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 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 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.

Legislative Update (Special Edition)

With the Legislature finally closing its books on the 96th Legislature there were many issues that made their way through the process that kept MSMS on its toes. We provided several letters of support or opposition, provides hours of testimony to the House and Senate, and made hundreds of office visits and phone calls and e-mails. All of this truly helped shape the health policy that Michigan gained over the past two years. Now that the session is over we want to take a look at the issues that affected all of us:

Liability Reform:

Drs Elmassian and Chafty Testifying

The largest victory for MSMS this year was the passage of reforms that would bring Michigan's tort climate back toward what was originally passed by the legislature in 1993. Senate Bills 1115 and 1118 were passed by the legislature in, what some would call, a legendary lame duck session of the Michigan Legislature. These reforms did not come without the battles including five committee hearings in the Senate on these bills which lead to huge crowds in the committee rooms. Those who were for and those against the reforms packed the room wanting to make their presence known to the committee and how they felt.

View at tort reform hearing.

After hours and hours of testimony the Senate committee moved the legislation to the floor and from there the legislation had covered it first real hurdle. Deliberations, discussions, amendments, and speeches against and for the legislation lead us to the final day of working session for the legislature where the House finally took up the legislation on the floor and gave it its blessing to send it to the Governor for his signature. It has been almost twenty years since there has been some significant tort reform for medical malpractice in Michigan until the end of this session, these tort reforms will be good for physicians but more importantly good for patients.

Wayne State Medical Students
 lobbying for Tort Reform.

Earlier in the term MSMS worked on legislation that would allow those physicians who are employed to volunteer in clinics and be provided protections that are afforded to those who are retired and work in the clinics (House Bill 4350). There was contention with this legislation since it provided what some classified as blanket immunity has they had in the later tort reform debate. Working with the members of the Senate, MSMS and other parties were able to come to an agreement that would provide the protection to those who are not contractually compelled to work in clinics to receive the liability protections of those who are retired and volunteering. It was a great day for medicine by opening the door to those physicians who wish to give of their time to help those who need the help the most.

Medical Marihuana:

Dr. Newman testifying to the Senate
Judiciary committee on Medical Marihuana

In this term Medical Marihuana left us with the question of what a "bona-fide patient/physician relationship" was in the eyes of the law. In medicine that question can lead to several answers. The face to face relationship all the way to telemedicine can lead to the definition of a patient/physician relationship. The Medical Marihuana statute stated that grey area that required patients to have this relationship with their physician but did not state what that relationship looked like and left law enforcement and the medical community scratching their heads. Insert House Bill 4851 which for the purposes of Medical Marihuana defined what that relationship looked like. Now patients would have to have contact with their physicians regularly rather that a one and done visit as some were seeing for those who were looking to obtain a certification for Medical Marihuana.

Insurance:

Insurance was an issue that started right away in the session with the attempt by the House to change the Michigan Auto No Fault system. House Bill 4936 wanted to provide levels of coverage that a person can obtain that would provide a certain level of financial coverage for any personal injury that occurred in an auto accident. From the state this was an issue that MSMS was against. Legislators were looking to provide choice for those individuals who were looking to save on car insurance and also provide relief to the Michigan Catastrophic Claims Fund, the fund that covers those gravely injured in an auto accident. Proponents of the legislation stated that the changed needed to happen since in its current form it would bankrupt the system. Opponents of the legislation asked to see the numbers and in the end were never given the opportunity to see the hard data. The House Insurance committee did pass a series of reformed and sent it to the House floor for their consideration but were never able to obtain the votes. Expect this issue back again the new session.

It wouldn't be a complete legislative session if Blue Cross/Blue Shield wasn't involved in some way. This term they had the backing of the Governor and finally found a way to get out from under PA 350 or the Nonprofit Health Care Corporation Reform Act. This act provided the tax breaks that the Blues enjoyed but also provided some requirements that the Blues did not enjoy. With the impending implementation of the health insurance exchange in Michigan, the Governor thought it was time to bring a change to the Blues and give them the ability to compete in the insurance exchange among other reasons and push for legislation to reform the Blues. The Legislature responded and created a nonprofit mutual insurer in the state of Michigan and providing a path to those incorporated under PA 350 to convert into this mutual insurer. This legislation did not come without a cost, requiring that the Blues pay to the state $1.56 Billion from now until 2018. This money will be placed in a health fund used to cover health projects and subsides Medigap policies until 2021 at a cost of $120 Million a year. The Governor received his wish and Senate Bills 1293 and 1294 were sent to his desk where they await his eventual signature.

Helmets:

Before the Legislature left for the summer break this past year they decided to take up an issue that has been on the burners of the legislature for years. They finally made a decision on the age old question, should you be required to wear a helmet while operating a motorcycle? In their opinion you should not be required since it was your individual right to determine whether you ride with a helmet or not. Senate Bill 291 made its way through the legislature going through its ups and downs, being amended several time, and at one point being used in the same conversation the changes with Auto No Fault, but in the end it was finally time according to the legislature to act on this measure. MSMS was adamantly opposed to the legislation reasoning that the having helmet on in an accident will give you the greatest chance to walk away from that accident but the Governor and Legislature did not see it that way and now today we have those who cherish their individual freedoms riding without a helmet. Time will tell if this was a wise decision for Michigan.

Graduate Medical Education:

Every year at MSMS we always face small battles when it comes to the budget, whether it’s trying to get more money for Medicaid, trying to stop the cut to public health funding, or trying to keep J-1 visa waivers in the budget we always have some small battles. One that always continued to come up and we feel will continue to, is the funding for Graduate Medical Education. The Governor has presented his last two budgets to the legislature with significant cuts to the program citing that the priority should be funding Medicaid at a higher level so that physicians will service more patients on Medicaid rather than funding the training of new physicians, fresh out of medical school. We see and understand the investment on Graduate Medical Education and what care this provides to those who need to care the most. Through work and education of the legislators we have been able to stay away from the deep cuts proposed by the Governor and only work hard to absorb small cuts from the legislature. In the coming years we will have to continue this fight to keep GME at its current level rather than seeing another cut to the program.

Affordable Care Act:

This is the only federal issue that made out list this year. We all know about the sustainable growth rate (SGR) and how we face looming cuts into Medicare but somehow Congress always finds a way to kick the can down the road. This time we think it will be the same but with the fiscal cliff casting a shadow on other impending issues, it could take some serious lifting by Congress to get this done on time.

US Supreme Court rendering opinion
in Affordable Care Hearings.

But now on to the Affordable Care Act and the decision from United States Supreme Court that some say rocked and other say solidified the nation in the future of its health care. The Supreme Court upheld the law saying that it was in the taxing authority of Congress to mandate insurance for people and was not within the commerce clause of the US Constitution. This left many states that were waiting for a decision under the gun if they were going to start creating their own health insurance exchanges. As for Michigan an attempt was tried with legislation that was sent from the Senate to the House, Senate Bill 693, but failed to gain the proper support from the committee. The state will now have a state/federal partnership exchange in 2014.

Scope of Practice:

This year the Medical Society found itself involved in looking at the future of medicine and how the team approach to care can continue to grow in Michigan. At the start of the term, physician assistants and physicians came together to find ways to grow their partnership in Medicine and came out of those discussions with Senate Bill 384 which brought more clarification on the relationship between PA's and Physicians, strengthening it, providing greater avenues to provides the best care.
Physical Therapists made an attempt this year to provide direct access for patients, bypassing the physician in House Bill 4603. Nurses also were looking for some clarification on their profession and how they fit into the team approach of medicine with Senate Bill 481. Both of these pieces of legislation did not make through the entire legislative process but MSMS is looking forward to continuing discussions with these groups to better strengthen the medical team in Michigan.

Autism:

Dr. Phillip Wise with Lt. Governor
Brian Calley at the signing of the Autism
Legislation.

This legislative term saw the largest advancement in mental health parity in Michigan in decades. MSMS has always had a long standing policy to support mental health parity in the insurance coverage of treatment of mental health conditions. Michigan took a step towards that this term by requiring the coverage of services surrounding the treatment of Autism. This was a priority of the Lieutenant Governor, Brian Calley; an issue that he worked hard for when he was a member of the Michigan House. Senate Bills 414, 415, and 981 started in June of 2011 with 981 adding in March 2012 and by April 18, 2012 it was the law of the land that insurers had to start to cover Autism services and treatment in Michigan. This is one small victory towards the larger goal of mental health parity.

Claims Tax:

Starting in 2011 there were rumblings from the federal government that the use tax that was set up by Michigan to tax the insurers that held Medicaid plans in Michigan was going to be ruled illegal and could penalize the State by holding back funds for Michigan's Medicaid program. A dilemma was presented to the legislature on what to do to replace the revenue needed to obtain the funds needed for Medicaid. Thus the claims tax proposal was created. Senate Bills 347 and 348 eliminated the use tax and created a claims assessment or tax on each of the insurance claims filed at a 1% level in Michigan. This was supposed to solve the revenue shortfall that would come with the elimination of the Use Tax but that as time moved on it proved not to be the case and this year the Medicaid faces a $140 Million shortfall that has to be filled somehow. The Senate tried to move Senate Bill 1359 which would provide an adjustable rate to make the need for revenue but was rejected by the Senate Appropriations committee. The legislature continues to look for solutions for the shortfall.

Abortion:

Abortion was an issue that seemed to be on the forefront this term with the legislature as looked tightens up regulations surrounding this hot button issue. There were several bills introduced and has testimony taken but in the end, these bills were placed into one large bill House Bill 5711. This legislation took a look at four major issues the legislature felt needed to be addressed: the licensing of facilities that perform abortions, the disposal of remains, and the liability protections needed by a physician who performs abortions, and the use of telemedicine in an abortion. Those against this bill called this issue the War on Women and continued to push for its stall in the House and the Senate. Those efforts did fail and in the early morning hours of the last day of session, the House concurred with the Senate and sent the bill to be enrolled and presented to the Governor. It’s currently uncertain if the Governor will sign the legislation.

Abortion found its way into the blue cross mutualization changes mentioned above with amendments that were added by the House to require that coverage for elective abortions be an opt-in coverage rather than an opt-out situation when purchasing coverage. We will have to wait and see the impact it will have on Michiganders.

Impaired Drivers:

Dr. Spanaki testifying with Senator
Schuitmaker on Senate Bills 402 & 403

An issue that MSMS has been working on for several years was finally accomplished this legislative term by providing liability protections for physicians who report to the Michigan Secretary of State that a person may be impaired to operate a motor vehicle. Senate Bills 402 and 403 started in the Senate Transportation committee and made their way through the entire process landing on the Governor's desk at the end of the second week of December. With the Governor's signature on this legislation physicians can report those patients they feel should not be operating a motor vehicle and let the Secretary of State decide whether that individual should be driving.

Bullying:

A major issue for the MSMS Alliance with past term was the creation of regulations for schools on how to handle instances of bullying. House Bill 4163 was created to provide the school districts have plans in place to handle bullying and plans that are specific to their school district but meet certain requirements required in the act. In December of 2011 Michigan joined other states by have the Governor sign Matt's Safe School Law into law.

Concussions  and High School Athletes:

Watching local high school sports over the past several years there continues to be a push to be faster, be stronger, hit harder and just become more physical overall. With this drive the amount of concussions happening in High School athletics was rising sharply leaving physicians, parents, coaches, and school personal concerned for the safety of the students playing athletics. This lead to the introduction of Senate Bill 1122 and House Bill 5697. Both of these pieces of legislation set into motion procedures that needed to be taken by school personal, what clearance was needed to be obtained by the athlete to compete again and what literature was needed to be provided to the athletes and parents on concussions and their treatment. We are hopeful that this will protect those athletes that want to compete at their highest levels.

With a busy legislative term over, MSMS is looking forward to what the next legislative term will bring. Some of the same issues mentioned today could very well make their way back into the legislative picture in the coming term. Stay with MSMS to get the latest information on issues going through the legislature that affect you and your practice at http://www.msms.org.advocacy. We will be taking a break now until the start of the new term, hope you all have a great new year!

 

Legislative Update Week of November 26th

The first week of the legislative lame duck term was off and running right away this week. The House and Senate started working on several issues including some issues important to physicians around Michigan. Wayne State Medical School also made it up to the Capitol this week providing their insight to lawmakers on issues like tort reform and graduate medical education. Let's jump right into it.

House:

The House started their week of long goodbyes from members that will not be returning to Lansing at the end of the year. The House did consider and pass Senate Bills 402 and 403 that would provide protections to physicians to report patients to the Secretary of State, in their opinion, the patient should not be operating a motor vehicle. The package will now make its away to the Governor's desk where all indications are that the legislation will be signed.

The House Health Policy committee met on Thursday with an extensive agenda but ended up only considering Senate Bill 693, a bill that would create a health insurance exchange in Michigan. Testimony was impassioned by those who were against not just the exchange but the entire Affordable Care Act asking the members of the committee not to vote for the bill. The testimony continued and extended the comments that were made about the subject earlier on in the year to the end of committee, where Chairwoman Haines called for a vote on the bill. The bill failed to gain support out of committee with a count of 9 against, 5 in favor, and 2 passing. The Speaker put out the following statement:

“It was my hope the committee would find that a state-run exchange afforded us more control over the unacceptable over-reach by the federal government regarding the health care of Michigan citizens,” Mr. Bolger said in a statement. “After due diligence, however, it is clear that there were too many unanswered questions for the (Health Policy) committee to feel comfortable with a state-run exchange and we will not have one in Michigan.”

The committee adjourned for the day after the vote where rumors were that it would be the last House Health Policy committee for the term. MSMS will continue to monitor the activity of the committee.

The House Insurance committee also came into session on Thursday this week and went to recess right away. The committee did not reconvene once the House session started due to what some say was a lack of a substitute bill for the Blue Cross/Blue Shield conversion. The committee will be scheduled to meet in the coming week.

Senate:

The Senate brought a dogfight to the floor between interest group by working on Senate Bills 1115, 1117, and 1118. These are three out of the four tort reform bills that MSMS has been supporting and working on. After hard work between the groups some compromises were made and placed in the bills. The Michigan Association of Justice was able to get some more amendments placed into the legislation that were not favored by MSMS. With the amendments being added the Senate voted all three bills to the House where the work will continue. MSMS will be working to take out some of the harmful amendments added during the Senate session.

The Senate Appropriations committee met to consider Senate Bill 1359, among others, which provided a fix for the Insurance Claims Tax that was added to replace the Medicaid Use Tax.  The Senate Fiscal Agency along with the Michigan Department of Treasury projected that with the $400 Million that needed to be made up with the repeal of the use tax the state was going to be $144 Million short in funding for the current fiscal year. The committee heard testimony from General Motors being opposed to the legislation since it would be a cost for them since they self insure their employees. At the end of the committee there were pretty strong signs that getting a fix for the Claims tax was going to be difficult.

The Senate Health Policy committee also met this week to consider House Bill 5315 and Senate Bill 975. MSMS commented to the committee that it has concerns with SB 975 but that we were working with the sponsor to find a solution to our differences. Both pieces of legislation were passed to the full Senate on party lines.

Wayne State Lobby Day:

Wayne State students speak with
Senator Smith.

Wayne State brought some of their up and coming physicians to the Capitol to have meetings with legislators and to lobby them on two issues that they felt were important to them, Tort Reform and Graduate Medical Education. With over 65 students invading the Capitol, several groups of students were able to meet with members directly in their offices, while other groups caught them in the lobby of the Senate and House as they made their way out of the chambers.

Drs Bizon and Elmassian addressing
the Wayne Students.

Later in day Dr. Bizon and Dr. Elmassian joined the students to share their thoughts on the future of medicine, why it was important to be lobbying to the legislature, and how they can make a difference in their community. Both were able to join the students later in the afternoon to work with them and support their efforts to lobby the legislature. Dr. Elmassian commented on how he was impressed with the turnout from the students and how we needed to continue to have efforts like this moving forward. "All schools should be thinking of doing this, it would be great for medicine and their future as physicians."

Next week should bring more activity in the legislature, stay with MSMS to get the up to date information including when committee meetings are and what they are considering for the day on the House and Senate floors. Go to http://www.msms.org/advocacy to get all of the information you need.

Legislative Update: Spring Wrap Up

Now that the legislature has moved into a summer session calendar it’s time to wrap up on some of the issues that have been on the radar of the Medical Society, let’s review:

Budget:

This year saw another cut scheduled for Graduate Medical Education with the introduction of the Governor's budget recommendation. Governor Snyder wanted to take $17 Million out of the program for other uses, the legislature in some ways disagreed with that recommendations and only took $8.5 Million which was much better than what the Governor has recommended. Primary care physicians will now start to see an increase in Medicaid rates thanks to the Affordable Care Act providing an increase in Medicaid funding to the tune of $281 Million. Included in Medicaid now is payment for services surrounding Autism and OB/GYN's receiving a small bump in their reimbursement rates. We now look to find a way to restore the $8.5 Million that was cut from GME in the coming months.

Helmet Law:

This spring the long battle to keep helmets on motorcyclists was finally lost with the Senate pushing the repeal of the helmet requirement for all motorcyclists in Michigan. As disappointing as this development was MSMS continues to push for the safety of all motorists on the roads, motorcyclists or not and is pushing for the tracking of individuals that were involved in accidents and whether a helmet was used to see if personal freedom is really worth the safety of all.

Medical Marihuana:

MSMS worked with members in the House and the House Judiciary committee to help create a narrow definition of what a patient-physician relationship is when concerning Medical Marihuana. The statute currently in place provided no direction on that relationship leaving many ambiguities when dealing with Marihuana. This definition now provides protections to both patient and physician when dealing with certification for the substance. This bill was sent to the Senate where it is in the Senate Judiciary committee awaiting a vote to the Senate floor.

Abortion:

Before the House left for the summer they attempted to jam a package of bills through the House that dealt with four issues supported by right to life. These issues ranged from the banning of the practice of tele-abortions to requiring increased levels of liability coverage for those who perform a certain amount of abortions. This was a heated issue between those for and against leaving for one interesting committee meeting where then the bills were voted out of committee on the same day as the hearing, which is uncommon for this legislature. This practice left some with a sour taste in their mouths leaving for nothing short of a floor fight which left some members without speaking privileges after the debates on the House floor. The main bill of the package was passed out sent to the Senate, where it is unknown if the Senate even wants to address this hot potato.

Autism:

A small victory but one that could lead to total mental health parity, the legislature finally required that health insurers, private and public, cover the costs associated with Autism. Those who were against providing the coverage were finally able to come to a compromise with the help and encouragement of the Lieutenant Governor. This issue has been close to him since he was a member of the House, so it was fitting that he signed the bill the put this into law. MSMS hopes that this issue will not stop here and the fight will continue until we get total mental health parity.

Tort Reform:

MSMS over the past month has started to push tort reforms for the purposes of finding ways to increase access to patients all over Michigan who need the care. With the Affordable Care Act reforms hanging the balance, the increase of patients who cannot gain access just by the sure numbers of physicians are staying stable while the demand rises sharply, we find that there is simply not enough in the workforce to meet the demand. With the reforms it would make Michigan a more attractive place to practice medicine providing more opportunities for physicians to come and practice here, answering the question of how we address those who need the care and can't find it. The bills started in the Senate and still await a vote from the Senate Insurance committee. MSMS is hopeful that the legislation will be move soon to help those patients who need it the most.

MSMS now looks towards the fall where issues like tort reform, auto insurance reform, and others still linger from the spring session. Once the legislature gets back into session, MSMS will continue to cover all of the activity for you. Just go to http://www.msms.org/advocacy to stay up to date with all that is happening in Lansing and beyond. The Legislative update will be back in July to cover the one session day scheduled for the legislature.

Legislative Update: Week of May 28th

This week saw a flurry of budget activity this week with conference committees meeting throughout the Tuesday, Wednesday, Thursday period. The House also took the time to push a cut in the Michigan income tax that was scheduled to come at the beginning of next year ahead of schedule. The House spent most of Thursday night in session, passing all but the education budget, scheduling an unusual Friday session day for the House. Lets review the rest of the week in Lansing:

Senate:

The Senate Insurance committee continued taking testimony on Senate bills 1115-1118, the Patients First Reform package that amends Michigan's tort reform to protect access to Michigan's patients. MSMS testified last week in the committee, coverage on that can be found in last week article. The committee is expected to take a vote on the legislation this coming Tuesday. The Senate Health Policy committee scheduled a hearing for Thursday to take up Senate bill 481 which would expand the scope of practice and provide independence for advance practice nurses. Due to the budget, the committee was cancelled and scheduled for this coming Wednesday at 9:00am.

House:

The House worked long through the week, even into Friday working on the budget. While waiting for the conference committees to come to a conclusion they had the ability to work on some of the other lingering issues. The House did pass House bill 5338 which would amend the public health code to allow the Director of the Department of Community Health to issue orders to place designer substances on the controlled substances list i.e. K2. As mentioned before the House did pass their version of tax relief by upping the time when the rollback of the income tax would take effect.

Budget:

Budget was the main story this week. The Senate passed through all of its individual budget conference reports and the government omnibus that included everything but education funding. The House did the same with the government omnibus but had to wait until Friday's session to pass the education omnibus or "school bus" as it was affectionately called.

The Department of Community Health budget saw some good come out of the conference report. First the legislature rejected the $17 million cut to GME suggested by the governor; rather the legislature funded it with an extra $8.6 million more than what the governor had proposed and a victory from looking at such a substantial cut. Primary care physicians are going to see a rise in their reimbursement rates from Medicaid as $281 Million of federal funding was put into Medicaid to raise the rates for primary care (excluding ER physicians and some OB services) to Medicare rates. This change was a part of the Affordable Care Act. Investments in Health Kids Dental, Medicaid coverage for Autism, and Health Michigan Fund were all positive and more than had expected. The budget now goes to the Governor for his signature.

For the latest legislative news and activity check out http://www.msms.org/advocacy. Help support those who support you, go to http://www.mdpac.org to find out how you can help!

Legislative Update: Week of May 21st

This week has been a busy one for MSMS as the tort reform package supported by MSMS has seen some activity in the Senate with activity upcoming in the House. Budgets were the story of the week as the Governor, Speaker, and Majority Leader came to an agreement on the target numbers for the different budgets. Let's review this week's activity:

Senate:

(From midweek)


Michael Chafty, MD, JD

The Senate Insurance committee took testimony on Senate Bill 1115, 1116, 1117, 1118, affectionately known as the "The Patients First Reform" package. This effort, spearheaded by MSMS and the physician community, is the first significant tort reform package since the early 1990's.

Elmassian and Chafty testify for
the Senate Insurance Committee

MSMS offered testimony from two different avenues during the hearing, first coming from MSMS Preident-Elect Kenneth Elmassian, DO and Michael Chafty, MD, JD, who chairs the MSMS Board Legislative Policy Committee. Both of the physicians commented on how the having these reforms for Michigan's physicians puts Michigan in a category that it has never been accustomed to: a destination for physicians to practice. "Like many other states, prior to the adoption of meaningful tort reform in 1993 Michigan was a state in crisis," said Dr. Elmassian. Elmassian went on to say, "Those of us who live through this crisis are obligated to be vigilant to maintain the intent of the reforms passed in 1993. Senate Bills 1115-1118 seek to do just that."


Kenneth Elmassian, DO

Opponents against the legislation said that it would hinder the patent's or the patent's family's ability to gain recourse for a mistake of a physician. They also say it would take away the ability to provide for the services that a person needs to counter the pain and suffering sustained by the injury. Another argument against the bills was that the tort reforms would not help an impending physician shortage in Michigan because we simply don't have one. Referring to a study from the AMA from 1995, as was pointed out by Dr. Chafty in his testimony, the amount of physicians Michigan has is the right number to serve the population that needs health care. Dr. Chafty noted that with the increasing amount of physicians getting closer to retirement and the growth in the amount of people that are going to need care, the need for physicians will grow to an amount of 4,500 by 2020.

The committee continued taking testimony until 4:30pm that day. It will reconvene again in a week to continue taking the testimony from all of those wishing to testify. MSMS will continue to offer coverage of the proceedings.

The Senate Health Policy committee did not meet this week but there are rumblings that the committee will be posting for the coming week taking up expanding scope of practice for nurses.

House:

The House Health Policy committee did meet this week and had a presentation on drug adherence from CVS pharmacies. MSMS was not able to attend the meeting but understands it was very informative.

The House Insurance committee met this week working on their continued effort to reform Michigan's auto no fault insurance system. This week they considered a series of bills that would exempt certain persons from being protected by the Personal Injury Protection (PIP) sections of the policy. MSMS was concerned with three bills in the package House Bill 5587, 5588, and 5589. These bills would exempt those committing a crime or in the process of committing a crime and their accomplice from PIP coverage and also those who are operating under the influence of alcohol or a controlled substance to be covered under PIP as well. The MSMS Legislation and Regulations committee will be considering these bills at their next meeting. We will continue to monitor their progress.

The House Judiciary committee will be scheduling a hearing for the House versions of the MSMS supported tort reform package this coming Thursday, May 31st at 10:30 am in the Anderson House Office Building. The House versions of the bills are 5669, 5670, 5671, and 5672. Once the committee meets, MSMS will have coverage of the events as they unfold on Twitter, Facebook and our blog.

Budget:

The House, Senate, and Governor have come to an agreement on the target numbers for the coming year's budget. This is positive news for the Department of Community Health budget where more money was allotted for the department which leave the possibility that GME could receive even more funding. MSMS is working with the legislative leaders to ensure just that. The House Republicans are looking to build into their budget an income tax relief package for Michigan that would reduce the income tax rate. Its uncertain the amount of savings that tax payers would see. MSMS will continue to stay with the budget until its signed into law.

For more information on Michigan politics and legislative activities stay connected with MSMS at http://www.msms.org/advocacy. With the upcoming elections, you need to know who support you and your profession, go to http://www.mdpac.org to find out that information and more!

Legislative Update: Week of May 14th

This week the legislature took aim at teachers, with the big issue being requiring teachers to give a certain amount of their paycheck towards their pensions, starting 401ks for new teachers entering the system, and changing some of the benefits current retirees have. This doesn't mean that health care took a back seat this week, let's review the weeks happenings:

House:

The House Health Policy committee met this week and considered a series of bills with the largest being House Bill 5643 which would require generic opioids be tamper resistant to prevent the breaking down of the medication for the purposes of a faster delivery. They also voted on House Bills 5089 and 5090 which deals with prescription drug disposal. The committee is expected to vote on House Bill 5643 next week. In the coming weeks the committee is also expected to start their work on Michigan's Insurance exchange that is mandated in the Affordable Care Act.

Senate:

The Senate Health Policy came back from its over month long hiatus to consider Senate Bill 1122 which would set up educational and procedural requirements for high school athletics for the instances of concussion. MSMS has been working with other concerned about the issues of concussion in high school athletics and provided input on the bill that was considered yesterday. The committee took testimony from MHSAA, physicians, parents, and athletes, all praising the efforts of the sponsors to put procedures in place to put the health of athletes first. The bill will be taken up for a vote at the next committee meeting.

Budget:

The story of the week that wasn't surrounding the elections, was the consensus revenue estimating conference that happened last Wednesday. The House and Senate Fiscal Agencies along with the Michigan Department of Treasury sat down and revised their estimates on the amount of revenue coming into Michigan for the coming fiscal year. The conference was nothing but good news for Michigan's future as they forecasted Michigan's unemployment should fall below 8% by calendar year 2014 and the amount of personal income is forecasted to rise, which means more people going to work and putting more money in their pockets.
With this, it also means a bump for the state coffers with a $49 Million increase in revenue for the next coming fiscal year in General Fund/General Purpose dollars. School aide is forcasted to get an even bigger bump of just over $114 Million. This is great news for Michigan showing that the state is in a solid recovery. With the additional $49 Million, GME could see some of that funding head its way, which would go a long way in trying to solve our physician shortage problem. MSMS will continue to monitor and advocate for some of those additional dollars.

The legislature has set their final date before heading home for summer break, June 14th will be the last session day until the fall. For more information on all of the state and federal legislative activities go to http://www.msms.org/advocacy. With the elections coming up we need to support those that support Michigan's physicians. Go to http://www.mdpac.org to find out how you can help!

Legislative Update: Weel of April 23rd

This week the legislature put the pedal to the metal you could say and was set the tackle several issues including moving the budgets to their different chambers, and tackling the issue of cyber charter schools and lifting the cap in the amount of cyber charters can be in Michigan. Both chambers worked later than usual this week pushing the budget process forward, let’s review:

House:

The House Health Policy committee met this week with what looked to be a loaded agenda but last second four bills that dealt with oral chemotherapy parity were pulled due to the lack of the needed votes to pass the legislation. The committee did take testimony on House Bills 5089 and 5090 which created a repository for prescription drugs that were not used and still within their packaging and then also providing for a process for destruction for those prescription that cannot be used. Testimony was very positive on the issue, praising the legislature to creating a system that was seen as a first step to deal with the some of the problems associated with left over prescriptions. There were some concerns about the liability issues that could arise from dispensing the drugs again as they could be seen as "second rate" drugs. It is unknown when the committee will consider taking a vote on the issue.

The committee also considered Senate Bill 723 which creates the online Piece of Mind registry. MSMS stands in support of the legislation as it looks to privately streamline the way the power of attorney, do not resuscitate orders, and other end of life issues are handled. It is expected the committee will be voting on the legislation very soon.

The House Families, Children, and Seniors committee considered a package of bills that deal with elder abuse and creating elder death teams. MSMS was interested in Senate Bill 457 that required the county medical examiner to create an elder death team to investigate suspicious elder deaths. This is an issue that could, especially in rural areas in Michigan, hamper the ability of the medical examiner to complete his/hers duties. We will continue to watch this legislation.

Senate:

The Senate considered one item this week that did pique the interest of the Medical Society that provides for the overall public good. House Bill 4393 was passed out of the Senate and ordered to the Governor's office for signature. The bill would exempt minors that turn themselves in for treatment of alcohol poisoning or other complications associated with the overuse of alcohol from receiving a minor in position ticket. This is a great tool the now takes the fear away from kids that need the help but fear running into trouble with the law. The Governor's office has not voiced any concerns with the legislation.

The Senate Insurance committee considered and voted on extremely quickly House Bills 5408 and 5421 which would require insurers pay for telemedicine. This passed through the House pretty handily and is expected to do the same in the Senate. Abortion was the issue that returned to the Senate Judiciary committee this week. The committee considered House Bill 4798, 4799, 5134, 5181, and 5182 which is a package of bills that makes it illegal for a health professional, including physicians, to coerce anyone into an abortion. The Michigan chapter of the American College of Obstetricians and Gynecologists submitted a letter in opposition to the measures, MSMS stood with ACOG in agreement with their position. It is expected that the committee will vote on these measures in the coming weeks.

Appropriations:

This week the majority of the work in both the House and the Senate was associated with the budget. The Senate passed their version of the Department of Community Health budget, Senate Bill 950. The Senate continued it stance to keep Graduate Medical Education funded with a place holder and still keeping in the requirements for the department to rework the GME formula. One surprise though, was the addition of an amendment to the DCH budget that would allow smoking for fundraising events done privately and have been in existence for more than 10 years. The language was placed in the boilerplate section of the bill so its enforcement is somewhat questionable but this is one of what MSMS is sure to be, several attempts to weaken the Dr. Ron Davis smoking law.

The House wrapped their budgets up again into to separate bills, one called the school bus (all of the education appropriations) and the big bus (everything else). The House omnibus appropriations bill is 5365. The over six hundred page bill provides appropriations for several state departments. GME was continued at the current levels for this fiscal year but included an almost additional million dollars. The House did not consider the smoking amendment to the budget.

Now bills will switch chambers and consideration and budget targets will start to align. The next big day is in mid May when the Michigan Department of Treasury, House Fiscal Agency, and the Senate Fiscal Agency come together to revise revenue estimates for the coming fiscal year for the state. The timeline for the budget in completion by June 1st.

For more information on things happening in Lansing and beyond head to www.msms.org/advocacy. With elections right around the corner, your support to MDPAC helps to support our allies, support MDPAC at www.mdpac.org.

Legislative Update: Week of April 16th

As the legislature comes back into session after its two week spring break, money, appropriations and budgets weigh on the minds of the legislators. What does that mean for health care, well Medicaid and Medicaid funding are now the top topics floating around the halls of the Capitol, lets review the activities of this last week:

House:

The House Health Policy Committee did meet on Thursday to consider one bill House Bill 4718 which would allow dental assistant to work with dental hygienists when the dentist was not in the office to supervise, under current statues the dentist needs to be present in the office for a dental assistant to provide a second set of hands. Testimony was taken on the legislation and should be taken up for a vote next week. They also had a presentation from J & B Medical to demonstrate telemedicine and the products they were offering for physicians and patients.

Senate:

The Senate did not have Health Policy committee this week and the majority of the work done by the Senate surrounded environmental protections and rules for the Department of Environmental Quality.

Appropriations:

This is where the majority of the work in the Legislature was done this week. Both full Appropriations Committees considered their respective budget bills. The Senate continued with the recommendation from the subcommittee and had the $100 placeholder for graduate medical education and kept in the boilerplate (language that says how the money is needed to be spent or offers legislative intent) that the Department of Community Health needs to create a formula for GME funding that promotes primary care and keeping residents in Michigan.

The House committee agreed with their subcommittee and kept the $18 Million appropriated to graduate medical education. This is an increase from this current fiscal year of just under $1 Million. The chambers are expected to swap bills and start the process over again to come to some conclusion and to hopefully have the budget done by June 1.

Autism:

This week Governor Snyder was in Afghanistan to meet with the members of the Michigan National Guard and soldiers from Michigan offering support for those serving and letting them know there will be support for them when they return to Michigan. With the Governor being out of the country Lieutenant Governor Brian Calley was acting Governor for the past week and had the privilege of signing the Autism insurance bills. Lieutenant Governor Calley has personal experience dealing with Autism which made the bill signing an extra special event. MSMS was invited to attend the signing and did.

For more information concerning government and health activities or if your wondering what the legislature is doing, check out our website at http://www.msms.org/advocacy.

For those wanting to get involved in helping shape Michigan's direction visit and support MDPAC at http://www.mdpac.org

Legislative Update: Week of March 26th

With the Supreme Court taking the attention from most people this week the Michigan legislature made a few waves themselves this week just before they take off for Spring Break. Autism made its way through the House and the Senate along with the Senate make a surprise move by the Senate to pass Senate Bill 291 that would eliminate the requirement for Motorcyclists in Michigan to use a crash helmet. Let's take a look at the rest of the activity this week:

House:

The House received the autism insurance package this week from the Families, Children, & Seniors committee. It was voted out of committee on Tuesday and sent to the House floor where they were determined to pass the legislation. By the end of the day on Thursday the House and Senate had concurred on the bills and sent them to the Governor for his signature. It has been reported that the Governor will be signing the bills sometime early next week.

The House Judiciary committee met on Thursday to consider the changes to Michigan's Medical Marihuana act. There were a few changes that the Medical Society worked with the bill sponsor and other stakeholders to finalize House Bill 4851. This and the other bills are now expected to head to the House floor where a larger fight might be waiting to pass these bills.

Senate:

The Senate received the autism bills from the House on Thursday which allowed them to concur in the amendments from the House and then send them to the Governor. Other than the helmet repeal being passed by the Senate, activity was pretty quiet on the health care front this week.

Appropriations:

The House and Senate subcommittees this week released their recommendation for the Department of Community Health Budget for the coming fiscal year. The House in a exciting move for medicine did not concur with the funding cut in Graduate Medical Education and added additional dollars for GME. Although the additional dollars did not make whole the cut GME experienced last year it is still a positive step forward. The Senate on the other hand had a different idea when reporting out the budget  placing $100 placeholders in line items through out the bill. Now the bills will be sent to the full appropriation committee for their consideration.

For more information, including information on the Supreme Court hearing on the Affordable Care Act go to MSMS's advocacy page for information and more. The Legislature will now be on Spring Break, and so will we, unless breaking news happens. Enjoy and we'll see you in two weeks!

Legislative Update: Week of February 20th

We apologize for the lengthy absence but we're are back at it this week and we have a lot to cover, so lets dive right in! The attempted changes in Michigan's Auto No-Fault system continue to loom in the House. In its current version many members are finding that voting for this would leave a sour taste in their mouths and make them vote on an issues that they really just don't want to vote on. Conversations on this issue have gone quiet for the moment, but we will continue to watch and act when the time is needed.

Last week the Governor Snyder presented his budget to both House and Senate Appropriations committees. On the Health side of things there are some positives and some negatives. On the positive side there will be an increase in Medicaid rates for primary care physicians excluding emergency room physicians to 100% of Medicare rates, which totals just over $281 Million. On the downside the Governor put GME back in his sights and reduced GME another 17% which overall totals 32% from this fiscal year and the coming fiscal year. Now the House and Senate subcommittees will begin to hear testimony from DCH concerning the budget and work to create their own.

The House Health Policy committee has been working on a couple issues, one the consolidation of substance abuse with community mental health and the other requiring reimbursement for telemedicine. The committee next week looks to vote on the telemedicine issue while the other issue was voted out of committee. The committee of the next few weeks thought will be Judiciary. The House Judiciary committee began taking testimony on changes to Michigan's Marihuana Act, providing changes to the act including defining what a bona-fide patient/physician relationship is. In the coming weeks the committee will take public testimony.

In the Senate, the Senate Health Policy committee will also be starting their Medical Marihuana hearings. MSMS will be taking active roles in both the House and Senate committees by providing testimony to the committee members on the position of the society on this issue.

For an updated calendar of all committee meetings and session schedules go to http://www.msms.org/advocacy.

Legislative Update: Week of December 12th

The legislature went into their last week of session for the year with a plan to move a significant amount of legislation surrounding a variety of topics. Some of the bigger headline pieces dealt with lifting the caps on the amount of charter schools there can be in Michigan and some clean up and changes within the different tax codes.

The one piece of legislation that both chambers considered that would effect the physician community directly was House Bill 5014 that would provide a supplemental appropriation for different departments. Included in the list of those where money was appropriated was towards Graduate Medical Education. Just over $8 Million gross was appropriated towards GME which only filled half of the gap that was left from the beginning of the year.

Committees did not meet this week with it being the last session week of the year. The legislature will reconvene on January 11 at Noon. The Governor is slated to present his State of the State address on January 18th usually around 6:30-7:00 p.m. We will be taking a break for the holidays, we wish you and yours the best for this holiday season, see you in 2012.

Legislative Update: Week of November 28th

The legislature was back in session this week after the two week holiday break. Auto no fault continues to stay at the fore front of the issue MSMS is working on but for the legislature that was a different story. The House still continues to work on the no fault issue, trying to find members of their caucus to support the changes while the Senate looks on. There were two issues that MSMS was interested in that did get some movement this week, lets review:

House:

The House this week received back HB 5014 that provides supplemental appropriations for several state departments. Included in the appropriations proposal that came back from the senate was a $3 Million General Fund / General Purpose (GF/GP) appropriations for graduate medical education. This would calculate to a just over $8 Million increase in GME funding with state and federal dollars. The House Appropriations Subcommittee for the Department of Community Health took testimony this week on the inclusion of the GME money and what it meant for programs. Dr. Eric Scher from Henry Ford Health Systems testified at the committee hearing.

The House Health Policy Committee continued taking testimony from interested parties involved with the implementation of a health insurance exchange.The House in general worked on issues dealing with local governments and watercraft safety.

Senate:

The Senate this week dealt primarily with issues surrounding unemployment but did consider one issue that the legislation and regulations committee of MSMS considered. SB 798 allows for the temporary scheduling of drugs and controlled substances if deemed necessary by the Department of Community Health. It was passed out of the Senate and sent to the House for their consideration. The Senate Health Policy committee was scheduled to meet but did not because of the lengthy session day on Thursday.