Substitute For

HOUSE BILL NO. 5523

A bill to make, supplement, and adjust appropriations for various state departments and agencies for the fiscal year ending September 30, 2022; to provide for certain conditions on appropriations; and to provide for the expenditure of the appropriations.

the people of the state of michigan enact:


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part 1

line-item appropriations

Sec. 101. There is appropriated for various state departments and agencies to supplement appropriations for the fiscal year ending September 30, 2022, from the following funds:

APPROPRIATION SUMMARY

 

 

 

GROSS APPROPRIATION

 

$

1,077,025,700


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Interdepartmental grant revenues:

 

 

 

Total interdepartmental grants and intradepartmental transfers

 

 

0

ADJUSTED GROSS APPROPRIATION

 

$

1,077,025,700

Federal revenues:

 

 

 

Total federal revenues

 

 

1,077,025,700

Special revenue funds:

 

 

 

Total local revenues

 

 

0

Total private revenues

 

 

0

Total other state restricted revenues

 

 

0

State general fund/general purpose

 

$

0

SEC. 102. DEPARTMENT OF EDUCATION

 

 

 

(1) APPROPRIATION SUMMARY

 

 

 

GROSS APPROPRIATION

 

$

250,000

Interdepartmental grant revenues:

 

 

 

ADJUSTED GROSS APPROPRIATION

 

$

250,000

Federal revenues:

 

 

 

Total federal revenues

 

 

250,000

Special revenue funds:

 

 

 

Total local revenues

 

 

0

Total private revenues

 

 

0

Total other state restricted revenues

 

 

0

State general fund/general purpose

 

$

0

(2) ONE-TIME APPROPRIATIONS

 

 

 

ARP work-based learning health services academies

 

$

250,000

GROSS APPROPRIATION

 

$

250,000

Appropriated from:

 

 

 


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Federal revenues:

 

 

 

Coronavirus state fiscal recovery fund

 

 

250,000

State general fund/general purpose

 

$

0

Sec. 103. DEPARTMENT OF HEALTH AND HUMAN SERVICES

 

 

 

(1) APPROPRIATION SUMMARY

 

 

 

GROSS APPROPRIATION

 

$

1,076,775,700

Interdepartmental grant revenues:

 

 

 

Total interdepartmental grants and intradepartmental transfers

 

 

0

ADJUSTED GROSS APPROPRIATION

 

$

1,076,775,700

Federal revenues:

 

 

 

Total federal revenues

 

 

1,076,775,700

Special revenue funds:

 

 

 

Total local revenues

 

 

0

Total private revenues

 

 

0

Total other state restricted revenues

 

 

0

State general fund/general purpose

 

$

0

(2) ONE-TIME APPROPRIATIONS

 

 

 

ARP - cooperative agreement for emergency response

 

$

59,409,300

ARP - COVID-19 early treatments

 

 

50,000,000

ARP - COVID-19 early treatments procurements reserve fund

 

 

25,000,000

ARP - epidemiology and lab capacity enhancing detection expansion

 

 

367,327,300

ARP - epidemiology and lab capacity school safety

 

 

150,799,300


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ARP - health care recruitment, retention, and training reserve fund

 

 

300,000,000

ARP - nursing facility room conversion pilot project

 

 

10,000,000

ARP - nursing home respirators

 

 

5,000,000

ARP - statewide emergency preparedness platform

 

 

5,000,000

ARP - vaccine support

 

 

90,239,800

MI Choice waiver program presumptive eligibility risk pool

 

 

5,000,000

Program of all-inclusive care for the elderly startup costs

 

 

9,000,000

GROSS APPROPRIATION

 

$

1,076,775,700

Appropriated from:

 

 

 

Federal revenues:

 

 

 

Coronavirus state fiscal recovery fund

 

 

395,000,000

Total other federal revenues

 

 

681,775,700

State general fund/general purpose

 

$

0

 

part 2

provisions concerning appropriations

general sections

Sec. 201. Pursuant to section 30 of article IX of the state constitution of 1963, total state spending from state sources under part 1 for the fiscal year ending September 30, 2022 is $0.00 and total state spending from state sources to be paid to local units of government is $0.00.

Sec. 202. The appropriations made and expenditures authorized under this part and part 1 and the departments, commissions, boards, offices, and programs for which appropriations are made


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under this part and part 1 are subject to the management and budget act, 1984 PA 431, MCL 18.1101 to 18.1594.

Sec. 203. If the state administrative board, acting under section 3 of 1921 PA 2, MCL 17.3, transfers funds from an amount appropriated under this act, the legislature may, by a concurrent resolution adopted by a majority of the members elected to and serving in each house, inter-transfer funds within this act for the particular department, board, commission, office, or institution.

Sec. 204. Funds appropriated in part 1 are subject to applicable federal audit and reporting requirements. Prompt action shall be taken if instances of noncompliance are identified, including noncompliance identified in an audit finding. If any instance of noncompliance is identified, including noncompliance identified in an audit finding, the state budget director shall take necessary and immediate action to rectify it. The state budget director shall notify the senate and house appropriations committees and the senate and house fiscal agencies when an instance of noncompliance is identified.

Sec. 205. (1) Funds appropriated in part 1 from the federal American rescue plan act of 2021, Public Law 117-2, must be allocated and expended in a manner consistent with federal rules and regulations.

(2) Rules and regulations include, but are not limited to, the following categorical recipient limitations for funding eligibility:

(a) Individuals who experienced economic harm or negative economic impacts as a result of the COVID-19 pandemic.

(b) Communities that experienced an increase in violence as a result of the COVID-19 pandemic.


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(c) Communities that experienced an increase in gun violence as a result of the COVID-19 pandemic.

(d) Communities that experienced increased difficulty in accessing or providing services to respond to or mitigate the effects of violence resulting from the COVID-19 pandemic.

(3) Rules and regulations generally limit awards granted from funds appropriated in part 1 to amounts that are related and reasonably proportional to the extent and type of harm experienced as a result of the COVID-19 pandemic.

Sec. 206. The state budget director shall report on the status of funds appropriated in part 1, and all funds appropriated related to the coronavirus relief effort, to the senate and house appropriations committees and the senate and house fiscal agencies on a monthly basis until all funds are exhausted.

 

DEPARTMENT OF EDUCATION

Sec. 251. (1) From the funds appropriated in part 1 for ARP work-based learning health services academies, the department of education shall allocate $250,000.00 as competitive grants to school districts and intermediate school districts that provide pupils in grades 9 through 12 with expanded opportunities for work-based learning health services academies hosted in partnership with a national academy foundation. Programs funded under this subsection are intended to increase the number of pupils who are college- and career-ready after high school graduation.

(2) To be eligible for a competitive grant funded under this section, the school district or intermediate school district must demonstrate that it has established a partnership with a national academy foundation, has at least 1 business entity on its advisory


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council, and has a higher education institution or technical school on its advisory council, and submit a spending plan.

(3) The department of education shall prioritize competitive grant awards under this section that target critical-need occupations.

(4) The department of education may award planning grants not to exceed $12,000.00 and expense grants for national academy foundation partnerships not to exceed $3,500.00 a year.

(5) The unexpended funds appropriated in part 1 for ARP work-based learning health services academies are designated as a work project appropriation, and any unencumbered or unallotted funds shall not lapse at the end of the fiscal year and shall be available for expenditures for projects under this section until the projects have been completed. The following is in compliance with section 451a of the management and budget act, 1984 PA 431, MCL 18.1451a:

(a) The purpose of the project is to support work-based learning health services academies in partnership with a national academy foundation.

(b) The project will be accomplished by utilizing competitive grants.

(c) The total estimated cost of the project is $250,000.00.

(d) The tentative completion date is September 30, 2023.

 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Sec. 301. (1) The funds appropriated in part 1 for ARP - cooperative agreement for emergency response must be used, to the greatest extent possible under federal rules and regulations, to assist in administering monoclonal treatments. Any of the funds


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appropriated in this section that cannot be used to assist in administering monoclonal treatments must not be spent but lapse.

(2) The unexpended funds appropriated in part 1 for ARP - cooperative agreement for emergency response are designated as a work project appropriation, and any unencumbered or unallotted funds shall not lapse at the end of the fiscal year and shall be available for expenditures for projects under this section until the projects have been completed. The following is in compliance with section 451a of the management and budget act, 1984 PA 431, MCL 18.1451a:

(a) The purpose of the project is to conduct activities necessary to assist in administering monoclonal treatments.

(b) The project will be accomplished by utilizing state employees or contracts.

(c) The total estimated cost of the project is $59,409,300.00.

(d) The tentative completion date is September 30, 2026.

Sec. 302. (1) From the funds appropriated in part 1 for ARP COVID-19 early treatments, the department of health and human services shall allocate $50,000,000.00 to establish not less than 1 COVID-19 early treatment site within each of this state's 8 emergency preparedness regions, which are a part of this state's health care preparedness plan and health care coalitions.

(2) To become an eligible COVID-19 early treatment site, the entity must also offer COVID-19 testing at the same location and be located near a population center of its emergency preparedness region. A COVID-19 early treatment site may be a local department of health and human services office, a local public health department office, or a local health care provider. A COVID-19 early treatment site may offer COVID-19 vaccines but a COVID-19


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early treatment site must not be required to administer COVID-19 vaccines.

(3) Not less than $10,000,000.00 of the funds appropriated in this this section must be allocated to local health care providers.

(4) An eligible COVID-19 early treatment site must do all of the following:

(a) Maximize the number of monoclonal treatments that can be administered.

(b) Establish eligibility criteria for monoclonal treatments that are not more stringent than federal eligibility criteria for monoclonal treatments.

(c) Prioritize monoclonal treatments for high-risk individuals.

(d) Not use an individual's vaccination status as a factor for eligibility for monoclonal treatments.

(e) Demonstrate the ability to bill public and private insurance for the cost to administer monoclonal treatments.

(f) Provide monoclonal treatments at no cost to the individual.

(g) Follow informed consent requirements prior to administering a monoclonal treatment, including providing all of the following:

(i) Information on alternatives to receiving a monoclonal treatment.

(ii) Information on whether the monoclonal treatment has received full or emergency use authorization from the United States Food and Drug Administration.

(iii) Information on and in what manner the development of the monoclonal treatment utilized aborted fetal tissue or human


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embryonic stem cell derivation lines.

(iv) Age-appropriate communications.

(5) An eligible COVID-19 early treatment site may use funds allocated in this section for facility upgrade and conversion costs, lease and rent costs, staffing costs, personal protection equipment costs, and any other costs associated with providing a monoclonal treatment that is not covered by public or private insurance of the individual that receives the monoclonal treatment.

(6) The department of health and human services may set aside not more than 10% of the funds allocated in this section to reimburse eligible COVID-19 treatment sites for the cost of administering monoclonal treatments to individuals without public or private health insurance.

(7) As other early treatments for COVID-19 are authorized by the United States Food and Drug Administration, eligible COVID-19 early treatment sites may also administer those early treatments, provided that the eligible COVID-19 early treatment sites continue to follow the requirements of this section.

(8) As other early treatments for COVID-19 are authorized by the United States Food and Drug Administration, the department of health and human services my utilize the funds set aside in subsection (6) to reimburse eligible COVID-19 early treatment sites for the cost of administering those treatments to individuals without public or private health insurance.

(9) As used in this section:

(a) "Local health care provider" includes, but is not limited to, a hospital, physician's office, pharmacy, infusion center, blood or plasma donation center, nursing facility, adult day care facility, and program of all-inclusive care for the elderly


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location.

(b) "High-risk individuals" means individuals at higher risk for progression to severe COVID-19 including, but not limited to, the following:

(i) Individuals over the age of 65.

(ii) Individuals who are obese or overweight.

(iii) Pregnant women.

(iv) Individuals with chronic kidney disease.

(v) Individuals with diabetes.

(vi) Individuals with immunosuppressive disease.

(vii) Individuals undergoing immunosuppressive treatment.

(viii) Individuals with cardiovascular disease or hypertension.

(ix) Individuals with chronic lung disease.

(x) Individuals with sickle cell disease.

(xi) Individuals with neurodevelopmental disorders.

(xii) Individuals with medical-related technological dependences.

(xiii) Individuals with other complex medical conditions.

Sec. 303. (1) From the funds appropriated in part 1 for ARP COVID-19 early treatments procurements reserve fund, the department of health and human services shall allocate $10,000,000.00 to purchase additional monoclonal treatments in addition to the supply of federally allocated monoclonal treatments. The department of health and human services shall distribute the additional monoclonal treatments to eligible COVID-19 early treatment sites funded in this part and part 1 based on need and utilization.

(2) The funds appropriated in part 1 for ARP COVID-19 early treatments procurements reserve fund not allocated in subsection


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(1), must not be expended unless a legislative transfer request is issued by the state budget office and the requirements of the legislative transfer process are met, under section 393(2) of the management and budget act, 1984 PA 431, MCL 18.1393.

(3) Concurrently with issuing a legislative transfer request under subsection (2), the department of health and human services shall provide a report to the house and senate appropriations committees, the house and senate fiscal agencies, and the state budget office on the types of COVID-19 early treatments to be purchased, the United States Food and Drug Administration approval status of the COVID-19 early treatments, and the distribution methodology across the eligible COVID-19 early treatment sites funded in this part and part 1.

Sec. 304. (1) From the funds appropriated in part 1 for ARP - epidemiology and lab capacity enhancing detection expansion, the department of health and human services shall allocate not less than $100,000,000.00 to assist private businesses with procuring coronavirus testing supplies and equipment for their staff that have received an exemption from any government-mandated COVID-19 vaccine mandate so their staff can continue to be in compliance with testing requirements related to any government-mandated COVID-19 vaccine mandate.

(2) From the funds appropriated in part 1 for ARP - epidemiology and lab capacity enhancing detection expansion, $117,000,000.00 is allocated to eligible COVID-19 early treatment sites funded in this part and part 1 for coronavirus testing supplies and equipment.

(3) The unexpended funds appropriated in part 1 for ARP - epidemiology and lab capacity enhancing detection expansion are


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designated as a work project appropriation, and any unencumbered or unallotted funds shall not lapse at the end of the fiscal year and shall be available for expenditures for projects under this section until the projects have been completed. The following is in compliance with section 451a of the management and budget act, 1984 PA 431, MCL 18.1451a:

(a) The purpose of the project is to continue to monitor, respond to, and prevent COVID-19 by expanding testing, contact tracing, disease investigations and surveillance activities.

(b) The project will be accomplished by utilizing state employees or contracts.

(c) The total estimated cost of the project is $367,327,300.00.

(d) The tentative completion date is September 30, 2026.

Sec. 305. (1) From the funds appropriated in part 1 for ARP - epidemiology and lab capacity school safety, the department of health and human services shall purchase and maintain an inventory of coronavirus testing and contact tracing supplies and equipment, including home test kits, to distribute to school districts, public school academies, intermediate school districts, and nonpublic schools. The coronavirus testing and contact tracing supplies and equipment, including home test kits, shall be used for coronavirus testing and contact tracing staff and students including, but not limited to, teachers, counselors, administrators, support staff, aides, bus drivers, coaches, cafeteria staff, custodians, students playing contact sports, and other students as determined by the eligible school district, public school academy, intermediate school district, or nonpublic school, regardless of the individual's vaccination status.


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(2) Within 15 calendar days of the effective date of this act, the department of health and human services shall notify school districts, public school academies, intermediate school districts, and nonpublic schools of the option to not participate in the direct distribution of coronavirus testing and contact tracing supplies and equipment, including home test kits, the method by which the school district, public school academy, intermediate school district, or nonpublic school can opt out, and the maximum amount of direct financial reimbursement that each school district, public school academy, intermediate school district, or nonpublic school could receive based on an equitable head count distribution. If a school district, public school academy, intermediate school district, or nonpublic school notifies the department of health and human services and the Michigan Association of Intermediate School Administrators not more than 10 business days after receiving the required notification in this subsection from the department of health and human services that it does not wish to participate in the direct distribution of coronavirus testing and contact tracing supplies and equipment, including home test kits, that school district, public school academy, intermediate school district, or nonpublic school may request to receive direct financial reimbursement from the department of health and human services for coronavirus testing and contact tracing supplies and equipment, including home test kits, purchased directly by that school district, public school academy, intermediate school district, or nonpublic school. A school district, public school academy, intermediate school district, or nonpublic school that opts out as described in this subsection may purchase coronavirus testing and contact tracing supplies and equipment, including home test kits,


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either directly from the department of health and human services or from another source. The department of health and human services must provide direct financial reimbursement within 30 days of receipt of the request.

(3) The department of health and human services must maintain a publicly accessible online list of acceptable coronavirus testing and contact tracing supplies and equipment, including home test kits, that could be purchased with the funds appropriated in this section.

(4) No state or local government entity shall confiscate or redistribute coronavirus testing and contact tracing supplies and equipment, including home test kits, from an eligible school district, public school academy, intermediate school district, or nonpublic school without first receiving the consent of that eligible school district, public school academy, intermediate school district, or nonpublic school.

(5) The department of health and human services shall collaborate with the Michigan Association of Intermediate School Administrators to establish procedures for the as-needed redistribution of coronavirus testing and contract tracing supplies and equipment, including home kits, from school districts, public school academies, intermediate school districts, and nonpublic schools. The Michigan Association of Intermediate School Administrators shall coordinate the redistribution of coronavirus testing and contact tracing supplies and equipment, including home kits, based on need and after receiving the consent of that school district, public school academy, intermediate school district, or nonpublic school. Not more than 1% of the funds appropriated in part 1 for ARP - epidemiology and lab capacity school safety, or an


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amount equal to actual costs incurred, whichever is less, may be used by the Michigan Association of Intermediate School Administrators for administrative and logistical costs related to this subsection.

(6) Subsections (4) and (5) do not prohibit an eligible school district, public school academy, intermediate school district, or nonpublic school from voluntarily sending coronavirus testing and contact tracing supplies and equipment, including home test kits, in its possession to another eligible school district, public school academy, intermediate school district, or nonpublic school that is in need of additional coronavirus testing and contact tracing supplies and equipment, including home test kits.

(7) The department of health and human services shall collaborate with the department of education to effectuate this section.

(8) The unexpended funds appropriated in part 1 for ARP - epidemiology and lab capacity school safety are designated as a work project appropriation, and any unencumbered or unallotted funds shall not lapse at the end of the fiscal year and shall be available for expenditures for projects under this section until the projects have been completed. The following is in compliance with section 451a of the management and budget act, 1984 PA 431, MCL 18.1451a:

(a) The purpose of the project is to support screening and testing activities to facilitate the safe operations of in-person school instruction at eligible school districts, public school academies, intermediate school districts, and nonpublic schools.

(b) The project will be accomplished by utilizing state employees or contracts.


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(c) The total estimated cost of the project is $150,799,300.00.

(d) The tentative completion date is September 30, 2026.

Sec. 306. (1) From the funds appropriated in part 1 for ARP health care recruitment, retention, and training reserve fund, the department of health and human services shall allocate $150,000,000.00 for health care recruitment, retention, and training programming to health care employers that can demonstrate an eligible qualifying need under the rules and regulations of the federal coronavirus state fiscal recovery funding. Additionally, health care employers must not request funds under this section for any investments related to recruitment or retention announced before December 1, 2021.

(2) The department of health and human services must allocate 75% of the funds appropriated in this section to acute care and behavioral health care providers, of which not less than 10% must be allocated to small and rural providers.

(3) The department of health and human services must allocate 25% of the funds appropriated in this section to post-acute care providers and federally qualified health centers (FQHCs).

(4) The Michigan Health and Hospital Association shall administer the funds appropriated in subsection (2).

(5) As a condition of receiving funds appropriated in this section, a health care employer must agree to do all of the following:

(a) Not use an employee's vaccination status as a factor for distributing recruitment, retention, and training program funds.

(b) If the health care employer has a COVID-19 vaccine policy, that COVID-19 vaccine policy must allow for, except in instances


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where it is determined through clear and convincing evidence that an employee is not entitled to an exception, both of the following exemptions:

(i) Any employee for whom a physician certifies that a COVID-19 vaccine is or may be detrimental to the employee's health or is not appropriate.

(ii) Any employee who provides a written statement to the effect that the requirements of the COVID-19 vaccine policy cannot be met because of religious convictions or other consistently held objection to immunization.

(c) Not deny an employee's request for an exemption to a COVID-19 vaccine policy until the health care employer has exhausted every reasonable accommodation.

(d) Report to the department of health and human services the number of and reasons for any denials of an employee's request for exemption from a COVID-19 vaccine policy and all reasonable accommodations offered to the employee.

(e) Provide free COVID-19 testing to employees that are exempted from a COVID-19 vaccine policy, if the health care employer requires COVID-19 testing as a condition of compliance with an exemption to a COVID-19 vaccine policy.

(6) Nothing in subsection (5) requires a health care employer that receives funds appropriated in this section to violate any federal rule or regulation on a COVID-19 vaccine policy.

(7) By September 1, 2022, the department of health and human services shall aggregate the information reported from subsection (5)(d) and provide that aggregated information to the house and senate appropriation committees, the house and senate fiscal agencies, and the state budget office.


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(8) The funds appropriated in part 1 for ARP health care recruitment, retention, and training reserve fund not allocated in subsection (1) must not be expended unless a legislative transfer request is issued by the state budget office and the requirements of the legislative transfer process are met, under section 393(2) of the management and budget act, 1984 PA 431, MCL 18.1393.

Sec. 307. From the funds appropriated in part 1 for ARP nursing facility room conversion pilot project, the department of health and human services shall allocate $10,000,000.00 as a competitive grant program to reimburse nursing facilities that are awarded these grants for 50% of the cost for nursing facilities to convert multi-resident rooms into single resident rooms. The department of health and human services shall prioritize awarding competitive grants for the conversion of rooms that have more than 2 residents into single resident rooms.

Sec. 308. From the funds appropriated in part 1 for ARP nursing home respirators, the department of health and human services shall allocate $5,000,000.00 to assist nursing facilities, assisted living facilities, and other long-term care facilities in complying with Occupational Safety and Health Administration respiratory protection standards.

Sec. 309. From the funds appropriated in part 1 for ARP statewide emergency preparedness platform, the department of health and human services shall allocate $5,000,000.00 to purchase a 4-year subscription from a technology company that provides real-time visibility platforms for complex supply chains and operates as a cloud-based software as a services model (SaaS) located in a county with a population between 325,000 and 375,000 and in a city with a population greater than 100,000 according to the 2010 federal


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decennial census for an unlimited number of integrations to the state's statewide emergency preparedness information technology and data platforms.

Sec. 310. (1) The funds appropriated in part 1 for ARP - vaccine support are allocated for logistics and distribution of COVID-19 vaccines and must not be allocated for marketing, education, outreach, and other community engagement strategies.

(2) A recipient of a COVID-19 vaccine administered from the funds appropriated in part 1 for ARP - vaccine support shall be provided with information regarding or informed if and in what manner the development of the vaccine utilized aborted fetal tissue or human embryonic stem cell derivation lines.

(3) The unexpended funds appropriated in part 1 for ARP - vaccine support are designated as a work project appropriation, and any unencumbered or unallotted funds shall not lapse at the end of the fiscal year and shall be available for expenditures for projects under this section until the projects have been completed. The following is in compliance with section 451a of the management and budget act, 1984 PA 431, MCL 18.1451a:

(a) The purpose of the project is to increase COVID-19 vaccination capacity and facilitate safe administration and equitable distribution of COVID-19 vaccines.

(b) The project will be accomplished by utilizing state employees or contracts.

(c) The total estimated cost of the project is $90,239,800.00.

(d) The tentative completion date is September 30, 2026.

Sec. 311. (1) From the funds appropriated in part 1 for MI Choice waiver program presumptive eligibility risk pool, the department of health and human services shall allocate


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$5,000,000.00 to develop and implement a statewide risk pool to cover 90% of MI Choice waiver agents' exposure to financial losses for up to 6 weeks of services costs associated with incorrect presumptive eligibility determinations.

(2) Any MI Choice waiver agent that, at any point in time, incorrectly presumes eligibility for not less than 20% of its enrollees is not eligible for funding from this project for the balance of this project's term.

Sec. 312. From the funds appropriated in part 1 for program of all-inclusive care for the elderly startup costs, the department of health and human services shall allocate $9,000,000.00 to assist with facility costs, equipment costs, and any other start-up costs associated with establishing not less than 3 programs of all-inclusive care for the elderly locations in rural, underserved communities.