July 13, 2005, Introduced by Rep. Caswell and referred to the Committee on Appropriations.
A bill to amend 1978 PA 368, entitled
"Public health code,"
by amending section 20161 (MCL 333.20161), as amended by 2004 PA
469.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 20161. (1) The department shall assess fees and other
assessments for health facility and agency licenses and
certificates of need on an annual basis as provided in this
article. Except as otherwise provided in this article, fees and
assessments shall be paid in accordance with the following
schedule:
(a) Freestanding surgical outpatient
facilities................................ $238.00 per facility.
(b) Hospitals....................... $8.28 per licensed bed.
(c) Nursing homes, county medical care
facilities, and hospital long-term care
units .................................... $2.20 per licensed bed.
(d) Homes for the aged.............. $6.27 per licensed bed.
(e) Clinical laboratories........... $475.00 per laboratory.
(f) Hospice residences.............. $200.00 per license
survey; and $20.00 per
licensed bed.
(g) Subject to subsection (13), quality
assurance
assessment for nongovernmentally
owned
nursing homes and hospital long-term
care units................................ an amount resulting in
not more than 6% of
total industry
revenues.
(h) Subject to subsection (14), quality
assurance assessment for hospitals........ at a fixed or variable
rate that generates
funds not more than the
maximum allowable under
the federal matching
requirements, after
consideration for the
amounts in subsection
(14)(a)
and (j) (i).
(2) If a hospital requests the department to conduct a
certification survey for purposes of title XVIII or title XIX of
the social security act, the hospital shall pay a license fee
surcharge of $23.00 per bed. As used in this subsection, "title
XVIII" and "title XIX" mean those terms as defined in section
20155.
(3) The base fee for a certificate of need is $1,500.00 for
each application. For a project requiring a projected capital
expenditure of more than $500,000.00 but less than $4,000,000.00,
an additional fee of $4,000.00 shall be added to the base fee. For
a project requiring a projected capital expenditure of
$4,000,000.00 or more, an additional fee of $7,000.00 shall be
added to the base fee. The department of community health shall use
the fees collected under this subsection only to fund the
certificate of need program. Funds remaining in the certificate of
need program at the end of the fiscal year shall not lapse to the
general fund but shall remain available to fund the certificate of
need program in subsequent years.
(4) If licensure is for more than 1 year, the fees described
in subsection (1) are multiplied by the number of years for which
the license is issued, and the total amount of the fees shall be
collected in the year in which the license is issued.
(5) Fees described in this section are payable to the
department at the time an application for a license, permit, or
certificate is submitted. If an application for a license, permit,
or certificate is denied or if a license, permit, or certificate is
revoked before its expiration date, the department shall not refund
fees paid to the department.
(6) The fee for a provisional license or temporary permit is
the same as for a license. A license may be issued at the
expiration date of a temporary permit without an additional fee for
the balance of the period for which the fee was paid if the
requirements for licensure are met.
(7) The department may charge a fee to recover the cost of
purchase or production and distribution of proficiency evaluation
samples that are supplied to clinical laboratories pursuant to
section 20521(3).
(8) In addition to the fees imposed under subsection (1), a
clinical laboratory shall submit a fee of $25.00 to the department
for each reissuance during the licensure period of the clinical
laboratory's license.
(9) The cost of licensure activities shall be supported by
license fees.
(10) The application fee for a waiver under section 21564 is
$200.00 plus $40.00 per hour for the professional services and
travel expenses directly related to processing the application. The
travel expenses shall be calculated in accordance with the state
standardized travel regulations of the department of management and
budget in effect at the time of the travel.
(11) An applicant for licensure or renewal of licensure under
part 209 shall pay the applicable fees set forth in part 209.
(12) Except as otherwise provided in this section, the fees
and assessments collected under this section shall be deposited in
the state treasury, to the credit of the general fund.
(13) The quality assurance assessment collected under
subsection (1)(g) and all federal matching funds attributed to that
assessment shall be used only for the following purposes and under
the following specific circumstances:
(a) The quality assurance assessment and all federal matching
funds attributed to that assessment shall be used to finance
medicaid nursing home reimbursement payments. Only licensed nursing
homes and hospital long-term care units that are assessed the
quality assurance assessment and participate in the medicaid
program are eligible for increased per diem medicaid reimbursement
rates under this subdivision.
(b)
The quality assurance assessment shall be implemented on
May
10, 2002.
(b) (c)
The quality assurance assessment is based on the
number of licensed nursing home beds and the number of licensed
hospital long-term care unit beds in existence on July 1 of each
year,
shall be assessed upon implementation pursuant to
subdivision
(b) beginning May 10, 2002 and subsequently on October
1 of each following year, and is payable on a quarterly basis, the
first payment due 90 days after the date the assessment is
assessed.
(c) (d)
Beginning October 1, 2007 2008,
the department
shall no longer assess or collect the quality assurance assessment
or apply for federal matching funds.
(d) (e)
Upon implementation pursuant to subdivision (b)
Beginning May 10, 2002, the department of community health shall
increase the per diem nursing home medicaid reimbursement rates for
the balance of that year. For each subsequent year in which the
quality assurance assessment is assessed and collected, the
department of community health shall maintain the medicaid nursing
home reimbursement payment increase financed by the quality
assurance assessment.
(e) (f)
The department of community health shall implement
this section in a manner that complies with federal requirements
necessary to assure that the quality assurance assessment qualifies
for federal matching funds.
(f) (g)
If a nursing home or a hospital long-term care unit
fails to pay the assessment required by subsection (1)(g), the
department of community health may assess the nursing home or
hospital long-term care unit a penalty of 5% of the assessment for
each month that the assessment and penalty are not paid up to a
maximum of 50% of the assessment. The department of community
health may also refer for collection to the department of treasury
past due amounts consistent with section 13 of 1941 PA 122, MCL
205.13.
(g) (h)
The medicaid nursing home quality assurance
assessment fund is established in the state treasury. The
department of community health shall deposit the revenue raised
through the quality assurance assessment with the state treasurer
for deposit in the medicaid nursing home quality assurance
assessment fund.
(h) (i)
The department of community health shall not
implement this subsection in a manner that conflicts with 42 USC
1396b(w).
(i) (j)
The quality assurance assessment collected under
subsection (1)(g) shall be prorated on a quarterly basis for any
licensed beds added to or subtracted from a nursing home or
hospital long-term care unit since the immediately preceding July
1. Any adjustments in payments are due on the next quarterly
installment due date.
(j) (k)
In each fiscal year governed by this subsection,
medicaid reimbursement rates shall not be reduced below the
medicaid reimbursement rates in effect on April 1, 2002 as a direct
result of the quality assurance assessment collected under
subsection (1)(g).
(k) (l) In fiscal year 2004-2005 2005-2006, $21,900,000.00
of the quality assurance assessment collected pursuant to
subsection (1)(g) shall be appropriated to the department of
community health to support medicaid expenditures for long-term
care services. These funds shall offset an identical amount of
general fund/general purpose revenue originally appropriated for
that purpose.
(14) The quality assurance dedication is an earmarked
assessment collected under subsection (1)(h). That assessment and
all federal matching funds attributed to that assessment shall be
used
only for the following purposes purpose and under the
following specific circumstances:
(a) Part
of the quality assurance assessment shall be used to
To maintain the increased medicaid reimbursement rate increases as
provided
for in subdivision (d) (c). A portion of the funds
collected
from the quality assurance assessment may be used to
offset
any reduction to existing intergovernmental transfer
programs
with public hospitals that may result from implementation
of
the enhanced medicaid payments financed by the quality assurance
assessment.
Any portion of the funds collected from the quality
assurance
assessment reduced because of existing intergovernmental
transfer
programs shall be used to finance medicaid hospital
appropriations.
(b)
The quality assurance assessment shall be implemented on
October
1, 2002.
(b) (c)
The quality assurance assessment shall be assessed
on all net patient revenue, before deduction of expenses, less
medicare net revenue, as reported in the most recently available
medicare cost report and is payable on a quarterly basis, the first
payment due 90 days after the date the assessment is assessed. As
used in this subdivision, "medicare net revenue" includes medicare
payments and amounts collected for coinsurance and deductibles.
(c) (d)
Upon implementation pursuant to subdivision (b)
Beginning October 1, 2002, the department of community health shall
increase the hospital medicaid reimbursement rates for the balance
of that year. For each subsequent year in which the quality
assurance assessment is assessed and collected, the department of
community health shall maintain the hospital medicaid reimbursement
rate increase financed by the quality assurance assessments.
(d) (e)
The department of community health shall implement
this section in a manner that complies with federal requirements
necessary to assure that the quality assurance assessment qualifies
for federal matching funds.
(e) (f)
If a hospital fails to pay the assessment required
by subsection (1)(h), the department of community health may assess
the hospital a penalty of 5% of the assessment for each month that
the assessment and penalty are not paid up to a maximum of 50% of
the assessment. The department of community health may also refer
for collection to the department of treasury past due amounts
consistent with section 13 of 1941 PA 122, MCL 205.13.
(f) (g)
The hospital quality assurance assessment fund is
established in the state treasury. The department of community
health shall deposit the revenue raised through the quality
assurance assessment with the state treasurer for deposit in the
hospital quality assurance assessment fund.
(g) (h)
In each fiscal year governed by this subsection, the
quality assurance assessment shall only be collected and expended
if medicaid hospital inpatient DRG and outpatient reimbursement
rates and disproportionate share hospital and graduate medical
education payments are not below the level of rates and payments in
effect on April 1, 2002 as a direct result of the quality assurance
assessment collected under subsection (1)(h), except as provided in
subdivision (i)
(h).
(h) (i)
The quality assurance assessment collected under
subsection (1)(h) shall no longer be assessed or collected after
September
30, 2007 2008, or in the event that the quality
assurance assessment is not eligible for federal matching funds.
Any portion of the quality assurance assessment collected from a
hospital that is not eligible for federal matching funds shall be
returned to the hospital.
(i) (j)
In fiscal year 2004-2005,
$18,900,000.00 2005-
2006, $42,400,000.00 of the quality assurance assessment collected
pursuant to subsection (1)(h) shall be appropriated to the
department of community health to support medicaid expenditures for
hospital services and therapy. These funds shall offset an
identical amount of general fund/general purpose revenue originally
appropriated for that purpose.
(15) The quality assurance assessment provided for under this
section is a tax that is levied on a health facility or agency.
(16) As used in this section, "medicaid" means that term as
defined in section 22207.