Bill Text: MI HB4539 | 2017-2018 | 99th Legislature | Introduced

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Bill Title: Health facilities; quality assurance assessments; quality assurance assessment on ambulance providers; eliminate. Amends sec. 20161 of 1978 PA 368 (MCL 333.20161).

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2017-05-02 - Bill Electronically Reproduced 04/27/2017 [HB4539 Detail]

Download: Michigan-2017-HB4539-Introduced.html

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HOUSE BILL No. 4539

 

 

April 27, 2017, Introduced by Rep. Yanez and referred to the Committee on Health Policy.

 

      A bill to amend 1978 PA 368, entitled

 

"Public health code,"

 

by amending section 20161 (MCL 333.20161), as amended by 2016 PA

 

189.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

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

 

 2  assessments for health facility and agency licenses and

 

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

 

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

 

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

 

 6  in the following schedule:

 

 

7	(a) Freestanding surgical
8	outpatient facilities................$500.00 per facility
9	license.

1	(b) Hospitals...................$500.00 per facility
2	license and $10.00 per
3	licensed bed.
4	(c) Nursing homes, county
5	medical care facilities, and
6	hospital long-term care units........$500.00 per facility
7	license and $3.00 per
8	licensed bed over 100
9	licensed beds.
10	(d) Homes for the aged..........$6.27 per licensed bed.
11	(e) Hospice agencies............$500.00 per agency license.
12	(f) Hospice residences..........$500.00 per facility
13	license and $5.00 per
14	licensed bed.
15	(g) Subject to subsection
16	(11), quality assurance assessment
17	for nursing homes and hospital
18	long-term care units.................an amount resulting
19	in not more than 6%
20	of total industry
21	revenues.
22	(h) Subject to subsection
23	(12), quality assurance assessment
24	for hospitals........................at a fixed or variable
25	rate that generates
26	funds not more than the
27	maximum allowable under

1	the federal matching
2	requirements, after
3	consideration for the
4	amounts in subsection
5	(12)(a) and (i).
6	(i) Initial licensure
7	application fee for subdivisions
8	(a), (b), (c), (e), and (f)..........$2,000.00 per initial
9	license.

 

 

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

 

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

 

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

 

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

 

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

 

15  20155.

 

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

 

17  section for certificates of need:

 

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

 

19  each application. For a project requiring a projected capital

 

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

 

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

 

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

 

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

 

24  $8,000.00 is added to the base fee. For a project requiring a

 

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

 

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

 

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

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

 

 2  including a project scheduled for comparative review or for a

 

 3  consolidated licensed health facility application for acquisition

 

 4  or replacement.

 

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

 

 6  $1,000.00 for a certificate of need application that receives

 

 7  expedited processing at the request of the applicant.

 

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

 

 9  letter of intent requesting or resulting in a waiver from

 

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

 

11  certificate of need.

 

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

 

13  need covered clinical services shall pay $100.00 for each

 

14  certificate of need approved covered clinical service as part of

 

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

 

16  the survey data.

 

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

 

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

 

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

 

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

 

21  available to fund the certificate of need program in subsequent

 

22  years.

 

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

 

24  longer than 1 year after the date of issuance.

 

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

 

26  department at the time when an application for a license, permit,

 

27  or certificate is submitted. If an application for a license,

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

 

 2  certificate is revoked before its expiration date, the department

 

 3  shall not refund fees paid to the department.

 

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

 

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

 

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

 

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

 

 8  requirements for licensure are met.

 

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

 

10  by license fees.

 

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

 

12  $200.00 plus $40.00 per hour for the professional services and

 

13  travel expenses directly related to processing the application. The

 

14  travel expenses shall be are calculated in accordance with the

 

15  state standardized travel regulations of the department of

 

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

 

17  travel.

 

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

 

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

 

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

 

21  department shall deposit the fees and assessments collected under

 

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

 

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

 

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

 

25  program required under this article.

 

26        (11) The quality assurance assessment collected under

 

27  subsection (1)(g) and all federal matching funds attributed to that

 1  assessment shall must be used only for the following purposes and

 

 2  under the following specific circumstances:

 

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

 

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

 

 5  Medicaid nursing home reimbursement payments. Only licensed nursing

 

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

 

 7  quality assurance assessment and participate in the Medicaid

 

 8  program are eligible for increased per diem Medicaid reimbursement

 

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

 

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

 

11  pay the assessment required under subsection (1)(g) in accordance

 

12  with subdivision (c)(i) or in accordance with a written payment

 

13  agreement with this state shall not receive the increased per diem

 

14  Medicaid reimbursement rates under this subdivision until all of

 

15  its outstanding quality assurance assessments and any penalties

 

16  assessed under subdivision (f) have been paid in full. This

 

17  subdivision does not authorize or require the department to

 

18  overspend tax revenue in violation of the management and budget

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 1  assessed.

 

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

 

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

 

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

 

 5  to implement this subdivision as follows:

 

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

 

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

 

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

 

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

 

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

 

11  patient day of care provided within the immediately preceding year

 

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

 

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

 

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

 

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

 

16  maximum allowable assessment permitted under subsection (1)(g) less

 

17  the total amount to be paid by the nursing homes and long-term care

 

18  units with less than 40 licensed beds or with the maximum number,

 

19  or more than the maximum number, of licensed beds necessary to

 

20  secure federal approval of the application by the total number of

 

21  non-Medicare patient days of care provided within the immediately

 

22  preceding year by those nursing homes and long-term care units with

 

23  more than 39 licensed beds, but less than the maximum number of

 

24  licensed beds necessary to secure federal approval. The quality

 

25  assurance assessment, as provided under this subparagraph, shall

 

26  must be assessed in the first quarter after federal approval of the

 

27  waiver and shall must be subsequently assessed on October 1 of each

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

 

 2  payment due 90 days after the date the assessment is assessed.

 

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

 

 4  centers are exempt from the quality assurance assessment if the

 

 5  continuing care retirement center requires each center resident to

 

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

 

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

 

 8  residency and services and the continuing care retirement center

 

 9  utilizes all of the initial life interest payment before the

 

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

 

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

 

12  retirement center" means a nursing care facility that provides

 

13  independent living services, assisted living services, and nursing

 

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

 

15  has shared facilities or common areas, or both.

 

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

 

17  per diem nursing home Medicaid reimbursement rates for the balance

 

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

 

19  assurance assessment is assessed and collected, the department

 

20  shall maintain the Medicaid nursing home reimbursement payment

 

21  increase financed by the quality assurance assessment.

 

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

 

23  that complies with federal requirements necessary to ensure that

 

24  the quality assurance assessment qualifies for federal matching

 

25  funds.

 

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

 

27  to pay the assessment required by subsection (1)(g), the department

 1  may assess the nursing home or hospital long-term care unit a

 

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

 

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

 

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

 

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

 

 6  122, MCL 205.13.

 

 7        (g) The Medicaid nursing home quality assurance assessment

 

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

 

 9  deposit the revenue raised through the quality assurance assessment

 

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

 

11  quality assurance assessment fund.

 

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

 

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

 

14        (i) The department shall prorate the quality assurance

 

15  assessment collected under subsection (1)(g) shall be prorated on a

 

16  quarterly basis for any licensed beds added to or subtracted from a

 

17  nursing home or hospital long-term care unit since the immediately

 

18  preceding July 1. Any adjustments in payments are due on the next

 

19  quarterly installment due date.

 

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

 

21  reimbursement rates shall must not be reduced below the Medicaid

 

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

 

23  of the quality assurance assessment collected under subsection

 

24  (1)(g).

 

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

 

26  assessment collected under subsection (1)(g) shall be is equal to

 

27  13.2% of the federal funds generated by the nursing homes and

 1  hospital long-term care units quality assurance assessment,

 

 2  including the state retention amount. The state retention amount

 

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

 

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

 

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

 

 6  purpose revenue originally appropriated for that purpose.

 

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

 

 8  or collect the quality assurance assessment or apply for federal

 

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

 

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

 

11  shall not be assessed or collected after September 30, 2011 if the

 

12  quality assurance assessment is not eligible for federal matching

 

13  funds. Any portion of the quality assurance assessment collected

 

14  from a nursing home or hospital long-term care unit that is not

 

15  eligible for federal matching funds shall must be returned to the

 

16  nursing home or hospital long-term care unit.

 

17        (12) The quality assurance dedication is an earmarked

 

18  assessment collected under subsection (1)(h). That assessment and

 

19  all federal matching funds attributed to that assessment shall must

 

20  be used only for the following purpose and under the following

 

21  specific circumstances:

 

22        (a) To maintain the increased Medicaid reimbursement rate

 

23  increases as provided for in subdivision (c).

 

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

 

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

 

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

 

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

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

 

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

 

 3  includes Medicare payments and amounts collected for coinsurance

 

 4  and deductibles.

 

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

 

 6  the hospital Medicaid reimbursement rates for the balance of that

 

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

 

 8  assessment is assessed and collected, the department shall maintain

 

 9  the hospital Medicaid reimbursement rate increase financed by the

 

10  quality assurance assessments.

 

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

 

12  that complies with federal requirements necessary to ensure that

 

13  the quality assurance assessment qualifies for federal matching

 

14  funds.

 

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

 

16  subsection (1)(h), the department may assess the hospital a penalty

 

17  of 5% of the assessment for each month that the assessment and

 

18  penalty are not paid up to a maximum of 50% of the assessment. The

 

19  department may also refer for collection to the department of

 

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

 

21  122, MCL 205.13.

 

22        (f) The hospital quality assurance assessment fund is

 

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

 

24  revenue raised through the quality assurance assessment with the

 

25  state treasurer for deposit in the hospital quality assurance

 

26  assessment fund.

 

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

 1  department shall only collect and expend the quality assurance

 

 2  assessment shall only be collected and expended if Medicaid

 

 3  hospital inpatient DRG and outpatient reimbursement rates and

 

 4  disproportionate share hospital and graduate medical education

 

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

 

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

 

 7  assessment collected under subsection (1)(h), except as provided in

 

 8  subdivision (h).

 

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

 

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

 

11  assessed or collected after September 30, 2011 if the quality

 

12  assurance assessment is not eligible for federal matching funds.

 

13  Any portion of the quality assurance assessment collected from a

 

14  hospital that is not eligible for federal matching funds shall must

 

15  be returned to the hospital.

 

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

 

17  assessment collected under subsection (1)(h) shall be is equal to

 

18  13.2% of the federal funds generated by the hospital quality

 

19  assurance assessment, including the state retention amount. The

 

20  13.2% state retention amount described in this subdivision does not

 

21  apply to the Healthy Michigan plan. In the fiscal year ending

 

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

 

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

 

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

 

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

 

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

 

27  applied proportionately to each hospital quality assurance

 1  assessment program to determine the retention amount for each

 

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

 

 3  fiscal year to the department to support Medicaid expenditures for

 

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

 

 5  identical amount of general fund/general purpose revenue originally

 

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

 

 7  state budget office, and the Michigan Health and Hospital

 

 8  Association shall identify an appropriate retention amount for the

 

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

 

10  thereafter.

 

11        (13) The department may establish a quality assurance

 

12  assessment to increase ambulance reimbursement as follows:

 

13        (a) The quality assurance assessment authorized under this

 

14  subsection shall be used to provide reimbursement to Medicaid

 

15  ambulance providers. The department may promulgate rules to provide

 

16  the structure of the quality assurance assessment authorized under

 

17  this subsection and the level of the assessment.

 

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

 

19  that complies with federal requirements necessary to ensure that

 

20  the quality assurance assessment qualifies for federal matching

 

21  funds.

 

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

 

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

 

24        (d) The quality assurance assessment authorized under this

 

25  subsection shall not be collected after October 1, 2019. The

 

26  quality assurance assessment authorized under this subsection shall

 

27  no longer be collected or assessed if the quality assurance

 1  assessment authorized under this subsection is not eligible for

 

 2  federal matching funds.

 

 3        (13) (14) The quality assurance assessment provided for under

 

 4  this section is a tax that is levied on a health facility or

 

 5  agency.

 

 6        (14) (15) As used in this section:

 

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

 

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

 

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

 

10  than 90%.

 

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

 

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

 

13  after the date it is enacted into law.