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 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.