COMMUNITY HEALTH FY 2008-09 Appropriations

Summary: As Passed by the House

SB 1094 (H-1)

Analysts: Margaret Alston, Susan Frey, and Steve Stauff

	FY 2007-08 YTD	FY 2008-09 Executive	FY 2008-09	FY 2008-09	FY 2008-09	*Difference: House* *From FY 2007-08 YTD*
	as of2/07/08	Revised	Senate	House	Enacted	*Amount*	%
IDG/IDT	$39,410,200	$40,883,900	$40,883,900	$40,883,900		$1,473,700	3.7
Federal	6,708,510,700	7,159,785,100	7,159,893,600	7,146,514,600		438,003,900	6.5
Local	247,237,400	241,980,600	241,980,600	241,578,600		(5,658,800)	(2.3)
Private	65,519,800	66,686,800	66,686,800	66,686,800		1,167,000	1.8
Restricted	1,862,336,400	1,860,109,700	1,891,186,200	1,841,291,200		(21,045,200)	(1.1)
GF/GP	3,125,311,600	3,086,105,800	3,082,241,600	3,101,757,200		(23,554,400)	(0.8)
Gross	$12,048,326,100	$12,455,551,900	$12,482,872,700	$12,438,712,300		*$390,386,200*	*3.2*
FTEs	4,767.6	4,602.7	4,600.7	4,602.7		(164.9)	(3.5)

Overview

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

Major Budget Issues

Major Budget Changes From FY 2007-08 YTD Appropriations	FY 2007-08 YTD (as of2/07/08)	House Change From YTD
*1. Economic Adjustments* The House and Senate concur with the Executive Recommendation to include $4.2 million gross ($1.6 million GF/GP) to annualize the cost of the 2.0% salary/wage increase for non-bargaining and unionized employees effective April 2008, and finance economic adjustments for defined benefit/contribution retirement, insurance, building occupancy, food, worker's compensation, and gas, fuel, and utility costs for FY 2008-09.	Gross IDG Federal Restricted Local Private GF/GP	N/A N/A N/A N/A N/A N/A N/A	$4,188,800 (44,900) 1,091,300 177,800 1,317,500 400 $1,646,700
*2. Director and Other Unclassified Positions* The House does not concur with the Senate to reduce the salaries of the Director and other unclassified FTE positions by $299,300 GF/GP which represents 50% of the line item appropriation.	Gross GF/GP	$598,600 $598,600	$0 $0
*3. Consolidation of Human Resources* Concurring with the Executive Recommendation, the House and Senate recognize savings of $4.2 million gross ($2.5 million GF/GP) by consolidating the Department of Community Health's Human Resources Operations with the Department of Management and Budget pursuant to implementation of Executive Order 2007-30. Also, Human Resources Optimization savings of $285,500 gross (all GF/GP) are recognized.	Gross Federal Restricted Local GF/GP	N/A N/A N/A N/A N/A	($4,492,000) (316,500) (265,900) (1,127,200) ($2,782,400)
*4. Mental Illness in Jails* The House does not concur with the Senate to allocate $200,000 GF/GP for a study on the prevalence of mental illness in jails. (Sec. 427)	Gross Federal Private GF/GP	$13,409,500 3,121,000 190,000 $10,098,500	$0 0 0 $0
*5. Actuarially Sound Rates* The House and Senate concur with the Executive Recommendation to increase capitation payment rates for Health Plan Services by 5.0%, for Medicaid Mental Health Services by 3.4%, and for Medicaid Substance Abuse Services by 1.0% ($175.4 million gross, $69.7 million GF/GP) to ensure rates are actuarially sound in FY 2008-09.	Gross Federal Local Restricted GF/GP	$4,516,377,400 2,652,514,400 29,737,100 898,986,100 $935,139,800	$175,436,400 105,735,500 0 0 $69,700,900
*6. CMH Non-Medicaid Services Reduction* The House concurs with the Executive to include $7.25 million GF/GP reduction for CMH Non-Medicaid Services which will be offset by funds from a statewide and centralized mental health managed care risk pool. Mandating, rather than permitting, the use of funds from CMHSPs risk pooling arrangements to support publicly funded mental health services requires changes in the state's Mental Health Code. The Senate does not concur with the House and Executive Recommendation.	Gross GF/GP	$319,566,100 $319,566,100	($7,250,000) ($7,250,000)
*7. MentalHealth Court* Pilot Programs** Unlike the Executive, the Senate does not reinvest $2,253,800 GF/GP from savings achieved through creation of a statewide and centralized mental health managed care risk pool, in conjunction with $1.1 million from Judiciary, to implement five mental health court programs. Services that may be included in the programs are psychiatric counseling, case management, vocational training, housing assistance, program adherence monitoring, and training court and law enforcement personnel. The House allocates $1,434,100 GF/GP for mental health court pilot programs. (Sec. 459)	Gross GF/GP	$0 $0	$1,434,100 $1,434,100
*8. Wage Increase for Direct Care Workers* The House adds $9,027,000 gross ($4,108,900 GF/GP) to fully fund a 2.0% wage increase, effective April 1, 2009, for direct care workers in mental health settings. The Senate adds $10,068,000 gross ($4.0 million GF/GP) to finance a 2.0% wage increase for direct care workers. (Sec. 405)	Gross Federal Restricted Local GF/GP	$2,037,495,400 998,117,000 102,980,500 26,072,100 $910,325,800	$9,027,000 4,918,100 0 0 $4,108,900
*9. Multicultural Services* The House does not concur with the Senate to add $350,000 GF/GP for theChaldeanCultureCenter and $360,000 GF/GP for the Jewish Federation.	Gross GF/GP	$5,763,800 $5,763,800	$0 $0
*10. State Disability Assistance Program* The House adds $1,450,000 GF/GP for the State Disability Assistance Substance Abuse Services Program in which the funds are to be distributed based on local needs as determined by the department, in conjunction with coordinating agencies. (Sec. 406)	Gross GF/GP	$2,509,800 $2,509,800	$1,450,000 $1,450,000
*11. Community Substance Abuse Prevention, Education, and Treatment Programs* The House adds $2,450,000 GF/GP to the Community Substance Abuse Prevention, Education, and Treatment Programs line item. The funds are allocated to coordinating agencies to provide 90-day intensive substance abuse services including, but not limited to, residential services when appropriate for certain offenders who are referred to treatment by a drug treatment court or other court orders as a condition of parole. (Sec. 484)	Gross Federal Restricted GF/GP	$85,268,000 66,077,500 1,784,200 $17,406,300	$2,450,000 0 0 $2,450,000
*12. Criminal Background Check Program* In concurrence with the Executive, the House and Senate eliminate federal pilot grant revenue of $2.6 million for the Criminal Background Check Program for employees of health facilities as this grant has expired. Funding for this program is also reduced by $519,600 anticipating less federal Medicaid revenue and health systems fees/collections. Unlike the Senate, however, the House does not add $1.0 million GF/GP for the costs of background checks for newly hired nursing home employees.	Gross Federal Restricted GF/GP	$10,475,900 7,074,400 3,401,500 $0	($3,119,600) ($2,890,700) (228,900) $0
*13. Bureau of Health Professions Phone System* The House and	Gross Federal Restricted GF/GP	$20,950,600 3,476,700 17,473,900 $0	$1,500,000 0 1,500,000 $0
*14. Healthy* *Michigan* *Funded Projects* The House maintains current year Healthy Michigan Fund appropriations for projects and Medicaid. The House does not concur with Senate Healthy Michigan Fund changes or new funds for nurse family partnership and arthritis programs which offset Senate Healthy Michigan Fund reductions.	Gross Restricted GF/GP	$41,827,600 41,827,600 $0	$0 0 $0
*15.* *Michigan* *Health Initiative Fund Adjustments* The House concurs with the Senate to reduce Michigan Health Initiative (MHI) funds for public health programs by $1.4 million to reflect available Fund revenue. MHI funds are replaced with GF/GP for the sexually transmitted disease control program, and with federal funds in departmental administration. Reductions are made to the AIDS and risk reduction clearinghouse and media campaign, and to the bovine tuberculosis laboratory program. The House provides $50,000 GF/GP to partially offset the $300,000 reduction to bovine tuberculosis.	Gross Federal Restricted GF/GP	$10,525,600 0 10,525,600 $0	($475,000) 50,000 (1,441,700) $916,700
*16. Infectious Disease Targeted Initiatives* The House includes funding for intensified infectious disease efforts recommended by the Executive, which the Senate did not: (1) $1.0 million GF/GP for expanded testing and treatment of gonorrhea and chlamydia diseases in high-prevalence areas; and (2) $300,000 GF/GP to address contagious, antibiotic-resistant staphylococcus aureus ("staph") infections in health care facilities and in communities (MRSA and VRSA infections).	Gross GF/GP	N/A N/A	$1,300,000 $1,300,000
*17. Bioterrorism Funding Revisions and New Match Requirement* The House concurs with the Senate on funding changes for hospital and public health system bioterrorism preparedness, with a $100 difference. A net reduction of $600,100 reflects a $2.2 million decrease in federal grant funds, and new GF/GP and local funding of $1.6 million to satisfy new federal match requirements of 5% effective August 2008 and rising to 10% July 2009.	Gross Federal Local GF/GP	$50,953,300 50,953,300 0 $0	($600,100) (2,177,300) 500,000 $1,077,200
*18. Local Public Health Operations* Additional GF/GP funding of $2.0 million is provided by the House for the state share of public health services provided by local health departments: immunizations, infectious disease control, sexually transmitted disease control, hearing and vision screening, food protection, public water, private groundwater and on-site sewage management. The Senate had provided an additional $1.0 million.	Gross Local GF/GP	$40,618,400 5,150,000 $35,468,400	$2,000,000 0 $2,000,000
*19. Local Public Health Physician Recruitment Project* The House concurs with the Senate and provides $600,000 for a new initiative withMichiganStateUniversity and theUniversity ofMichigan to recruit and train qualified physicians to practice in local public health to address a shortage. The universities will provide half of the funding.	Gross Private GFGP	$0 0 $0	$600,000 300,000 $300,000
*20. Early Childhood Collaborative* The House maintains current year funding for the Early Childhood Collaborative Secondary Prevention program, and does not include a funding increase recommended by the Senate.	Gross GF/GP	$524,000 $524,000	$0 $0
*21. Senior Services* The House maintains current year funding of $6.8 million for care management of community services for frail low-income elderly at home, and does not include a funding increase or new Senior Olympics funding recommendations of the Senate. The House provides a $60,000 increase for Tribal Elders' programs.	Gross GFGP	$60,000 $60,000	$60,000 $60,000
*22. Medicaid Fund Source Adjustments* The House, Senate and Executive concur on an increase of federal Medicaid and SCHIP funds offsetting $176.9 million of GF/GP due to changes in federal match rates. A loss of Medicaid Benefits Trust Fund revenue would be made up by $10.6 million GF/GP. A shortfall of Merit Award Trust Fund revenue would be made up by $45.3 million GF/GP.	Gross Federal Local Merit Awd Restricted GF/GP	$9,462,685,400 5,588,042,500 43,009,700 139,000,000 1,500,111,200 $2,192,522,000	($1,356,900) 188,493,100 0 (45,300,000) (23,551,200) ($120,998,800)
*23. Hospital and Nursing Home State Retained QAAP* The House increases the state retained share of the hospital quality assurance assessment program (QAAP) by $8,150,000 and the nursing home QAAP by $8,613,900. The Senate concurred with the Executive's savings of $36.2 million GF/GP from setting the amount which the state retains from the hospital and nursing home QAAPs at a percentage of the total federal gain. Statutory changes would be necessary to implement the Executive's plan.	Gross Restricted GF/GP	$0 138,750,000 ($138,750,000)	$0 16,763,900 ($16,763,900)
*24. Physician Primary Care Funding Increase* The House proposal includes a $100 point of difference with the Senate's funding of $6.0 million gross ($2.4 million GF/GP) within the Physician Services line and $11.6 million gross ($4.6 million GF/GP) within the Health Plan Services line providing for a primary care rate increase for Medicaid physician services. (Sec. 1791)	Gross Federal GF/GP	N/A N/A N/A	$100 0 $100
*25. Pharmacy Dispensing Fee Increase* The House does not concur with the Senate to include within the Pharmaceutical Services line an additional $3.8 million gross ($1.5 million GF/GP) to provide a $0.75 per script increase in the Medicaid pharmacy dispensing fee.	Gross Federal Restricted GF/GP	$285,210,900 165,721,800 2,000,000 $117,489,100	$0 0 0 $0
*26. Healthy Kids Dental Expansion* The House includes $582,900 gross ($231,600 GF/GP) to expand the Healthy Kids Dental program inMuskegonCounty on July 1, 2009. The House does not concur with the Senate increase of $251,700 gross ($100,000 GF/GP) to expand the program inMontcalmCounty and $125,800 gross ($50,000 GF/GP) expanding to the City ofRoseville, both beginningJuly 1, 2009. (Sec. 1633)	Gross Federal Restricted GF/GP	$285,210,900 165,721,800 2,000,000 $117,489,100	$582,900 351,300 0 $231,600
*27. Community-Based Long-Term Care Services Savings and Expansion* The House and Executive concur on the expansion of community-based long-term care services by $32.4 million gross ($12.9 million GF/GP) funded through savings from reduced nursing home admissions. The funds are reallocated for: (1) expanding the PACE program, (2) expanding the MSHDA affordable assisted living program, (3) reducing the waiting list for the home and community-based waiver program, (4) adding specialized residential care to the current waiver, (5) activities of the single-point of entry program, (6) transitioning out of nursing homes occupants who will not need medical services, and (7) $363,200 gross ($176,500 GF/GP) that will be transferred to the Office of Long Term Care and Supports and Services for additional staffing. The Senate, however, did not concur with the plan to reallocate the savings to expand community-based long-term care services. The Senate did provide $636,800 gross ($253,000 GF/GP) to expand the MIChoice program and $363,200 gross ($176,500 GF/GP) for the Office of Long Term Care and Supports and Services for additional staffing.	Gross Federal Local Merit Awd Restricted GF/GP	$1,980,350,200 1,149,384,300 6,618,800 139,000,000 222,683,200 $462,663,900	$0 0 0 0 0 $0
*28. Limit Nursing Home Variable Cost Component Increase* The House and Executive concur on reducing the Long-Term Care Services line by $31.3 million gross ($12.4 million GF/GP) from savings created by limiting the growth rate of the nursing home variable cost component of nursing reimbursement from 4.9% to 2.5%. The Senate did not include this reduction.	Gross Federal Local Merit Awd Restricted GF/GP	$1,554,146,800 902,952,700 6,618,800 139,000,000 222,683,200 $282,892,100	($31,261,900) (18,841,600) 0 0 0 ($12,420,300)
*29. Create Adult Home Help Health Care Trust* The House funds the creation of an Adult Home Help Health Care Trust at $2,768,700 gross ($1,100,000 GF/GP), which would help support health care benefits for adult home help workers. The Senate funds the Trust at $2,517,000 gross ($1,000,000 GF/GP). (Sec. 1788)	Gross Federal GF/GP	N/A N/A N/A	$2,768,700 1,668,700 $1,100,000
*30. Increase Monthly Personal Care Supplement by $8* The House increases the Personal Care Services line by $1,344,000 Gross ($534,000 GF/GP) to provide for an $8.00 increase to the monthly personal care supplement payment provided for Medicaid eligible residents in adult foster care homes and homes for the aged. (Sec. 1805)	Gross Federal GF/GP	$30,716,100 17,846,100 $12,870,000	$1,344,000 810,000 $534,000
*31. Medicaid Consensus Adjustments* Adjusts Medicaid funding levels for multiple appropriation lines to reflect the consensus FY 2008-09 expenditures agreed to by the House and Senate Fiscal Agencies and the State Budget Office in May 2008.	Gross Federal Restricted GF/GP	N/A N/A N/A N/A	($35,078,800) (22,961,600) $2,806,700 ($14,923,900)

Major Budget Changes From FY 2007-08 YTD Appropriations

FY 2007-08 YTD

(as of2/07/08)

House

Change

From YTD

1. Economic Adjustments

The House and Senate concur with the Executive Recommendation to include $4.2 million gross ($1.6 million GF/GP) to annualize the cost of the 2.0% salary/wage increase for non-bargaining and unionized employees effective April 2008, and finance economic adjustments for defined benefit/contribution retirement, insurance, building occupancy, food, worker's compensation, and gas, fuel, and utility costs for FY 2008-09.

Gross

IDG

Federal

Restricted

Local
Private

GF/GP

N/A

N/A

$4,188,800

(44,900)

1,091,300

177,800

1,317,500

400

$1,646,700

2. Director and Other Unclassified Positions

The House does not concur with the Senate to reduce the salaries of the Director and other unclassified FTE positions by $299,300 GF/GP which represents 50% of the line item appropriation.

Gross

GF/GP

$598,600

$598,600

3. Consolidation of Human Resources

Concurring with the Executive Recommendation, the House and Senate recognize savings of $4.2 million gross ($2.5 million GF/GP) by consolidating the Department of Community Health's Human Resources Operations with the Department of Management and Budget pursuant to implementation of Executive Order 2007-30. Also, Human Resources Optimization savings of $285,500 gross (all GF/GP) are recognized.

Gross

Federal

Restricted

Local

GF/GP

N/A

N/A

($4,492,000)

(316,500)

(265,900)

(1,127,200)

($2,782,400)

4. Mental Illness in Jails

The House does not concur with the Senate to allocate $200,000 GF/GP for a study on the prevalence of mental illness in jails. (Sec. 427)

Gross

Federal

Private

GF/GP

$13,409,500

3,121,000

190,000

$10,098,500

5. Actuarially Sound Rates

The House and Senate concur with the Executive Recommendation to increase capitation payment rates for Health Plan Services by 5.0%, for Medicaid Mental Health Services by 3.4%, and for Medicaid Substance Abuse Services by 1.0% ($175.4 million gross, $69.7 million GF/GP) to ensure rates are actuarially sound in FY 2008-09.

Gross

Federal

Local

Restricted

GF/GP

$4,516,377,400

2,652,514,400

29,737,100

898,986,100

$935,139,800

$175,436,400

105,735,500

$69,700,900

6. CMH Non-Medicaid Services Reduction

The House concurs with the Executive to include $7.25 million GF/GP reduction for CMH Non-Medicaid Services which will be offset by funds from a statewide and centralized mental health managed care risk pool. Mandating, rather than permitting, the use of funds from CMHSPs risk pooling arrangements to support publicly funded mental health services requires changes in the state's Mental Health Code. The Senate does not concur with the House and Executive Recommendation.

Gross

GF/GP

$319,566,100

$319,566,100

($7,250,000)

($7,250,000)

7. MentalHealth Court Pilot Programs

Unlike the Executive, the Senate does not reinvest $2,253,800 GF/GP from savings achieved through creation of a statewide and centralized mental health managed care risk pool, in conjunction with $1.1 million from Judiciary, to implement five mental health court programs. Services that may be included in the programs are psychiatric counseling, case management, vocational training, housing assistance, program adherence monitoring, and training court and law enforcement personnel. The House allocates $1,434,100 GF/GP for mental health court pilot programs. (Sec. 459)

Gross

GF/GP

$1,434,100

$1,434,100

8. Wage Increase for Direct Care Workers

The House adds $9,027,000 gross ($4,108,900 GF/GP) to fully fund a 2.0% wage increase, effective April 1, 2009, for direct care workers in mental health settings. The Senate adds $10,068,000 gross ($4.0 million GF/GP) to finance a 2.0% wage increase for direct care workers. (Sec. 405)

Gross

Federal

Restricted

Local

GF/GP

$2,037,495,400

998,117,000

102,980,500

26,072,100

$910,325,800

$9,027,000

4,918,100

$4,108,900

9. Multicultural Services

The House does not concur with the Senate to add $350,000 GF/GP for theChaldeanCultureCenter and $360,000 GF/GP for the Jewish Federation.

Gross

GF/GP

$5,763,800

$5,763,800

10. State Disability Assistance Program

The House adds $1,450,000 GF/GP for the State Disability Assistance Substance Abuse Services Program in which the funds are to be distributed based on local needs as determined by the department, in conjunction with coordinating agencies. (Sec. 406)

Gross

GF/GP

$2,509,800

$2,509,800

$1,450,000

$1,450,000

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

The House adds $2,450,000 GF/GP to the Community Substance Abuse Prevention, Education, and Treatment Programs line item. The funds are allocated to coordinating agencies to provide 90-day intensive substance abuse services including, but not limited to, residential services when appropriate for certain offenders who are referred to treatment by a drug treatment court or other court orders as a condition of parole. (Sec. 484)

Gross

Federal

Restricted

GF/GP

$85,268,000

66,077,500

1,784,200

$17,406,300

$2,450,000

$2,450,000

12. Criminal Background Check Program

In concurrence with the Executive, the House and Senate eliminate federal pilot grant revenue of $2.6 million for the Criminal Background Check Program for employees of health facilities as this grant has expired. Funding for this program is also reduced by $519,600 anticipating less federal Medicaid revenue and health systems fees/collections. Unlike the Senate, however, the House does not add $1.0 million GF/GP for the costs of background checks for newly hired nursing home employees.

Gross

Federal

Restricted

GF/GP

$10,475,900

7,074,400

3,401,500

($3,119,600)

($2,890,700)

(228,900)

13. Bureau of Health Professions Phone System

The House and

Gross

Federal

Restricted

GF/GP

$20,950,600

3,476,700

17,473,900

$1,500,000

1,500,000

14. Healthy Michigan Funded Projects

The House maintains current year Healthy Michigan Fund appropriations for projects and Medicaid. The House does not concur with Senate Healthy Michigan Fund changes or new funds for nurse family partnership and arthritis programs which offset Senate Healthy Michigan Fund reductions.

Gross

Restricted

GF/GP

$41,827,600

41,827,600

15. Michigan Health Initiative Fund Adjustments

The House concurs with the Senate to reduce Michigan Health Initiative (MHI) funds for public health programs by $1.4 million to reflect available Fund revenue. MHI funds are replaced with GF/GP for the sexually transmitted disease control program, and with federal funds in departmental administration. Reductions are made to the AIDS and risk reduction clearinghouse and media campaign, and to the bovine tuberculosis laboratory program. The House provides $50,000 GF/GP to partially offset the $300,000 reduction to bovine tuberculosis.

Gross

Federal

Restricted

GF/GP

$10,525,600

10,525,600

($475,000)

50,000

(1,441,700)

$916,700

16. Infectious Disease Targeted Initiatives

The House includes funding for intensified infectious disease efforts recommended by the Executive, which the Senate did not: (1) $1.0 million GF/GP for expanded testing and treatment of gonorrhea and chlamydia diseases in high-prevalence areas; and (2) $300,000 GF/GP to address contagious, antibiotic-resistant staphylococcus aureus ("staph") infections in health care facilities and in communities (MRSA and VRSA infections).

Gross

GF/GP

N/A

N/A

$1,300,000

$1,300,000

17. Bioterrorism Funding Revisions and New Match Requirement

The House concurs with the Senate on funding changes for hospital and public health system bioterrorism preparedness, with a $100 difference. A net reduction of $600,100 reflects a $2.2 million decrease in federal grant funds, and new GF/GP and local funding of $1.6 million to satisfy new federal match requirements of 5% effective August 2008 and rising to 10% July 2009.

Gross

Federal

Local

GF/GP

$50,953,300

50,953,300

($600,100)

(2,177,300)

500,000

$1,077,200

18. Local Public Health Operations

Additional GF/GP funding of $2.0 million is provided by the House for the state share of public health services provided by local health departments: immunizations, infectious disease control, sexually transmitted disease control, hearing and vision screening, food protection, public water, private groundwater and on-site sewage management. The Senate had provided an additional $1.0 million.

Gross

Local

GF/GP

$40,618,400

5,150,000

$35,468,400

$2,000,000

$2,000,000

19. Local Public Health Physician Recruitment Project

The House concurs with the Senate and provides $600,000 for a new initiative withMichiganStateUniversity and theUniversity ofMichigan to recruit and train qualified physicians to practice in local public health to address a shortage. The universities will provide half of the funding.

Gross

Private

GFGP

$600,000

300,000

$300,000

20. Early Childhood Collaborative

The House maintains current year funding for the Early Childhood Collaborative Secondary Prevention program, and does not include a funding increase recommended by the Senate.

Gross

GF/GP

$524,000

$524,000

21. Senior Services

The House maintains current year funding of $6.8 million for care management of community services for frail low-income elderly at home, and does not include a funding increase or new Senior Olympics funding recommendations of the Senate. The House provides a $60,000 increase for Tribal Elders' programs.

Gross

GFGP

$60,000

$60,000

$60,000

$60,000

22. Medicaid Fund Source Adjustments

The House, Senate and Executive concur on an increase of federal Medicaid and SCHIP funds offsetting $176.9 million of GF/GP due to changes in federal match rates. A loss of Medicaid Benefits Trust Fund revenue would be made up by $10.6 million GF/GP. A shortfall of Merit Award Trust Fund revenue would be made up by $45.3 million GF/GP.

Gross

Federal

Local

Merit Awd

Restricted

GF/GP

$9,462,685,400

5,588,042,500

43,009,700

139,000,000

1,500,111,200

$2,192,522,000

($1,356,900)

188,493,100

(45,300,000)

(23,551,200)

($120,998,800)

23. Hospital and Nursing Home State Retained QAAP

The House increases the state retained share of the hospital quality assurance assessment program (QAAP) by $8,150,000 and the nursing home QAAP by $8,613,900. The Senate concurred with the Executive's savings of $36.2 million GF/GP from setting the amount which the state retains from the hospital and nursing home QAAPs at a percentage of the total federal gain. Statutory changes would be necessary to implement the Executive's plan.

Gross

Restricted

GF/GP

138,750,000

($138,750,000)

16,763,900

($16,763,900)

24. Physician Primary Care Funding Increase

The House proposal includes a $100 point of difference with the Senate's funding of $6.0 million gross ($2.4 million GF/GP) within the Physician Services line and $11.6 million gross ($4.6 million GF/GP) within the Health Plan Services line providing for a primary care rate increase for Medicaid physician services. (Sec. 1791)

Gross

Federal

GF/GP

N/A

N/A

$100

$100

25. Pharmacy Dispensing Fee Increase

The House does not concur with the Senate to include within the Pharmaceutical Services line an additional $3.8 million gross ($1.5 million GF/GP) to provide a $0.75 per script increase in the Medicaid pharmacy dispensing fee.

Gross

Federal

Restricted

GF/GP

$285,210,900

165,721,800

2,000,000

$117,489,100

26. Healthy Kids Dental Expansion

The House includes $582,900 gross ($231,600 GF/GP) to expand the Healthy Kids Dental program inMuskegonCounty on July 1, 2009. The House does not concur with the Senate increase of $251,700 gross ($100,000 GF/GP) to expand the program inMontcalmCounty and $125,800 gross ($50,000 GF/GP) expanding to the City ofRoseville, both beginningJuly 1, 2009. (Sec. 1633)

Gross

Federal

Restricted

GF/GP

$285,210,900

165,721,800

2,000,000

$117,489,100

$582,900

351,300

$231,600

27. Community-Based Long-Term Care Services Savings and Expansion

The House and Executive concur on the expansion of community-based long-term care services by $32.4 million gross ($12.9 million GF/GP) funded through savings from reduced nursing home admissions. The funds are reallocated for: (1) expanding the PACE program, (2) expanding the MSHDA affordable assisted living program, (3) reducing the waiting list for the home and community-based waiver program, (4) adding specialized residential care to the current waiver, (5) activities of the single-point of entry program, (6) transitioning out of nursing homes occupants who will not need medical services, and (7) $363,200 gross ($176,500 GF/GP) that will be transferred to the Office of Long Term Care and Supports and Services for additional staffing. The Senate, however, did not concur with the plan to reallocate the savings to expand community-based long-term care services. The Senate did provide $636,800 gross ($253,000 GF/GP) to expand the MIChoice program and $363,200 gross ($176,500 GF/GP) for the Office of Long Term Care and Supports and Services for additional staffing.

Gross

Federal

Local

Merit Awd

Restricted

GF/GP

$1,980,350,200

1,149,384,300

6,618,800

139,000,000

222,683,200

$462,663,900

28. Limit Nursing Home Variable Cost Component Increase

The House and Executive concur on reducing the Long-Term Care Services line by $31.3 million gross ($12.4 million GF/GP) from savings created by limiting the growth rate of the nursing home variable cost component of nursing reimbursement from 4.9% to 2.5%. The Senate did not include this reduction.

Gross

Federal

Local

Merit Awd

Restricted

GF/GP

$1,554,146,800

902,952,700

6,618,800

139,000,000

222,683,200

$282,892,100

($31,261,900)

(18,841,600)

($12,420,300)

29. Create Adult Home Help Health Care Trust

The House funds the creation of an Adult Home Help Health Care Trust at $2,768,700 gross ($1,100,000 GF/GP), which would help support health care benefits for adult home help workers. The Senate funds the Trust at $2,517,000 gross ($1,000,000 GF/GP). (Sec. 1788)

Gross

Federal

GF/GP

N/A

N/A

$2,768,700

1,668,700

$1,100,000

30. Increase Monthly Personal Care Supplement by $8

The House increases the Personal Care Services line by $1,344,000 Gross ($534,000 GF/GP) to provide for an $8.00 increase to the monthly personal care supplement payment provided for Medicaid eligible residents in adult foster care homes and homes for the aged. (Sec. 1805)

Gross

Federal

GF/GP

$30,716,100

17,846,100

$12,870,000

$1,344,000

810,000

$534,000

31. Medicaid Consensus Adjustments

Adjusts Medicaid funding levels for multiple appropriation lines to reflect the consensus FY 2008-09 expenditures agreed to by the House and Senate Fiscal Agencies and the State Budget Office in May 2008.

Gross

Federal

Restricted

GF/GP

N/A

N/A

($35,078,800)

(22,961,600)

$2,806,700

($14,923,900)

Major Boilerplate Changes From FY 2007-08
GENERAL *Sec. 272. Administrative Efficiencies, Shared Services, and Consolidations –* MODIFIED The Senate revises current law to require the Department to make efforts to implement results of a study that encourages administrative efficiencies for local public health departments, CMHSPs, coordinating agencies on substance abuse, and area agencies on aging. The House revises current law to require the Department to make recommendations based on the results of the FY 2008-09 study.
**Sec. 285. Prescription Drug Website– NEW** The House does not concur with the Senate's new section requiring DCH to operate a prescription drug website that educates individuals regarding prescription drugs, provides a list of prescription drug prices, and provides links to other websites that offer free or discounted prescription drug programs.
**Sec. 286. Medicaid Administrative Hearings– NEW** The House does not concur with Senate language requiring DCH to make all Medicaid administrative hearing decisions issued on or afterOctober 1, 2008 available to the public by posting them onMichigan's Internet website without personal identifying information.
COMMUNITY MENTAL HEALTH/SUBSTANCE ABUSE SERVICES PROGRAMS **Sec. 430. Carry Forward of Medicaid Capitation Payments– NEW** The House does not concur with the Senate's new language expressing legislative intent that PIHPs have the option to carry forward a portion of the nonfederal share of Medicaid capitation payments into the subsequent fiscal year.
*Sec. 481. Centralized PIHP Risk Pool* - NEW/MODIFIED New language is proposed by the Senate requiring the establishment of a board that includes representatives from each PIHP if the state creates a centralized PIHP risk pool and prohibiting the use of risk pool funds to offset reductions in other non-Medicaid mental payments to CMHSPs. The House modifies the Senate proposal by allowing the use of PIHP risk pool funds to offset non-Medicaid mental payments to CMHSPs.
**Sec. 483. Cost-Benefit Analysis of Suspension of Medicaid Status– NEW** The Senate proposes new language requiring DCH, in conjunction with the Department of Corrections, to prepare a cost-benefit analysis of suspending rather than terminating the Medicaid status of a recipient with serious mental illness or emotional disturbance who becomes incarcerated in a state or local correctional facility. The House proposes language requiring a Medicaid recipient to remain eligible for medical assistance during a period of incarceration or detention and limiting the Medicaid coverage to off-site inpatient hospitalization.
STATE PSYCHIATRIC HOSPITALS, CENTERS FOR PERSONS WITH DEVELOPMENTAL DISABILITIES, AND FORENSIC AND PRISON MENTAL HEALTH SERVICES **Sec. 609. Tobacco Use in State Psychiatric Facilities– NEW** The House does not concur with a new Senate provision that prohibits the use of all tobacco products in and on the grounds of state psychiatric facilities.
PUBLIC HEALTH *Sec. 905. Hearing and Vision Screening Services Allocation* - DELETED The House deletes language establishing $5.15 million of local public health operations line items funds to continue to be used to fund hearing and vision screening, initiated when funding was reduced for one year in FY 2005-06.
**Sec. 1115. After-School Partnership– NEW** New House language requires the Department to collaborate with the state board of education and other state departments regarding implementation of recommendations of the Michigan After-School Initiative, and appropriates $25,000 GF/GP.
**Sec. 1116. Coordinated Regional Perinatal System– NEW** The House includes new language that requires the Department to convene a discussion regarding a coordinated regional perinatal system. Requires a report byApril 1, 2009 including recommendations for policy and funding.
**Sec. 1302. Allocation of Funds for Forensic Nurse Examiner Programs- DELETED** Language is eliminated that allocates up to $50,000 of federal funds for expansion of forensic nurse examiner programs.
MEDICAL SERVICES *Sec. 1607. Medicaid Presumptive Eligibility for Pregnant Women* – MODIFIED Concurs with the Senate in the addition of a new subsection mandating enrollment of Medicaid eligible pregnant women into Medicaid HMOs. The House provides an exception for women who have an established relationship with a Medicaid participating physician who is not associated with a Medicaid HMO.
*Sec. 1670. MIChild Program Eligibility* – MODIFIED Includes new language that requires the Department to assure that an external quality review of each MIChild services contractor is performed, which analyzes quality, timeliness, and access to health care services provided by the contractor to MIChild beneficiaries.
*Sec. 1680. Nursing Home Wage Pass-Through* – MODIFIED Both the House and Senate add intent language that would provide nursing home employees an enhanced wage or benefit equating to 50¢ per employee hour. The House language provides more detail than Senate language on the wage pass-through. Funding for the pass-through is supported by an appropriation increase in the Long-Term Care Services line.
*Sec. 1690.* **MIChoice and Adult Home Help Quality Assurance Indicators, Improvement Plans and Incident Reports– NEW** The House adds new language that requires the Department to submit a report on the adult home help and MIChoice program quality assurance indicators, quality improvement plans, critical incidents and their resolutions.
**Sec. 1800. Immunosuppressant Drug Substitution Protocol– NEW** The Senate included language that requires the Department to develop a protocol for the substitution of immunosuppressant drugs for Medicaid patients who receive transplants. The House bill makes it optional for the Department to develop the protocol.
*Sec. 1806. Expansion ofCountyHealth* **Plans– NEW** Establishes a $100 place-holder in the County Indigent Care and Third Share Plans appropriation line for the expansion of county health plans.
*Sec. 1807. Medicaid Reimbursement of Primary Care Physicians Providing Mental Health Services* – NEW The House adds new language that allows the Department to convene a workgroup and provide a report evaluating the feasibility of establishing a Medicaid payment mechanism for the reimbursement of mental health services by primary care physicians.
**Sec. 1808. Medicaid Ambulance Quality Assurance Assessment Program (QAAP)– NEW** The House adds new language authorizing $100 in the Ambulance Services appropriation line for an ambulance QAAP.

Major Boilerplate Changes From FY 2007-08

GENERAL

Sec. 272. Administrative Efficiencies, Shared Services, and Consolidations – MODIFIED

The Senate revises current law to require the Department to make efforts to implement results of a study that encourages administrative efficiencies for local public health departments, CMHSPs, coordinating agencies on substance abuse, and area agencies on aging. The House revises current law to require the Department to make recommendations based on the results of the FY 2008-09 study.

Sec. 285. Prescription Drug Website– NEW

The House does not concur with the Senate's new section requiring DCH to operate a prescription drug website that educates individuals regarding prescription drugs, provides a list of prescription drug prices, and provides links to other websites that offer free or discounted prescription drug programs.

Sec. 286. Medicaid Administrative Hearings– NEW

The House does not concur with Senate language requiring DCH to make all Medicaid administrative hearing decisions issued on or afterOctober 1, 2008 available to the public by posting them onMichigan's Internet website without personal identifying information.

COMMUNITY MENTAL HEALTH/SUBSTANCE ABUSE SERVICES PROGRAMS

Sec. 430. Carry Forward of Medicaid Capitation Payments– NEW

The House does not concur with the Senate's new language expressing legislative intent that PIHPs have the option to carry forward a portion of the nonfederal share of Medicaid capitation payments into the subsequent fiscal year.

Sec. 481. Centralized PIHP Risk Pool - NEW/MODIFIED

New language is proposed by the Senate requiring the establishment of a board that includes representatives from each PIHP if the state creates a centralized PIHP risk pool and prohibiting the use of risk pool funds to offset reductions in other non-Medicaid mental payments to CMHSPs. The House modifies the Senate proposal by allowing the use of PIHP risk

pool funds to offset non-Medicaid mental payments to CMHSPs.

Sec. 483. Cost-Benefit Analysis of Suspension of Medicaid Status– NEW

The Senate proposes new language requiring DCH, in conjunction with the Department of Corrections, to prepare a cost-benefit analysis of suspending rather than terminating the Medicaid status of a recipient with serious mental illness or emotional disturbance who becomes incarcerated in a state or local correctional facility. The House proposes language requiring a Medicaid recipient to remain eligible for medical assistance during a period of incarceration or detention and limiting the Medicaid coverage to off-site inpatient hospitalization.

STATE PSYCHIATRIC HOSPITALS, CENTERS FOR PERSONS WITH DEVELOPMENTAL DISABILITIES, AND FORENSIC AND PRISON MENTAL HEALTH SERVICES

Sec. 609. Tobacco Use in State Psychiatric Facilities– NEW

The House does not concur with a new Senate provision that prohibits the use of all tobacco products in and on the grounds of state psychiatric facilities.

PUBLIC HEALTH

Sec. 905. Hearing and Vision Screening Services Allocation - DELETED

The House deletes language establishing $5.15 million of local public health operations line items funds to continue to be used to fund hearing and vision screening, initiated when funding was reduced for one year in FY 2005-06.

Sec. 1115. After-School Partnership– NEW

New House language requires the Department to collaborate with the state board of education and other state departments regarding implementation of recommendations of the Michigan After-School Initiative, and appropriates $25,000 GF/GP.

Sec. 1116. Coordinated Regional Perinatal System– NEW

The House includes new language that requires the Department to convene a discussion regarding a coordinated regional perinatal system. Requires a report byApril 1, 2009 including recommendations for policy and funding.

Sec. 1302. Allocation of Funds for Forensic Nurse Examiner Programs- DELETED

Language is eliminated that allocates up to $50,000 of federal funds for expansion of forensic nurse examiner programs.

MEDICAL SERVICES

Sec. 1607. Medicaid Presumptive Eligibility for Pregnant Women – MODIFIED

Concurs with the Senate in the addition of a new subsection mandating enrollment of Medicaid eligible pregnant women into Medicaid HMOs. The House provides an exception for women who have an established relationship with a Medicaid participating physician who is not associated with a Medicaid HMO.

Sec. 1670. MIChild Program Eligibility – MODIFIED

Includes new language that requires the Department to assure that an external quality review of each MIChild services contractor is performed, which analyzes quality, timeliness, and access to health care services provided by the contractor to MIChild beneficiaries.

Sec. 1680. Nursing Home Wage Pass-Through – MODIFIED

Both the House and Senate add intent language that would provide nursing home employees an enhanced wage or benefit equating to 50¢ per employee hour. The House language provides more detail than Senate language on the wage pass-through. Funding for the pass-through is supported by an appropriation increase in the Long-Term Care Services line.

Sec. 1690. MIChoice and Adult Home Help Quality Assurance Indicators, Improvement Plans and Incident Reports– NEW

The House adds new language that requires the Department to submit a report on the adult home help and MIChoice program quality assurance indicators, quality improvement plans, critical incidents and their resolutions.

Sec. 1800. Immunosuppressant Drug Substitution Protocol– NEW

The Senate included language that requires the Department to develop a protocol for the substitution of immunosuppressant drugs for Medicaid patients who receive transplants. The House bill makes it optional for the Department to develop the protocol.

Sec. 1806. Expansion ofCountyHealth Plans– NEW

Establishes a $100 place-holder in the County Indigent Care and Third Share Plans appropriation line for the expansion of county health plans.

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

The House adds new language that allows the Department to convene a workgroup and provide a report evaluating the feasibility of establishing a Medicaid payment mechanism for the reimbursement of mental health services by primary care physicians.

Sec. 1808. Medicaid Ambulance Quality Assurance Assessment Program (QAAP)– NEW

The House adds new language authorizing $100 in the Ambulance Services appropriation line for an ambulance QAAP.