HB 4344, As Passed Senate

HB-4344, As Passed Senate, September 6, 2007

SENATE SUBSTITUTE FOR

HOUSE BILL NO. 4344

A bill to make appropriations for the department of community

health and certain state purposes related to mental health, public

health, and medical services for the fiscal year ending September

30, 2008; to provide for the expenditure of those appropriations;

to create funds; to require and provide for reports; to prescribe

the powers and duties of certain local and state agencies and

departments; and to provide for disposition of fees and other

income received by the various state agencies.

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

PART 1

LINE-ITEM APPROPRIATIONS

Sec. 101. Subject to the conditions set forth in this act, the

amounts listed in this part are appropriated for the department of

House Bill No. 4344 as amended September 6, 2007

community health for the fiscal year ending September 30, 2008,

from the funds indicated in this part. The following is a summary

of the appropriations in this part:

DEPARTMENT OF COMMUNITY HEALTH

<<(1)>> APPROPRIATION SUMMARY:

Full-time equated unclassified positions........... 0

Full-time equated classified positions............. 0

Average population................................. 0

GROSS APPROPRIATION.................................... $ <<(100)>>

Interdepartmental grant revenues:

Total interdepartmental grants and intradepartmental

transfers............................................ 0

ADJUSTED GROSS APPROPRIATION........................... $ <<(100)>>

Federal revenues:

Total federal revenues................................. 0

Special revenue funds:

Total local revenues................................... 0

Total private revenues................................. 0

Merit award trust fund................................. 0

Total other state restricted revenues.................. 0

State general fund/general purpose..................... $ <<(100)

(2) BUDGETARY SAVINGS

Budgetary savings.................................... $ (100)

GROSS APPROPRIATION.................................... $ (100)

Appropriated from:

State general fund/general purpose..................... $ (100)>>

PART 2

PROVISIONS CONCERNING APPROPRIATIONS

GENERAL SECTIONS

Sec. 201. Pursuant to section 30 of article IX of the state

House Bill No. 4344 as amended September 6, 2007

constitution of 1963, total state spending from state resources

under part 1 for fiscal year 2007-2008 is <<($100.00)>> and state

spending

from state resources to be paid to local units of government for

fiscal year 2007-2008 is $0.00.

Sec. 202. (1) The appropriations authorized under this act are

subject to the management and budget act, 1984 PA 431, MCL 18.1101

to 18.1594.

(2) Funds for which the state is acting as the custodian or

agent are not subject to annual appropriation.

Sec. 209. (1) Funds appropriated in part 1 shall not be used

for the purchase of foreign goods or services, or both, if

competitively priced and comparable quality American goods or

services, or both, are available.

(2) Funds appropriated in part 1 shall not be used for the

purchase of out-of-state goods or services, or both, if

competitively priced and comparable quality Michigan goods or

services, or both, are available.

(3) The department shall report quarterly to the senate and

house appropriations subcommittees on community health and the

senate and house fiscal agencies any purchase of goods or services,

or both, valued over $10,000.00 from out-of-state or foreign-based

firms. Each violation of subsection (1) or (2) shall result in a

$50,000.00 reduction in the departmental administration and

management line.

Sec. 211. (1) If the revenue collected by the department from

fees and collections exceeds the amount appropriated in part 1, the

revenue may be carried forward with the approval of the state

budget director into the subsequent fiscal year. The revenue

carried forward under this section shall be used as the first

source of funds in the subsequent fiscal year.

(2) The department shall provide a report to the senate and

house appropriations subcommittees on community health and the

senate and house fiscal agencies on the balance of each of the

restricted funds administered by the department as of September 30,

2008.

Sec. 215. (1) The department shall report no later than March

1, 2008 on each specific policy change made to implement enacted

legislation to the senate and house appropriations subcommittees on

community health, the senate and house standing committees on

health policy, the chairperson of the joint committee on

administrative rules, the senate and house fiscal agencies, and the

senate and house policy offices.

(2) Funds appropriated in part 1 shall not be used to prepare

regulatory plans or promulgate rules that fail to reduce the

disproportionate economic impact on small businesses pursuant to

section 40 of the administrative procedures act of 1969, 1969 PA

306, MCL 24.240.

Sec. 248. The department shall allow ambulatory surgery

centers in this state to fully participate in the Medicaid program

by January 1, 2008. Ambulatory surgery centers that provide

services to Medicaid-eligible patients shall be reimbursed in the

same manner as hospitals. The reimbursement schedule for ambulatory

surgery centers shall be developed and implemented in consultation

with the industry and shall be provided to the senate and house

House Bill No. 4344 as amended September 6, 2007

appropriations subcommittees on the department of community health

and the senate and house fiscal agencies by November 1, 2007.

Sec. 264. (1) Upon submission of a Medicaid waiver, a Medicaid

state plan amendment, or a similar proposal to the centers for

Medicare and Medicaid services, the department shall notify the

house and senate appropriations subcommittees on community health

and the house and senate fiscal agencies of the submission.

(2) The department is required to report within 15 days after

initial contact to the senate and house appropriations

subcommittees on community health and the senate and house fiscal

agencies of any formal or informal discussions with the centers for

Medicare and Medicaid services or the federal department of health

and human services regarding the structure of any future Medicaid

waiver application.

<<Sec. 269. The amount appropriated in part 1 for medical services pharmaceutical services includes funds to cover reimbursement of mental health medications under the Medicaid program. Reimbursement procedures for mental health medications shall be the same as those that were followed in fiscal year 2005-2006, and utilization procedures for such medications shall adhere to section 1625, the department's fiscal year 2006-2007 contract with Medicaid health plans, and section 109h of the social welfare act, 1939 PA 280, MCL 400.109h.>>

Sec. 271. The department shall provide the senate and house

appropriations subcommittees on community health and the senate and

house fiscal agencies information on any contracts that will expire

in fiscal year 2007-2008. This report shall be provided by March 1,

2008.

Sec. 272. (1) The department shall establish a committee

composed of members of each house of the legislature and

representatives of the department of community health. The

committee shall identify necessary modifications in current law,

payment methodology, and department policy that will permit greater

consolidation of local provision of necessary medical supports and

services. This committee shall specifically address all of the

following:

(a) Program changes to encourage greater consolidation of

local public health departments into district health departments.

(b) Program changes to encourage greater consolidation of

CMHSPs across communities.

substance abuse coordinating agencies into local CMHSPs.

(d) Program changes to encourage greater consolidation of area

agencies on aging across communities.

(2) The department shall ensure that all of the following

organizations participate in relevant discussions:

(a) The Michigan association of community mental health

boards.

(b) The Michigan association of local public health.

agencies.

(d) The area agencies on aging association of Michigan.

(3) The committee established under subsection (1) shall

provide a draft report on initial findings by March 1, 2008 to the

senate and house appropriations subcommittees on community health,

the senate and house committees on health policy, the senate and

house fiscal agencies, and the state budget director. The report

shall detail concepts discussed by the committee and any

recommended changes in state law or appropriations to bring about

greater consolidation of these services.

(4) It is the intent of the legislature to mandate

consolidation in the provision of local mental health and substance

abuse, local public health, and services to the aging in some

House Bill No. 4344 as amended September 6, 2007

fashion by January 1, 2009.

Sec. 273. The department shall provide a report to the senate

and house appropriations subcommittees on community health and the

senate and house fiscal agencies on every program that receives

more than $0.00 in healthy Michigan funds. The report shall provide

detail regarding all of the following:

(a) A summary of organizations receiving these funds.

(b) Measures of the effectiveness of these programs in

improving the health of Michigan residents.

Sec. 275. From the funds appropriated in part 1, the following

amounts are allocated:

(a) <<$100.00>> for a reverse 9-1-1 program in a community hosting

mental health facility.

(b) <<$100.00>> for the greater Flint health coalition.

(d) <<$100.00>> for efforts to combat the spread of animal-borne

illnesses.

(e) <<$100.00>> for the HealthKey program for the uninsured.

(f) <<$100.00>> for multicultural educational and cultural

facilities.

Sec. 276. Funds appropriated in part 1 shall not be used by a

principal executive department, state agency, or authority to hire

a person to provide legal services that are the responsibility of

the attorney general.

Sec. 281. From the funds appropriated in part 1, the

department shall implement continuous improvement efficiency

mechanisms in the programs administered by the department. The

continuous improvement efficiency mechanisms shall identify changes

made in programs to increase efficiency and reduce expenditures in

the programs. On March 31, 2008 and September 30, 2008, the

department shall report to the state budget director, the senate

and house appropriations subcommittees, and the senate and house

fiscal agencies on the progress made toward increased efficiencies

in departmental programs. At a minimum, each report shall include

information on the program review process, the type of improvement

mechanisms implemented, and actual and projected expenditure

savings as a result of the increased program efficiencies.

Sec. 351. (1) From the funds appropriated in part 1 for the

methamphetamine cleanup fund, the department shall allow local

governments to apply for money to cover their administrative costs

associated with the methamphetamine cleanup efforts. The funds

allocated to local governments for the administrative cost

associated with methamphetamine cleanup efforts shall not exceed

$800.00 per property.

(2) The department shall work with the Michigan association of

counties to ensure that counties are aware that the funds

appropriated in part 1 for methamphetamine cleanup activities are

available.

Sec. 401. Funds appropriated in part 1 are intended to support

a system of comprehensive community mental health services under

the full authority and responsibility of local CMHSPs or specialty

prepaid health plans. The department shall ensure that each CMHSP

or specialty prepaid health plan provides all of the following:

(a) A system of single entry and single exit.

(b) A complete array of mental health services including, but

not limited to, all of the following services:

(i) Residential and other individualized living arrangements.

(ii) Outpatient services.

(iii) Acute inpatient services.

(iv) Long-term, 24-hour inpatient care in a structured, secure

environment.

services through agreements with state-operated psychiatric

hospitals, units, and centers in facilities owned or leased by the

state, and privately owned hospitals, units, and centers licensed

by the state pursuant to sections 134 to 149b of the mental health

code, 1974 PA 258, MCL 330.1134 to 330.1149b.

(d) Individualized plans of service that are sufficient to

meet the needs of individuals, including those discharged from

psychiatric hospitals or centers, and that ensure a full range of

recipient needs is addressed through the CMHSPs or specialty

prepaid health plan's program or through assistance with locating

and obtaining services to meet these needs.

(e) A system of case or care management to monitor and ensure

the provision of services consistent with the individualized plan

of services and supports.

(f) A system of continuous quality improvement.

(g) A system to monitor and evaluate the mental health

services provided.

(h) A system that serves at-risk and delinquent youth as

required under the mental health code, 1974 PA 258, MCL 330.1001 to

330.2106.

Sec. 403. (1) From the funds appropriated in part 1 for

multicultural services, the department shall ensure that CMHSPs or

specialty prepaid health plans meet with multicultural service

providers to develop a workable framework for contracting service

delivery and reimbursements.

(2) The department shall ensure that multicultural service

providers confirm that recipients of services funded through the

multicultural services line meet the citizenship documentation

standards established for Medicaid eligibility.

Sec. 404. (1) Not later than May 31 of each fiscal year, the

department shall provide a report on the community mental health

services programs to the members of the house and senate

appropriations subcommittees on community health, the house and

senate fiscal agencies, and the state budget director that includes

the information required by this section.

(2) The report shall contain information for each CMHSP or

specialty prepaid health plan and a statewide summary, each of

which shall include at least all of the following information:

(a) A demographic description of service recipients that, at a

minimum, includes reimbursement eligibility, client population,

age, ethnicity, housing arrangements, and diagnosis.

(b) Per capita expenditures by client population group.

description of funding authorized; expenditures by client group and

fund source; and cost information by service category, including

administration. Service category shall include all department-

approved services.

(d) Data describing service outcomes including, but not

limited to, an evaluation of consumer satisfaction, consumer

choice, and quality of life concerns including, but not limited to,

housing and employment.

(e) Information about access to community mental health

services programs including, but not limited to, all of the

following:

(i) The number of people receiving requested services.

(ii) The number of people who requested services but did not

receive services.

(iii) The average length of time people who requested services

but did not receive services have been waiting to receive services,

listed separately for each service provided.

(f) The number of second opinions requested under the mental

health code, 1974 PA 258, MCL 330.1001 to 330.2106, and the

determination of any appeals.

(g) An analysis of information provided by community mental

health service programs in response to the needs assessment

requirements of the mental health code, 1974 PA 258, MCL 330.1001

to 330.2106, including information about the number of persons in

the service delivery system who have requested and are clinically

appropriate for different services.

(h) Lapses and carryforwards during fiscal year 2006-2007 for

CMHSPs or specialty prepaid health plans.

(i) Information about contracts for mental health services

entered into by CMHSPs or specialty prepaid health plans with

providers, including, but not limited to, all of the following:

(i) The amount of the contract, organized by type of service

provided.

(ii) Payment rates, organized by the type of service provided.

(iii) Administrative costs for services provided to CMHSPs or

specialty prepaid health plans.

(j) Information on the community mental health Medicaid

managed care program, including, but not limited to, both of the

following:

(i) Expenditures by each CMHSP or specialty prepaid health plan

organized by Medicaid eligibility group, including per eligible

individual expenditure averages.

(ii) Performance indicator information required to be submitted

to the department in the contracts with CMHSPs or specialty prepaid

health plans.

(k) An estimate of the number of FTEs employed by each CMHSP

and specialty prepaid health plan as of September 30, 2007 and an

estimate of the number of FTEs employed through contracts with

provider organizations as of September 30, 2007.

(l) Data on the number of pharmaceutical prescriptions written

by CMHSP and specialty prepaid health plan employees or contractors

on behalf of CMHSP and specialty prepaid health plan clients,

broken down into the following categories:

(i) Client population group.

(ii) Class of medication.

(iii) Number of prescriptions per client during the fiscal year.

(3) The department shall include data reporting requirements

prescribed under subsection (2) in the annual contract with each

individual CMHSP or specialty prepaid health plan.

(4) The department shall take all reasonable actions to ensure

that the data required under this section are complete and

consistent among all CMHSPs and specialty prepaid health plans.

Sec. 423. (1) The department shall work cooperatively with the

departments of human services, corrections, education, state

police, and military and veterans affairs to coordinate and improve

the delivery of substance abuse prevention, education, and

treatment programs within existing appropriations.

(2) The department shall establish a workgroup composed of

representatives of the department; the departments of human

services, corrections, education, state police, and military and

veterans affairs; coordinating agencies; CMHSPs; and any other

persons considered appropriate to examine and review the source and

expenditure of all public and private funds made available for

substance abuse programs and services. The workgroup shall develop

and recommend cost-effective measures for the expenditure of funds

and delivery of substance abuse programs and services. The

department shall submit the findings of the workgroup to the house

and senate appropriations subcommittees on community health, the

house and senate fiscal agencies, and the state budget director by

May 31, 2008.

(3) It is the intent of the legislature to reduce the drug

control policy line by $10,000.00 general fund if this report is

not provided by the date provided in this section.

Sec. 425. (1) The department, in conjunction with efforts to

implement the MPRI, shall cooperate with the department of

corrections to share data and information as they relate to

prisoners being released who are HIV positive or positive for the

Hepatitis C antibody, or both. By April 1, 2008, the department

shall report to the senate and house appropriations subcommittees

on community health, the senate and house fiscal agencies, and the

state budget director on all of the following:

(a) The progress and results of its work with the department

of corrections.

(b) The potential outcomes from its work with the department

of corrections.

result of the work under this section.

(d) The programs' potential impact on the state budget.

(e) The number of prisoners released to the community by

parole, discharge on the maximum sentence, or transfer to community

residential placement who are HIV positive, positive for the

Hepatitis C antibody, or both.

(f) The number of offenders successfully referred to the local

public health department, by county, and number of parolees

participating in treatment for Hepatitis C, HIV, or both, after 6

months in the community, by county.

(2) If funds become available through an intergovernmental

transfer from the department of corrections, the department shall

participate in testing of prisoners for HIV and the Hepatitis C

antibody.

Sec. 426. The department shall cooperate with the department

of corrections in providing information for and developing a

report. The report shall, by April 1, 2008, provide the following

data concerning mental health and substance abuse services during

fiscal year 2006-2007:

(a) The number of prisoners receiving substance abuse

services, including a description and breakdown of the type of

substance abuse services provided to prisoners, by major offense

type.

(b) The number of prisoners with a primary diagnosis of mental

illness and the number of those prisoners receiving mental health

services, including a description and breakdown, encompassing, at a

minimum, the categories of inpatient, residential, and outpatient

care, of the type of mental health services provided to those

prisoners, by major offense type.

illness and receiving substance abuse services, including a

description and breakdown, encompassing, at a minimum, the

categories of inpatient, residential, and outpatient care, of the

type of treatment provided to those prisoners, by major offense

type.

(d) Data indicating if prisoners receiving mental health

services for a primary diagnosis of mental illness were previously

hospitalized in a state psychiatric hospital for persons with

mental illness, by major offense type.

(e) Data indicating whether prisoners with a primary diagnosis

of mental illness and receiving substance abuse services were

previously hospitalized in a state psychiatric hospital for persons

with mental illness.

(f) The cost of pharmaceuticals for prisoners with a primary

diagnosis of mental illness itemized by type and manufacturer.

(g) Quarterly and fiscal year-to-date expenditures itemized by

vendor, status of payments from contractors to vendors, and

projected year-end expenditures from accounts for substance abuse

treatment and mental health care.

(h) The number of prisoners that have had their primary

diagnosis of mental illness changed while in prison by a mental

health clinician from an earlier diagnosis received in prison or

while hospitalized in a state psychiatric hospital for persons with

mental illness, itemized by current and previous diagnosis.

(i) The number of prisoners with a primary diagnosis of mental

illness that previously had received substance abuse services,

including a description and breakdown, encompassing, at a minimum,

the categories of inpatient, residential, and outpatient care, of

the type of treatment provided to those prisoners.

Sec. 450. (1) No later than October 1, 2007, the department

shall implement the recommendations of the workgroup composed of

CMHSPs or specialty prepaid health plans and departmental staff on

streamlining the audit and reporting requirements for CMHSPs or

specialty prepaid health plans and contractors performing services

for CMHSPs or specialty prepaid health plans.

(2) No later than March 31, 2008, the department shall submit

a report to the house of representatives and senate appropriations

subcommittees on community health, the house and senate fiscal

agencies, and the state budget office on steps taken to implement

the recommendations of the workgroup and the progress of the

implementation of the recommendations of the workgroup.

Sec. 452. Unless otherwise authorized by law, the department

shall not implement retroactively any policy that would lead to a

negative financial impact on community mental health services

programs or prepaid inpatient health plans.

Sec. 458. By March 1, 2008, the department shall provide each

of the following to the house of representatives and senate

appropriations subcommittees on community health, the house and

senate fiscal agencies, and the state budget director:

(a) An updated plan for implementing recommendations of the

Michigan mental health commission made in the commission's report

dated October 15, 2004.

(b) A report that evaluates the cost-benefit of establishing

secure residential facilities of fewer than 17 beds for adults with

serious mental illness, modeled after such programming in Oregon

and other states.

office, a report that evaluates the cost-benefit of establishing a

specialized mental health court program that diverts adults with

serious mental illness alleged to have committed an offense deemed

nonserious into treatment prior to the filing of any charges.

(d) It is the intent of the legislature to reduce the

departmental administration and management line by $50,000.00 if

this report is not provided by the date provided in this section.

Sec. 459. (1) From the funds appropriated in part 1 for

community mental health non-Medicaid services, the department shall

provide $65,000,000.00 to a CMHSP located in a county with a

population of more than 1,500,000.

(2) From the funds appropriated in part 1 for community mental

health non-Medicaid services, the department shall provide

$35,000,000.00 to a community mental health authority created

pursuant to section 205 of the mental health code, 1974 PA 258, MCL

330.1205, and that is located in a county with a population of more

than 1,500,000.

Sec. 462. The department shall implement a funding equity plan

for all CMHSPs that receive funds appropriated under the community

mental health non-Medicaid services line. The funding plan should

reflect a combination of a more equitable distribution methodology

based on proxy measures of need and the recognition of varying

expenditure needs of CMHSPs. The department shall submit the

written equity funding plan to the senate and house subcommittees

on community health, the senate and house fiscal agencies, and the

state budget director by March 1, 2008.

Sec. 464. It is the intent of the legislature that revenue

received by the department from liquor license fees be expended at

not less than the amount provided in fiscal year 2006-2007, to fund

programs for the prevention, rehabilitation, care, and treatment of

alcoholics pursuant to sections 543(1) and 1115(2) of the Michigan

liquor control code of 1998, 1998 PA 58, MCL 436.1543 and 436.2115.

Sec. 467. If funds become available, the department shall

increase funding paid from the community substance abuse

prevention, education, and treatment programs line item to the

substance abuse coordinating agencies to the level of funding

provided in fiscal year 2002-2003.

Sec. 468. (1) To foster a more efficient administration of and

to integrate care in publicly funded mental health and substance

abuse services, the department shall recommend changes in its

criteria for the incorporation of a city, county, or regional

substance abuse coordinating agency into a local community mental

health authority that will encourage those city, county, or

regional coordinating agencies to incorporate as local community

mental health authorities. If necessary, the department may make

accommodations or adjustments in formula distribution to address

administrative costs related to the recommended changes to the

criteria made in accordance with this section and to the

incorporation of the additional coordinating agencies into local

community mental health authorities provided that all of the

following are satisfied:

(a) The department provides funding for the administrative

costs incurred by coordinating agencies incorporating into

community mental health authorities. The department shall not

provide more than $75,000.00 to any coordinating agency for

administrative costs.

(b) The accommodations or adjustments do not favor

coordinating agencies that voluntarily elect to integrate with

local community mental health authorities.

other coordinating agencies.

(d) The department shall provide to the senate and house

appropriations subcommittees on community health and the senate and

house fiscal agencies a comprehensive plan for the consolidation of

each substance abuse coordinating agency into local community

mental health authorities by March 1, 2008.

(2) It is the intent of the legislature to mandate

consolidation of substance abuse and mental health services under 1

administrative structure by January 1, 2009.

Sec. 471. From the funds appropriated in part 1 for

coordinating agencies and the Salvation Army harbor light program,

administrative costs for these agencies as a percentage of their

total expenditures shall not exceed their percentage in fiscal year

2004-2005 or 9%, whichever is less.

Sec. 478. The department shall not be liable for any costs

associated with the mental health court pilot project funded

through an interdepartmental grant provided by the judicial branch.

Sec. 479. (1) A PIHP, Medicaid HMO, and FQHC may establish an

early mental health services intervention pilot project. This

project shall provide care coordination as well as disease and

pharmacy management to eligible recipients suffering from chronic

disease including diabetes, asthma, substance addiction, or stroke.

Participating organizations may make use of data sharing, joint

information technology efforts, and financial incentives to health

providers and recipients in this program.

(2) The pilot project shall make use of preestablished

objectives and outcome measures to determine the cost effectiveness

of the program. Data shall also be collected by participating

organizations to study the correlation between early mental health

treatment to program participants and improvement in the management

of their chronic disease.

(3) The department shall request any necessary Medicaid state

plan amendments or waivers to ensure participation in this program

by eligible Medicaid recipients.

Sec. 605. (1) The department shall not implement any closures

or consolidations of state hospitals, centers, or agencies until

CMHSPs or specialty prepaid health plans have programs and services

in place for those individuals currently in those facilities and a

plan for service provision for those persons who would have been

admitted to those facilities.

(2) All closures or consolidations are dependent upon adequate

department-approved CMHSP plans that include a discharge and

aftercare plan for each individual in the facility. A discharge and

aftercare plan shall address the individual's housing needs. A

homeless shelter or similar temporary shelter arrangement is

inadequate to meet the individual's housing needs.

(3) Four months after receipt of the certification of closure

required in section 19(6) of the state employees' retirement act,

1943 PA 240, MCL 38.19, the department shall provide a closure plan

to the house and senate appropriations subcommittees on community

health and the state budget director.

(4) Upon the closure of state-run operations and after

transitional costs have been paid, the remaining balances of funds

appropriated for that operation shall be transferred to CMHSPs or

specialty prepaid health plans responsible for providing services

for persons previously served by the operations.

(5) The department shall create a contingency plan for the

closure for each of the adult mental health facilities, and a copy

of these plans shall be submitted to the senate and house

appropriations subcommittees on community health and senate and

house fiscal agencies by September 30, 2008.

Sec. 607. If Senate Bill No. 369 of 2007 is enacted into law,

the department shall provide all necessary support to state

hospitals to ensure that mandated changes in the operation of state

hospitals and centers are completed in a timely and efficient

manner.

Sec. 608. The department, with the cooperation of the

department of management and budget, shall establish and implement

a bid process to identify a single private contractor to provide

food service and custodial services at each of the state-operated

hospitals and centers by January 1, 2008.

Sec. 651. By April 30, 2008, the department shall submit a

report to the house and senate fiscal agencies and the state budget

director on the activities and efforts of the department to improve

the health status of the citizens of this state with regard to the

goals and objectives stated in the "Healthy Michigan 2010" report

and the measurable progress made toward those goals and objections.

Sec. 652. From the funds appropriated in part 1 for minority

health grants and contracts, the department shall ensure that the

distribution of funds are distributed in such a way to meet all of

the following requirements:

(a) One-third of the funds is allocated for projects targeting

communities in counties with a population of less than 100,000

people.

(b) One-third of the funds is allocated for projects targeting

communities in counties with a population of at least 100,000 and

less than 250,000 people.

communities with a population of 250,000 people or more.

Sec. 707. (1) The funds appropriated in part 1 for the nursing

scholarship program established in section 16315 of the public

health code, 1978 PA 368, MCL 333.16315, shall be used to increase

the number of nurses practicing in Michigan. The board of nursing

is encouraged to structure scholarships funded under this act in a

manner that rewards recipients who intend to practice nursing in

Michigan. In addition, the department and board of nursing shall

work cooperatively with the Michigan higher education assistance

authority to coordinate scholarship assistance with scholarships

provided pursuant to the Michigan nursing scholarship act, 2002 PA

591, MCL 390.1181 to 390.1189.

(2) The department shall provide a report to the senate and

house appropriations subcommittees on community health and the

senate and house fiscal agencies on the efforts undertaken to

enforce the residency requirements established in section 4 of the

Michigan nursing scholarship act, 2002 PA 591, MCL 390.1184, and

the total amount repaid to the Michigan higher education assistance

authority for violation of these requirements.

Sec. 715. The department shall maintain existing contractual

and funding arrangements to provide testing, certification, and

inspection services for emergency medical service providers through

December 31, 2007.

House Bill No. 4344 as amended September 6, 2007

Sec. 716. The department shall give first priority to provider

complaint investigations to instances that are alleged to have

occurred within 2 years of the initial complaint.

Sec. 801. In the expenditure of funds appropriated in part 1

for AIDS programs, the department and its subcontractors shall

ensure that individuals between the age of 9 and 18 receive

priority for prevention, education, and outreach services.

Sec. 806. From the funds appropriated in part 1 for

immunization local agreements, <<$100.00>> shall be allocated for the

purchase of childhood recommended vaccines for the underinsured

population ages birth through 18 years of age.

Sec. 902. If a county that has participated in a district

health department or an associated arrangement with other local

health departments takes action to cease to participate in such an

arrangement after October 1, 2007, the department shall have the

authority to assess a penalty from the local health department's

operational accounts in an amount equal to no more than 6.25% of

the local health department's local public health operations

funding. This penalty shall only be assessed to the local county

that requests the dissolution of the health department.

Sec. 904. (1) Funds appropriated in part 1 for local public

health operations shall be prospectively allocated to local health

departments to support immunizations, infectious disease control,

sexually transmitted disease control and prevention, hearing

screening, vision services, food protection, public water supply,

private groundwater supply, and on-site sewage management. Food

protection shall be provided in consultation with the Michigan

department of agriculture. Public water supply, private groundwater

supply, and on-site sewage management shall be provided in

consultation with the Michigan department of environmental quality.

(2) Local public health departments shall be held to

contractual standards for the services described in subsection (1).

(3) Distributions in subsection (1) shall be made only to

counties that maintain local spending in fiscal year 2006-2007 of

at least the amount expended in fiscal year 1992-1993 for the

services described in subsection (1).

(4) By April 1, 2008, the department shall make available upon

request a report to the senate and house appropriations

subcommittee on community health, the senate and house fiscal

agency, and the state budget director on the planned allocation of

the funds appropriated for local public health operations and the

results achieved through this allocation in fiscal year 2006-2007.

Sec. 906. The department shall reduce the allocation to each

local public health department through the local public health

operations line by 6.25% of the local public health department's

administrative expenditure. General fund savings realized through

this reduction shall be transferred to the rural health services

line.

Sec. 907. The department shall recommend changes in the

distribution of funds in part 1 for local public health operations

that would encourage consolidation of local public health

departments into district health departments. These recommendations

are to be provided to the senate and house appropriations

subcommittees on community health and the senate and house fiscal

House Bill No. 4344 as amended September 6, 2007

agencies by March 1, 2008.

Sec. 1030. (1) From the funds appropriated in part 1, the

department shall allocate an amount not to exceed $0.00 for a

statewide before- or after-school program for elementary-aged

children. This allocation shall be distributed via grants to

counties based upon demonstrated need. No single county shall

receive any more than 20% of the total allocation, and priority for

distribution of this funding shall be granted to programs that have

secured additional governmental and nongovernmental matching funds.

(2) The department shall share the administrative duties of

operating this program with the department of human services and

the state board of education.

(3) Funding referenced in subsection (1) shall be reserved for

programs that use curriculum focused upon improving academic

performance and health behavior, including abstinence from abuse of

alcohol and illegal drugs.

Sec. 1031. (1) From the funds appropriated in part 1, <<$100.00>>

shall be used to establish an incentive-based pilot program for

level I and level II trauma hospitals to ensure greater state

utilization of an interactive, evidence-based treatment guideline

model for traumatic brain injury.

(2) This pilot program shall be placed in a county with a

population between 175,000 and 200,000.

Sec. 1104. (1) Before April 1, 2008, the department shall

submit a report to the house and senate fiscal agencies and the

state budget director on planned allocations from the amounts

appropriated in part 1 for local MCH services, prenatal care

outreach and service delivery support, family planning local

agreements, and pregnancy prevention programs. Using applicable

federal definitions, the report shall include information on all of

the following:

(a) Funding allocations.

(b) Actual number of women, children, and adolescents served

and the amounts expended for each group for the fiscal year 2005-

2006.

and rural communities.

(2) The department shall ensure that the expenditure of funds

through the programs described in subsection (1) is sufficient to

meet the needs of rural communities.

Sec. 1105. For all programs for which an appropriation is made

in part 1, the department shall contract with those local agencies

best able to serve clients. Factors to be used by the department in

evaluating agencies under this section shall include ability to

serve high risk population groups; ability to provide access to

individuals in need of services in rural communities; ability to

serve low-income clients, where applicable; availability of, and

access to, service sites; management efficiency; and ability to

meet federal standards, when applicable.

Sec. 1106a. (1) Federal abstinence money appropriate and

expended under part 1 for the purpose of promoting abstinence

education shall provide abstinence education to teenagers most

likely to engage in high-risk behavior as their primary focus and

may include programs that include 9- to 17-year-olds. Programs

funded shall meet all of the following guidelines:

(a) Teaches the gains to be realized by abstaining from sexual

activity.

(b) Teaches abstinence from sexual activity outside of

marriage as the expected standard for all school-aged children.

out-of-wedlock pregnancy, sexually-transmitted diseases, and other

health problems.

(d) Teaches that monogamous relationship in the context of

marriage is the expected standard of human sexual activity.

(e) Teaches that sexual activity outside of marriage is likely

to have harmful effects.

(f) Teaches that bearing children outside of wedlock is likely

to have harmful consequences.

(g) Teaches young people how to avoid sexual advances and how

alcohol and drug use increases vulnerability to sexual advances.

(h) Teaches the importance of attaining self-sufficiency

before engaging in sexual activity.

(2) Coalitions, organizations, and programs that do not

provide contraceptives to minors and demonstrate efforts to include

parental involvement as a means of reducing the risk of teens

becoming pregnant shall be given priority in the allocations of

funds.

(3) Programs and organizations that meet the guidelines of

subsection (1) and criteria of subsection (2) shall have the option

of receiving all or part of their funds directly from the

department.

House Bill No. 4344 as amended September 6, 2007

(4) The department shall ensure that federal abstinence money

appropriated and expended under part 1 for abstinence education is

distributed in a manner that meets the needs of rural communities.

Sec. 1107. Of the amount appropriated and expended under part

1 for prenatal outreach and service delivery support, not more than

6.25% shall be expended for local administration, data processing,

and evaluation.

Sec. 1111. The department shall allocate no less than 93.75%

of the funds appropriated in part 1 for family planning local

agreements and the pregnancy prevention program for the direct

provision of family planning/pregnancy prevention services.

Sec. 1132. From the funds appropriated in part 1, <<$100.00>> shall

be allocated for nurse family partnership program.

Sec. 1133. The department shall release infant mortality rate

data to all local public health departments 72 hours or more before

releasing infant mortality rate data to the public.

Sec. 1152. The department shall require that all Medicaid

children participating in the special supplemental food program for

women, infants, and children receive lead screening testing.

Sec. 1153. The department shall ensure that individuals

residing in rural communities have sufficient access to the

services offered through the WIC program.

Sec. 1413. The legislature affirms the commitment to locally-

based services. The legislature supports the role of local county

board of commissioners in the approval of area agency on aging

plans. Local counties may request to change membership in the area

agencies on aging if the change is to an area agency on aging that

is contiguous to that county pursuant to office of services to the

aging policies and procedures for area agency on aging designation.

The department shall adjust allocations to area agencies on aging

to account for any changes in county membership. The department

shall ensure annually that county boards of commissioners are aware

that county membership in area agencies on aging can be changed

subject to office of services to the aging policies and procedures

for area agency on aging designation. The legislature supports the

office of services to the aging working with others to provide

training to commissioners to better understand and advocate for

aging issues. It is the intent of the legislature to prohibit area

agencies on aging from providing direct services, other than access

services, unless the agencies receive a waiver from the commission

on services to the aging. The legislature's intent in this section

is conditioned on compliance with federal and state laws, rules,

and policies.

Sec. 1416. The legislature strongly affirms its commitment to

provide in-home services, resources, and assistance for the frail

elderly who are not being served by the Medicaid home and

community-based services waiver program.

Sec. 1417. The department shall provide to the senate and

house appropriations subcommittees on community health, senate and

house fiscal agencies, and state budget director a report by March

30, 2008 that contains all of the following:

(a) The total allocation of all public resources made to each

area agency on aging in the state.

(b) Detail on the expenditure of these funds by each area

agency on aging broken down by resources devoted to personnel

costs, the cost of constructing and maintaining structures owned

and operated by the agency, and provision of services to eligible

recipients.

Sec. 1418. The department shall ensure that no more than 5% of

funds allocated to area agencies on aging are utilized for

administrative functions. Area agencies on aging shall provide an

amount equivalent to administrative expenditure in previous years

over the 5% cap to care and case management services seniors

receiving home care.

Sec. 1502. Upon approval of a waiver from the federal

government for the Michigan first health care plan, the department

shall provide the senate and house of representatives

appropriations subcommittees on community health, the senate and

house fiscal agencies, and the state budget director with a report

detailing the process that will be utilized to determine which

insurance entities will be selected for participation in the

Michigan first health care plan. The department shall not award a

single-source contract to a health plan through the Michigan first

health care plan. The department shall contract with at least 4

insurance entities to provide coverage through the Michigan first

health care plan.

Sec. 1610. The department of community health shall provide an

administrative procedure for the review of cost report grievances

by medical services providers with regard to reimbursement under

the medical services program. Settlements of properly submitted

cost reports shall be paid not later than 9 months from receipt of

the final report.

Sec. 1615. Unless prohibited by federal or state law or

regulation, the department shall require enrolled Medicaid

providers to submit their billings for services electronically.

Sec. 1620. (1) For fee-for-service recipients who do not

reside in nursing homes, the pharmaceutical dispensing fee shall be

$2.50 or the pharmacy's usual and customary charge, whichever is

less. For nursing home residents, the pharmaceutical dispensing fee

shall be $2.75 or the pharmacy's usual and customary charge,

whichever is less.

(2) The department shall require a prescription drug copayment

for Medicaid recipients of $1.00 for a generic drug and $3.00 for a

brand name drug, except as prohibited by federal or state law or

regulation.

(3) It is the intent of the legislature that if the department

realizes savings as a result of the implementation of average

manufacturer's price for reimbursement of multiple source generic

medication dispensing as imposed pursuant to the federal deficit

reduction act of 2005, Public Law 109-171, the savings shall be

returned to pharmacies in the form of an increased dispensing fee

for medications not to exceed $2.00. The savings shall be

calculated as the difference in state expenditure between the

current methodology of payment, which is maximum allowable cost,

and the proposed new reimbursement method of average manufacturer's

price.

Sec. 1621. The department may implement prospective drug

utilization review and disease management systems. The prospective

drug utilization review and disease management systems authorized

by this section shall have physician oversight, shall focus on

patient, physician, and pharmacist education, and shall be

developed in consultation with the national pharmaceutical council,

Michigan state medical society, Michigan association of osteopathic

physicians, Michigan pharmacists association, Michigan health and

hospital association, and Michigan nurses' association.

Sec. 1622. The department shall expand the pharmacy quality

improvement program to target inappropriate prescribing of biologic

medications.

Sec. 1657. (1) Reimbursement for medical services to screen

and stabilize a Medicaid recipient, including stabilization of a

psychiatric crisis, in a hospital emergency room shall not be made

contingent on obtaining prior authorization from the recipient's

HMO. If the recipient is discharged from the emergency room, the

hospital shall notify the recipient's HMO within 24 hours of the

diagnosis and treatment received.

(2) If the treating hospital determines that the recipient

will require further medical service or hospitalization beyond the

point of stabilization, the hospital must receive authorization

from the recipient's HMO prior to admitting the recipient.

(3) Subsections (1) and (2) shall not be construed as a

requirement to alter an existing agreement between an HMO and its

contracting hospitals or as a requirement that an HMO must

reimburse for services that are not considered to be medically

necessary.

(4) Prior to contracting with an HMO for managed care services

that did not have a contract with the department before October 1,

2002, the department shall receive assurances from the office of

financial and insurance services that the HMO meets the net worth

and financial solvency requirements contained in chapter 35 of the

insurance code of 1956, 1956 PA 218, MCL 500.3501 to 500.3580.

(5) The department shall provide a report to the senate and

house appropriations subcommittees on community health and senate

and house fiscal agencies examining how payment policies in the

current Medicaid program create financial incentives for health

facilities to admit recipients from the emergency room. The report

shall include recommendations for changes in Medicaid policy and

state statute that can mitigate the effect of these incentives and

reduce nonemergency use of emergency rooms.

Sec. 1662. (1) The department shall assure that an external

quality review of each contracting HMO is performed that results in

an analysis and evaluation of aggregated information on quality,

timeliness, and access to health care services that the HMO or its

contractors furnish to Medicaid beneficiaries.

(2) The department shall provide a copy of the analysis of the

Medicaid HMO annual audited employer data and information set

reports and the annual external quality review report to the senate

and house appropriations subcommittees on community health, the

senate and house fiscal agencies, and the state budget director,

within 30 days of the department's receipt of the final reports

from the contractors.

(3) The department shall work with the Michigan association of

health plans and the Michigan association for local public health

to improve service delivery and coordination in the MSS/ISS and

EPSDT programs. The department shall provide a report to the senate

and house appropriations subcommittees on community health and

senate and house fiscal agencies on the results of this cooperation

by June 25, 2008.

(4) The department shall assure that training and technical

assistance are available for EPSDT and MSS/ISS for Medicaid health

plans, local health departments, and MSS/ISS contractors.

Sec. 1682. (1) The department shall implement enforcement

actions as specified in the nursing facility enforcement provisions

of section 1919 of title XIX, 42 USC 1396r.

(2) From the money received as the result of noncompliance

with medical services certification regulations, $1,300,000.00

shall be appropriated to a health care management company to

compile results of a survey to evaluate the quality of care and

level of satisfaction of nursing home residents, their families,

and employees. Additional penalty money, characterized as private

funds, received by the department shall increase authorizations and

allotments in the long-term care accounts.

(3) The department is authorized to provide civil monetary

penalty funds to the disability network of Michigan to be

distributed to the 15 centers for independent living for the

purpose of assisting individuals with disabilities who reside in

nursing homes to return to their own homes.

(4) Any unexpended penalty money, at the end of the year,

shall carry forward to the following year.

Sec. 1684. (1) Of the funds appropriated in part 1 for the

Medicaid home- and community-based services waiver program, the

payment rate allocated for administrative expenses for fiscal year

2007-2008 shall continue at the rate implemented in fiscal year

2005-2006 after the $2.00 per person per day mandated reduction.

(2) The savings realized from continuing the reduced

administrative rate shall be reallocated to increase enrollment in

the waiver program and to provide direct services to eligible

program participants.

(3) The department shall provide a report by April 1, 2008 to

the house of representatives and senate appropriations

subcommittees on community health and the house and senate fiscal

agencies on the number of nursing home patients discharged who are

subsequently enrolled in the Medicaid home- and community-based

services waiver program, and the associated cost savings.

Sec. 1686. (1) The department shall submit a report by October

1, 2007 to the house and senate appropriations subcommittees on

community health and the house and senate fiscal agencies on the

progress of 4 Medicaid long-term care single point of entry

services pilot projects. The department shall also submit a final

plan to the house and senate subcommittees on community health and

the house and senate fiscal agencies 60 days prior to any expansion

of the program.

(2) In addition to the report required under subsection (1),

the department shall report all of the following to the house and

senate appropriations subcommittees on community health and the

house and senate fiscal agencies by September 30, 2008:

(a) The total cost of the single point of entry program.

(b) The total cost of each designated single point of entry.

program.

(d) The total number of emergent single point of entry cases

involving transfer from hospital settings to long-term care

settings and the average length of time for placement of those

cases in long-term care settings.

(3) It is the intent of the legislature that funding for

single point of entry for long-term care end on September 30, 2008

(4) Funds appropriated for the financing of the Medicaid long-

term care single point of entry services pilot projects are

contingent upon legislative receipt of the report required in

subsection (1).

(5) As used in this section, "single point of entry" means a

system that enables consumers to access Medicaid long-term care

services and supports through 1 agency or organization and that

promotes consumer education and choice of long-term care options.

Sec. 1687. (1) From the funds appropriated in part 1 for long-

term care services, the department shall contract with a stand-

alone psychiatric facility that provides at least 20% of its total

care to Medicaid recipients to provide access to Medicaid

recipients who require specialized Alzheimer's disease or dementia

care.

(2) The department shall report to the senate and house

appropriations subcommittees on community health and the senate and

house fiscal agencies on the effectiveness of the contract required

under subsection (1) to improve the quality of services to Medicaid

recipients.

Sec. 1689. (1) Priority in enrolling additional persons in the

Medicaid home and community-based services waiver program shall be

given to those who are currently residing in nursing homes or who

are eligible to be admitted to a nursing home if they are not

provided home and community-based services. The department shall

implement screening and assessment procedures to assure that no

additional Medicaid-eligible persons are admitted to nursing homes

who would be more appropriately served by the Medicaid home and

community-based services waiver program. If there is a net decrease

in the number of Medicaid nursing home days of care during the most

recent quarter in comparison with the previous quarter and a net

cost savings attributable to moving individuals from a nursing home

to the home and community-based services waiver program, the

department shall transfer the net cost savings to the home and

community-based services waiver program. If a transfer is required,

it shall be done on a quarterly basis.

(2) Within 30 days of the end of each fiscal quarter, the

department shall provide a report to the senate and house

appropriations subcommittees on community health and the senate and

house fiscal agencies that details existing and future allocations

for the home and community-based services waiver program by regions

as well as the associated expenditures. The report shall include

information regarding the net cost savings from moving individuals

from a nursing home to the home and community-based services waiver

program, the number of individuals transitioned from nursing homes

to the home and community-based services waiver program, the number

House Bill No. 4344 as amended September 6, 2007

of individuals on waiting lists by region for the program, the

long-term care support services, including food stamps, housing

subsidies and meals on wheels that individuals on waiting lists are

currently receiving, the number of individuals on waiting lists who

are currently enrolled in Medicaid, and the amount of funds

transferred.

(3) The department shall devote an additional <<$100.00>>

gross/<<$100.00>> general fund to serve additional individuals through

the home and community-based services waiver program. These funds

shall be used to provide services to individuals who are currently

residing in nursing homes for 6 months or longer. The department

shall alter increase average reimbursement for waiver services to

individuals served in this expansion to $80.00 per day.

Sec. 1690. The department shall adjust administrative

reimbursement to nursing homes for Medicaid services to achieve a

<<$100.00>> reduction in state general fund general purpose expenditure.

Sec. 1691. The funding increase provided in fiscal year 2006-

2007 for the adult home help program shall be passed through to

adult home help workers subject to the following conditions:

(a) Adult home help workers providing care under the adult

home help program shall receive a wage of at least $7.25 per hour

in all counties, effective October 1, 2007 until June 30, 2008.

Adult home help workers providing care under the adult home help

program shall receive a wage of at least $7.50 per hour in all

counties effective July 1, 2008.

(b) The department, in conjunction with the department of

human services, shall revise any policies, rules, procedures, or

regulations that may be an administrative barrier to the

implementation of the wage adjustments described in this section.

Sec. 1695. (1) The department shall establish a workgroup to

design and implement changes in Medicaid reimbursement to nursing

facilities that account for case mix by October 1, 2008. The

workgroup will include representatives from the department, the

health care association of Michigan, the Michigan county medical

care facility council, and the Michigan association of homes and

services for the aging.

(2) The department shall provide updates on the progress of

the workgroup quarterly to the senate and house appropriations

subcommittees on community health and to the senate and house

fiscal agencies.

Sec. 1710. Any proposed changes by the department to the

MIChoice home and community-based services waiver program screening

process shall be provided to the members of the house and senate

appropriations subcommittees on community health 60 days prior to

implementation of the proposed changes.

Sec. 1713. (1) The department, in conjunction with the

Michigan dental association, shall undertake a study to determine

the level of participation by Michigan licensed dentists in the

state's Medicaid program. The study shall identify the distribution

of dentists throughout the state, the volume of Medicaid recipients

served by each participating dentist, and areas in the state

underserved for dental services.

(2) The study described in subsection (1) shall also include

an assessment of what factors may be related to the apparent low

participation by dentists in the Medicaid program, and the study

shall make recommendations as to how these barriers to

participation may be reduced or eliminated.

(3) This study shall be provided to the senate and house

appropriations subcommittees on community health and the senate and

house fiscal agencies no later than April 1, 2008.

Sec. 1717. (1) The department shall create 2 pools for

distribution of disproportionate share hospital funding. The first

pool, totaling $45,000,00.00, shall be distributed using the

distribution methodology used in fiscal year 2003-2004. The second

pool, totaling $5,000,000.00, shall be distributed to nonpublic

unaffiliated hospitals and hospital systems that received less than

$900,000.00 in disproportionate share hospital payments in fiscal

year 2003-2004 based on a formula that is weighted proportional to

the product of each eligible system's Medicaid revenue and each

eligible system's Medicaid utilization, except that no payment of

less than $1,000 shall be made.

(2) By September 30, 2008, the department shall report to the

senate and house appropriations subcommittee on community health

and the senate and house fiscal agencies on the new distribution of

funding to each eligible hospital from the 2 pools.

Sec. 1720. The department shall continue its Medicare recovery

program.

Sec. 1724. The department shall allow licensed pharmacies to

purchase injectable drugs for the treatment of respiratory

syncytial virus for shipment to physicians' offices to be

administered to specific patients. If the affected patients are

Medicaid eligible, the department shall reimburse pharmacies for

the dispensing of the injectable drugs and reimburse physicians for

the administration of the injectable drugs.

Sec. 1725. The department shall continue to work with the

department of human services to reduce Medicaid eligibility errors

related to basic eligibility requirements and income requirements.

The department shall provide a report to the senate and house

appropriations subcommittees on community health and senate and

house fiscal agencies by March 1, 2008 on the results of this

effort.

Sec. 1731. (1) Subject to subsection (2), the department shall

continue an asset test to determine Medicaid eligibility for

individuals who are parents, caretaker relatives, or individuals

between the ages of 18 and 21 and who are not required to be

covered under federal Medicaid requirements.

(2) Regardless of the results of the asset test established

under subsection (1), an individual who is between the ages of 18

and 21 and is not required to be covered under the federal Medicaid

requirements is not eligible for the state Medicaid program if his

or her parent, parents, or legal guardian has health care coverage

for him or her or has access to health care coverage for him or

her.

Sec. 1732. The department shall assure that, if proposed

modifications to the quality assurance assessment program for

nursing homes are not implemented, the projected general

fund/general purpose savings shall not be achieved through

reductions in nursing home reimbursement rates.

Sec. 1733. The department shall seek additional federal funds

to permit the state to provide financial support for electronic

prescribing and other health information technology initiatives.

Sec. 1734. The department shall seek federal funds that will

permit the state to provide financial incentives for positive

health behavior practiced by Medicaid recipients. The structure of

this incentive program may be similar to programs in other states

that authorize monetary rewards to be deposited in individual

accounts for Medicaid recipients who demonstrate positive changes

in health behavior.

Sec. 1738. The department shall explore ways to increase the

federal disproportionate share hospital cap. The department shall

provide a report to the senate and house appropriations

subcommittees on community health and senate and house fiscal

agencies by March 1, 2008 on the results of this effort.

Sec. 1739. (1) The department shall continue to establish

medical outcome targets for the 10 most prevalent and costly

ailments affecting Medicaid recipients. The department may use

indicators that recipients are successfully managing chronic

disease, measures of recipient compliance with treatment plans, and

studies of the proportion of Medicaid providers who follow

established best practices in treating chronic disease as possible

medical outcome target measures. The department shall make bonus

payments, independent of HMO rate adjustments utilized in fiscal

year 2005-2006, available to Medicaid HMOs that meet these outcome

targets.

(2) The department shall provide a report to the senate and

house appropriations subcommittees on community health and senate

and house fiscal agencies by March 1, 2008 on the results of this

effort.

Sec. 1747. In order to be reimbursed for adult home help

services provided to Medicaid recipients, the matching of adult

home help providers with service recipients shall be coordinated by

the local county department of human services.

Sec. 1751. The department shall provide a report by April 1,

2008 to the house and senate appropriations subcommittees on

community health and the house and senate fiscal agencies on

establishing Medicaid diagnosis related group rates based upon fee-

for-service and health plan costs. It is the intent of the

legislature to reduce the departmental administration and

management line by $50,000.00 if this report is not provided by the

date required in this section.

Sec. 1753. The department shall take steps to obtain data from

auto insurers on insurance payouts for health care claims. If the

auto insurers do not voluntarily release the information upon

request, the department shall propose legislation to require those

insurers to disclose that information upon request. The department

shall provide the information received under this section to

Medicaid health plans. The department shall provide a report to the

senate and house appropriations subcommittees on community health

and senate and house fiscal agencies by March 1, 2008 on the

results of this effort.

Sec. 1756. Not later than March 1, 2008, the department shall

establish and implement a specialized case and care management

program to serve the most costly Medicaid beneficiaries who are not

enrolled in a health plan and are noncompliant with medical

management, including persons with chronic diseases and mental

health diagnoses, high prescription drug utilizers, members

demonstrating noncompliance with previous medical management, and

neonates. The case and care management program shall, at a minimum,

provide a performance payment incentive for physicians who manage

the recipient's care and health costs in the most effective way.

The department may also develop additional contractual arrangements

with 1 or more Medicaid HMOs for the provision of specialized case

management services. Contracts with Medicaid HMOs may include

provisions requiring collection of data related to Medicaid

recipient compliance. Measures of patient compliance may include

the proportion of clients who fill their prescriptions, the rate of

clients who do not show for scheduled medical appointments, and the

proportion of clients who use their medication.

Sec. 1757. The department shall direct the department of human

services to obtain proof from all Medicaid recipients that they are

legal United States citizens or otherwise legally residing in this

country before approving Medicaid eligibility.

Sec. 1758. The department shall submit a report on the number

of individuals who receive the emergency services only Medicaid

benefit and the annual amount of Medicaid expenditures for this

population to the house and senate appropriations subcommittees on

community health and the house and senate fiscal agencies by April

1, 2008. It is the intent of the legislature to reduce the

departmental administration and management line by $50,000.00 if

House Bill No. 4344 as amended September 6, 2007

this report is not provided by the date provided in this section.

Sec. 1761. (1) The department shall distribute all funds

recovered by the medical services administration from prior and

future Medicaid access to care initiative payments exceeding the

hospital upper payment limit for inpatient and outpatient services

to a hospital that meets any of the following characteristics:

(a) Is located in a rural county as determined by the most

recent United States census or is located in a city or a village or

township with a population of not more than 12,000 in a county with

a population with not more than 70,000 as of the official federal

2000 decennial census.

(b) Is a Medicare sole community hospital.

hospital.

(2) The distribution under subsection (1) shall be based upon

each hospital's Medicaid fee-for-service and HMO payments as

developed in consultation with rural hospitals and the Michigan

health and hospital association.

<<Sec. 1763. In order to reduce healthcare costs, the department

shall adopt an interoperable hub that provides secure aggregation and

access to medication history data through the use of an existing,

outsourced health information exchange infrastructure. The infrastructure

will provide cross domain single sign-on allowing for realtime, data

aggregation across disparate organizations and system. Funds appropriated in part 1 will be used to fund a risk adverse, budget-neutral 10-month production pilot in Southeast Michigan with a Michigan-based service provider.>>

Sec. 1764. The department will annually certify rates paid to

Medicaid health plans as being actuarially sound in accordance with

federal requirements and will provide a copy of the rate

certification and approval immediately to the house of

representatives and senate appropriations subcommittees on

community health and the house and senate fiscal agencies.

Sec. 1770. The department shall evaluate the likely impact of

modifying the structure of the state's Medicaid program to link

payment for health services to a priority list established by an

independent commission. This study shall be submitted to the senate

and house appropriations subcommittees and the senate and house

fiscal agencies by March 1, 2008.

Sec. 1771. The department shall only make disproportionate

share hospital payments available to health facilities that

participate in data sharing or outcome measurement programs.

Sec. 1773. The department shall establish and implement a bid

process to identify a single private contractor to provide Medicaid

covered nonemergency transportation services in each county with a

population over 500,000 individuals.

Sec. 1774. The department shall provide the senate and house

appropriations subcommittees on community health and the senate and

house fiscal agencies by March 1, 2008 a report that details all of

the following:

(a) Expenditure of money follows the person funds to date.

(b) Estimated general fund savings generated through use of

money follows the person.

money follows the person grant.

Sec. 1775. (1) The department shall study the feasibility of

using managed care organizations to deliver Medicaid long-term care

services. The study shall focus upon the following:

House Bill No. 4344 as amended September 6, 2007

(a) If there are a sufficient number of managed care

organizations interested in providing these services.

(b) The extent of services provided through Medicaid managed

long-term care.

associated with implementing managed care for these services.

(2) The department shall report the results of this study to

the senate and house appropriations subcommittees on community

health and the senate and house fiscal agencies by June 1, 2008.

<<Sec. 1776. If the department continues to utilize the Medicare

outpatient prospective payment system methodology to reimburse hospitals

for Medicaid clients seen in the outpatient setting including the

emergency room, then the Medicaid reduction factor utilized by the

department to compute the amount of payment made by Medicaid health plans

to hospitals must be revenue neutral and actuarially sound.

Sec. 1777. From the funds appropriated in part 1 for long-term

care services, the department shall permit nursing homes to use a

dining assistant to feed residents who need assistance or

encouragement with eating but do not have complicated feeding

problems including, but not limited to, difficulty swallowing,

recurring lung aspirations, tube or parenteral feedings, or

behavioral issues that may compromise nutritional intake.

Sec. 1779. The department shall explore methods to identify

Medicaid fee-for-service recipients who could benefit from use of

complex case management, chronic disease management, and transition

management techniques in the management of their medical care.

Senate Bill No. 4344 as amended September 6, 2007

Sec. 1780. From the funds appropriated in part 1 for health

plan services, the department shall devote <<$100.00>> gross/<<$100.00>>

general fund general purpose to provide a 4% increase in Medicaid

reimbursement to physicians for primary care services.

Sec. 1781. The department may conduct a pilot project to

demonstrate improvements in the efficiency and effectiveness of the

plan first program, long-term care programs, and other programs as

identified by the department. In conducting the pilot project, the

department shall consult with other affected programs and agencies.

In conducting the pilot, the department or its designee shall have

direct access to the department of human services eligibility,

budget, and registration systems for purposes of initial

processing, including taking applications, assisting applicants in

completing the application, providing information and referrals,

obtaining required documentation to complete processing of the

application, and assuring the information contained on the

application form is complete. To the extent practical and

desirable, trusted third-party data sources may be accessed to

verify income and asset information during the financial

eligibility determination process. The department shall issue a

report to the legislature summarizing the results of the pilot

project and recommendations for the future.

Sec. 1782. Medicaid coverage for adult dental services shall

include scaling and root planing at not less than the level in

effect on October 1, 2002.