed, registered, or certified in a health 07725'02 9 1 profession or specialty by another state or country shall 2 disclose that fact on the application form. 3 Sec. 16186. (1) An individual who is licensed to practice a 4 health profession in another state or, until January 1, 2004, is 5 licensed to practice a health profession in a province of Canada, 6 who is registered in another state, or who holds A HEALTH PROFES- 7 SION SPECIALTY FIELD LICENSE OR specialty certification from 8 another state and who applies for licensure, registration,or9 specialty certification, OR A HEALTH PROFESSION SPECIALTY FIELD 10 LICENSE in this state may be granted an appropriate license or 11 registration or specialty certification OR HEALTH PROFESSION SPE- 12 CIALTY FIELD LICENSE upon satisfying the board or task force to 13 which the applicant applies as to all of the following: 14 (a) The applicant substantially meets the requirements of 15 this article and rules promulgated under this article for licen- 16 sure, registration,orspecialty certification, OR A HEALTH 17 PROFESSION SPECIALTY FIELD LICENSE. 18 (b) Subject to subsection (3), the applicant is licensed, 19 registered, or SPECIALTY certified OR SPECIALTY LICENSED in 20 another state or, until January 1, 2004, is licensed in a prov- 21 ince in Canada that maintains standards substantially equivalent 22 to those of this state. 23 (c) Subject to subsection (3), until January 1, 2004, if the 24 applicant is licensed to practice a health profession in a prov- 25 ince in Canada, the applicant completed the educational require- 26 ments in Canada or in the United States for licensure in Canada 27 or in the United States. 07725'02 10 1 (d) Until January 1, 2004, if the applicant is licensed to 2 practice a health profession in a province in Canada, that the 3 applicant will perform the professional services for which he or 4 she bills in this state, and that any resulting request for third 5 party reimbursement will originate from the applicant's place of 6 employment in this state. 7 (2) Before licensing, registering,orSPECIALTY 8 certifying, OR GRANTING A HEALTH PROFESSION SPECIALTY FIELD 9 LICENSE TO the applicant, the board or task force to which the 10 applicant applies may require the applicant to appear personally 11 before it for an interview to evaluate the applicant's relevant 12 qualifications. 13 (3) For purposes of the amendatory act that added this sub- 14 section, an applicant who is licensed in a province in Canada who 15 meets the requirements of subsection (1)(c) and takes and passes 16 a national examination in this country that is approved by the 17 appropriate Michigan licensing board, or who takes and passes a 18 Canadian national examination approved by the appropriate 19 Michigan licensing board, is considered to have met the require- 20 ments of subsection (1)(b). This subsection does not apply if 21 the department, in consultation with the appropriate licensing 22 board, promulgates a rule disallowing the use of this subsection 23 for an applicant licensed in a province in Canada. 24 Sec. 16261. (1)A personAN INDIVIDUAL who is not 25 licensed or registered under this article shall not use an insig- 26 nia, title, or letter, or a word, letter, or phrase singly or in 27 combination, with or without qualifying words, letters, or 07725'02 11 1 phrases, under a circumstance to induce the belief that the 2personINDIVIDUAL is licensed or registered in this state, is 3 lawfully entitled in this state to engage in the practice of a 4 profession regulated by this article, or is otherwise in compli- 5 ance with this article. 6 (2) An individual shall not announce or hold himself or her- 7 self out to the public as limiting his or her practice to, as 8 being specially qualified in, or as giving particular attention 9 to a health profession specialty field for which a board issues a 10 specialty certification OR A HEALTH PROFESSION SPECIALTY FIELD 11 LICENSE, without first having obtainedaTHE specialty certifi- 12 cation OR HEALTH PROFESSION SPECIALTY field license. 13 Sec. 16323. Fees fora personAN INDIVIDUAL licensed or 14 seeking licensure to practice as a dentist, dental assistant, or 15 dental hygienist under part 166 are as follows: 16 (a) Application processing fees: 17 (i) Dentist.............................................$ 20.00 18 (ii) Dental assistant................................... 10.00 19 (iii) Dental hygienist.................................. 15.00 20 (iv)DentalHEALTH PROFESSION specialty FIELD LICENSE 21 FOR A DENTIST....................................... 20.00 22 (b) Examination fees: 23 (i) Dental assistant's examination, complete............ 70.00 24 (ii) Dental assistant's examination, per part........... 35.00 25 (iii)DentalDENTIST'S HEALTH PROFESSION specialty 26 FIELD LICENSE examination, complete................. 300.00 07725'02 12 1 (iv)DentalDENTIST'S HEALTH PROFESSION specialty 2 FIELD LICENSE examination, per part................ 100.00 3 (c) License fees, per year: 4 (i) Dentist............................................. 90.00 5 (ii) Dental assistant................................... 10.00 6 (iii) Dental hygienist.................................. 20.00 7 (iv)DentalDENTIST'S HEALTH PROFESSION specialty 8 FIELD LICENSE....................................... 15.00 9 (d) Temporary license fees: 10 (i) Dentist............................................. 20.00 11 (ii) Dental assistant................................... 5.00 12 (iii) Dental hygienist.................................. 10.00 13 (e) Limited license fee, per year: 14 (i) Dentist............................................. 25.00 15 (ii) Dental assistant................................... 5.00 16 (iii) Dental hygienist.................................. 10.00 17 (f) Examination review fees: 18 (i) Dental preclinical or DENTIST'S HEALTH PROFESSION 19 specialty FIELD LICENSE............................. 50.00 20 (ii) Dental assistant................................... 20.00 21 Sec. 16608. (1) The board may issue a health profession 22 specialtycertificationFIELD LICENSE to a licensed dentist who 23 has advanced training beyond that required for initial licensure 24 and who has demonstrated competency through examination or other 25 evaluative processes in 1 or more of the following HEALTH 26 PROFESSION specialty fields: prosthodontics, endodontics, oral 27 and maxillofacial surgery, orthodontics, pediatric dentistry, 07725'02 13 1 periodontics, or oral pathology. A LICENSED DENTIST WHO HOLDS A 2 HEALTH PROFESSION SPECIALTY CERTIFICATION IN 1 OR MORE OF THE 3 HEALTH PROFESSION SPECIALTY FIELDS LISTED IN THIS SUBSECTION ON 4 THE EFFECTIVE DATE OF THE AMENDATORY ACT THAT ADDED 5 SUBSECTIONS (3) AND (4) IS CONSIDERED TO HOLD A HEALTH PROFESSION 6 SPECIALTY FIELD LICENSE IN EACH OF THOSE HEALTH PROFESSION SPE- 7 CIALTY FIELDS AND MAY OBTAIN RENEWAL OF EACH HEALTH PROFESSION 8 SPECIALTY FIELD LICENSE ON THE EXPIRATION DATE OF THE SPECIALTY 9 CERTIFICATION. 10 (2) A health profession specialtycertificationFIELD 11 LICENSE issued pursuant to subsection (1) shall be renewed con- 12 currently with the license to practice dentistry. 13 (3) THIS SECTION DOES NOT PROHIBIT A LICENSED DENTIST WHO 14 HAS NOT BEEN ISSUED A HEALTH PROFESSION SPECIALTY FIELD LICENSE 15 UNDER SUBSECTION (1) FROM PERFORMING SERVICES IN 1 OR MORE OF THE 16 HEALTH PROFESSION SPECIALTY FIELDS LISTED IN SUBSECTION (1). 17 (4) FOR PURPOSES OF THE ADMINISTRATION OF THE GENERAL RULES 18 OF THE BOARD OF DENTISTRY IN THE MICHIGAN ADMINISTRATIVE CODE, A 19 REFERENCE TO SPECIALTY CERTIFICATION IS A REFERENCE TO A HEALTH 20 PROFESSION SPECIALTY FIELD LICENSE. 21 Sec. 20161. (1) The department shall assess fees for health 22 facility and agency licenses and certificates of need on an 23 annual basis as provided in this article. Except as otherwise 24 provided in this article, fees shall be paid in accordance with 25 the following fee schedule: 26 (a) Freestanding surgical 27 outpatient facilities............ $ 238.00 per facility. 07725'02 14 1 (b) Hospitals............... $ 8.28 per licensed bed. 2 (c) Nursing homes, county 3 medical care facilities, and hos- 4 pital long-term care units....... $ 2.20 per licensed bed. 5 (d) Homes for the aged...... $ 6.27 per licensed bed. 6 (e) Clinical laboratories... $ 475.00 per laboratory. 7 (f) Hospice residences...... $ 200.00 per license survey; 8 and $20.00 per licensed bed. 9 (g) Subject to 10 subsection (13), quality assur- 11 ance assessment fee for nongov- 12 ernmentally owned nursing 13 homes and hospital long-term care 14 units............................ an amount resulting in not 15 more than a 7% increase in 16 aggregate medicaid nursing home 17 and hospital long-term care 18 unit payment rates, net of 19 assessments, above the rates 20 that were in effect on April 1, 21 2002. 22 (H) SUBJECT TO 23 SUBSECTION (14), QUALITY ASSUR- 24 ANCE ASSESSMENT FEE FOR 25 HOSPITALS........................ AT A RATE THAT GENERATES 26 FUNDS NOT MORE THAN THE MAXIMUM 27 ALLOWABLE UNDER THE FEDERAL 07725'02 15 1 MATCHING REQUIREMENTS, AFTER 2 CONSIDERATION FOR THE AMOUNTS 3 IN SUBSECTION (14)(A) AND (K). 4 (2) If a hospital requests the department to conduct a cer- 5 tification survey for purposes of title XVIII or title XIX of the 6 social security act, the hospital shall pay a license fee sur- 7 charge of $23.00 per bed. As used in this subsection, "title 8 XVIII" and "title XIX" mean those terms as defined in section 9 20155. 10 (3) The base fee for a certificate of need is $750.00 for 11 each application. For a project requiring a projected capital 12 expenditure of more than $150,000.00 but less than $1,500,000.00, 13 an additional fee of $2,000.00 shall be added to the base fee. 14 For a project requiring a projected capital expenditure of 15 $1,500,000.00 or more, an additional fee of $3,500.00 shall be 16 added to the base fee. 17 (4) If licensure is for more than 1 year, the fees described 18 in subsection (1) are multiplied by the number of years for which 19 the license is issued, and the total amount of the fees shall be 20 collected in the year in which the license is issued. 21 (5) Fees described in this section are payable to the 22 department at the time an application for a license, permit, or 23 certificate is submitted. If an application for a license, 24 permit, or certificate is denied or if a license, permit, or cer- 25 tificate is revoked before its expiration date, the department 26 shall not refund fees paid to the department. 07725'02 16 1 (6) The fee for a provisional license or temporary permit is 2 the same as for a license. A license may be issued at the 3 expiration date of a temporary permit without an additional fee 4 for the balance of the period for which the fee was paid if the 5 requirements for licensure are met. 6 (7) The department may charge a fee to recover the cost of 7 purchase or production and distribution of proficiency evaluation 8 samples that are supplied to clinical laboratories pursuant to 9 section 20521(3). 10 (8) In addition to the fees imposed under subsection (1), a 11 clinical laboratory shall submit a fee of $25.00 to the depart- 12 ment for each reissuance during the licensure period of the clin- 13 ical laboratory's license. 14 (9) Except for the licensure of clinical laboratories, not 15 more than half the annual cost of licensure activities as deter- 16 mined by the department shall be provided by license fees. 17 (10) The application fee for a waiver under section 21564 is 18 $200.00 plus $40.00 per hour for the professional services and 19 travel expenses directly related to processing the application. 20 The travel expenses shall be calculated in accordance with the 21 state standardized travel regulations of the department of man- 22 agement and budget in effect at the time of the travel. 23 (11) An applicant for licensure or renewal of licensure 24 under part 209 shall pay the applicable fees set forth in 25 part 209. 07725'02 17 1 (12) The fees collected under this section shall be 2 deposited in the state treasury, to the credit of the general 3 fund. 4 (13) The quality assurance assessment fee collected under 5 subsection (1)(g) and all federal matching funds attributed to 6 that fee shall be used only for the following purposes and under 7 the following specific circumstances: 8 (a) The quality assurance assessment fee and all federal 9 matching funds attributed to that fee shall be used to maintain 10 the increased per diem medicaid reimbursement rate increases as 11 provided for in subdivision (e). Only licensed nursing homes and 12 hospital long-term care units that are assessed the quality 13 assurance assessment fee and participate in the medicaid program 14 are eligible for increased per diem medicaid reimbursement rates 15 under this subdivision. 16 (b) The quality assurance assessment fee shall be imple- 17 mented on the effective date of the amendatory act that added 18 this subsection. 19 (c) The quality assurance assessment fee is based on the 20 number of licensed nursing home beds and the number of licensed 21 hospital long-term care unit beds in existence on July 1 of each 22 year, shall be assessed upon implementation pursuant to 23 subdivision (b) and subsequently on October 1 of each following 24 year, and is payable on a quarterly basis, the first payment due 25 90 days after the date the fee is assessed. 07725'02 18 1 (d) Beginning October 1, 2007, the department shall no 2 longer assess or collect the quality assurance assessment fee or 3 apply for federal matching funds. 4 (e) Upon implementation pursuant to subdivision (b), the 5 department of community health shall increase the per diem nurs- 6 ing home medicaid reimbursement rates for the balance of that 7 year. For each subsequent year in which the quality assurance 8 assessment fee is assessed and collected, the department of com- 9 munity health shall maintain the medicaid nursing home reimburse- 10 ment payment increase financed by the quality assurance assess- 11 ment fee. 12 (f) The department of community health shall implement this 13 section in a manner that complies with federal requirements nec- 14 essary to assure that the quality assurance assessment fee quali- 15 fies for federal matching funds. 16 (g) If a nursing home or a hospital long-term care unit 17 fails to pay the assessment required by subsection (1)(g), the 18 department of community health may assess the nursing home or 19 hospital long-term care unit a penalty of 5% of the assessment 20 for each month that the assessment and penalty are not paid up to 21 a maximum of 50% of the assessment. The department of community 22 health may also refer for collection to the department of trea- 23 sury past due amounts consistent with section 13 of 1941 PA 122, 24 MCL 205.13. 25 (h) The medicaid nursing home quality assurance assessment 26 fund is established in the state treasury. The department of 27 community health shall deposit the revenue raised through the 07725'02 19 1 quality assurance assessment fee with the state treasurer for 2 deposit in the medicaid nursing home quality assurance assessment 3 fund. 4 (i) Neither the department of consumer and industry services 5 nor the department of community health shall implement this sub- 6 section in a manner that conflicts with SECTION 1903(w) OF TITLE 7 XIX OF THE SOCIAL SECURITY ACT, 42 U.S.C.1396b(w)1396b. 8 (j) The quality assurance assessment fee collected under 9 subsection (1)(g) shall be prorated on a quarterly basis for any 10 licensed beds added to or subtracted from a nursing home or hos- 11 pital long-term care unit since the immediately preceding 12 July 1. Any adjustments in payments are due on the next quar- 13 terly installment due date. 14 (k) In each fiscal year governed by this subsection, medi- 15 caid reimbursement rates shall not be reduced below the medicaid 16 reimbursement rates in effect on April 1, 2002 as a direct result 17 of the quality assurance assessment fee collected under 18 subsection (1)(g). 19 (l) The amounts listed in this subdivision are appropriated 20 for the department of community health, subject to the conditions 21 set forth in this subsection, for the fiscal year ending 22 September 30, 2003: 23 MEDICAL SERVICES 24 Long-term care services...................... $ 1,469,003,900 25 Gross appropriation.......................... $ 1,469,003,900 26 Appropriated from: 07725'02 20 1 Federal revenues: 2 Total federal revenues....................... 814,122,200 3 Special revenue funds: 4 Medicaid quality assurance assessment........ 44,829,000 5 Total local revenues......................... 8,445,100 6 State general fund/general purpose........... $ 601,607,600 7 (14) THE QUALITY ASSURANCE DEDICATION IS AN EARMARKED 8 ASSESSMENT FEE COLLECTED UNDER SUBSECTION (1)(H) AND ALL FEDERAL 9 MATCHING FUNDS ATTRIBUTED TO THAT FEE SHALL BE USED ONLY FOR THE 10 FOLLOWING PURPOSES AND UNDER THE FOLLOWING SPECIFIC 11 CIRCUMSTANCES: 12 (A) PART OF THE QUALITY ASSURANCE ASSESSMENT FEE SHALL BE 13 USED TO MAINTAIN THE INCREASED MEDICAID REIMBURSEMENT RATE 14 INCREASES AS PROVIDED FOR IN SUBDIVISION (D). A PORTION OF THE 15 FUNDS COLLECTED FROM THE QUALITY ASSURANCE ASSESSMENT FEE MAY BE 16 USED TO OFFSET ANY REDUCTION TO EXISTING INTERGOVERNMENTAL TRANS- 17 FER PROGRAMS WITH PUBLIC HOSPITALS THAT MAY RESULT FROM IMPLEMEN- 18 TATION OF THE ENHANCED MEDICAID PAYMENTS FINANCED BY THE QUALITY 19 ASSURANCE ASSESSMENT FEE. ANY PORTION OF THE FUNDS COLLECTED 20 FROM THE QUALITY ASSURANCE ASSESSMENT FEE REDUCED BECAUSE OF 21 EXISTING INTERGOVERNMENTAL TRANSFER PROGRAMS SHALL BE USED TO 22 FINANCE MEDICAID HOSPITAL APPROPRIATIONS. 23 (B) THE QUALITY ASSURANCE ASSESSMENT FEE SHALL BE IMPLE- 24 MENTED ON THE EFFECTIVE DATE OF THE AMENDATORY ACT THAT ADDED 25 THIS SUBSECTION. 26 (C) THE QUALITY ASSURANCE ASSESSMENT FEE SHALL BE ASSESSED 27 ON ALL NET PATIENT REVENUE, BEFORE DEDUCTION OF EXPENSES, LESS 07725'02 21 1 MEDICARE NET REVENUE, AS REPORTED ON THE MOST RECENTLY AVAILABLE 2 MEDICARE COST REPORT AND IS PAYABLE ON A QUARTERLY BASIS, THE 3 FIRST PAYMENT DUE 90 DAYS AFTER THE DATE THE FEE IS ASSESSED. AS 4 USED IN THIS SUBDIVISION, "MEDICARE NET REVENUE" INCLUDES MEDI- 5 CARE PAYMENTS AND AMOUNTS COLLECTED FOR COINSURANCE AND 6 DEDUCTIBLES. 7 (D) UPON IMPLEMENTATION PURSUANT TO SUBDIVISION (B), THE 8 DEPARTMENT OF COMMUNITY HEALTH SHALL INCREASE THE HOSPITAL MEDI- 9 CAID REIMBURSEMENT RATES FOR THE BALANCE OF THAT YEAR. FOR EACH 10 SUBSEQUENT YEAR IN WHICH THE QUALITY ASSURANCE ASSESSMENT FEE IS 11 ASSESSED AND COLLECTED, THE DEPARTMENT OF COMMUNITY HEALTH SHALL 12 MAINTAIN THE HOSPITAL MEDICAID REIMBURSEMENT RATE INCREASE 13 FINANCED BY THE QUALITY ASSURANCE ASSESSMENT FEES. 14 (E) THE DEPARTMENT OF COMMUNITY HEALTH SHALL IMPLEMENT THIS 15 SECTION IN A MANNER THAT COMPLIES WITH FEDERAL REQUIREMENTS NEC- 16 ESSARY TO ASSURE THAT THE QUALITY ASSURANCE ASSESSMENT FEE QUALI- 17 FIES FOR FEDERAL MATCHING FUNDS. 18 (F) IF A HOSPITAL FAILS TO PAY THE ASSESSMENT REQUIRED BY 19 SUBSECTION (1)(H), THE DEPARTMENT OF COMMUNITY HEALTH MAY ASSESS 20 THE HOSPITAL A PENALTY OF 5% OF THE ASSESSMENT FOR EACH MONTH 21 THAT THE ASSESSMENT AND PENALTY ARE NOT PAID UP TO A MAXIMUM OF 22 50% OF THE ASSESSMENT. THE DEPARTMENT OF COMMUNITY HEALTH MAY 23 ALSO REFER FOR COLLECTION TO THE DEPARTMENT OF TREASURY PAST DUE 24 AMOUNTS CONSISTENT WITH SECTION 13 OF 1941 PA 122, MCL 205.13. 25 (G) THE HOSPITAL QUALITY ASSURANCE ASSESSMENT FUND IS ESTAB- 26 LISHED IN THE STATE TREASURY. THE DEPARTMENT OF COMMUNITY HEALTH 27 SHALL DEPOSIT THE REVENUE RAISED THROUGH THE QUALITY ASSURANCE 07725'02 22 1 ASSESSMENT FEE WITH THE STATE TREASURER FOR DEPOSIT IN THE 2 HOSPITAL QUALITY ASSURANCE ASSESSMENT FUND. 3 (H) IN EACH FISCAL YEAR GOVERNED BY THIS SUBSECTION, THE 4 QUALITY ASSURANCE ASSESSMENT FEE SHALL ONLY BE COLLECTED AND 5 EXPENDED IF MEDICAID HOSPITAL INPATIENT DRG AND OUTPATIENT REIM- 6 BURSEMENT RATES, DISPROPORTIONATE SHARE HOSPITAL AND GRADUATE 7 MEDICAL EDUCATION PAYMENTS ARE NOT BELOW THE LEVEL OF RATES AND 8 PAYMENTS IN EFFECT ON APRIL 1, 2002 AS A DIRECT RESULT OF THE 9 QUALITY ASSURANCE ASSESSMENT FEE COLLECTED UNDER SUBSECTION 10 (1)(H), EXCEPT AS PROVIDED IN SUBDIVISION (J). 11 (I) THE AMOUNTS LISTED IN THIS SUBDIVISION ARE APPROPRIATED 12 FOR THE DEPARTMENT OF COMMUNITY HEALTH, SUBJECT TO THE CONDITIONS 13 SET FORTH IN THIS SUBSECTION, FOR THE FISCAL YEAR ENDING 14 SEPTEMBER 30, 2003: 15 MEDICAL SERVICES 16 HOSPITAL SERVICES AND THERAPY................ $ 779,289,100 17 GROSS APPROPRIATION.......................... $ 779,289,100 18 APPROPRIATED FROM: 19 FEDERAL REVENUES: 20 TOTAL FEDERAL REVENUES....................... 431,812,800 21 SPECIAL REVENUE FUNDS: 22 MEDICAID QUALITY ASSURANCE ASSESSMENT........ 66,513,500 23 TOTAL LOCAL REVENUES......................... 0 24 STATE GENERAL FUND/GENERAL PURPOSE........... $ 280,962,800 25 (J) THE QUALITY ASSURANCE ASSESSMENT FEE COLLECTED UNDER 26 SUBSECTION (1)(H) SHALL NO LONGER BE ASSESSED OR COLLECTED AFTER 27 SEPTEMBER 30, 2004, OR IN THE EVENT THAT THE QUALITY ASSURANCE 07725'02 23 1 ASSESSMENT FEE IS NOT ELIGIBLE FOR FEDERAL MATCHING FUNDS. ANY 2 PORTION OF AN ASSESSMENT COLLECTED FROM A HOSPITAL THAT IS NOT 3 ELIGIBLE FOR FEDERAL MATCHING FUNDS SHALL BE RETURNED TO THE 4 HOSPITAL. 5 (K) IN FISCAL YEAR 2002-2003, $18,900,000.00 OF THE QUALITY 6 ASSURANCE ASSESSMENT FEE SHALL BE DEPOSITED INTO THE GENERAL 7 FUND. 8 (15)(14)As used in this section, "medicaid" means that 9 term as defined in section 22207. 07725'02 Final page. KAO