Legislative Update Week of August 26th.

With the leaves starting to turn, children starting to collect their supplies for the upcoming school year and the sounds of football filling the weekends, it must mean that fall is around the corner. With that also means that the legislature is back in session ready to deal with the pending question that everyone has been working on and waiting for an answer to, Medicaid Expansion HB 4714. The Senate met this past week on Tuesday to finally answer that question, but lets review how we ended up here.

June:

The House has passed their version of the Medicaid Expansion leaving it to the Senate to work on the issue before the legislative summer break. The Senate discharges the bill from committee consideration the last week of session starting the debates internally in the Senate Republican caucus on how they were for or against the expansion. During this time the Governor is away on an economic mission in Israel and the Lieutenant Governor was in the Upper Peninsula of Michigan leaving the executives out of Lansing and leaving Medicaid floundering.

Wednesday of the final week the Lieutenant Governor cuts his trip short to head back to Lansing to work with the Senators to somehow help push Medicaid over the finish line in the Senate. At the same time two other Senators say they are working on or have alternative proposals for the Senate to consider. After Wednesday no progress had been made in moving the vote forward leaving Thursday the final day before the legislature headed out for summer and leaving the Governor on a plane back from Israel to Michigan to try to push the expansion over the finish line.

The Governor made his appearance just before noon on Thursday and starting meeting with individual senators one on one, trying to get their issues solved so that the Senate could vote on Medicaid that day. Hours dragged on leaving by 5:00 pm that day still votes short in the Senate and a frustrated Governor having a press conference saying that the Senate should stay rather than go home and solve the expansion issue. The Senate had another plan and sent the Medicaid expansion bill to the Senate Government Operations committee where a work group would be created to work on the bill over the summer. The Senate broke for the summer leaving Medicaid still hanging in the wings.

July and August:

Senator Richardville convened the Government Operations committee announcing that there would be a work group that would be drafting legislation that would be suitable to all parties in the Senate and that they would meet on a weekly basis. Senator Kahn, MD was the lead of the work group, using his experience as a physician to provide clarity, insight, and leadership to the work group. The Government Operations committee would meet every two weeks looking for an update on the progress of the work group and report to those who attended the committee meetings.

The workgroup finally came to the committee with a product at the end of July where then the committee took testimony from the interested groups on their opinions and either support or nonsupport for the legislation. The committee also considered two other Medicaid plans that were provided by Senators Collbeck and Caswell. SB 422 and SB 459 and SB 460 were the alternative plans provided to the committee. Many of the groups testifying supported HB 4714 but did not provide their support for the other pieces of legislation. At the end of the committee meeting all three plans made it out where a showdown was expected on the Senate floor.

August 27th:

The Senate came in for their final summer session day with high stakes looming over the Senate. This was the day that the Medicaid vote was going to happen, leaving the hallway to the Senate chambers full of advocates for or against Medicaid expansion ready to push votes the way they wanted to. The Lieutenant Governor was ready to break any tie votes that had come on the floor; the stage was set. The Senate took up HB 4714 where the vote on it the firs time left them one vote short 19-18 with Senator Collbeck abstaining from voting. Since this wasn't a majority of the Senate voting for the bill failed.

A reconsideration motion was made quickly after and the leadership of the Senate along with the Governor's office continued to work on the members that were still in opposition of the legislation. Finally after some amendments the vote was taken again and this time Senator Casperson, a Republican from Escanaba, switched his vote and voted for the expansion allowing the legislation to pass 20-18. The legislation still waits in the Senate thought since the chamber fell two votes short on granting the legislation immediate effect. The Senate will be considering this on Tuesday September 2nd when they come back to start their fall schedule.

Stay with MSMS to get all of the up to date information surround Medicaid other issue at http://www.msms.org/advocacy.

Legislative Update Week of June 17th

The Legislature saw the light at the end of the tunnel with this being the final week before they leave on their summer recess. This week started with the Lieutenant Governor in the Upper Peninsula and the Governor in Israel working on creating economic development for Michigan but with the Medicaid expansions hanging in the balance, we saw trips being cut short with both the Lieutenant Governor and the Governor coming back to Lansing to try to get the Medicaid expansion across the finish line. Let’s review the week:

House:

The House started out this week with having a number of topics on the agenda including House bill 4736 that would allow Expedited Partner Therapy in Michigan. This was on the agenda for Wednesday for the House to take up but everything took a back seat to what was happening across the hall in the Senate.

Senate:

The Senate found itself in the limelight, where it wanted it or not, this week with the possible consideration of HB 4714 or the bill that addresses Medicaid expansion. Starting out the week the Senate Republicans were having troubles meeting their own imposed requirement where a majority of their caucus has to vote in favor of the legislation before they will consider an issue on the full Senate floor. Wednesday found the majority of those lobbying in the Capitol working on the Senate asking Senators to support the expansion. The Lieutenant Governor made his want back to Lansing to join those lobbying the Senate Republicans on supporting the exchange. At the end of the day, Wednesday saw no action on the expansion and left some wondering if it would ever get done.

Thursday and final day of session before the summer break, found those hoping for the Medicaid expansion to make its way to the Governor's desk, but with the Governor gone in Israel for the past week, it was hard for supports of the legislation to find any hope of moving the issue forward. Then word came that the Governor was on his way back to Lansing and would be at the Capitol before noon. With the Governor's arrival eminent, supports continued working with Senators to push them to support House Bill 4714. When the Governor arrived, he talked with his staff that had been working on the Senate, giving him a status report, and then started working members of the Senate. This went on for most of the afternoon where he also called representatives from the supporting groups to fill them in on his progress which was not promising at the time.



Kenneth Elmassian, DO, President of MSMS in the background at
the Governor's Medicaid Expansion Press Conference.
From the Detroit News
http://www.detroitnews.com/article/20130620/POLITICS02/306200084

Finally, after five hours of working the Senate, the Governor called a press conference with supports of the expansion asking the Senate to take a vote on the expansion rather than heading home for summer break. Kenneth Elmassian, DO, President of the Michigan State Medical Society was there for MSMS. "Every discussion about health care and health policy in Lansing should start and end with what is best for Michigan patients. The Healthy Michigan Plan puts patients first, helping more families receive the health care they so desperately need while being responsible with residents' tax dollars," said Elmassian in a statement. He went on to say, "Physicians across Michigan are grateful for Governor Snyder's steadfast leadership and look forward to working with lawmakers this summer and into the fall on reforms that put patients first."

Now the Senate will be back in August on the 27th to hopefully finish the work done on the Medicaid expansion, those supporting the package now have until August to continue working to garner support for the package. The blog will now take a break until the legislature comes back into session in August. Follow MSMS though through our twitter feed and Facebook page to get up to date information on what is happening over the summer at http://www.msms.org/advocacy.

Legislative Update Week of June 10th

With the clock ticking away on the amount of time left in the legislative calendar for this first part of the year, Medicaid reform was front and center throughout the entire week, leaving one chamber looking on to see what would be done. Let's review the past week.

House:

With the Senate looking on the House Michigan Competiveness Committee was signaling that there was a substitute bill to House Bill 4714 at the start of their meeting on Tuesday, where the committee continued to take testimony, this time from those individuals who are associated with the Tea Party. Comments offered to the committee from those testifying had nothing to do with the legislation but rather how they disliked the Affordable Care Act and any expansion of any government service or program. After the testimony from the Tea Party the committee adjourned and reconviened on Wednesday where they approved the legislation as substituted along with some amendments that were also tacked on by members of the committee. A further analysis of the legislation can be see here.

Dr. Kenneth Elmassian, President
of MSMS sharing his feelings
about the Michigan Medicaid Reform.

Wednesday the House moved the legislation through second reading leaving a showdown within the Republican caucus on Thursday to move the legislation out of the House to the Senate. The day started at it's usual time with both caucuses heading back to their respective rooms to discuss the upcoming vote on the Medicaid reform package. The subsititute stripped out some of the harsh language including the 48 month drop out of the program was changed to after 48 momths increasing co-pays for the program. Also an amendment was added that at the end of the 48 months a 90 day period would be added on to allow patients to be ready for the changes. After hours of working the room, those support the legislation were able to get the votes needed to pass the bill to the Senate with a vote of 76 for and 31 against.

Now the legislation heads to the Senate as they choose what to do with it over the summer break. The House did also send legislation to the Senate that would allow those who have military expereince to use that if they are looking to be licensed as an EMT. This was part of a larger package aimed to help veterans coming home looking for a job.

With a week left there are several issues still on the docket that both chambers are looking to complete before the summer break. Stay with MSMS to get the up to date information on the issues that will effect the physician community. Go to http://www.msms.org/advocacy to get all the information.

Legislative Update Week of June 3rd.

With the summer recess looming on the horizon, both chambers are looking to finish up some of the larger issues that have been on the plate for the legislature. Lets review the activity of this week and whats still to come:

Senate:

The Senate concurred with the conference report for the General Government Omnibus budget, which covers the Department of Community Health budget as well. With the budget now agreed to by the both House and Senate, it will be heading to the Governor's desk for his signature.

House:

The House Michigan Competitiveness Committee convened again this week to consider the House Republican Medicaid Reform package. House Bill 4714 would require the state to ask for a waiver for their Medicaid program that would require full support of expansion by the Federal Government along with a 48 month limit for those able bodied individuals using Medicaid. There were rumors that the legislation was going to be voted out this week by the committee but it did not happen. Instead there was notification that a substitute piece of legislation would be introduced which would make the plan more attractive to the groups who are against this major change. We wait to see what the substitute legislation will look like, but signals from the chair of the committee along with the Speaker of the House is that the new legislation will have the 48 month limit included in it.

The House Judiciary committee came together with the House Health Policy committee to take testimony on House Bills 4694, 4695, 4696 and 4697, which is enabling legislation to create Mental Health courts statewide in Michigan, bring them under the authority of the State Court Administrator's Office (SCAO) and allow them to direct funding for the program. The General Government Omnibus budget included $2 Million for the courts in Michigan, now with this legislation it these court could become a reality. The joint committee heard testimony from those involved in the Mental Health court in Kalamazoo on Tuesday when the joint committee meet. The Judiciary committee continued taking testimony on this issue on Thursday  hearing from the judge in charge of the Mental Health court in Kalamazoo. This legislation is likely to be moved out of the committee at their next meeting as this was one of the issues that Republicans were interested in moving before the start of the break.

The House Health Policy Committee also meet this week to consider a host of issues including taking a vote on House Bill 4736, a bill that would bring EPT to Michigan. The legislation made it out of committee with no signs of fight back from the members of the committee with a vote of 13 yes votes 0 No votes and 2 passes. Now the legislation will be sent to the full House for their consideration and we are hopeful for a vote before the House members leave for break. The committee also took a vote on changing the grade requirement for immunizations. The push to to move the record from 6th to 7th grade since those who are in 6th grade may be younger than what traditionally someone in 6th grade would be. This legislation headed to the House as well.

The Coming Weeks:

The House has several large issues they are looking to tackle before heading home on their summer recess. Transportation and road funding is the major problem facing the legislators at the moment. Looking to increase the tax on gasoline while it is so high or tacking on an increase to your registration fees are just a couple of the ways the House is looking at to solve this road funding issue. Medicaid expansion will be in the limelight for the next couple weeks as well. The House is committed to get their Medicaid reform legislation to the Senate before break. Those are the two largest issues facing the legislature that are trying to be teed up to send to the other chamber.

For more information on what is happening in Lansing and beyond follow us at http://www.msms.org/advocacy. You can get all of the information there and from our Facebook and Twitter feeds. What to know what is happening politically? Check out MDPAC at http://www.mdpac.org to get all the information on who will be running for what in the coming months ahead.

Legislative Update Week of May 27th

This week the legislature saw a short but very important week with the House working hard to meet it's self imposed deadline of getting the budget approved. Let's take a look at what happened before the legislators left for the week:

Budget:

The Detroit Regional Chamber had it's annual policy conference on Mackinac Island this week that included names like Governors Jeb Bush and Scott Walker. This left the legislator looking at a shorten schedule for this past week with the conference starting on Wednesday. The House started with the School Aide budget with an increase in the foundation allowance for most school districts around Michigan that averaged out to $52 per student. The Senate agreed with the House and the Conference Committee' s work and passed the Education Omnibus budget, sending it to the Governor for his signature.

The General Government Omnibus budget is still in limbo. The House received the report of the Conference Committee, a report that came without the Medicaid Expansion. Mental Health Services saw the majority of extra funding with the Governor's push for greater access and increased services for those needing mental services. The House voted the bill out on party lines to the Senate for their approval but the Senate decided with the short timeline for the week that they were not interested in rushing the budget through. The Senate will be considering the budget this coming week.

This coming week the budget will be finalized, Expedited Partner Therapy could see a vote in the House Health Policy committee along with other action. Stay will MSMS to get the most up to date information at http://www.msms.org/advocacy.

Legislative Update week of May 20th

The end of the yearly budget race is now in the sights of the lawmakers as the leadership teams of both houses were able to come to an agreement on where they wanted to budget to fall out, does that include the expansion of Medicaid, let's review the activities of the week.

House:

The House Health Policy committee this week took testimony on a host of legislation. House Bill 4736 which would bring Expedited Partner Therapy to Michigan, that could make it the 36th state to put this policy into place. Dr. Annette Mercatante, health officer of St. Clair County Health Department, testified on behalf of MSMS and the Michigan Association of Local Public Health. Dr. Mercatante was able to provide the experiences of those working in the public health field and those working in the local public health departments. Dr. Jody Jones testified on behalf of ACOG providing the aspects of pregnant mothers and their unborn children. The committee also considered Senate bills 237, 238, and 239 that would change immunization requirements by having children be immunized by the 7th grade rather than the 6th grade. It is expected that the House committee will take the legislation up for a vote on June 4th.



Senate:

The Senate Health Policy committee also met this week considering two items during their meeting. The the State deciding not the implement their own health insurance exchange, regulations have to now be put into place to deal with the impending changes. One of those changes came up in the committee in the form of Senate Bill 324 that would provide some regulations for navigators of the exchange. This bill rushed out of committee and on to the Senate floor where it has been posted to be considered in the House Health Policy committee on June 4th. Senate Bill 373 was also considered which would allow the Board of Pharmacy to allow for pilot projects for applications of prescriptions. This legislation will be heading to the House as well but not at the same speed at the navigators legislation.

Budget:

This week the final hurdle was crossed by the legislator allowing for the considerations of the different departmental budgets. Last week the May Revenue Estimating conference met letting the legislators know that there was just over $400 Million extra revenue coming into the State for the next fiscal year. major questions of road and education funding, a fix for the HICA tax that funnels into Medicaid, along with other ideas were thrown out on the table for consideration. After discussions between the leadership the decision was made to put the majority of that funding into road construction and maintenance and also putting $75 Million into the State's rainy day fund.

This left no discussion of a fix for the HICA tax shortfall and the Medicaid expansion with the news of the spending priorities with the new found money. This goes for the agreement discussions as well between the House and Senate leadership when looking at finalizing the numbers for the coming year's budget, leaving the Medicaid expansion off the table. Signs are not positive for those support the expansion with the feasibility of the expansion being including in this budget bill less likely by the day, leaving the legislator no choice than to do a separate bill if they choose to expand the program.  Conference committees will start meeting next week with the hope that a budget solution will be found by the end of next week.

Stay with MSMS to get the up to date information on what is happening in Lansing and beyond; go to http://www.msms.org/advocacy. Your support keeps physician issues on the forefront of the legislators, we need your continual support, go to http://www.mdpac.org to see how you can help today.

Legislative Update Week of May 13th

The Legislature received it's updated estimates on revenue for the coming fiscal year on Wednesday which sparked activity on the budgets in the House and Senate. The Senate finally sent its MDCH budget proposal to the full House without the Medicaid Expansion dollars realized in the budget, while House Republicans started taking testimony on their solution to the Medicaid question. Let's review the activities of the week:

House:

The House this week in the common procedural move "zeroed" out the budget proposals that the Senate sent to the House and sent them back which now sets up the budgets to go to conference committee. One lingering issue that the House will most certainly address next week is the MDCH budget that was finally sent to the House for their consideration without the Medicaid Expansion dollars allocated in the budget, leaving the question still on the table of the expansion will survive in Michigan.

The House Health Policy committee this week considered Senate Bill 165 and House Bill 4156 in its traditional second hearing fashion was looking to take a vote on the legislation. The committee provided a substitute to Senate Bill 165 and House Bill 4156 and sent them on their way to the House floor for consideration. The Senate bill will have to be sent back to the Senate for concurrence since the House amended the bill.

The main attraction this week was actually the House Michigan Competitiveness Committee which had House Bill 4714 which is the Republican answer to the Medicaid Expansion question. Committee meetings on this legislation started on Tuesday with hearing in the afternoon and then continued again on Thursday. Republicans are looking for major Medicaid reform and on Thursday had the opportunity to ask the Michigan Department of Community Health Director Jim Haveman and Medicaid Director Steve Finton if they felt that direction Republicans were taking was a good idea and to provide a general overview of the current system in Michigan. It is expected that the process will continue into the next week or two before any potential action from the committee.

The Senate

The Senate Health Policy committee reconvened this week where health insurance was on their radar. The committee considered Senate Bill 324 which would provide the licensure and governance of insurance "Navigators" in Michigan. With the pending implementation of the health insurance exchanges the use of navigators will be crucial to those looking to obtain health insurance. Currently under Michigan statute there is no mention of navigators leaving them to be unlicensed and unregulated on a state level. The committee just took testimony on the legislation and would expect to vote the legislation out before the summer break begins.

Expedited Partner Therapy Press Conference

On this past Thursday the National Coalition of STD Directors (NCSD) along with MSMS, the Michigan section of ACOG, MALPH, and the Michigan Pharmacists Association had a press conference and reception to education lawmakers on the policies of Expedited Partner Therapy. Representatives Gail Haines and George Darany were gracious hosts of the reception and press conference with Representative Darany being able to highlight his legislation House Bull 4736 that would bring EPT to Michigan.
     
"The treatment is critical to prevent reinfections and further transmission for untreated partners," Rep. Darany said in the press conference. Jeff Phillips, MD represented MSMS at the press conference providing his thoughts and expertise to the panel. "It's frustrating seeing these patients come back time and again with an infection that is easily treatable," said Phillips after the press conference. Stephanie Arnold Pang from NCSD provided the national outlook of the practice of EPT and what they are seeing from the different states that have implemented the policies. "If you don't treat a partner of a patient with an STD, the treatment of that index patient is not effective, they are just going to be reinfected and it will cause more costs and visits on our health care system," said Arnold Pang. The legislation is now scheduled for a hearing on May 21st with a possible voting out of the committee on June 4th.

Stay with MSMS to get the most up to date information on all of the items MSMS is following in the legislature and beyond at http://www.msms.org/advocacy.

Legislative Update Week of May 6th

This week Medicaid took the spotlight away from all of the other activities as the House Republicans produced their plan to reform Medicaid so that they could accept the expansion of the highly utilized program. Let's review that and the other activities of the week in the Michigan Legislature.

House:

The House saw little activity this week as the Tulip festival was underway on the west side of the state. This left little action by committees and the full House. The House Health Policy committee did schedule a hearing for the 14th where they will be likely voting on the Senate Bill 165 and House Bill 4156.

Senate:

The Senate this week considered Senate Bills 237, 238, and 239 which would change the grade requirements for immunizations in Michigan. The Senate Health Policy committee saw little to no objection of moving this legislation forward and neither did the full Senate Floor. The bills passed the floor without any objection and have now moved to the House where they have been referred to the House Health Policy committee.

Medicaid Reform:

Outline of Republican Medicaid Reform
Source: Michigan Republican Caucus

Over the past several months the Legislature has been grappling with expanding Michigan's Medicaid program to bring in those individuals who are at 133% of poverty or worse in to the program. Many in both chambers feel that they are setting up Michigan for legacy costs that could hamper the other essential services that the state provides, for example road funding and education. MSMS, the Michigan Hospital Association, along with other medical groups have come out with the Governor and supported the expansion.

Feelings in the legislature still where they were when the expansion was first announced found themselves asking for reforms in Medicaid, where it has the perception of being a huge money drain that is full of inefficiencies and waste. From the mindset both House and Senate members have been trying to find a way to reform Medicaid to allow for the expansion to happen while continuing to be fiscal responsible. House Republicans this past Thursday feel that they have the answer.

Their plan (House Bill 4714) looks like this:

• Requires that the expansion be 100% funding by the federal government.
• Would require those on Medicaid to pay a co-pay or deductible that falls within 5% of their income.
• Would set up Health Savings account for those on Medicaid.
• Preventative care would be a little or no cost to the patient.
• Providing incentives for those patients on long term care to get well and make themselves better.
• Options to those on Medicaid to choose private plans for insurance, similar to a insurance exchange except specific to Medicaid.
• Would only allow those who are single and able to be on Medicaid for 48 months which is seeking to rid them of an entitlement feeling.

It is uncertain when and if this proposal will receive a hearing but be assured it will be similar to the Auto No-Fault or Tort Reform hearings that have happened in the past. Stay with MSMS to get all of the up to date information on this and others at http://www.msms.org/advocacy.

 

Legislative Update Week of April 29th

Words of Auto No-Fault reform continued to stay in the air this week as the House Insurance committee while the topic of abortion found its way to the Senate Judiciary committee. Let's review the events of the past week:

House:

The House Health Policy committee met this week and considered two items which the committee took only testimony. The first bill was House Bill 4156 which would create liability protections for nurses who are practicing under a special volunteer license. This practice is common for other health professionals including physicians, dentists, and others. Little opposition was brought to the committee's attention and this bill should be voted on next week in the committee. The second bill the committee reviewed was Senate Bill 165 which would require hospitals to provide in writing information to the patient's parent or guardian, if the patient was a minor, on the use or non use of life sustaining treatment or non beneficial treatment. The committee is expected to vote this legislation out in the coming week as well.

The main event this week was again in the House Insurance committee where they continued taking testimony on House Bill 4612 that would reform Michigan's Auto No-Fault system. The committee started in the morning back in their normal committee location in the House Office Building. The committee room along with two other rooms were pack full of people concerned about the impending changes brought forth by the legislature. The committee went until Noon where it broke so that the members could go to Session to work on the items planned for the full House that day. After Session the members of the committee came back and continued until just after 5:00pm. Just before the committee broke, Chairman Lund asked for amendments to the bill and ran those, which would take away the $50,000 cap for retrofitting houses or cars and removing the 16 hours cap for in home care allowing for a full 24 hour in home care. After all the amendments were considered the committee took their vote seeing the legislation leave the House Insurance committee on a partisan vote, all Republicans voting for and the Democrats voting against. Now the legislation heads to the full House where some are saying that some members on the republican side don't want to vote on the issue.

Senate:

The Senate this week had the youth in mind this week. Starting with the Health Policy Committee, they considered Senate Bills 237, 238, 239 that would amend the Public Health Code, School Code, and the School Aid Act to move the grade requirement from 6th grade to 7th grade starting January 2014. Legislation was provided to move the grade requirement so that it would be able to fit all of the age requirements that health professionals were looking to obtain. These bills were sent to the Senate Floor after the committee voted out the legislation. It would expected for the Senate to consider the bills in the coming week.

The Senate Judiciary committee took another track this past meeting and had a discussion with the Department of Licensure and Regulatory Affairs about conflicts of interest on their licensure boards. This topic arose after a situation in Muskegon which involved the Michigan Board of Medicine. MSMS as been actively engaged with the issue of the committee and is working with the committee and the Board of Medicine to answer any and all questions.

Budget:

Budgets at this point are at a stand still. It is expected here in the next couple weeks that the House and Senate will whats called "zero out" the budgets sent by their colleagues in the other chamber returning the legislation back to their original chamber and finally sending them to Conference committee. All members of the Appropriations committee are awaiting the May Revenue Estimating Conference here in the coming weeks.

Stay with MSMS and MSMS Government Relations to get the up to date information either at http://www.msms.org/advocacy or on Twitter or Facebook!

Legislative Update Week of April 22nd

This week saw the start of an issue that MSMS has been concerned with for the past decade. The second attempt in the past four years to reform Michigan's Auto No Fault system officially started; while at the same time taking attention away from both chambers passing their respective budget bills furthering that process down the road. Let’s review the activities of the past week:

House

This week the full House took action on their budget bills sending their usual two budget bills to the Senate for their consideration. The general government budget omnibus legislation saw the least amount of controversy with the education omnibus bill, affectionately known as the "School Bus" has a harder time moving due to some language that dealt with employee contracts. Both bills are now in the Senate passing another hurdle in the budget process.

More importantly the House finally sent Senate Bills 178 and 179 to the Governor for his consideration. These pieces of legislation would help create the uniformed prior authorization forms for physicians when looking to obtain authorization for prescriptions. This will finally bring some solid reforms providing physicians more time with patients and less time doing paperwork.

The House Health Policy committee this week had a presentation on CRE infections. This topic came about from an article that was in the WashingtonPost concerning the increase in the dangerous infections around the country and that only a few states were tracking them. Matthew Sims, MD, who is the Director of the Department of Infectious Disease Research at Beaumont hospital, testified for the medical society on the effects of the infections in Michigan what health systems and physicians are doing about it. There could be future legislation that could require physicians report the instances of CRE infections.

Picture inside committee room for
the No-Fault hearing.

The House Insurance committee takes the award this week with the most active and anticipated committee. House bill 4612 was introduced this week that would provide a major overhaul of the automotive no-fault insurance system that Michigan currently has. As we mentioned last week in the Update, this would provide a cap of coverage for those in a catastrophic accident to $1 Million, provide a pilot program for those looking for low cost insurance and have a low value vehicle, and a major attempt to strike back against fraud. Tempers flared and words were heated between those testifying and member of the committee which boiled over to member to member heated exchanges.

The committee was held in the largest room available to the House for committees and still had four more rooms and hallways full of people wanting to testify and get their voice heard on the issue. The committee went late into the afternoon with the promise that those who wanted to testify could. Finally at the end of the day the committee was not able to get through everyone leaving with more committee meetings to happen here in the near future. MSMS is working with the Coalition Protecting Auto No-Fault (CPAN) in providing information for the committee members on why this is the wrong move for Michigan. We will continue working with our partners to stop this harmful legislation.

Senate:

The senate had more of a mundane week by having them primarily working on their budgets, sending each individual budget to the House for their consideration; a different move from the House that bundled their budgets together. Multiple amendments were made on the floor including the amendment to place the Medicaid expansion money in the Department of Community Health budget, but failed along party lines. With the expansion money still left out it leaves supporters working and pushing for the money to be included. At this point we wait to see the work of the crucial conference committees that will ultimately make the decision on the expansion money.

This week is the MSMS House of Delegates in Grand Rapids. We will be providing an overview of the issues that happened at the annual meeting. Follow MSMS at http://www.msms.org/advocacy to get the up to date information from our Twitter and Facebook feeds. Stay with us as well to get the most up to date information on the issue affecting physicians around Michigan.

 

Legislative Update Week of April 15th

This week saw a flurry of legislative activity on health issues and other that are big for the medical community, lets get into the review:

House:



Dr. Kenneth Elmassian testifying
to the House Health Policy Committee

This week the House Health Policy committee took testimony on House Bill 4524, the Patient Right to Know legislation. Dr. Kenneth Elmassian, MSMS President-Elect, testified to the committee providing his expertise to the committee on this issue. "It gives patients more information when they are seeking and receiving their health care," Elmassian said. "Let's be honest, the health care system is very confusing. Patients deserve better than the system is currently giving them." The committee members fired back though leaving those in the committee wondering if the legislation would have a hard time getting out. We will be waiting to see what the committee will do in the coming week and we will let you know if the legislation moves further in the process.

Senate:

Dr. Rose Ramirez answering questions
in the Senate Triple R committee.

The Senate Reform, Restructuring, and Reinventing committee this week took its final week of testimony and moved Senate Bill 2 out of the committee to the full Senate Floor for its consideration. We reported before that this legislation would provide a sweeping change to the Public Health code providing independance for NP's CNM's and CNS-C's. For more indepth information on the original bill click on "2" above to obtain bill language and legislative analysis from the Senate Fiscal Agency. Dr. Rose Ramirez, MSMS's Speaker of the House, testified to the committee with her personal professional experience starting out in nursing and then obtaining her MD and working as a physician. "As physicians, our overarching concern is with the well-being of our patients and that the laws and regulations of Michigan lead to health care that is safe, efficient, and of the highest quality.  Patients benefit from having a focused, team-based approach that encourages communication and collaboration among the various members of the team," Dr. Ramirez testified. Through the efforts of the testimony the legislation still made its way out of the committee with a vote count of 6-1.

Budget:

This week saw the Senate Appropriations committee working on their budgets getting them through committee and sent to the full Senate for their consideration. Still left out of the budget was the money for the MSMS supported expansion of Medicaid. Many people around the capitol say that this is a vote that some of the members are either against or uneasy about taking. We could see the budgets get to their final conference committee before a decision is made about the Medicaid expansion.

Auto No Fault:

This week the Governor, along with House and Senate Insurance Chairman, introduced their plan to reform Michigan's Auto No-Fault system. This is round two to a fail attempt last session. That plan created levels of coverage that a individual could purchase that would bring savings to the buyer of the plan. This time around they are taking a different approach by providing a cap for coverage up to $1 Million. Also in the new proposal there will be a pilot program that would provide lower cost insurance for those who in poverty, have a clean driving record, and have a low value vehicle. With this program they are hoping that it will entice those who do not have insurance to purchase it. In terms of fraud they are want to begin an auditor program that will be constantly looking for fraud. With this plan officials say that families with two vehicles could see a yearly savings of $250. 

“Take a good look at this plan: is it really in the public’s best interest? I hardly think so. Capping lifetime benefits at $1 million for the catastrophically injured ultimately will shove the most vulnerable victims onto Medicaid and will pile the financial responsibility to the taxpayers," said John Cornack, President of the Coalition Protecting Auto No-Fault (CPAN). We expect here in the next few weeks that hearings will begin in the appropriate committees.

Stay with MSMS to get the up to date information on twitter @msmsgovtaffairs, on Facebook or online at http://www.MSMS.org/advocacy.

Legislative Update Week of April 8th

Budgets were the word for the legislature this week as the public had the first opportunity to see what the legislature was thinking in funding the government for the next fiscal year. In term of the Community Health budget, Medicaid was put front and center. Let’s review the activities of the past week:

House:

The House this made noise in what was introduced rather than the action that was taken by the body. Representative Gail Haines introduced House Bill 4524 that would require health professionals to wear identification cards so that patients will know who is who. There have been discussions that patients are sometimes confused on who their physician, PA, NP, nurse, etc are; by providing an increased identification hopefully it will provide clarity for the patient and the patient's family.


Dr. Elmassion and Representative Haines
at Patient Right to Know Press Conference.

MSMS hosted a press conference with Rep. Haines and Dr. Kenneth Elmassian, MSMS's President-Elect. They discussed with WLNS the importance of the legislation and the importance of providing clarity to those receiving the care. The House Health Policy committee will be considering the legislation, only taking testimony at their upcoming meeting on April 16th.

The House Health Policy committee has continued their work by furthering their education and knowledge base on the issue effecting Michigan's health care. The topic for this committee meeting was long term care and the effects it is having on insurance carriers. Blue Cross Blue Shield of Michigan along with the Michigan Association of Health Plans testified to the committee providing their insights on the issue of long term care. The committee will be meeting next week to consider several issues including House Bill 4524.

Senate:

The Senate this week considered one piece of legislation that would have direct effects in the medical community, licensure of pharmacy technicians, Senate Bill 92. Currently in Michigan pharmacy techs are not licensed or controlled by the Michigan Board of Pharmacy but rather fall under the purview of the Pharmacist. Because of this, pharmacy techs that are engaged in illegal activities are being let go and then are picked up by another employer where they can continue their illegal activities. By being licensed they now will have to face sanctions and fear of losing a license and having to have a license to practice; it will create a failsafe to keep the bad actors out. This legislation did get through the full Senate and will now be heading to the House Health Policy committee. The Senate Health Policy committee did not meet this past week.

Budget:

This week the Senate subcommittee for the Department of Community Health passed out their recommendation for the upcoming fiscal year. MSMS has been a proponent with the Governor in the Medicaid expansion. Both the House and Senate committees were not so excite about expanding the rolls of Medicaid and left the expansion money out of their budget plans. The Senate did provide language in their bill to ask the federal government to provide a waiver for their program to allow Medicaid to add incentives in the Medicaid program to lead to healthier lifestyles .
Also the committee deciced that restoring funding for Graduate Medical Education would be a priority of the committee. Dr. John Bizon, MSMS President had this to say about it, "By preserving these critical education tools, is is clear that the primary focus of the Subcommittee on the Department of Community Health was imporving the health of Michigan patients for generations and that;s great new for families across our state. Senator John Moolenaar and his colleagues are to be commended for their work on this important issue."

The House, in usual fashion for the past couple years, took all of their budgets and combined them into one massive budget bill. For more information on the House or Senate bills, click on the links provided. With the budgets now out, the legislature has taken one step in what will be many more to come.

For more information on what is happening in Lansing and beyond stay with MSMS at http://www.msms.org/advocacy.

Legislative Update Week of March 18th

With the Educational Achievement Authority leaving those watching the legislature waiting until the end of the week the House signaled that they are not in favor of the Medicaid expansion by leaving money out for those programs with the first movement on the Department of Community Health Budget and the Senate signaling that they aren't interested in working on the money for the exchange, health care is becoming front and center; let’s review the week:

House:

Dr. Kay Watnick speaking to the press
about the tanning legislation.

The House this week took up House Bills 4274 and 4275 that would require interested parties work with the Insurance Commissioner or create a standardized two page prior authorization form for prescriptions. Now the legislation will move to the Senate for their consideration. This week Representative Jim Townsend introduced House Bill 4405 that would restrict the use of tanning beds by minors in Michigan, 16 and under. Kay Watnick, MD, a dermatologists and Immediate Past President of the Michigan Dermatological Society attended a press conference with Representative Townsend at MSMS to discuss the legislation. "Indoor tanning beds emit up to 15 times more ultraviolet rays than what is emit from the sun," said Dr. Watnick. The legislation is referred to the House standing committee on Regulatory Reform.

Senate:

The Senate Health Policy Committee convened this week to consider two items, Senate Bills 136 and 237, 238, and 239. Senate Bill 136 would allow for a conscientious objection to providing certain treatments based on a moral or religious objection by the physician. If there is an emergent situation the physician may not use the objection to not provide treatment. MSMS has worked with the sponsor of the legislation to find a compromise that we feel will be productive for everyone and continue to work with the sponsor. MSMS continues to oppose the legislation. The legislation was sent to the Senate floor for its consideration. Senate Bills 237, 238 and 239 would amend the public health code along with the school code to update the ages needed for vaccinations. The committee took testimony on the issue and is expected to vote out the legislation at its next hearing.

The full Senate considered their version of the prior authorization legislation by passing Senate Bills 178 and 179. These bills will head to the House Health Policy committee for testimony. It is uncertain at this point which legislation will be the final bills passed.

Budget:

The House Appropriations Subcommittee passed it first version of the Department of Community Health budget (House Bill 4213) this week with leaving the Medicaid expansion out of the budget. There were concerns that lawmakers had on the costs to consumers and sustainability of the program with some on the inside asking for reforms to the program before money will be appropriated for the expansion. This is just the first of what will be many more rounds to come. The Senate is expected to pass their version in the coming weeks.

The Health Insurance Exchange it a snag this week in the Senate will the Senate Majority Leader stating that the exchange was virtually dead for the moment. It will be interesting to see what the next moves of the Senate will be with the implementation of the exchange due at the end of this year.

For more information on what is happening in Lansing and beyond stay with MSMS at http://www.msms.org/advocacy. Your voice counts; make it heard by supporting MDPAC! Find more information at http://www.mdpac.org.

Legislative Update Week of March 11th

With the budget and road funding taking the front seat for the legislature over the past couple weeks, this week the House switched to education with the House Education committee passing out the Education Achievement Authority legislation; while in the Senate bear petting seemed to be on their minds. Lets review what happened in the terms of health care:

House

This week the House Health Policy committee meet to hear a presentation and consider House Resolution 11 which requests that syringe and scalpel safety scores be included in the accreditation audits of health facilities. Over the past couple years there has been a push from some within the legislature along with other outside groups with a vested interest in sharps safety to push for the safety scores to be added to the standards. The committee did take testimony and reported the resolution favorably to the full House for their consideration. It was adopted by the House on the next day after the committee meeting.

Senate:

The Senate Health Policy committee meet to consider Senate Bill 136, commonly known as the Conscientious Objector act, it would provide limited provisions for physicians to decline providing treatment to patients if they have an objection due to their conscience. The committee took testimony but did not act on the legislation. The committee also considered Senate Bill 165 which would require health facilities to provide information to patients on the life-sustaining treatment options or denial of nonbenifical treatment within a facility. If a minor is involved they legal guardian would receive the information. The committee did act on the legislation, voting it to the Senate floor.

Budget:

The subcommittees took a break this week to prepare their perspective budget bills to begin moving the budgets between the chambers. The House bill is HB 4213 with the Senate bill still to come. This is the start of the legislative votes that will continue from now until just before June. Stay with MSMS for updates on the budget along with other activities in the Michigan Legislature at http://www.msms.org/advocacy.

Legislative Update Week of March 4th

With the House sending the bill to fund the insurance exchange and with the expansion of Medicaid, the Affordable Care Act was and has been front and center on the minds of those in the legislature over the past couple weeks. There were other items that made their radar as well though, lets review the actions of the week:

House:

The House Health Policy committee meet this week and in true fashion took a vote on House Bills 4274 and 4275 which would bring stakeholders together to create a new prior authorization form that would be two pages and uniform for all insurance providers in Michigan. The legislation did pass the committee with support from all of the committee except for one member. The legislation will now head to the House floor for a vote to send it to the Senate.

Senate:

The Senate Insurance committee considered their versions of the prior authorization legislation. Senate Bills 178 and 179 which are the same as the House bill mentioned above. Steven Newman, MD and MSMS Immediate Past President came to testify to the Senate committee on their importance. The committee did pass the legislation out to the full Senate for their consideration which could be as early as next week.

Budget:

This week both committees heard testimony from the Department of Community Health on Michigan Mental Health and Substance Abuse systems and for the Office of the Aging. The Governor in his budget recommendation wanted to provide jail diversion programs and innovations to the Mental Health system and place those who need mental health care and on Medicaid to have that covered by Medicaid. Huge steps forward towards total mental health parity. Though these changes the department along with the Governor feel they can provide savings and while not cutting the care. Those wanting to testify will have the opportunity on Monday when the House committee will take public testimony on the subjects.

Medical Student Lobby Day:

This past Tuesday, close to 25 medical students from the 4 medical schools in Michigan came to Lansing to lobby key legislators on issues that were important to them. They arrived at MSMS at 9:00am to begin their day with a program happening at MSMS in the morning. John Bizon, MD and MSMS President joined the group in the morning to discuss the issues that are affecting the physician community currently and lay out the issues that MSMS is fighting for.

After lunch and a review of the issues the students broke up into groups, covering close to 20 meeting with different House and Senate members discussing their positions on Graduate Medical Education and the Medicaid Expansion. At the end of their day, the students had the opportunity to meet with Sentor Roger Kahn, MD for just a brief minute. At the end of their visit, the students took a group photo on the steps of the Capitol.

Want to stay involved with whats happening in Lansing following MSMS at http://www.msms.org/advocacy. Looking to make a difference in the legislature support MDPAC. Go to http://www.mdpac.org for information on how you can help.

Legislative Update Week of February 25th

The legislature continued their work on the budget for the coming fiscal year while finally providing a solution to the Blue Cross question on whether action would be finalized, lets take a look at the week's activities:

House:

The House finally answered the questions of those around Lansing wondering when the Blue Cross mutualization legislation would be passed by the House and would the language of the legislation have the damaging abortion language that stopped the package in its tracks at the Governor's desk. On Thursday that answer was it was time to get this legislation to the Governor and without the abortion amendments that killed the legislation last time. The Governor will sign the legislation in the coming weeks.

Steven Newman, MD testifying
to the House Health Policy Committee

The House Health Policy Committee meet to discuss House Bills 4274 and 4275. These bills would create a group of stakeholders that would have to create a two page prior authorization form for prescription prior authorizations. Steven Newman, MD and MSMS Immediate Past President testified to the committee offering MSMS's support. If tradition continues in the committee then it is expected that the committee will take a vote next week.

Senate:

The Senate Reforms, Restructuring, and Reinventing committee continued taking testimony this week on Senate Bill 2 which would expand scope for Advanced Practice Nurses. It is unclear when action will happen on this legislation but we assume that some action will happen and could in the near future. The Senate also concurred on the changes the the Blue Cross mutualization passing the final legislative hurdle sending the legislation on its way to the Governor.

Budget:

This week both the House and Senate Committees working on the Department of Community Health budget had presentation from those associated with Public Health and health policy and administration. The Public Health side of the department has several situations and programs working, the Governor's 4x4 plan, meningitis outbreak, and infant mortality just to name a few. The House committee will take public testimony on these budgets this coming Monday.

For information on what's happening in Lansing and Washington follow MSMS at http://www.msms.org/advocacy.

Legislative Update Week of February 18th

The legislature this week continued their work on the budget for the upcoming fiscal year. The House finally has been receiving work done by the committees, allowing for consideration and for the first votes on the House floor for this young legislative session. Let's review the activities of the past week:

House:

The House Insurance committee took its last bits of testimony on Senate Bills 61 and 62, which would provide for the mutualization of Blue Cross in Michigan. The legislation came out of committee lacking the controversial abortion amendments that hampered the legislation last time, hopefully gaining support from the Governor this time without the amendments. The legislation will now head to the House floor where the amendments could be tacked on or added to the legislation, but it is accepted that the House will act on the legislation in the coming week.

Senate:

The Senate Reforms, Restructuring and Reinventing committee meet to continue taking testimony on Senate Bill 2 which would expand the scope of practice for advanced practice nurses. This legislation has been somewhat controversial in the medical community and many have found it interesting that the legislation was sent to this committee rather than the Senate Health Policy committee. It was unclear before the hearing whether or not the committee was going to take action on the legislation but in the end did not. MSMS is continuing to work with the sponsor of the legislation to find a compromise that would be suitable for all of the interested parties. We will keep you up to date on the actions of this legislation.

Appropriations:

Both House and Senate subcommittees meet this week to hear testimony from the largest part of the Department of Community Health budget, medical services or Medicaid. The expansion of Medicaid, which is a policy MSMS supports, was a hotly contested topic among the Senators while their presentation from the Medicaid director, Director Fitton. Many of the Senators on the committee had a hard time of seeing where the savings would come from if the state went ahead and expanded Michigan Medicaid program. Looking at the Medicaid 67% of the money is federal where the state only provides 16% of general fund / general purpose dollars to the program. It will be interesting to see how the expansion will play out in the coming months.

MSMS New Lawmakers Reception:

MSMS, as they do at the start of every legislative session, held its New Lawmakers reception at the MSMS Headquarters in East Lansing. The event was well attended by physicians and lawmakers alike with Senator Roger Kahn, MD and Representative Sean McCann to name a few that joined us. "This is a great opportunity to reach out to our lawmakers", said Raymond Rudoni, MD who is the chair of the MSMS Legislative and Regulations committee. The event went on past its end time and was hailed as a success with participation from medical students to retirees.

Legislative Update Week of February 11th

With the budget being presented by the Governor we're now off to the races on what can be described as an up and down next couple months for the next couple months. Blue Cross Blue Shield is still in the works in the House with the Senate waiting for the House's next move with the health insurance issues. Let's review the week:

House:

The House Appropriations Subcommittee for Community Health started its work on the FY 2014 budget by welcoming the Director of the Michigan Department of Community Health to the committee for an overview of the State Budget. Out of this presentation the Director laid out the priorities of the administration as it pertained to Michigan's health care Major topics were the Medcaid expansion, mental health, and infant mortality to mention a few. Now the committee will have presentation from Medicaid, Behavioral Health, and Office of Services for the Aging in the coming weeks.

The House Insurance committee took testimony on Senate Bills 61 and 62 which provides for the mutualization of BC/BS. The House, similar to last time, started discussions about the abortion language that was in the previous legislation and one of the major reasons of why the Governor vetoed the legislation last time. It is uncertain at this point whether abortion language will be in the bills moving forward.

Senate:

The Senate Committee on Reform, Restructuring and Reinventing took testimony on Senate Bill 2 which would define the scope of practice for advanced practice nurses which included nurse practitioners, nurse midwifes, and certified nurse specialists. This is an issue that the society is leary about but have been working tirelessly with the sponsor to answer his question on the the concerns that the medical community has with the legislation. It is uncertain at this point when the legislation will move but rumblings have said that it could be as early as next month.

Stay with MSMS to get the latest up to date information on all that is happening in Lansing and beyond at http://www.msms.org/advocacy. You support of MDPAC helps those in Lansing work better with physicians go to http://www.mdpac.org to find out how you can help.

Legislative Update Week of February 4th

The past two weeks the Legislature has started to pick up some steam with the Senate moving the blue cross mutualization part two through the Senate and the Governor presenting this budget to the Legislature, let’s review the activities of the past couple weeks:

House:

Committees have been finally formed with Rep. Gail Haines continuing her leadership as Chair of the House Health Policy committee. Rep. Matt Lori will continue his leadership as Chair of the Appropriations subcommittee on the Department of Community Health. The House Health Policy committee started it normal routine for the beginning of the year with briefings from the Department of Community Health for the new members of the committee. With the budget being presented the House Appropriations subcommittees will start to have presentations from their respective state departments.

Senate:

The Senate Insurance Committee over these past couple weeks considered the Blue Cross mutualization issue that started in the last term of the Legislature. This time the Senate listened to the Governor's recommendations in his veto of the previous legislation and passed what the Senate has passed the first time out of committee. The legislation made its way to the Senate floor where it was approved and sent to the House for their consideration where it was sent to the House Insurance Committee.

Budget Presentation:

The Governor this past Thursday Governor Snyder presented to the Legislature his recommendations for fiscal year 2014. With this announcement on Wednesday of supporting the implementation of the Medicaid expansion in Michigan the Governor set out to provide his road map for the financial future for Michigan in the coming fiscal year.

With the Medicaid expansion already being revealed, his announcement for increasing funding for Michigan's infrastructure and budgeting a 2% increase for K-12 funding, the Governor just gave the Legislature some specifics on what he wanted to do for FY 2014.

The Governor asked for increase funding for mental health services, mental health homes, and innovation programs all in an effort to support and strengthen a program that needs it. Many of Michigan's children continue to go without proper dental care, with this budget as with the last, the Governor proposes support Healthy Kids Dental by adding additional funding for the program. With the Governor's report from the task force on Infant Mortality being release middle of last year, he was unable to provide funding for any solutions that the report found, with this fiscal year that is different and proposes adding $2.5 Million to help curb mortality.

With medicine changing the need for innovation is needed now more than ever and the Governor recognizes this, and did so by adding $3 Million for innovation grants for those looking to pioneer medicine's next big breakthrough in Michigan. On the downside Graduate Medical Education took another blow with a recommendation of a cut around $7 Million.

Now it will be up to the legislature on their direction with the budget for FY 2014. MSMS will continue to track and advocate the best for all of Michigan's patients and physicians. Continue to stay with MSMS to receive updates on what is happening at http://www.msms.org/advocacy.