HB-4447, As Passed House, June 11, 2015HB-4447, As Passed Senate, June 10, 2015

 

 

 

 

 

 

 

 

 

 

 

SENATE SUBSTITUTE FOR

 

HOUSE BILL NO. 4447

 

 

 

 

 

 

 

 

 

 

 

      A bill to amend 1978 PA 368, entitled

 

"Public health code,"

 

by amending sections 6237, 6238, 20104, 20106, 20145, 20155, 20161,

 

20501, 20521, and 20551 (MCL 333.6237, 333.6238, 333.20104,

 

333.20106, 333.20145, 333.20155, 333.20161, 333.20501, 333.20521,

 

and 333.20551), sections 6237 and 6238 as amended by 2012 PA 501,

 

section 20104 as amended by 2010 PA 381, section 20106 as amended

 

by 2014 PA 449, section 20145 as amended by 2004 PA 469, section

 

20155 as amended by 2012 PA 322, and section 20161 as amended by

 

2013 PA 137; and to repeal acts and parts of acts.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

 1        Sec. 6237. The Until October 1, 2019, the department shall

 

 2  issue a license assess a $500.00 fee for licenses on an annual

 

 3  basis upon determining that the applicant has complied with this

 


 1  part and rules promulgated under this part. A licensee shall

 

 2  prominently display the license while it is in effect.

 

 3        Sec. 6238. (1) A standard license issued under this part is

 

 4  effective for no longer than 1 year after the date of issuance. The

 

 5  department may issue a provisional license to an applicant

 

 6  temporarily unable to comply with this part or the rules

 

 7  promulgated under this part. The department may renew or extend a

 

 8  provisional license issued under this section for not more than 1

 

 9  year. The department may issue a temporary, nonrenewable permit for

 

10  not more than 90 days if additional time is needed for the

 

11  department to properly investigate or for the applicant to

 

12  undertake remedial action.

 

13        (2) The department shall make at least 1 visit to each

 

14  licensed substance use disorder program every 3 years for survey

 

15  and evaluation for the purpose of licensure.

 

16        (3) The department may waive the visit required by subsection

 

17  (2) if the licensed program requests a waiver and submits the

 

18  following:

 

19        (a) Evidence that it is currently fully accredited by an

 

20  accrediting body with expertise in the health facility type and the

 

21  accrediting organization is accepted by the department.

 

22        (b) A copy of the most recent accreditation executive summary

 

23  submitted to the department at least 30 days from licensure

 

24  renewal. Submission of an executive summary does not prevent or

 

25  prohibit the department from requesting the entire accreditation

 

26  report if the department considers it necessary.

 

27        (4) Accreditation information provided to the department under


 1  subsection (3) is confidential, is not a public record, and is not

 

 2  subject to court subpoena. The department shall use the

 

 3  accreditation information only as provided in this section. The

 

 4  department shall properly destroy the documentation after a

 

 5  decision on the waiver request is made.

 

 6        (5) The department shall grant a waiver under subsection (3)

 

 7  if the accreditation report submitted is less than 3 years old and

 

 8  there is no indication of substantial noncompliance with licensure

 

 9  standards or of deficiencies that represent a threat to public

 

10  safety or patient care in the accreditation report.

 

11        (6) Denial of waiver request by the department is not subject

 

12  to appeal.

 

13        (7) This section does not prohibit the department from

 

14  conducting an inspection or citing a violation of this part related

 

15  to a complaint.

 

16        Sec. 20104. (1) "Certification" means the issuance of a

 

17  document by the department to a health facility or agency attesting

 

18  to the fact that the health facility or agency meets both of the

 

19  following:

 

20        (a) It complies with applicable statutory and regulatory

 

21  requirements and standards.

 

22        (b) It is eligible to participate as a provider of care and

 

23  services in a specific federal or state health program.

 

24        (2) "Clinical laboratory" means a facility patronized by, or

 

25  at the direction of, a physician, health officer, or other person

 

26  authorized by law to obtain information for the diagnosis,

 

27  prevention, or treatment of disease or the assessment of a medical


 1  condition by the microbiological, serological, histological,

 

 2  hematological, immunohematological, biophysical, cytological,

 

 3  pathological, or biochemical examination of materials derived from

 

 4  the human body, except as provided in section 20507.

 

 5        (2) (3) "Consumer" means a person who is not a provider of

 

 6  health care as defined in section 1531(3) of title 15 of the public

 

 7  health service act, 42 USC 300n.

 

 8        (3) (4) "County medical care facility" means a nursing care

 

 9  facility, other than a hospital long-term care unit, which that

 

10  provides organized nursing care and medical treatment to 7 or more

 

11  unrelated individuals who are suffering or recovering from illness,

 

12  injury, or infirmity and which that is owned by a county or

 

13  counties.

 

14        (4) (5) "Direct access" means access to a patient or resident

 

15  or to a patient's or resident's property, financial information,

 

16  medical records, treatment information, or any other identifying

 

17  information.

 

18        (5) (6) "Freestanding surgical outpatient facility" means a

 

19  facility, other than the office of a physician, dentist,

 

20  podiatrist, or other private practice office, offering a surgical

 

21  procedure and related care that in the opinion of the attending

 

22  physician can be safely performed without requiring overnight

 

23  inpatient hospital care. It Freestanding surgical outpatient

 

24  facility does not include a surgical outpatient facility owned by

 

25  and operated as part of a hospital.

 

26        (6) (7) "Good moral character" means that term as defined in

 

27  section 1 of 1974 PA 381, MCL 338.41.


 1        Sec. 20106. (1) "Health facility or agency", except as

 

 2  provided in section 20115, means:

 

 3        (a) An ambulance operation, aircraft transport operation,

 

 4  nontransport prehospital life support operation, or medical first

 

 5  response service.

 

 6        (b) A clinical laboratory.

 

 7        (b) (c) A county medical care facility.

 

 8        (c) (d) A freestanding surgical outpatient facility.

 

 9        (d) (e) A health maintenance organization.

 

10        (e) (f) A home for the aged.

 

11        (f) (g) A hospital.

 

12        (g) (h) A nursing home.

 

13        (h) (i) A hospice.

 

14        (i) (j) A hospice residence.

 

15        (j) (k) A facility or agency listed in subdivisions (a) to (h)

 

16  (g) located in a university, college, or other educational

 

17  institution.

 

18        (2) "Health maintenance organization" means that term as

 

19  defined in section 3501 of the insurance code of 1956, 1956 PA 218,

 

20  MCL 500.3501.

 

21        (3) "Home for the aged" means a supervised personal care

 

22  facility, other than a hotel, adult foster care facility, hospital,

 

23  nursing home, or county medical care facility that provides room,

 

24  board, and supervised personal care to 21 or more unrelated,

 

25  nontransient, individuals 60 years of age or older. Home for the

 

26  aged includes a supervised personal care facility for 20 or fewer

 

27  individuals 60 years of age or older if the facility is operated in


 1  conjunction with and as a distinct part of a licensed nursing home.

 

 2  Home for the aged does not include an area excluded from this

 

 3  definition by section 17(3) of the continuing care community

 

 4  disclosure act, 2014 PA 448, MCL 554.917.

 

 5        (4) "Hospice" means a health care program that provides a

 

 6  coordinated set of services rendered at home or in outpatient or

 

 7  institutional settings for individuals suffering from a disease or

 

 8  condition with a terminal prognosis.

 

 9        (5) "Hospital" means a facility offering inpatient, overnight

 

10  care, and services for observation, diagnosis, and active treatment

 

11  of an individual with a medical, surgical, obstetric, chronic, or

 

12  rehabilitative condition requiring the daily direction or

 

13  supervision of a physician. Hospital does not include a mental

 

14  health hospital licensed or operated by the department of community

 

15  health or a hospital operated by the department of corrections.

 

16        (6) "Hospital long-term care unit" means a nursing care

 

17  facility, owned and operated by and as part of a hospital,

 

18  providing organized nursing care and medical treatment to 7 or more

 

19  unrelated individuals suffering or recovering from illness, injury,

 

20  or infirmity.

 

21        Sec. 20145. (1) Before contracting for and initiating a

 

22  construction project involving new construction, additions,

 

23  modernizations, or conversions of a health facility or agency with

 

24  a capital expenditure of $1,000,000.00 or more, a person shall

 

25  obtain a construction permit from the department. The department

 

26  shall not issue the permit under this subsection unless the

 

27  applicant holds a valid certificate of need if a certificate of


 1  need is required for the project pursuant to under part 222.

 

 2        (2) To protect the public health, safety, and welfare, the

 

 3  department may promulgate rules to require construction permits for

 

 4  projects other than those described in subsection (1) and the

 

 5  submission of plans for other construction projects to expand or

 

 6  change service areas and services provided.

 

 7        (3) If a construction project requires a construction permit

 

 8  under subsection (1) or (2), but does not require a certificate of

 

 9  need under part 222, the department shall require the applicant to

 

10  submit information considered necessary by the department to assure

 

11  that the capital expenditure for the project is not a covered

 

12  capital expenditure as defined in section 22203(9).

 

13        (4) If a construction project requires a construction permit

 

14  under subsection (1), but does not require a certificate of need

 

15  under part 222, the department shall require the applicant to

 

16  submit information on a 1-page sheet, along with the application

 

17  for a construction permit, consisting of all of the following:

 

18        (a) A short description of the reason for the project and the

 

19  funding source.

 

20        (b) A contact person for further information, including

 

21  address and phone number.

 

22        (c) The estimated resulting increase or decrease in annual

 

23  operating costs.

 

24        (d) The current governing board membership of the applicant.

 

25        (e) The entity, if any, that owns the applicant.

 

26        (5) The information filed under subsection (4) shall be made

 

27  publicly available by the department by the same methods used to


 1  make information about certificate of need applications publicly

 

 2  available.

 

 3        (6) The review and approval of architectural plans and

 

 4  narrative shall require that the proposed construction project is

 

 5  designed and constructed in accord with applicable statutory and

 

 6  other regulatory requirements. In performing a construction permit

 

 7  review for a health facility or agency under this section, the

 

 8  department shall, at a minimum, apply the standards contained in

 

 9  the document entitled "Minimum Design Standards for Health Care

 

10  Facilities in Michigan" published by the department and dated March

 

11  1998. July 2007. The standards are incorporated by reference for

 

12  purposes of this subsection. The department may promulgate rules

 

13  that are more stringent than the standards if necessary to protect

 

14  the public health, safety, and welfare.

 

15        (7) The department shall promulgate rules to further prescribe

 

16  the scope of construction projects and other alterations subject to

 

17  review under this section.

 

18        (8) The department may waive the applicability of this section

 

19  to a construction project or alteration if the waiver will not

 

20  affect the public health, safety, and welfare.

 

21        (9) Upon request by the person initiating a construction

 

22  project, the department may review and issue a construction permit

 

23  to a construction project that is not subject to subsection (1) or

 

24  (2) if the department determines that the review will promote the

 

25  public health, safety, and welfare.

 

26        (10) The department shall assess a fee for each review

 

27  conducted under this section. The fee is .5% of the first


 1  $1,000,000.00 of capital expenditure and .85% of any amount over

 

 2  $1,000,000.00 of capital expenditure, up to a maximum of

 

 3  $60,000.00.

 

 4        (11) As used in this section, "capital expenditure" means that

 

 5  term as defined in section 22203(2), except that it capital

 

 6  expenditure does not include the cost of equipment that is not

 

 7  fixed equipment.

 

 8        Sec. 20155. (1) Except as otherwise provided in this section

 

 9  and section 20155a, the department shall make annual and other

 

10  visits to each health facility or agency licensed under this

 

11  article for the purposes of survey, evaluation, and consultation.

 

12  at least 1 visit to each licensed health facility or agency every 3

 

13  years for survey and evaluation for the purpose of licensure. A

 

14  visit made according to a complaint shall be unannounced. Except

 

15  for a county medical care facility, a home for the aged, a nursing

 

16  home, or a hospice residence, the department shall determine

 

17  whether the visits that are not made according to a complaint are

 

18  announced or unannounced. Beginning June 20, 2001, the The

 

19  department shall ensure that each newly hired nursing home

 

20  surveyor, as part of his or her basic training, is assigned full-

 

21  time to a licensed nursing home for at least 10 days within a 14-

 

22  day period to observe actual operations outside of the survey

 

23  process before the trainee begins oversight responsibilities.

 

24        (2) The state shall establish a process that ensures both of

 

25  the following:

 

26        (a) A newly hired nursing home surveyor shall not make

 

27  independent compliance decisions during his or her training period.


 1        (b) A nursing home surveyor shall not be assigned as a member

 

 2  of a survey team for a nursing home in which he or she received

 

 3  training for 1 standard survey following the training received in

 

 4  that nursing home.

 

 5        (3) Beginning November 1, 2012, the The department shall

 

 6  perform a criminal history check on all nursing home surveyors in

 

 7  the manner provided for in section 20173a.

 

 8        (4) A member of a survey team shall not be employed by a

 

 9  licensed nursing home or a nursing home management company doing

 

10  business in this state at the time of conducting a survey under

 

11  this section. The department shall not assign an individual to be a

 

12  member of a survey team for purposes of a survey, evaluation, or

 

13  consultation visit at a nursing home in which he or she was an

 

14  employee within the preceding 3 years.

 

15        (5) Representatives from all nursing home provider

 

16  organizations and the state long-term care ombudsman or his or her

 

17  designee shall be invited to participate in the planning process

 

18  for the joint provider and surveyor training sessions. The

 

19  department shall include at least 1 representative from nursing

 

20  home provider organizations that do not own or operate a nursing

 

21  home representing 30 or more nursing homes statewide in internal

 

22  surveyor group quality assurance training provided for the purpose

 

23  of general clarification and interpretation of existing or new

 

24  regulatory requirements and expectations.

 

25        (6) The department shall make available online the general

 

26  civil service position description related to the required

 

27  qualifications for individual surveyors. The department shall use


 1  the required qualifications to hire, educate, develop, and evaluate

 

 2  surveyors.

 

 3        (7) The department shall ensure that each annual survey team

 

 4  is composed of an interdisciplinary group of professionals, 1 of

 

 5  whom must be a registered nurse. Other members may include social

 

 6  workers, therapists, dietitians, pharmacists, administrators,

 

 7  physicians, sanitarians, and others who may have the expertise

 

 8  necessary to evaluate specific aspects of nursing home operation.

 

 9        (8) Except as otherwise provided in this section and section

 

10  20155a, the department shall make at least a biennial visit to each

 

11  licensed clinical laboratory, each nursing home, and each hospice

 

12  residence for the purposes of survey, evaluation, and consultation.

 

13  The department shall semiannually provide for joint training with

 

14  nursing home surveyors and providers on at least 1 of the 10 most

 

15  frequently issued federal citations in this state during the past

 

16  calendar year. The department shall develop a protocol for the

 

17  review of citation patterns compared to regional outcomes and

 

18  standards and complaints regarding the nursing home survey process.

 

19  The review will be included in the report required under subsection

 

20  (20). Except as otherwise provided in this subsection, beginning

 

21  with his or her first full relicensure period after June 20, 2000,

 

22  each member of a department nursing home survey team who is a

 

23  health professional licensee under article 15 shall earn not less

 

24  than 50% of his or her required continuing education credits, if

 

25  any, in geriatric care. If a member of a nursing home survey team

 

26  is a pharmacist licensed under article 15, he or she shall earn not

 

27  less than 30% of his or her required continuing education credits


 1  in geriatric care.

 

 2        (9) The department shall make a biennial visit to each

 

 3  hospital for survey and evaluation for the purpose of licensure.

 

 4  Subject to subsection (12), the department may waive the biennial

 

 5  visit required by this subsection (1) if a hospital, as part of a

 

 6  timely application for license renewal, health facility or agency,

 

 7  requests a waiver and submits both of the following as applicable

 

 8  and if all of the requirements of subsection (11) are met:

 

 9        (a) Evidence that it is currently fully accredited by a body

 

10  with expertise in hospital accreditation whose hospital

 

11  accreditations are the health facility or agency type and the

 

12  accrediting organization is accepted by the United States

 

13  department of health and human services Department of Health and

 

14  Human Services for purposes of section 1865 of part C E of title

 

15  XVIII of the social security act, 42 USC 1395bb.

 

16        (b) A copy of the most recent accreditation report, for the

 

17  hospital or executive summary, issued by a body described in

 

18  subdivision (a), and the hospital's health facility's or agency's

 

19  responses to the accreditation report is submitted to the

 

20  department at least 30 days from license renewal. Submission of an

 

21  executive summary does not prevent or prohibit the department from

 

22  requesting the entire accreditation report if the department

 

23  considers it necessary.

 

24        (c) For a nursing home, a standard federal certification

 

25  survey conducted within the immediately preceding 9 to 15 months

 

26  that shows substantial compliance or has an accepted plan of

 

27  correction, if applicable.


 1        (10) Except as provided in subsection (14), accreditation

 

 2  information provided to the department under subsection (9) is

 

 3  confidential, is not a public record, and is not subject to court

 

 4  subpoena. The department shall use the accreditation information

 

 5  only as provided in this section and shall return the accreditation

 

 6  information to the hospital within a reasonable time properly

 

 7  destroy the documentation after a decision on the waiver request is

 

 8  made.

 

 9        (11) The department shall grant a waiver under subsection (9)

 

10  if the accreditation report submitted under subsection (9)(b) is

 

11  less than 2 3 years old or the standard federal survey submitted

 

12  under subsection (9)(c) is less than 15 months old and there is no

 

13  indication of substantial noncompliance with licensure standards or

 

14  of deficiencies that represent a threat to public safety or patient

 

15  care. in the report, in complaints involving the hospital, or in

 

16  any other information available to the department. If the

 

17  accreditation report or standard federal survey is 2 or more years

 

18  too old, the department may do 1 of the following:

 

19        (a) Grant an extension of the hospital's current license until

 

20  the next accreditation survey is completed by the body described in

 

21  subsection (9)(a).

 

22        (b) Grant a waiver under subsection (9) based on the

 

23  accreditation report that is 2 or more years old, on condition that

 

24  the hospital promptly submit the next accreditation report to the

 

25  department.

 

26        (c) Deny deny the waiver request and conduct the visits

 

27  required under subsection (9). Denial of a waiver request by the


 1  department is not subject to appeal.

 

 2        (12) This section does not prohibit the department from citing

 

 3  a violation of this part during a survey, conducting investigations

 

 4  or inspections according to section 20156, or conducting surveys of

 

 5  health facilities or agencies for the purpose of complaint

 

 6  investigations or federal certification. This section does not

 

 7  prohibit the bureau of fire services created in section 1b of the

 

 8  fire prevention code, 1941 PA 207, MCL 29.1b, from conducting

 

 9  annual surveys of hospitals, nursing homes, and county medical care

 

10  facilities.

 

11        (13) At the request of a health facility or agency, the

 

12  department may conduct a consultation engineering survey of a

 

13  health facility and provide professional advice and consultation

 

14  regarding health facility construction and design. A health

 

15  facility or agency may request a voluntary consultation survey

 

16  under this subsection at any time between licensure surveys. The

 

17  fees for a consultation engineering survey are the same as the fees

 

18  established for waivers under section 20161(10).20161(8).

 

19        (14) If the department determines that substantial

 

20  noncompliance with licensure standards exists or that deficiencies

 

21  that represent a threat to public safety or patient care exist

 

22  based on a review of an accreditation report submitted under

 

23  subsection (9)(b), the department shall prepare a written summary

 

24  of the substantial noncompliance or deficiencies and the hospital's

 

25  health facility's or agency's response to the department's

 

26  determination. The department's written summary and the hospital's

 

27  health facility's or agency's response are public documents.


 1        (15) The department or a local health department shall conduct

 

 2  investigations or inspections, other than inspections of financial

 

 3  records, of a county medical care facility, home for the aged,

 

 4  nursing home, or hospice residence without prior notice to the

 

 5  health facility or agency. An employee of a state agency charged

 

 6  with investigating or inspecting the health facility or agency or

 

 7  an employee of a local health department who directly or indirectly

 

 8  gives prior notice regarding an investigation or an inspection,

 

 9  other than an inspection of the financial records, to the health

 

10  facility or agency or to an employee of the health facility or

 

11  agency, is guilty of a misdemeanor. Consultation visits that are

 

12  not for the purpose of annual or follow-up inspection or survey may

 

13  be announced.

 

14        (16) The department shall maintain a record indicating whether

 

15  a visit and inspection is announced or unannounced. Survey findings

 

16  gathered at each health facility or agency during each visit and

 

17  inspection, whether announced or unannounced, shall be taken into

 

18  account in licensure decisions.

 

19        (17) The department shall require periodic reports and a

 

20  health facility or agency shall give the department access to

 

21  books, records, and other documents maintained by a health facility

 

22  or agency to the extent necessary to carry out the purpose of this

 

23  article and the rules promulgated under this article. The

 

24  department shall not divulge or disclose the contents of the

 

25  patient's clinical records in a manner that identifies an

 

26  individual except under court order. The department may copy health

 

27  facility or agency records as required to document findings.


 1  Surveyors shall use electronic resident information, whenever

 

 2  available, as a source of survey-related data and shall request

 

 3  facility assistance to access the system to maximize data export.

 

 4        (18) The department may delegate survey, evaluation, or

 

 5  consultation functions to another state agency or to a local health

 

 6  department qualified to perform those functions. However, the The

 

 7  department shall not delegate survey, evaluation, or consultation

 

 8  functions to a local health department that owns or operates a

 

 9  hospice or hospice residence licensed under this article. The

 

10  delegation shall be by cost reimbursement contract between the

 

11  department and the state agency or local health department. Survey,

 

12  evaluation, or consultation functions shall not be delegated to

 

13  nongovernmental agencies, except as provided in this section. The

 

14  department may accept voluntary inspections performed by an

 

15  accrediting body with expertise in clinical laboratory

 

16  accreditation under part 205 if the accrediting body utilizes forms

 

17  acceptable to the department, applies the same licensing standards

 

18  as applied to other clinical laboratories, and provides the same

 

19  information and data usually filed by the department's own

 

20  employees when engaged in similar inspections or surveys. The

 

21  voluntary inspection described in this subsection shall be agreed

 

22  upon by both the licensee and the department.

 

23        (19) If, upon investigation, the department or a state agency

 

24  determines that an individual licensed to practice a profession in

 

25  this state has violated the applicable licensure statute or the

 

26  rules promulgated under that statute, the department, state agency,

 

27  or local health department shall forward the evidence it has to the


 1  appropriate licensing agency.

 

 2        (20) The department may consolidate all information provided

 

 3  for any report required under this section and section 20155a into

 

 4  a single report. The department shall report to the appropriations

 

 5  subcommittees, the senate and house of representatives standing

 

 6  committees having jurisdiction over issues involving senior

 

 7  citizens, and the fiscal agencies on March 1 of each year on the

 

 8  initial and follow-up surveys conducted on all nursing homes in

 

 9  this state. The report shall include all of the following

 

10  information:

 

11        (a) The number of surveys conducted.

 

12        (b) The number requiring follow-up surveys.

 

13        (c) The average number of citations per nursing home for the

 

14  most recent calendar year.

 

15        (d) The number of night and weekend complaints filed.

 

16        (e) The number of night and weekend responses to complaints

 

17  conducted by the department.

 

18        (f) The average length of time for the department to respond

 

19  to a complaint filed against a nursing home.

 

20        (g) The number and percentage of citations disputed through

 

21  informal dispute resolution and independent informal dispute

 

22  resolution.

 

23        (h) The number and percentage of citations overturned or

 

24  modified, or both.

 

25        (i) The review of citation patterns developed under subsection

 

26  (8).

 

27        (j) Implementation of the clinical process guidelines and the


 1  impact of the guidelines on resident care.

 

 2        (k) Information regarding the progress made on implementing

 

 3  the administrative and electronic support structure to efficiently

 

 4  coordinate all nursing home licensing and certification functions.

 

 5        (l) The number of annual standard surveys of nursing homes

 

 6  that were conducted during a period of open survey or enforcement

 

 7  cycle.

 

 8        (m) The number of abbreviated complaint surveys that were not

 

 9  conducted on consecutive surveyor workdays.

 

10        (n) The percent of all form CMS-2567 reports of findings that

 

11  were released to the nursing home within the 10-working-day

 

12  requirement.

 

13        (o) The percent of provider notifications of acceptance or

 

14  rejection of a plan of correction that were released to the nursing

 

15  home within the 10-working-day requirement.

 

16        (p) The percent of first revisits that were completed within

 

17  60 days from the date of survey completion.

 

18        (q) The percent of second revisits that were completed within

 

19  85 days from the date of survey completion.

 

20        (r) The percent of letters of compliance notification to the

 

21  nursing home that were released within 10 working days of the date

 

22  of the completion of the revisit.

 

23        (s) A summary of the discussions from the meetings required in

 

24  subsection (24).

 

25        (t) The number of nursing homes that participated in a

 

26  recognized quality improvement program as described under section

 

27  20155a(3).


 1        (21) The department shall report March 1 of each year to the

 

 2  standing committees on appropriations and the standing committees

 

 3  having jurisdiction over issues involving senior citizens in the

 

 4  senate and the house of representatives on all of the following:

 

 5        (a) The percentage of nursing home citations that are appealed

 

 6  through the informal dispute resolution process.

 

 7        (b) The number and percentage of nursing home citations that

 

 8  are appealed and supported, amended, or deleted through the

 

 9  informal dispute resolution process.

 

10        (c) A summary of the quality assurance review of the amended

 

11  citations and related survey retraining efforts to improve

 

12  consistency among surveyors and across the survey administrative

 

13  unit that occurred in the year being reported.

 

14        (22) Subject to subsection (23), a clarification work group

 

15  comprised of the department in consultation with a nursing home

 

16  resident or a member of a nursing home resident's family, nursing

 

17  home provider groups, the American medical directors association,

 

18  Medical Directors Association, the state long-term care ombudsman,

 

19  and the federal centers for medicare and medicaid services Centers

 

20  for Medicare and Medicaid Services shall clarify the following

 

21  terms as those terms are used in title XVIII and title XIX and

 

22  applied by the department to provide more consistent regulation of

 

23  nursing homes in this state:

 

24        (a) Immediate jeopardy.

 

25        (b) Harm.

 

26        (c) Potential harm.

 

27        (d) Avoidable.


 1        (e) Unavoidable.

 

 2        (23) All of the following clarifications developed under

 

 3  subsection (22) apply for purposes of subsection (22):

 

 4        (a) Specifically, the term "immediate jeopardy" means a

 

 5  situation in which immediate corrective action is necessary because

 

 6  the nursing home's noncompliance with 1 or more requirements of

 

 7  participation has caused or is likely to cause serious injury,

 

 8  harm, impairment, or death to a resident receiving care in a

 

 9  nursing home.

 

10        (b) The likelihood of immediate jeopardy is reasonably higher

 

11  if there is evidence of a flagrant failure by the nursing home to

 

12  comply with a clinical process guideline adopted under subsection

 

13  (25) than if the nursing home has substantially and continuously

 

14  complied with those guidelines. If federal regulations and

 

15  guidelines are not clear, and if the clinical process guidelines

 

16  have been recognized, a process failure giving rise to an immediate

 

17  jeopardy may involve an egregious widespread or repeated process

 

18  failure and the absence of reasonable efforts to detect and prevent

 

19  the process failure.

 

20        (c) In determining whether or not there is immediate jeopardy,

 

21  the survey agency should consider at least all of the following:

 

22        (i) Whether the nursing home could reasonably have been

 

23  expected to know about the deficient practice and to stop it, but

 

24  did not stop the deficient practice.

 

25        (ii) Whether the nursing home could reasonably have been

 

26  expected to identify the deficient practice and to correct it, but

 

27  did not correct the deficient practice.


 1        (iii) Whether the nursing home could reasonably have been

 

 2  expected to anticipate that serious injury, serious harm,

 

 3  impairment, or death might result from continuing the deficient

 

 4  practice, but did not so anticipate.

 

 5        (iv) Whether the nursing home could reasonably have been

 

 6  expected to know that a widely accepted high-risk practice is or

 

 7  could be problematic, but did not know.

 

 8        (v) Whether the nursing home could reasonably have been

 

 9  expected to detect the process problem in a more timely fashion,

 

10  but did not so detect.

 

11        (d) The existence of 1 or more of the factors described in

 

12  subdivision (c), and especially the existence of 3 or more of those

 

13  factors simultaneously, may lead to a conclusion that the situation

 

14  is one in which the nursing home's practice makes adverse events

 

15  likely to occur if immediate intervention is not undertaken, and

 

16  therefore constitutes immediate jeopardy. If none of the factors

 

17  described in subdivision (c) is present, the situation may involve

 

18  harm or potential harm that is not immediate jeopardy.

 

19        (e) Specifically, "actual harm" means a negative outcome to a

 

20  resident that has compromised the resident's ability to maintain or

 

21  reach, or both, his or her highest practicable physical, mental,

 

22  and psychosocial well-being as defined by an accurate and

 

23  comprehensive resident assessment, plan of care, and provision of

 

24  services. Harm does not include a deficient practice that only may

 

25  cause or has caused limited consequences to the resident.

 

26        (f) For purposes of subdivision (e), in determining whether a

 

27  negative outcome is of limited consequence, if the "state


 1  operations manual" or "the guidance to surveyors" published by the

 

 2  federal centers for medicare and medicaid services Centers for

 

 3  Medicare and Medicaid Services does not provide specific guidance,

 

 4  the department may consider whether most people in similar

 

 5  circumstances would feel that the damage was of such short duration

 

 6  or impact as to be inconsequential or trivial. In such a case, the

 

 7  consequence of a negative outcome may be considered more limited if

 

 8  it occurs in the context of overall procedural consistency with an

 

 9  accepted clinical process guideline adopted under subsection (25),

 

10  as compared to a substantial inconsistency with or variance from

 

11  the guideline.

 

12        (g) For purposes of subdivision (e), if the publications

 

13  described in subdivision (f) do not provide specific guidance, the

 

14  department may consider the degree of a nursing home's adherence to

 

15  a clinical process guideline adopted under subsection (25) in

 

16  considering whether the degree of compromise and future risk to the

 

17  resident constitutes actual harm. The risk of significant

 

18  compromise to the resident may be considered greater in the context

 

19  of substantial deviation from the guidelines than in the case of

 

20  overall adherence.

 

21        (h) To improve consistency and to avoid disputes over

 

22  avoidable and unavoidable negative outcomes, nursing homes and

 

23  survey agencies must have a common understanding of accepted

 

24  process guidelines and of the circumstances under which it can

 

25  reasonably be said that certain actions or inactions will lead to

 

26  avoidable negative outcomes. If the "state operations manual" or

 

27  "the guidance to surveyors" published by the federal centers for


 1  medicare and medicaid services Centers for Medicare and Medicaid

 

 2  Services is not specific, a nursing home's overall documentation of

 

 3  adherence to a clinical process guideline with a process indicator

 

 4  adopted under subsection (25) is relevant information in

 

 5  considering whether a negative outcome was avoidable or unavoidable

 

 6  and may be considered in the application of that term.

 

 7        (24) The department shall conduct a quarterly meeting and

 

 8  invite appropriate stakeholders. Appropriate stakeholders shall

 

 9  include at least 1 representative from each nursing home provider

 

10  organization that does not own or operate a nursing home

 

11  representing 30 or more nursing homes statewide, the state long-

 

12  term care ombudsman or his or her designee, and any other clinical

 

13  experts. Individuals who participate in these quarterly meetings,

 

14  in conjunction with the department, may designate advisory

 

15  workgroups to develop recommendations on the discussion topics that

 

16  should include, at a minimum, all of the following:

 

17        (a) Opportunities for enhanced promotion of nursing home

 

18  performance, including, but not limited to, programs that encourage

 

19  and reward providers that strive for excellence.

 

20        (b) Seeking quality improvement to the survey and enforcement

 

21  process, including clarifications to process-related policies and

 

22  protocols that include, but are not limited to, all of the

 

23  following:

 

24        (i) Improving the surveyors' quality and preparedness.

 

25        (ii) Enhanced communication between regulators, surveyors,

 

26  providers, and consumers.

 

27        (iii) Ensuring fair enforcement and dispute resolution by


 1  identifying methods or strategies that may resolve identified

 

 2  problems or concerns.

 

 3        (c) Promoting transparency across provider and surveyor

 

 4  communities, including, but not limited to, all of the following:

 

 5        (i) Applying regulations in a consistent manner and evaluating

 

 6  changes that have been implemented to resolve identified problems

 

 7  and concerns.

 

 8        (ii) Providing consumers with information regarding changes in

 

 9  policy and interpretation.

 

10        (iii) Identifying positive and negative trends and factors

 

11  contributing to those trends in the areas of resident care,

 

12  deficient practices, and enforcement.

 

13        (d) Clinical process guidelines.

 

14        (25) Subject to subsection (27), the department shall develop

 

15  and adopt clinical process guidelines. The department shall

 

16  establish and adopt clinical process guidelines and compliance

 

17  protocols with outcome measures for all of the following areas and

 

18  for other topics where the department determines that clarification

 

19  will benefit providers and consumers of long-term care:

 

20        (a) Bed rails.

 

21        (b) Adverse drug effects.

 

22        (c) Falls.

 

23        (d) Pressure sores.

 

24        (e) Nutrition and hydration including, but not limited to,

 

25  heat-related stress.

 

26        (f) Pain management.

 

27        (g) Depression and depression pharmacotherapy.


 1        (h) Heart failure.

 

 2        (i) Urinary incontinence.

 

 3        (j) Dementia.

 

 4        (k) Osteoporosis.

 

 5        (l) Altered mental states.

 

 6        (m) Physical and chemical restraints.

 

 7        (n) Culture-change principles, person-centered caring, and

 

 8  self-directed care.

 

 9        (26) The department shall biennially review and update all

 

10  clinical process guidelines as needed and shall continue to develop

 

11  and implement clinical process guidelines for topics that have not

 

12  been developed from the list in subsection (25) and other topics

 

13  identified as a result of the meetings required in subsection (24).

 

14  The department shall consider recommendations from an advisory

 

15  workgroup created under subsection (24) on clinical process

 

16  guidelines. The department shall include training on new and

 

17  revised clinical process guidelines in the joint provider and

 

18  surveyor training sessions as those clinical process guidelines are

 

19  developed and revised.

 

20        (27) Beginning November 1, 2012, representatives

 

21  Representatives from each nursing home provider organization that

 

22  does not own or operate a nursing home representing 30 or more

 

23  nursing homes statewide and the state long-term care ombudsman or

 

24  his or her designee shall be permanent members of any clinical

 

25  advisory workgroup created under subsection (24). The department

 

26  shall issue survey certification memorandums to providers to

 

27  announce or clarify changes in the interpretation of regulations.


 1        (28) The department shall maintain the process by which the

 

 2  department director of the division of nursing home monitoring or

 

 3  his or her designee or the director of the division of operations

 

 4  or his or her designee reviews and authorizes the issuance of a

 

 5  citation for immediate jeopardy or substandard quality of care

 

 6  before the statement of deficiencies is made final. The review

 

 7  shall be to assure that the applicable concepts, clinical process

 

 8  guidelines, and other tools contained in subsections (25) to (27)

 

 9  are being used consistently, accurately, and effectively. As used

 

10  in this subsection, "immediate jeopardy" and "substandard quality

 

11  of care" mean those terms as defined by the federal centers for

 

12  medicare and medicaid services.Centers for Medicare and Medicaid

 

13  Services.

 

14        (29) Upon availability of funds, the department shall give

 

15  grants, awards, or other recognition to nursing homes to encourage

 

16  the rapid implementation or maintenance of the clinical process

 

17  guidelines adopted under subsection (25).

 

18        (30) The department shall instruct and train the surveyors in

 

19  the clinical process guidelines adopted under subsection (25) in

 

20  citing deficiencies.

 

21        (31) A nursing home shall post the nursing home's survey

 

22  report in a conspicuous place within the nursing home for public

 

23  review.

 

24        (32) Nothing in this amendatory act shall be construed to

 

25  limit section limits the requirements of related state and federal

 

26  law.

 

27        (33) As used in this section:


 1        (a) "Consecutive days" means calendar days, but does not

 

 2  include Saturday, Sunday, or state- or federally-recognized

 

 3  holidays.

 

 4        (b) "Form CMS-2567" means the federal centers for medicare and

 

 5  medicaid services' Centers for Medicare and Medicaid Services' form

 

 6  for the statement of deficiencies and plan of correction or a

 

 7  successor form serving the same purpose.

 

 8        (c) "Title XVIII" means title XVIII of the social security

 

 9  act, 42 USC 1395 to 1395kkk.

 

10        (d) "Title XIX" means title XIX of the social security act, 42

 

11  USC 1396 to 1396w-5.

 

12        Sec. 20161. (1) The department shall assess fees and other

 

13  assessments for health facility and agency licenses and

 

14  certificates of need on an annual basis as provided in this

 

15  article. Except Until October 1, 2019, except as otherwise provided

 

16  in this article, fees and assessments shall be paid as provided in

 

17  the following schedule:

 

 

18             (a) Freestanding surgical

19        outpatient facilities................$238.00 $500.00 per facility

20                                             license.

21             (b) Hospitals...................$8.28 $500.00 per facility

22                                             license and $10.00 per

23                                             licensed bed.

24             (c) Nursing homes, county

25        medical care facilities, and

26        hospital long-term care units........$2.20 $500.00 per facility

27                                             license and $3.00 per


 1                                             licensed bed over 100

 2                                             licensed beds.

 3             (d) Homes for the aged..........$6.27 per licensed bed.

 4             (e) Clinical laboratories.......$475.00 per laboratory.

 5             (e) Hospice agencies............$500.00 per agency license.

 6             (f) Hospice residences..........$200.00 $500.00 per

 7                                             facility license survey;

 8                                             and $20.00 $5.00 per

 9                                             licensed bed.

10             (g) Subject to subsection

11        (13), (11), quality assurance assessment

12        for nursing homes and hospital

13        long-term care units.................an amount resulting

14                                             in not more than 6%

15                                             of total industry

16                                             revenues.

17             (h) Subject to subsection

18        (14), (12), quality assurance assessment

19        for hospitals........................at a fixed or variable

20                                             rate that generates

21                                             funds not more than the

22                                             maximum allowable under

23                                             the federal matching

24                                             requirements, after

25                                             consideration for the

26                                             amounts in subsection

27                                             (14)(a) (12)(a) and (i).


 1             (i) Initial licensure

 2        application fee for subdivisions

 3        (a), (b), (c), (e), and (f)..........$2,000.00 per initial

 4                                             license.

 

 

 5        (2) If a hospital requests the department to conduct a

 

 6  certification survey for purposes of title XVIII or title XIX of

 

 7  the social security act, the hospital shall pay a license fee

 

 8  surcharge of $23.00 per bed. As used in this subsection, "title

 

 9  XVIII" and "title XIX" mean those terms as defined in section

 

10  20155.

 

11        (3) All of the following apply to the assessment under this

 

12  section for certificates of need:

 

13        (a) The base fee for a certificate of need is $3,000.00 for

 

14  each application. For a project requiring a projected capital

 

15  expenditure of more than $500,000.00 but less than $4,000,000.00,

 

16  an additional fee of $5,000.00 is added to the base fee. For a

 

17  project requiring a projected capital expenditure of $4,000,000.00

 

18  or more but less than $10,000,000.00, an additional fee of

 

19  $8,000.00 is added to the base fee. For a project requiring a

 

20  projected capital expenditure of $10,000,000.00 or more, an

 

21  additional fee of $12,000.00 is added to the base fee.

 

22        (b) In addition to the fees under subdivision (a), the

 

23  applicant shall pay $3,000.00 for any designated complex project

 

24  including a project scheduled for comparative review or for a

 

25  consolidated licensed health facility application for acquisition

 

26  or replacement.

 

27        (c) If required by the department, the applicant shall pay


 1  $1,000.00 for a certificate of need application that receives

 

 2  expedited processing at the request of the applicant.

 

 3        (d) The department shall charge a fee of $500.00 to review any

 

 4  letter of intent requesting or resulting in a waiver from

 

 5  certificate of need review and any amendment request to an approved

 

 6  certificate of need.

 

 7        (e) A health facility or agency that offers certificate of

 

 8  need covered clinical services shall pay $100.00 for each

 

 9  certificate of need approved covered clinical service as part of

 

10  the certificate of need annual survey at the time of submission of

 

11  the survey data.

 

12        (f) The department of community health shall use the fees

 

13  collected under this subsection only to fund the certificate of

 

14  need program. Funds remaining in the certificate of need program at

 

15  the end of the fiscal year shall not lapse to the general fund but

 

16  shall remain available to fund the certificate of need program in

 

17  subsequent years.

 

18        (4) If licensure is for more than 1 year, the fees described

 

19  in subsection (1) are multiplied by the number of years for which

 

20  the license is issued, and the total amount of the fees shall be

 

21  collected in the year in which the license is issued.A license

 

22  issued under this part is effective for no longer than 1 year after

 

23  the date of issuance.

 

24        (5) Fees described in this section are payable to the

 

25  department at the time an application for a license, permit, or

 

26  certificate is submitted. If an application for a license, permit,

 

27  or certificate is denied or if a license, permit, or certificate is


 1  revoked before its expiration date, the department shall not refund

 

 2  fees paid to the department.

 

 3        (6) The fee for a provisional license or temporary permit is

 

 4  the same as for a license. A license may be issued at the

 

 5  expiration date of a temporary permit without an additional fee for

 

 6  the balance of the period for which the fee was paid if the

 

 7  requirements for licensure are met.

 

 8        (7) The department may charge a fee to recover the cost of

 

 9  purchase or production and distribution of proficiency evaluation

 

10  samples that are supplied to clinical laboratories under section

 

11  20521(3).

 

12        (8) In addition to the fees imposed under subsection (1), a

 

13  clinical laboratory shall submit a fee of $25.00 to the department

 

14  for each reissuance during the licensure period of the clinical

 

15  laboratory's license.

 

16        (7) (9) The cost of licensure activities shall be supported by

 

17  license fees.

 

18        (8) (10) The application fee for a waiver under section 21564

 

19  is $200.00 plus $40.00 per hour for the professional services and

 

20  travel expenses directly related to processing the application. The

 

21  travel expenses shall be calculated in accordance with the state

 

22  standardized travel regulations of the department of technology,

 

23  management, and budget in effect at the time of the travel.

 

24        (9) (11) An applicant for licensure or renewal of licensure

 

25  under part 209 shall pay the applicable fees set forth in part 209.

 

26        (10) (12) Except as otherwise provided in this section, the

 

27  fees and assessments collected under this section shall be


 1  deposited in the state treasury, to the credit of the general fund.

 

 2  The department may use the unreserved fund balance in fees and

 

 3  assessments for the criminal history check program required under

 

 4  this article.

 

 5        (11) (13) The quality assurance assessment collected under

 

 6  subsection (1)(g) and all federal matching funds attributed to that

 

 7  assessment shall be used only for the following purposes and under

 

 8  the following specific circumstances:

 

 9        (a) The quality assurance assessment and all federal matching

 

10  funds attributed to that assessment shall be used to finance

 

11  medicaid Medicaid nursing home reimbursement payments. Only

 

12  licensed nursing homes and hospital long-term care units that are

 

13  assessed the quality assurance assessment and participate in the

 

14  medicaid Medicaid program are eligible for increased per diem

 

15  medicaid Medicaid reimbursement rates under this subdivision. A

 

16  nursing home or long-term care unit that is assessed the quality

 

17  assurance assessment and that does not pay the assessment required

 

18  under subsection (1)(g) in accordance with subdivision (c)(i) or in

 

19  accordance with a written payment agreement with the state shall

 

20  not receive the increased per diem medicaid Medicaid reimbursement

 

21  rates under this subdivision until all of its outstanding quality

 

22  assurance assessments and any penalties assessed pursuant to under

 

23  subdivision (f) have been paid in full. Nothing in this This

 

24  subdivision shall be construed to does not authorize or require the

 

25  department to overspend tax revenue in violation of the management

 

26  and budget act, 1984 PA 431, MCL 18.1101 to 18.1594.

 

27        (b) Except as otherwise provided under subdivision (c),


 1  beginning October 1, 2005, the quality assurance assessment is

 

 2  based on the total number of patient days of care each nursing home

 

 3  and hospital long-term care unit provided to nonmedicare non-

 

 4  Medicare patients within the immediately preceding year and shall

 

 5  be assessed at a uniform rate on October 1, 2005 and subsequently

 

 6  on October 1 of each following year, and is payable on a quarterly

 

 7  basis, the first payment due 90 days after the date the assessment

 

 8  is assessed.

 

 9        (c) Within 30 days after September 30, 2005, the department

 

10  shall submit an application to the federal centers for medicare and

 

11  medicaid services Centers for Medicare and Medicaid Services to

 

12  request a waiver pursuant according to 42 CFR 433.68(e) to

 

13  implement this subdivision as follows:

 

14        (i) If the waiver is approved, the quality assurance

 

15  assessment rate for a nursing home or hospital long-term care unit

 

16  with less than 40 licensed beds or with the maximum number, or more

 

17  than the maximum number, of licensed beds necessary to secure

 

18  federal approval of the application is $2.00 per nonmedicare non-

 

19  Medicare patient day of care provided within the immediately

 

20  preceding year or a rate as otherwise altered on the application

 

21  for the waiver to obtain federal approval. If the waiver is

 

22  approved, for all other nursing homes and long-term care units the

 

23  quality assurance assessment rate is to be calculated by dividing

 

24  the total statewide maximum allowable assessment permitted under

 

25  subsection (1)(g) less the total amount to be paid by the nursing

 

26  homes and long-term care units with less than 40 or with the

 

27  maximum number, or more than the maximum number, of licensed beds


 1  necessary to secure federal approval of the application by the

 

 2  total number of nonmedicare non-Medicare patient days of care

 

 3  provided within the immediately preceding year by those nursing

 

 4  homes and long-term care units with more than 39, but less than the

 

 5  maximum number of licensed beds necessary to secure federal

 

 6  approval. The quality assurance assessment, as provided under this

 

 7  subparagraph, shall be assessed in the first quarter after federal

 

 8  approval of the waiver and shall be subsequently assessed on

 

 9  October 1 of each following year, and is payable on a quarterly

 

10  basis, the first payment due 90 days after the date the assessment

 

11  is assessed.

 

12        (ii) If the waiver is approved, continuing care retirement

 

13  centers are exempt from the quality assurance assessment if the

 

14  continuing care retirement center requires each center resident to

 

15  provide an initial life interest payment of $150,000.00, on

 

16  average, per resident to ensure payment for that resident's

 

17  residency and services and the continuing care retirement center

 

18  utilizes all of the initial life interest payment before the

 

19  resident becomes eligible for medical assistance under the state's

 

20  medicaid Medicaid plan. As used in this subparagraph, "continuing

 

21  care retirement center" means a nursing care facility that provides

 

22  independent living services, assisted living services, and nursing

 

23  care and medical treatment services, in a campus-like setting that

 

24  has shared facilities or common areas, or both.

 

25        (d) Beginning May 10, 2002, the department of community health

 

26  shall increase the per diem nursing home medicaid Medicaid

 

27  reimbursement rates for the balance of that year. For each


 1  subsequent year in which the quality assurance assessment is

 

 2  assessed and collected, the department of community health shall

 

 3  maintain the medicaid Medicaid nursing home reimbursement payment

 

 4  increase financed by the quality assurance assessment.

 

 5        (e) The department of community health shall implement this

 

 6  section in a manner that complies with federal requirements

 

 7  necessary to assure ensure that the quality assurance assessment

 

 8  qualifies for federal matching funds.

 

 9        (f) If a nursing home or a hospital long-term care unit fails

 

10  to pay the assessment required by subsection (1)(g), the department

 

11  of community health may assess the nursing home or hospital long-

 

12  term care unit a penalty of 5% of the assessment for each month

 

13  that the assessment and penalty are not paid up to a maximum of 50%

 

14  of the assessment. The department of community health may also

 

15  refer for collection to the department of treasury past due amounts

 

16  consistent with section 13 of 1941 PA 122, MCL 205.13.

 

17        (g) The medicaid Medicaid nursing home quality assurance

 

18  assessment fund is established in the state treasury. The

 

19  department of community health shall deposit the revenue raised

 

20  through the quality assurance assessment with the state treasurer

 

21  for deposit in the medicaid Medicaid nursing home quality assurance

 

22  assessment fund.

 

23        (h) The department of community health shall not implement

 

24  this subsection in a manner that conflicts with 42 USC 1396b(w).

 

25        (i) The quality assurance assessment collected under

 

26  subsection (1)(g) shall be prorated on a quarterly basis for any

 

27  licensed beds added to or subtracted from a nursing home or


 1  hospital long-term care unit since the immediately preceding July

 

 2  1. Any adjustments in payments are due on the next quarterly

 

 3  installment due date.

 

 4        (j) In each fiscal year governed by this subsection, medicaid

 

 5  Medicaid reimbursement rates shall not be reduced below the

 

 6  medicaid Medicaid reimbursement rates in effect on April 1, 2002 as

 

 7  a direct result of the quality assurance assessment collected under

 

 8  subsection (1)(g).

 

 9        (k) The state retention amount of the quality assurance

 

10  assessment collected pursuant to under subsection (1)(g) shall be

 

11  equal to 13.2% of the federal funds generated by the nursing homes

 

12  and hospital long-term care units quality assurance assessment,

 

13  including the state retention amount. The state retention amount

 

14  shall be appropriated each fiscal year to the department of

 

15  community health to support medicaid Medicaid expenditures for

 

16  long-term care services. These funds shall offset an identical

 

17  amount of general fund/general purpose revenue originally

 

18  appropriated for that purpose.

 

19        (l) Beginning October 1, 2015, 2019, the department shall no

 

20  longer assess or collect the quality assurance assessment or apply

 

21  for federal matching funds. The quality assurance assessment

 

22  collected under subsection (1)(g) shall no longer be assessed or

 

23  collected after September 30, 2011, in the event that the quality

 

24  assurance assessment is not eligible for federal matching funds.

 

25  Any portion of the quality assurance assessment collected from a

 

26  nursing home or hospital long-term care unit that is not eligible

 

27  for federal matching funds shall be returned to the nursing home or


 1  hospital long-term care unit.

 

 2        (12) (14) The quality assurance dedication is an earmarked

 

 3  assessment collected under subsection (1)(h). That assessment and

 

 4  all federal matching funds attributed to that assessment shall be

 

 5  used only for the following purpose and under the following

 

 6  specific circumstances:

 

 7        (a) To maintain the increased medicaid Medicaid reimbursement

 

 8  rate increases as provided for in subdivision (c).

 

 9        (b) The quality assurance assessment shall be assessed on all

 

10  net patient revenue, before deduction of expenses, less medicare

 

11  Medicare net revenue, as reported in the most recently available

 

12  medicare Medicare cost report and is payable on a quarterly basis,

 

13  the first payment due 90 days after the date the assessment is

 

14  assessed. As used in this subdivision, "medicare "Medicare net

 

15  revenue" includes medicare Medicare payments and amounts collected

 

16  for coinsurance and deductibles.

 

17        (c) Beginning October 1, 2002, the department of community

 

18  health shall increase the hospital medicaid Medicaid reimbursement

 

19  rates for the balance of that year. For each subsequent year in

 

20  which the quality assurance assessment is assessed and collected,

 

21  the department of community health shall maintain the hospital

 

22  medicaid Medicaid reimbursement rate increase financed by the

 

23  quality assurance assessments.

 

24        (d) The department of community health shall implement this

 

25  section in a manner that complies with federal requirements

 

26  necessary to assure ensure that the quality assurance assessment

 

27  qualifies for federal matching funds.


 1        (e) If a hospital fails to pay the assessment required by

 

 2  subsection (1)(h), the department of community health may assess

 

 3  the hospital a penalty of 5% of the assessment for each month that

 

 4  the assessment and penalty are not paid up to a maximum of 50% of

 

 5  the assessment. The department of community health may also refer

 

 6  for collection to the department of treasury past due amounts

 

 7  consistent with section 13 of 1941 PA 122, MCL 205.13.

 

 8        (f) The hospital quality assurance assessment fund is

 

 9  established in the state treasury. The department of community

 

10  health shall deposit the revenue raised through the quality

 

11  assurance assessment with the state treasurer for deposit in the

 

12  hospital quality assurance assessment fund.

 

13        (g) In each fiscal year governed by this subsection, the

 

14  quality assurance assessment shall only be collected and expended

 

15  if medicaid Medicaid hospital inpatient DRG and outpatient

 

16  reimbursement rates and disproportionate share hospital and

 

17  graduate medical education payments are not below the level of

 

18  rates and payments in effect on April 1, 2002 as a direct result of

 

19  the quality assurance assessment collected under subsection (1)(h),

 

20  except as provided in subdivision (h).

 

21        (h) The quality assurance assessment collected under

 

22  subsection (1)(h) shall no longer be assessed or collected after

 

23  September 30, 2011 in the event that the quality assurance

 

24  assessment is not eligible for federal matching funds. Any portion

 

25  of the quality assurance assessment collected from a hospital that

 

26  is not eligible for federal matching funds shall be returned to the

 

27  hospital.


 1        (i) The state retention amount of the quality assurance

 

 2  assessment collected pursuant to under subsection (1)(h) shall be

 

 3  equal to 13.2% of the federal funds generated by the hospital

 

 4  quality assurance assessment, including the state retention amount.

 

 5  In the fiscal year ending September 30, 2016, there is a 1-time

 

 6  additional retention amount of up to $92,856,100.00. The state

 

 7  retention percentage shall be applied proportionately to each

 

 8  hospital quality assurance assessment program to determine the

 

 9  retention amount for each program. The state retention amount shall

 

10  be appropriated each fiscal year to the department of community

 

11  health to support medicaid Medicaid expenditures for hospital

 

12  services and therapy. These funds shall offset an identical amount

 

13  of general fund/general purpose revenue originally appropriated for

 

14  that purpose.

 

15        (13) The department may establish a quality assurance

 

16  assessment to increase ambulance reimbursement as follows:

 

17        (a) The quality assurance assessment authorized under this

 

18  subsection shall be used to provide reimbursement to Medicaid

 

19  ambulance providers. The department may promulgate rules to provide

 

20  the structure of the quality assurance assessment authorized under

 

21  this subsection and the level of the assessment.

 

22        (b) The department shall implement this subsection in a manner

 

23  that complies with federal requirements necessary to ensure that

 

24  the quality assurance assessment qualifies for federal matching

 

25  funds.

 

26        (c) The total annual collections by the department under this

 

27  subsection shall not exceed $20,000,000.00.


 1        (d) The quality assurance assessment authorized under this

 

 2  subsection shall not be collected after October 1, 2019. The

 

 3  quality assurance assessment authorized under this subsection shall

 

 4  no longer be collected or assessed if the quality assurance

 

 5  assessment authorized under this subsection is not eligible for

 

 6  federal matching funds.

 

 7        (14) (15) The quality assurance assessment provided for under

 

 8  this section is a tax that is levied on a health facility or

 

 9  agency.

 

10        (15) (16) As used in this section, "medicaid" "Medicaid" means

 

11  that term as defined in section 22207.

 

12        Sec. 20501. (1) As used in this part, : "laboratory" means a

 

13  facility for the biological, microbiological, serological,

 

14  chemical, immunohematological, hematological, biophysical,

 

15  cytological, pathological, or other examination of materials

 

16  derived from the human body for the purpose of providing

 

17  information for the diagnosis, prevention, or treatment of any

 

18  disease or impairment of, or the assessment of the health of, human

 

19  beings.

 

20        (a) "Laboratory director" means the individual responsible for

 

21  administration of the technical and scientific operation of a

 

22  clinical laboratory, including the supervision of procedures and

 

23  reporting of findings.

 

24        (b) "Owner" means a person who owns and controls a clinical

 

25  laboratory.

 

26        (2) In addition, article 1 contains general definitions and

 

27  principles of construction applicable to all articles in this code.


 1  and part 201 contains definitions applicable to this part.

 

 2        Sec. 20521. (1) The owner, laboratory director, and governing

 

 3  body of a clinical laboratory are responsible for the operation of

 

 4  the clinical laboratory.

 

 5        (2) The laboratory director is responsible for the making and

 

 6  keeping of an accurate record for each specimen examined and

 

 7  procedure followed.

 

 8        (3) A clinical laboratory shall analyze test samples submitted

 

 9  by the department and report to the department on the results of

 

10  the analyses, except that proficiency evaluation programs of

 

11  recognized professional organizations may be acceptable to the

 

12  department in lieu thereof. The analyses and reports may be

 

13  considered by the department in taking action under section 20165

 

14  or 20525.Only a physician, dentist, or other person authorized by

 

15  law can order a laboratory test that has been classified by the

 

16  Food and Drug Administration as moderate or high complexity. A

 

17  laboratory test that is classified by the Food and Drug

 

18  Administration as waived does not require an order.

 

19        Sec. 20551. (1) A laboratory or other place where live

 

20  bacteria, fungi, mycoplasma, parasites, viruses, or other

 

21  microorganisms of a pathogenic nature are handled, cultivated,

 

22  sold, given away, or shipped from or to or where recombinant

 

23  deoxyribonucleic acid research is done shall be registered with the

 

24  department, and a registration number shall be issued to each place

 

25  registered. An application for a registration number shall be made

 

26  by the person in charge of the laboratory or other place where the

 

27  pathogens are handled or where recombinant deoxyribonucleic acid


 1  research is done. The registration number is valid for 1 year and

 

 2  may be renewed upon application to the department.

 

 3        (2) A clinical laboratory licensed in microbiology under

 

 4  sections 20501 to 20525 is registered for purposes of this section

 

 5  and section 20552, and its license number shall be used as its

 

 6  registration number.

 

 7        (2) (3) As used in sections 20551 this section and section

 

 8  20552, "handled", "cultivated", or "shipped" does not include the

 

 9  collection of specimens, the initial inoculation of specimens into

 

10  transport media or culture media, or the shipment to registered

 

11  laboratories, but does include any additional work performed on

 

12  cultivated pathogenic microorganisms or any recombinant

 

13  deoxyribonucleic acid research is done.

 

14        Enacting section 1. Sections 20511, 20515, and 20525 of the

 

15  public health code, 1978 PA 368, MCL 333.20511, 333.20515, and

 

16  333.20525, are repealed.

 

17        Enacting section 2. This amendatory act takes effect October

 

18  1, 2015.