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!