May 3, 2018, Introduced by Senator COLBECK and referred to the Committee on Health Policy.
A bill to amend 1978 PA 368, entitled
"Public health code,"
by amending sections 2612, 20101, 20115, 20145, 20155, 20161,
20164, 20165, 20166, 21551, 21562, and 21563 (MCL 333.2612,
333.20101, 333.20115, 333.20145, 333.20155, 333.20161, 333.20164,
333.20165, 333.20166, 333.21551, 333.21562, and 333.21563), section
2612 as added by 1990 PA 138, sections 20101 and 20166 as amended
by 1988 PA 332, section 20115 as amended by 2012 PA 499, section
20145 as amended by 2015 PA 104, section 20155 as amended by 2015
PA 155, section 20161 as amended by 2016 PA 189, section 20164 as
amended by 1990 PA 179, section 20165 as amended by 2008 PA 39,
section 21551 as amended by 1990 PA 331, and sections 21562 and
21563 as added by 1990 PA 252; and to repeal acts and parts of
acts.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
1 Sec. 2612. (1) The department may establish with Michigan
2 state university State
University and other parties determined
3 appropriate by the department a nonprofit corporation pursuant to
4 under the nonprofit
corporation act, Act No. 162 of the Public Acts
5 of 1982, being sections 1982
PA 162, MCL 450.2101 to 450.3192. of
6 the Michigan Compiled Laws. The
purpose of the corporation shall be
7 is to establish and operate a center for rural health. In
8 fulfilling its purpose, the corporation shall do all of the
9 following:
10 (a) Develop a coordinated rural health program that addresses
11 critical questions and problems related to rural health and
12 provides mechanisms for influencing health care policy.
13 (b) Perform and coordinate research regarding rural health
14 issues.
15 (c) Periodically review state and federal laws and judicial
16 decisions pertaining to health care policy and analyze the impact
17 on the delivery of rural health care.
18 (d) Provide technical assistance and act as a resource for the
19 rural health community in this state.
20 (e) Suggest changes in medical education curriculum that would
21 be beneficial to rural health.
22 (f) Assist rural communities with all of the following:
23 (i) Applications for grants.
24 (ii) The recruitment and retention of health professionals.
25 (iii) Needs assessments and planning activities for rural
26 health facilities.
1 (g) Serve as an advocate for rural health concerns.
2 (h) Conduct periodic seminars on rural health issues.
3 (i) Establish and implement a visiting professor program.
4 (j) Conduct consumer oriented rural health education programs.
5 (k) Designate a certificate of need ombudsman to provide
6 technical assistance and consultation to rural health care
7 providers and rural communities regarding certificate of need
8 proposals and applications under part 222. The ombudsman shall also
9 act as an advocate for rural health concerns in the development of
10 certificate of need review standards under part 222.
11 (2) The incorporators of the corporation shall select a board
12 of directors consisting of a representative from each of the
13 following organizations:
14 (a) The Michigan state medical society State Medical Society
15 or its successor. The representative appointed selected under
this
16 subdivision shall be a physician practicing in a county with a
17 population of not more than 100,000.
18 (b) The Michigan osteopathic physicians' society Osteopathic
19 Association or its
successor. The representative appointed selected
20 under this subdivision shall be a physician practicing in a county
21 with a population of not more than 100,000.
22 (c) The Michigan nurses association Nurses Association or its
23 successor. The representative appointed selected under
this
24 subdivision shall be a nurse practicing in a county with a
25 population of not more than 100,000.
26 (d) The Michigan hospital association Health and Hospital
27 Association or its successor. The representative selected under
1 this subdivision shall be from a hospital in a county with a
2 population of not more than 100,000.
3 (e) The Michigan primary care association Primary Care
4 Association or its
successor. The representative appointed selected
5 under this subdivision shall be a health professional practicing in
6 a county with a population of not more than 100,000.
7 (f) The Michigan association Association for local public
8 health Local Public
Health or its successor. The
representative
9 appointed selected
under this subdivision shall be from a
county
10 health department for a county with a population of not more than
11 100,000 or from a district health department with at least 1 member
12 county with a population of not more than 100,000.
13 (g) The office of the governor.
14 (h) The department. of public health.
15 (i) The department of commerce licensing
and regulatory
16 affairs.
17 (j) The Michigan senate. The individual selected under this
18 subdivision shall be from a district located at least in part in a
19 county with a population of not more than 100,000.
20 (k) The Michigan house of representatives. The individual
21 selected under this subdivision shall be from a district located at
22 least in part in a county with a population of not more than
23 100,000.
24 (3) The board of directors of the corporation shall appoint an
25 internal management committee for the center for rural health. The
26 management committee shall consist of representatives from each of
27 the following:
1 (a) The college College
of human medicine Human Medicine of
2 Michigan state university.State University.
3 (b) The college College
of osteopathic medicine Osteopathic
4 Medicine of Michigan state
university.State University.
5 (c) The college College
of nursing Nursing of
Michigan state
6 university.State
University.
7 (d) The college College
of veterinary medicine Veterinary
8 Medicine of Michigan state
university.State University.
9 (e) The cooperative extension service of Michigan state
10 university.State
University Extension.
11 (f) The department. of public health.
12 Sec. 20101. (1) The words and phrases defined in sections
13 20102 to 20109 apply to all parts in this article except part 222
14 and have the meanings ascribed to them in those sections.
15 (2) In addition, article 1 contains general definitions and
16 principles of construction applicable to all articles in this code.
17 Sec. 20115. (1) The department may promulgate rules to further
18 define the term "health facility or agency" and the definition of a
19 health facility or agency listed in section 20106 as required to
20 implement this article. The department may define a specific
21 organization as a health facility or agency for the sole purpose of
22 certification authorized under this article. For purpose of
23 certification only, an organization defined in section 20106(5),
24 20108(1), or 20109(4) is considered a health facility or agency.
25 The term "health facility or agency" does not mean a visiting nurse
26 service or home aide service conducted by and for the adherents of
27 a church or religious denomination for the purpose of providing
1 service for those who depend upon spiritual means through prayer
2 alone for healing.
3 (2) The department shall promulgate rules to differentiate a
4 freestanding surgical outpatient facility from a private office of
5 a physician, dentist, podiatrist, or other health professional. The
6 department shall specify in the rules that a facility including,
7 but not limited to, a private practice office described in this
8 subsection must be licensed under this article as a freestanding
9 surgical outpatient facility if that facility performs 120 or more
10 surgical abortions per year and publicly advertises outpatient
11 abortion services.
12 (3) The department shall promulgate rules that in effect
13 republish R 325.3826, R 325.3832, R 325.3835, R 325.3857, R
14 325.3866, R 325.3867, and R 325.3868 of the Michigan administrative
15 code, Administrative
Code, but shall include in the rules
standards
16 for a freestanding surgical outpatient facility or private practice
17 office that performs 120 or more surgical abortions per year and
18 that publicly advertises outpatient abortion services. The
19 department shall assure ensure
that the standards are consistent
20 with the most recent United States supreme court Supreme Court
21 decisions regarding state regulation of abortions.
22 (4) Subject to section 20145, and part 222, the
department may
23 modify or waive 1 or more of the rules contained in R 325.3801 to R
24 325.3877 of the Michigan administrative code Administrative Code
25 regarding construction or equipment standards, or both, for a
26 freestanding surgical outpatient facility that performs 120 or more
27 surgical abortions per year and that publicly advertises outpatient
1 abortion services, if both of the following conditions are met:
2 (a) The freestanding surgical outpatient facility was in
3 existence and operating on December 31, 2012.
4 (b) The department makes a determination that the existing
5 construction or equipment conditions, or both, within the
6 freestanding surgical outpatient facility are adequate to preserve
7 the health and safety of the patients and employees of the
8 freestanding surgical outpatient facility or that the construction
9 or equipment conditions, or both, can be modified to adequately
10 preserve the health and safety of the patients and employees of the
11 freestanding surgical outpatient facility without meeting the
12 specific requirements of the rules.
13 (5) By January 15 each year, the department of community
14 health and human services shall provide the following information
15 to the department: of licensing and regulatory affairs:
16 (a) From data received by the department of community health
17 and human services through the abortion reporting requirements of
18 section 2835, all of the following:
19 (i) The name and location of each facility at which abortions
20 were performed during the immediately preceding calendar year.
21 (ii) The total number of abortions performed at that facility
22 location during the immediately preceding calendar year.
23 (iii) The total number of surgical abortions performed at that
24 facility location during the immediately preceding calendar year.
25 (b) Whether a facility at which surgical abortions were
26 performed in the immediately preceding calendar year publicly
27 advertises abortion services.
1 (6) As used in this section:
2 (a) "Abortion" means that term as defined in section 17015.
3 (b) "Publicly advertises" means to advertise using directory
4 or internet advertising including yellow pages, white pages, banner
5 advertising, or electronic publishing.
6 (c) "Surgical abortion" means an abortion that is not a
7 medical abortion as that term is defined in section 17017.
8 Sec. 20145. (1) Before contracting for and initiating a
9 construction project involving new construction, additions,
10 modernizations, or conversions of a health facility or agency with
11 a capital expenditure of $1,000,000.00 or more, a person shall
12 obtain a construction permit from the department. The department
13 shall not issue the permit under this subsection unless the
14 applicant holds a valid certificate of need if a certificate of
15 need is required for the project under part 222.
16 (2) To protect the public health, safety, and welfare, the
17 department may promulgate rules to require construction permits for
18 projects other than those described in subsection (1) and the
19 submission of plans for other construction projects to expand or
20 change service areas and services provided.
21 (3) If a construction project requires a construction permit
22 under subsection (1) or (2), but does not require a certificate of
23 need under part 222, the department shall require the applicant to
24 submit information considered necessary by the department to assure
25 that the capital expenditure for the project is not a covered
26 capital expenditure as defined in section 22203(9).
27 (3) (4) If For
a construction project that requires
a
1 construction permit under subsection (1), but does not require a
2 certificate of need under part 222, the department shall require
3 the applicant to submit information on a 1-page sheet, along with
4 the application for a construction permit, consisting of all of the
5 following:
6 (a) A short description of the reason for the project and the
7 funding source.
8 (b) A contact person for further information, including the
9 person's address and phone number.
10 (c) The estimated resulting increase or decrease in annual
11 operating costs.
12 (d) The current governing board membership of the applicant.
13 (e) The entity, if any, that owns the applicant.
14 (4) (5) The department shall make the information filed under
15 subsection (4) shall be made (3) publicly available by
the
16 department by the same
methods used to make information about
17 certificate of need applications under former part 222 publicly
18 available.
19 (5) (6) The
review and approval of architectural plans and
20 narrative shall must
require that the proposed construction
project
21 is designed and constructed in accord with applicable statutory and
22 other regulatory requirements. In performing a construction permit
23 review for a health facility or agency under this section, the
24 department shall, at a minimum, apply the standards contained in
25 the document entitled "The 2007 Minimum Design Standards for Health
26 Care Facilities in Michigan" published by the department. and
dated
27 July 2007. The standards
are incorporated by reference for purposes
1 of this subsection. The department may promulgate rules that are
2 more stringent than the standards if necessary to protect the
3 public health, safety, and welfare.
4 (6) (7) The
department shall promulgate rules to further
5 prescribe the scope of construction projects and other alterations
6 subject to review under this section.
7 (7) (8) The
department may waive the applicability of this
8 section to a construction project or alteration if the waiver will
9 not affect the public health, safety, and welfare.
10 (8) (9) Upon
request by the person initiating a construction
11 project, the department may review and issue a construction permit
12 to a construction project that is not subject to subsection (1) or
13 (2) if the department determines that the review will promote the
14 public health, safety, and welfare.
15 (9) (10) The
department shall assess a fee for each review
16 conducted under this section. The fee is .5% of the first
17 $1,000,000.00 of capital expenditure and .85% of any amount over
18 $1,000,000.00 of capital expenditure, up to a maximum of
19 $60,000.00.
20 (10) (11) As
used in this section, "capital expenditure" means
21 that term as defined in section 22203(2), except that capital
22 expenditure does not include the cost of equipment that is not
23 fixed equipment.an
expenditure for a single project, including cost
24 of construction, engineering, and fixed equipment that under
25 generally accepted accounting principles is not properly chargeable
26 as an expense of operation. Capital expenditure includes a lease or
27 comparable arrangement by or on behalf of a health facility to
1 obtain a health facility, licensed part of a health facility, or
2 fixed equipment for a health facility, if the actual purchase of a
3 health facility, licensed part of a health facility, or equipment
4 for a health facility would have been considered a capital
5 expenditure under former part 222. Capital expenditure includes the
6 cost of studies, surveys, designs, plans, working drawings,
7 specifications, and other activities essential to the acquisition,
8 improvement, expansion, addition, conversion, modernization, new
9 construction, or replacement of physical plant and fixed equipment.
10 Sec. 20155. (1) Except as otherwise provided in this section
11 and section 20155a, the department shall make at least 1 visit to
12 each licensed health facility or agency every 3 years for survey
13 and evaluation for the purpose of licensure. A visit made according
14 to a complaint shall must
be unannounced. Except for a county
15 medical care facility, a home for the aged, a nursing home, or a
16 hospice residence, the department shall determine whether the
17 visits that are not made according to a complaint are announced or
18 unannounced. The department shall ensure that each newly hired
19 nursing home surveyor, as part of his or her basic training, is
20 assigned full-time to a licensed nursing home for at least 10 days
21 within a 14-day period to observe actual operations outside of the
22 survey process before the trainee begins oversight
23 responsibilities.
24 (2) The department shall establish a process that ensures both
25 of the following:
26 (a) A newly hired nursing home surveyor does not make
27 independent compliance decisions during his or her training period.
1 (b) A nursing home surveyor is not assigned as a member of a
2 survey team for a nursing home in which he or she received training
3 for 1 standard survey following the training received in that
4 nursing home.
5 (3) The department shall perform a criminal history check on
6 all nursing home surveyors in the manner provided for in section
7 20173a.
8 (4) A member of a survey team must 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) The department shall invite representatives from all
16 nursing home provider organizations and the state long-term care
17 ombudsman or his or her designee to participate in the planning
18 process 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) The department shall semiannually provide for joint
10 training with nursing home surveyors and providers on at least 1 of
11 the 10 most frequently issued federal citations in this state
12 during the past calendar year. The department shall develop a
13 protocol for the review of citation patterns compared to regional
14 outcomes and standards and complaints regarding the nursing home
15 survey process. The department shall include the review under this
16 subsection in the report required under subsection (20). Except as
17 otherwise provided in this subsection, each member of a department
18 nursing home survey team who is a health professional licensee
19 under article 15 shall earn not less than 50% of his or her
20 required continuing education credits, if any, in geriatric care.
21 If a member of a nursing home survey team is a pharmacist licensed
22 under article 15, he or she shall earn not less than 30% of his or
23 her required continuing education credits in geriatric care.
24 (9) Subject to subsection (12), the department may waive the
25 visit required by subsection (1) if a health facility or agency,
26 requests a waiver and submits the following as applicable and if
27 all of the requirements of subsection (11) are met:
1 (a) Evidence that it is currently fully accredited by a body
2 with expertise in the health facility or agency type and the
3 accrediting organization is accepted by the United States
4 Department of Health and Human Services for purposes of section
5 1865 of the social security act, 42 USC 1395bb.
6 (b) A copy of the most recent accreditation report, or
7 executive summary, issued by a body described in subdivision (a),
8 and the health facility's or agency's responses to the
9 accreditation report is submitted to the department at least 30
10 days from license renewal. Submission of an executive summary does
11 not prevent or prohibit the department from requesting the entire
12 accreditation report if the department considers it necessary.
13 (c) For a nursing home, a standard federal certification
14 survey conducted within the immediately preceding 9 to 15 months
15 that shows substantial compliance or has an accepted plan of
16 correction, if applicable.
17 (10) Except as otherwise provided in subsection (14),
18 accreditation information provided to the department under
19 subsection (9) is confidential, is not a public record, and is not
20 subject to court subpoena. The department shall use the
21 accreditation information only as provided in this section and
22 properly destroy the documentation after a decision on the waiver
23 request is made.
24 (11) The department shall grant a waiver under subsection (9)
25 if the accreditation report submitted under subsection (9)(b) is
26 less than 3 years old or the standard federal survey submitted
27 under subsection (9)(c) is less than 15 months old and there is no
1 indication of substantial noncompliance with licensure standards or
2 of deficiencies that represent a threat to public safety or patient
3 care. If the accreditation report or standard federal survey is too
4 old, the department may deny the waiver request and conduct the
5 visits required under subsection (9). Denial of a waiver request by
6 the department is not subject to appeal.
7 (12) This section does not prohibit the department from citing
8 a violation of this part during a survey, conducting investigations
9 or inspections according to section 20156, or conducting surveys of
10 health facilities or agencies for the purpose of complaint
11 investigations or federal certification. This section does not
12 prohibit the bureau of fire services created in section 1b of the
13 fire prevention code, 1941 PA 207, MCL 29.1b, from conducting
14 annual surveys of hospitals, nursing homes, and county medical care
15 facilities.
16 (13) At the request of a health facility or agency, the
17 department may conduct a consultation engineering survey of a
18 health facility and provide professional advice and consultation
19 regarding health facility construction and design. A health
20 facility or agency may request a voluntary consultation survey
21 under this subsection at any time between licensure surveys. The
22 fees for a consultation engineering survey are the same as the fees
23 established for waivers under section 20161(8).20161(7).
24 (14) If the department determines that substantial
25 noncompliance with licensure standards exists or that deficiencies
26 that represent a threat to public safety or patient care exist
27 based on a review of an accreditation report submitted under
1 subsection (9)(b), the department shall prepare a written summary
2 of the substantial noncompliance or deficiencies and the health
3 facility's or agency's response to the department's determination.
4 The department's written summary and the health facility's or
5 agency's response are public documents.
6 (15) The department or a local health department shall conduct
7 investigations or inspections, other than inspections of financial
8 records, of a county medical care facility, home for the aged,
9 nursing home, or hospice residence without prior notice to the
10 health facility or agency. An employee of a state agency charged
11 with investigating or inspecting the health facility or agency or
12 an employee of a local health department who directly or indirectly
13 gives prior notice regarding an investigation or an inspection,
14 other than an inspection of the financial records, to the health
15 facility or agency or to an employee of the health facility or
16 agency, is guilty of a misdemeanor. Consultation visits that are
17 not for the purpose of annual or follow-up inspection or survey may
18 be announced.
19 (16) The department shall maintain a record indicating whether
20 a visit and inspection is announced or unannounced. Survey findings
21 gathered at each health facility or agency during each visit and
22 inspection, whether announced or unannounced, shall must be
taken
23 into account in licensure decisions.
24 (17) The department shall require periodic reports and a
25 health facility or agency shall give the department access to
26 books, records, and other documents maintained by a health facility
27 or agency to the extent necessary to carry out the purpose of this
1 article and the rules promulgated under this article. The
2 department shall not divulge or disclose the contents of the
3 patient's clinical records in a manner that identifies an
4 individual except under court order. The department may copy health
5 facility or agency records as required to document findings.
6 Surveyors shall use electronic resident information, whenever
7 available, as a source of survey-related data and shall request
8 facility assistance to access the system to maximize data export.
9 (18) The department may delegate survey, evaluation, or
10 consultation functions to another state agency or to a local health
11 department qualified to perform those functions. The department
12 shall not delegate survey, evaluation, or consultation functions to
13 a local health department that owns or operates a hospice or
14 hospice residence licensed under this article. The department shall
15 delegate under this subsection by cost reimbursement contract
16 between the department and the state agency or local health
17 department. The department shall not delegate survey, evaluation,
18 or consultation functions to nongovernmental agencies, except as
19 provided in this section. The voluntary inspection described in
20 this subsection must be agreed upon by both the licensee and the
21 department.
22 (19) If, upon investigation, the department or a state agency
23 determines that an individual licensed to practice a profession in
24 this state has violated the applicable licensure statute or the
25 rules promulgated under that statute, the department, state agency,
26 or local health department shall forward the evidence it has to the
27 appropriate licensing agency.
1 (20) The department may consolidate all information provided
2 for any report required under this section and section 20155a into
3 a single report. The department shall report to the appropriations
4 subcommittees, the senate and house of representatives standing
5 committees having jurisdiction over issues involving senior
6 citizens, and the fiscal agencies on March 1 of each year on the
7 initial and follow-up surveys conducted on all nursing homes in
8 this state. The department shall include all of the following
9 information in the report:
10 (a) The number of surveys conducted.
11 (b) The number requiring follow-up surveys.
12 (c) The average number of citations per nursing home for the
13 most recent calendar year.
14 (d) The number of night and weekend complaints filed.
15 (e) The number of night and weekend responses to complaints
16 conducted by the department.
17 (f) The average length of time for the department to respond
18 to a complaint filed against a nursing home.
19 (g) The number and percentage of citations disputed through
20 informal dispute resolution and independent informal dispute
21 resolution.
22 (h) The number and percentage of citations overturned or
23 modified, or both.
24 (i) The review of citation patterns developed under subsection
25 (8).
26 (j) Information regarding the progress made on implementing
27 the administrative and electronic support structure to efficiently
1 coordinate all nursing home licensing and certification functions.
2 (k) The number of annual standard surveys of nursing homes
3 that were conducted during a period of open survey or enforcement
4 cycle.
5 (l) The number of abbreviated complaint surveys that were not
6 conducted on consecutive surveyor workdays.
7 (m) The percent of all form CMS-2567 reports of findings that
8 were released to the nursing home within the 10-working-day
9 requirement.
10 (n) The percent of provider notifications of acceptance or
11 rejection of a plan of correction that were released to the nursing
12 home within the 10-working-day requirement.
13 (o) The percent of first revisits that were completed within
14 60 days from the date of survey completion.
15 (p) The percent of second revisits that were completed within
16 85 days from the date of survey completion.
17 (q) The percent of letters of compliance notification to the
18 nursing home that were released within 10 working days of the date
19 of the completion of the revisit.
20 (r) A summary of the discussions from the meetings required in
21 subsection (24).
22 (s) The number of nursing homes that participated in a
23 recognized quality improvement program as described under section
24 20155a(3).
25 (21) The department shall report on March 1 of each year to
26 the standing committees on appropriations and the standing
27 committees having jurisdiction over issues involving senior
1 citizens in the senate and the house of representatives on all of
2 the following:
3 (a) The percentage of nursing home citations that are appealed
4 through the informal dispute resolution process.
5 (b) The number and percentage of nursing home citations that
6 are appealed and supported, amended, or deleted through the
7 informal dispute resolution process.
8 (c) A summary of the quality assurance review of the amended
9 citations and related survey retraining efforts to improve
10 consistency among surveyors and across the survey administrative
11 unit that occurred in the year being reported.
12 (22) Subject to subsection (23), a clarification work group
13 comprised of the department in consultation with a nursing home
14 resident or a member of a nursing home resident's family, nursing
15 home provider groups, the American Medical Directors Association,
16 the state long-term care ombudsman, and the federal Centers for
17 Medicare and Medicaid Services shall clarify the following terms as
18 those terms are used in title XVIII and title XIX and applied by
19 the department to provide more consistent regulation of nursing
20 homes in this state:
21 (a) Immediate jeopardy.
22 (b) Harm.
23 (c) Potential harm.
24 (d) Avoidable.
25 (e) Unavoidable.
26 (23) All of the following clarifications developed under
27 subsection (22) apply for purposes of subsection (22):
1 (a) Specifically, the term "immediate jeopardy" means a
2 situation in which immediate corrective action is necessary because
3 the nursing home's noncompliance with 1 or more requirements of
4 participation has caused or is likely to cause serious injury,
5 harm, impairment, or death to a resident receiving care in a
6 nursing home.
7 (b) The likelihood of immediate jeopardy is reasonably higher
8 if there is evidence of a flagrant failure by the nursing home to
9 comply with a peer-reviewed, evidence-based, nationally recognized
10 clinical process guideline than if the nursing home has
11 substantially and continuously complied with peer-reviewed,
12 evidence-based, nationally recognized guidelines. If federal
13 regulations and guidelines are not clear, and if the clinical
14 process guidelines have been recognized, a process failure giving
15 rise to an immediate jeopardy may involve an egregious widespread
16 or repeated process failure and the absence of reasonable efforts
17 to detect and prevent the process failure.
18 (c) In determining whether or not there is immediate jeopardy,
19 the survey agency should consider at least all of the following:
20 (i) Whether the nursing home could reasonably have been
21 expected to know about the deficient practice and to stop it, but
22 did not stop the deficient practice.
23 (ii) Whether the nursing home could reasonably have been
24 expected to identify the deficient practice and to correct it, but
25 did not correct the deficient practice.
26 (iii) Whether the nursing home could reasonably have been
27 expected to anticipate that serious injury, serious harm,
1 impairment, or death might result from continuing the deficient
2 practice, but did not so anticipate.
3 (iv) Whether the nursing home could reasonably have been
4 expected to know that a widely accepted high-risk practice is or
5 could be problematic, but did not know.
6 (v) Whether the nursing home could reasonably have been
7 expected to detect the process problem in a more timely fashion,
8 but did not so detect.
9 (d) The existence of 1 or more of the factors described in
10 subdivision (c), and especially the existence of 3 or more of those
11 factors simultaneously, may lead to a conclusion that the situation
12 is one in which the nursing home's practice makes adverse events
13 likely to occur if immediate intervention is not undertaken, and
14 therefore constitutes immediate jeopardy. If none of the factors
15 described in subdivision (c) is present, the situation may involve
16 harm or potential harm that is not immediate jeopardy.
17 (e) Specifically, "actual harm" means a negative outcome to a
18 resident that has compromised the resident's ability to maintain or
19 reach, or both, his or her highest practicable physical, mental,
20 and psychosocial well-being as defined by an accurate and
21 comprehensive resident assessment, plan of care, and provision of
22 services. Harm does not include a deficient practice that only may
23 cause or has caused limited consequences to the resident.
24 (f) For purposes of subdivision (e), in determining whether a
25 negative outcome is of limited consequence, if the "state
26 operations manual" "State
Operations Manual" or "the
guidance to
27 surveyors" "The
Guidance to Surveyors" published
by the federal
1 Centers for Medicare and Medicaid Services does not provide
2 specific guidance, the department may consider whether most people
3 in similar circumstances would feel that the damage was of such
4 short duration or impact as to be inconsequential or trivial. In
5 such a case, the consequence of a negative outcome may be
6 considered more limited if it occurs in the context of overall
7 procedural consistency with a peer-reviewed, evidence-based,
8 nationally recognized clinical process guideline, as compared to a
9 substantial inconsistency with or variance from the guideline.
10 (g) For purposes of subdivision (e), if the publications
11 described in subdivision (f) do not provide specific guidance, the
12 department may consider the degree of a nursing home's adherence to
13 a peer-reviewed, evidence-based, nationally recognized clinical
14 process guideline in considering whether the degree of compromise
15 and future risk to the resident constitutes actual harm. The risk
16 of significant compromise to the resident may be considered greater
17 in the context of substantial deviation from the guidelines than in
18 the case of overall adherence.
19 (h) To improve consistency and to avoid disputes over
20 avoidable and unavoidable negative outcomes, nursing homes and
21 survey agencies must have a common understanding of accepted
22 process guidelines and of the circumstances under which it can
23 reasonably be said that certain actions or inactions will lead to
24 avoidable negative outcomes. If the "state operations
manual"
25 "State Operations Manual" or "the guidance to surveyors" "The
26 Guidance to Surveyors" published by the federal Centers for
27 Medicare and Medicaid Services is not specific, a nursing home's
1 overall documentation of adherence to a peer-reviewed, evidence-
2 based, nationally recognized clinical process guideline with a
3 process indicator is relevant information in considering whether a
4 negative outcome was avoidable or unavoidable and may be considered
5 in the application of that term.
6 (24) The department shall conduct a quarterly meeting and
7 invite appropriate stakeholders. The department shall invite as
8 appropriate stakeholders under this subsection at least 1
9 representative from each nursing home provider organization that
10 does not own or operate a nursing home representing 30 or more
11 nursing homes statewide, the state long-term care ombudsman or his
12 or her designee, and any other clinical experts. Individuals who
13 participate in these quarterly meetings, jointly with the
14 department, may designate advisory workgroups to develop
15 recommendations on the discussion topics that should include, at a
16 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) A nursing home shall use peer-reviewed, evidence-based,
15 nationally recognized clinical process guidelines or peer-reviewed,
16 evidence-based, best-practice resources to develop and implement
17 resident care policies and compliance protocols with measurable
18 outcomes specifically in the following clinical practice areas:
19 (a) Use of bed rails.
20 (b) Adverse drug effects.
21 (c) Prevention of falls.
22 (d) Prevention of pressure ulcers.
23 (e) Nutrition and hydration.
24 (f) Pain management.
25 (g) Depression and depression pharmacotherapy.
26 (h) Heart failure.
27 (i) Urinary incontinence.
1 (j) Dementia care.
2 (k) Osteoporosis.
3 (l) Altered mental states.
4 (m) Physical and chemical restraints.
5 (n) Person-centered care principles.
6 (26) In an area of clinical practice that is not listed in
7 subsection (25), a nursing home may use peer-reviewed, evidence-
8 based, nationally recognized clinical process guidelines or peer-
9 reviewed, evidence-based, best-practice resources to develop and
10 implement resident care policies and compliance protocols with
11 measurable outcomes to promote performance excellence.
12 (27) The department shall consider recommendations from an
13 advisory workgroup created under subsection (24). The department
14 may include training on new and revised peer-reviewed, evidence-
15 based, nationally recognized clinical process guidelines or peer-
16 reviewed, evidence-based, best-practice resources, which contain
17 measurable outcomes, in the joint provider and surveyor training
18 sessions to assist provider efforts toward improved regulatory
19 compliance and performance excellence and to foster a common
20 understanding of accepted peer-reviewed, evidence-based, best-
21 practice resources between providers and the survey agency. The
22 department shall post on its website all peer-reviewed, evidence-
23 based, nationally recognized clinical process guidelines and peer-
24 reviewed, evidence-based, best-practice resources used in a
25 training session under this subsection for provider, surveyor, and
26 public reference.
27 (28) Representatives from each nursing home provider
1 organization that does not own or operate a nursing home
2 representing 30 or more nursing homes statewide and the state long-
3 term care ombudsman or his or her designee are permanent members of
4 a clinical advisory workgroup created under subsection (24). The
5 department shall issue survey certification memorandums to
6 providers to announce or clarify changes in the interpretation of
7 regulations.
8 (29) The department shall maintain the process by which the
9 director of the long-term care division or his or her designee
10 reviews and authorizes the issuance of a citation for immediate
11 jeopardy or substandard quality of care before the statement of
12 deficiencies is made final. The review must assure ensure the
13 consistent and accurate application of federal and state survey
14 protocols and defined regulatory standards. As used in this
15 subsection, "immediate jeopardy" and "substandard quality of care"
16 mean those terms as defined by the federal Centers for Medicare and
17 Medicaid Services.
18 (30) Upon availability of funds, the department shall give
19 grants, awards, or other recognition to nursing homes to encourage
20 the rapid development and implementation of resident care policies
21 and compliance protocols that are created from peer-reviewed,
22 evidence-based, nationally recognized clinical process guidelines
23 or peer-reviewed, evidence-based, best-practice resources with
24 measurable outcomes to promote performance excellence.
25 (31) A nursing home shall post the nursing home's survey
26 report in a conspicuous place within the nursing home for public
27 review.
1 (32) Nothing in this section limits the requirements of
2 related state and federal law.
3 (33) As used in this section:
4 (a) "Consecutive days" means calendar days, but does not
5 include Saturday, Sunday, or state- or federally-recognized
6 holidays.
7 (b) "Form CMS-2567" means the federal Centers for Medicare and
8 Medicaid Services' form for the statement of deficiencies and plan
9 of correction or a successor form serving the same purpose.
10 (c) "Title XVIII" means title XVIII of the social security
11 act, 42 USC 1395 to 1395lll.
12 (d) "Title XIX" means title XIX of the social security act, 42
13 USC 1396 to 1396w-5.
14 Sec. 20161. (1) The department shall assess fees and other
15 assessments for health facility and agency licenses and
16 certificates of need on an
annual basis as provided in this
17 article. Until October 1, 2019, except as otherwise provided in
18 this article, fees and assessments shall must be
paid as provided
19 in the following schedule:
|
20 |
(a) Freestanding surgical |
|
21 |
outpatient facilities................$500.00 per facility |
|
22 |
license. |
|
23 |
(b) Hospitals...................$500.00 per facility |
|
24 |
license and $10.00 per |
|
25 |
licensed bed. |
|
26 |
(c) Nursing homes, county |
|
27 |
medical care facilities, and |
|
1 |
hospital long-term care units........$500.00 per facility |
|
2 |
license and $3.00 per |
|
3 |
licensed bed over 100 |
|
4 |
licensed beds. |
|
5 |
(d) Homes for the aged..........$6.27 per licensed bed. |
|
6 |
(e) Hospice agencies............$500.00 per agency license. |
|
7 |
(f) Hospice residences..........$500.00 per facility |
|
8 |
license and $5.00 per |
|
9 |
licensed bed. |
|
10 |
(g) Subject to subsection |
|
11 |
|
|
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 |
|
|
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 |
|
|
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 shall use the fees collected under this
13 subsection only to fund the certificate of need program. Funds
14 remaining in the certificate of need program at the end of the
15 fiscal year shall not lapse to the general fund but shall remain
16 available to fund the certificate of need program in subsequent
17 years.
18 (3) (4) A
license issued under this part is effective for no
19 longer than 1 year after the date of issuance.
20 (4) (5) Fees
described in this section are payable to the
21 department at the time when
an application for a license , or
22 permit , or certificate is submitted. If an application for a
23 license , or
permit , or certificate is denied or if a license , or
24 permit , or certificate is revoked before its expiration date, the
25 department shall not refund fees paid to the department.
26 (5) (6) The
fee for a provisional license or temporary permit
27 is the same as for a license. A license may be issued at the
1 expiration date of a temporary permit without an additional fee for
2 the balance of the period for which the fee was paid if the
3 requirements for licensure are met.
4 (6) (7) The
cost of licensure activities shall must be
5 supported by license fees.
6 (7) (8) The
application fee for a waiver under section 21564
7 is $200.00 plus $40.00 per hour for the professional services and
8 travel expenses directly related to processing the application. The
9 travel expenses shall must
be calculated in accordance with the
10 state standardized travel regulations of the department of
11 technology, management, and budget in effect at the time of the
12 travel.
13 (8) (9) An
applicant for licensure or renewal of licensure
14 under part 209 shall pay the applicable fees set forth in part 209.
15 (9) (10) Except
as otherwise provided in this section, the
16 fees and assessments collected under this section shall must be
17 deposited in the state treasury, to the credit of the general fund.
18 The department may use the unreserved fund balance in fees and
19 assessments for the criminal history check program required under
20 this article.
21 (10) (11) The
quality assurance assessment collected under
22 subsection (1)(g) and all federal matching funds attributed to that
23 assessment shall must
be used only for the following purposes
and
24 under the following specific circumstances:
25 (a) The quality assurance assessment and all federal matching
26 funds attributed to that assessment shall must be
used to finance
27 Medicaid nursing home reimbursement payments. Only licensed nursing
1 homes and hospital long-term care units that are assessed the
2 quality assurance assessment and participate in the Medicaid
3 program are eligible for increased per diem Medicaid reimbursement
4 rates under this subdivision. A nursing home or long-term care unit
5 that is assessed the quality assurance assessment and that does not
6 pay the assessment required under subsection (1)(g) in accordance
7 with subdivision (c)(i) or in accordance with a written payment
8 agreement with this state shall not receive the increased per diem
9 Medicaid reimbursement rates under this subdivision until all of
10 its outstanding quality assurance assessments and any penalties
11 assessed under subdivision (f) have been paid in full. This
12 subdivision does not authorize or require the department to
13 overspend tax revenue in violation of the management and budget
14 act, 1984 PA 431, MCL 18.1101 to 18.1594.
15 (b) Except as otherwise provided under subdivision (c),
16 beginning October 1, 2005, the quality assurance assessment is
17 based on the total number of patient days of care each nursing home
18 and hospital long-term care unit provided to non-Medicare patients
19 within the immediately preceding year, shall be is assessed
at a
20 uniform rate on October 1, 2005 and subsequently on October 1 of
21 each following year, and is payable on a quarterly basis, with the
22 first payment due 90 days after the date the assessment is
23 assessed.
24 (c) Within 30 days after September 30, 2005, the department
25 shall submit an application to the federal Centers for Medicare and
26 Medicaid Services to request a waiver according to 42 CFR 433.68(e)
27 to implement this subdivision as follows:
1 (i) If the waiver is approved, the quality assurance
2 assessment rate for a nursing home or hospital long-term care unit
3 with less than 40 licensed beds or with the maximum number, or more
4 than the maximum number, of licensed beds necessary to secure
5 federal approval of the application is $2.00 per non-Medicare
6 patient day of care provided within the immediately preceding year
7 or a rate as otherwise altered on the application for the waiver to
8 obtain federal approval. If the waiver is approved, for all other
9 nursing homes and long-term care units the quality assurance
10 assessment rate is to be calculated by dividing the total statewide
11 maximum allowable assessment permitted under subsection (1)(g) less
12 the total amount to be paid by the nursing homes and long-term care
13 units with less than 40 licensed beds or with the maximum number,
14 or more than the maximum number, of licensed beds necessary to
15 secure federal approval of the application by the total number of
16 non-Medicare patient days of care provided within the immediately
17 preceding year by those nursing homes and long-term care units with
18 more than 39 licensed beds, but less than the maximum number of
19 licensed beds necessary to secure federal approval. The quality
20 assurance assessment, as provided under this subparagraph, shall
21 must be assessed in the first quarter after federal approval of the
22 waiver and shall be subsequently assessed on October 1 of each
23 following year, and is payable on a quarterly basis, with the first
24 payment due 90 days after the date the assessment is assessed.
25 (ii) If the waiver is approved, continuing care retirement
26 centers are exempt from the quality assurance assessment if the
27 continuing care retirement center requires each center resident to
1 provide an initial life interest payment of $150,000.00, on
2 average, per resident to ensure payment for that resident's
3 residency and services and the continuing care retirement center
4 utilizes all of the initial life interest payment before the
5 resident becomes eligible for medical assistance under the state's
6 Medicaid plan. As used in this subparagraph, "continuing care
7 retirement center" means a nursing care facility that provides
8 independent living services, assisted living services, and nursing
9 care and medical treatment services, in a campus-like setting that
10 has shared facilities or common areas, or both.
11 (d) Beginning May 10, 2002, the department shall increase the
12 per diem nursing home Medicaid reimbursement rates for the balance
13 of that year. For each subsequent year in which the quality
14 assurance assessment is assessed and collected, the department
15 shall maintain the Medicaid nursing home reimbursement payment
16 increase financed by the quality assurance assessment.
17 (e) The department shall implement this section in a manner
18 that complies with federal requirements necessary to ensure that
19 the quality assurance assessment qualifies for federal matching
20 funds.
21 (f) If a nursing home or a hospital long-term care unit fails
22 to pay the assessment required by subsection (1)(g), the department
23 may assess the nursing home or hospital long-term care unit a
24 penalty of 5% of the assessment for each month that the assessment
25 and penalty are not paid up to a maximum of 50% of the assessment.
26 The department may also refer for collection to the department of
27 treasury past due amounts consistent with section 13 of 1941 PA
1 122, MCL 205.13.
2 (g) The Medicaid nursing home quality assurance assessment
3 fund is established in the state treasury. The department shall
4 deposit the revenue raised through the quality assurance assessment
5 with the state treasurer for deposit in the Medicaid nursing home
6 quality assurance assessment fund.
7 (h) The department shall not implement this subsection in a
8 manner that conflicts with 42 USC 1396b(w).
9 (i) The quality assurance assessment collected under
10 subsection (1)(g) shall must
be prorated on a quarterly basis for
11 any licensed beds added to or subtracted from a nursing home or
12 hospital long-term care unit since the immediately preceding July
13 1. Any adjustments in payments are due on the next quarterly
14 installment due date.
15 (j) In each fiscal year governed by this subsection, Medicaid
16 reimbursement rates shall must not be reduced below
the Medicaid
17 reimbursement rates in effect on April 1, 2002 as a direct result
18 of the quality assurance assessment collected under subsection
19 (1)(g).
20 (k) The state retention amount of the quality assurance
21 assessment collected under subsection (1)(g) shall must be
equal to
22 13.2% of the federal funds generated by the nursing homes and
23 hospital long-term care units quality assurance assessment,
24 including the state retention amount. The state retention amount
25 shall must be appropriated each fiscal year to the department
to
26 support Medicaid expenditures for long-term care services. These
27 funds shall must offset an identical amount of general fund/general
1 purpose revenue originally appropriated for that purpose.
2 (l) Beginning October 1, 2019, the department shall not assess
3 or collect the quality assurance assessment or apply for federal
4 matching funds. The quality assurance assessment collected under
5 subsection (1)(g) shall must
not be assessed or collected after
6 September 30, 2011 if the quality assurance assessment is not
7 eligible for federal matching funds. Any portion of the quality
8 assurance assessment collected from a nursing home or hospital
9 long-term care unit that is not eligible for federal matching funds
10 shall must be returned to the nursing home or hospital
long-term
11 care unit.
12 (11) (12) The
quality assurance dedication is an earmarked
13 assessment collected under subsection (1)(h). That assessment and
14 all federal matching funds attributed to that assessment shall must
15 be used only for the following purpose and under the following
16 specific circumstances:
17 (a) To maintain the increased Medicaid reimbursement rate
18 increases as provided for in subdivision (c).
19 (b) The quality assurance assessment shall must be
assessed on
20 all net patient revenue, before deduction of expenses, less
21 Medicare net revenue, as reported in the most recently available
22 Medicare cost report and is payable on a quarterly basis, with the
23 first payment due 90 days after the date the assessment is
24 assessed. As used in this subdivision, "Medicare net revenue"
25 includes Medicare payments and amounts collected for coinsurance
26 and deductibles.
27 (c) Beginning October 1, 2002, the department shall increase
1 the hospital Medicaid reimbursement rates for the balance of that
2 year. For each subsequent year in which the quality assurance
3 assessment is assessed and collected, the department shall maintain
4 the hospital Medicaid reimbursement rate increase financed by the
5 quality assurance assessments.
6 (d) The department shall implement this section in a manner
7 that complies with federal requirements necessary to ensure that
8 the quality assurance assessment qualifies for federal matching
9 funds.
10 (e) If a hospital fails to pay the assessment required by
11 subsection (1)(h), the department may assess the hospital a penalty
12 of 5% of the assessment for each month that the assessment and
13 penalty are not paid up to a maximum of 50% of the assessment. The
14 department may also refer for collection to the department of
15 treasury past due amounts consistent with section 13 of 1941 PA
16 122, MCL 205.13.
17 (f) The hospital quality assurance assessment fund is
18 established in the state treasury. The department shall deposit the
19 revenue raised through the quality assurance assessment with the
20 state treasurer for deposit in the hospital quality assurance
21 assessment fund.
22 (g) In each fiscal year governed by this subsection, the
23 quality assurance assessment shall must only
be collected and
24 expended if Medicaid hospital inpatient DRG and outpatient
25 reimbursement rates and disproportionate share hospital and
26 graduate medical education payments are not below the level of
27 rates and payments in effect on April 1, 2002 as a direct result of
1 the quality assurance assessment collected under subsection (1)(h),
2 except as provided in subdivision (h).
3 (h) The quality assurance assessment collected under
4 subsection (1)(h) shall must
not be assessed or collected after
5 September 30, 2011 if the quality assurance assessment is not
6 eligible for federal matching funds. Any portion of the quality
7 assurance assessment collected from a hospital that is not eligible
8 for federal matching funds shall must be returned to the
hospital.
9 (i) The state retention amount of the quality assurance
10 assessment collected under subsection (1)(h) shall must be
equal to
11 13.2% of the federal funds generated by the hospital quality
12 assurance assessment, including the state retention amount. The
13 13.2% state retention amount described in this subdivision does not
14 apply to the Healthy Michigan plan. In the fiscal year ending
15 September 30, 2016, there is a 1-time additional retention amount
16 of up to $92,856,100.00. Beginning in the fiscal year ending
17 September 30, 2017, and for each fiscal year thereafter, there is a
18 retention amount of $105,000,000.00 for each fiscal year for the
19 Healthy Michigan plan. The state retention percentage shall must be
20 applied proportionately to each hospital quality assurance
21 assessment program to determine the retention amount for each
22 program. The state retention amount shall must be
appropriated each
23 fiscal year to the department to support Medicaid expenditures for
24 hospital services and therapy. These funds shall must offset
an
25 identical amount of general fund/general purpose revenue originally
26 appropriated for that purpose. By May 31, 2019, the department, the
27 state budget office, and the Michigan Health and Hospital
1 Association shall identify an appropriate retention amount for the
2 fiscal year ending September 30, 2020 and each fiscal year
3 thereafter.
4 (12) (13) The
department may establish a quality assurance
5 assessment to increase ambulance reimbursement as follows:
6 (a) The quality assurance assessment authorized under this
7 subsection shall must
be used to provide reimbursement to
Medicaid
8 ambulance providers. The department may promulgate rules to provide
9 the structure of the quality assurance assessment authorized under
10 this subsection and the level of the assessment.
11 (b) The department shall implement this subsection in a manner
12 that complies with federal requirements necessary to ensure that
13 the quality assurance assessment qualifies for federal matching
14 funds.
15 (c) The total annual collections by the department under this
16 subsection shall must
not exceed $20,000,000.00.
17 (d) The quality assurance assessment authorized under this
18 subsection shall must
not be collected after October 1, 2019.
The
19 quality assurance assessment authorized under this subsection shall
20 must no longer be collected or assessed if the quality assurance
21 assessment authorized under this subsection is not eligible for
22 federal matching funds.
23 (13) (14) The
quality assurance assessment provided for under
24 this section is a tax that is levied on a health facility or
25 agency.
26 (14) (15) As
used in this section:
27 (a) "Healthy Michigan plan" means the medical
assistance plan
1 program described in section 105d of the social welfare act, 1939
2 PA 280, MCL 400.105d, that has a federal matching fund rate of not
3 less than 90%.
4 (b) "Medicaid" means that term as defined in section
22207.a
5 program for medical assistance established under title XIX of the
6 social security act, 42 USC 1396 to 1396w-5, and administered by
7 the department of health and human services under the social
8 welfare act, 1939 PA 280, MCL 400.1 to 400.119b.
9 Sec. 20164. (1) A license, certification, provisional license,
10 or limited license is valid for not more than 1 year after the date
11 of issuance, except as provided in section 20511 or part 209. or
12 210. A license for a
facility licensed under part 215 shall be is
13 valid for 2 years, except that provisional and limited licenses may
14 be valid for 1 year.
15 (2) A license , or
certification ,
or certificate of need is
16 not transferable and shall must state the persons,
buildings, and
17 properties to which it applies.
Applications for licensure or
18 certification because of transfer of ownership or essential
19 ownership interest shall not be acted upon until satisfactory
20 evidence is provided of compliance with part 222.
21 (3) If ownership is not voluntarily transferred, the
22 department shall be notified immediately and the new owner shall
23 apply for a license and certification not later than 30 days after
24 the transfer.
25 Sec. 20165. (1) Except as otherwise provided in this section,
26 after notice of intent to an applicant or licensee to deny, limit,
27 suspend, or revoke the applicant's or licensee's license or
1 certification and an opportunity for a hearing, the department may
2 deny, limit, suspend, or revoke the license or certification or
3 impose an administrative fine on a licensee if 1 or more of the
4 following exist:
5 (a) Fraud or deceit in obtaining or attempting to obtain a
6 license or certification or in the operation of the licensed health
7 facility or agency.
8 (b) A violation of this article or a rule promulgated under
9 this article.
10 (c) False or misleading advertising.
11 (d) Negligence or failure to exercise due care, including
12 negligent supervision of employees and subordinates.
13 (e) Permitting a license or certificate to be used by an
14 unauthorized health facility or agency.
15 (f) Evidence of abuse regarding a patient's health, welfare,
16 or safety or the denial of a patient's rights.
17 (g) Failure to comply with section 10115.
18 (h) Failure to comply with former part 222 or a term,
19 condition, or stipulation of a certificate of need issued under
20 former part 222, or both. This subdivision only applies to a
21 failure to comply that occurred before the effective date of the
22 amendatory act that repealed part 222.
23 (i) A violation of section 20197(1).
24 (2) The department may deny an application for a license or
25 certification based on a finding of a condition or practice that
26 would constitute a violation of this article if the applicant were
27 a licensee.
1 (3) Denial, suspension, or revocation of an individual
2 emergency medical services personnel license under part 209 is
3 governed by section 20958.
4 (4) If the department determines under subsection (1) that a
5 health facility or agency has violated section 20197(1), the
6 department shall impose an administrative fine of $5,000,000.00 on
7 the health facility or agency.
8 Sec. 20166. (1) Notice of intent to deny, limit, suspend, or
9 revoke a license or certification shall must be
given by certified
10 mail or personal service, shall set forth the particular reasons
11 for the proposed action, and shall fix a date, not less that than
12 30 days after the date of service, on which the applicant or
13 licensee shall be is
given the opportunity for a hearing
before the
14 director or the director's authorized representative. The hearing
15 shall must be conducted in accordance with the administrative
16 procedures act of 1969 and rules promulgated by the department. A
17 full and complete record shall must be kept of the
proceeding and
18 shall must be transcribed when requested by an interested
party,
19 who shall pay the cost of preparing the transcript.
20 (2) On the basis of a hearing or on the default of the
21 applicant or licensee, the department may issue, deny, limit,
22 suspend, or revoke a license or certification. A copy of the
23 determination shall must
be sent by certified mail or served
24 personally upon the applicant or licensee. The determination
25 becomes final 30 days after it is mailed or served, unless the
26 applicant or licensee within the 30 days appeals the decision to
27 the circuit court in the county of jurisdiction or to the Ingham
1 county County circuit court.
2 (3) The department may establish procedures, hold hearings,
3 administer oaths, issue subpoenas, or order testimony to be taken
4 at a hearing or by deposition in a proceeding pending at any stage
5 of the proceeding. A person may be compelled to appear and testify
6 and to produce books, papers, or documents in a proceeding.
7 (4) In case of disobedience of a subpoena, a party to a
8 hearing may invoke the aid of the circuit court of the jurisdiction
9 in which the hearing is held to require the attendance and
10 testimony of witnesses. The circuit court may issue an order
11 requiring an individual to appear and give testimony. Failure to
12 obey the order of the circuit court may be punished by the court as
13 a contempt.
14 (5) The department shall not deny, limit, suspend, or revoke a
15 license on the basis of an applicant's or licensee's failure to
16 show a need for a health facility or agency unless the health
17 facility or agency has did
not obtained obtain a
certificate of
18 need as required by former part 222.
19 Sec. 21551. (1) A hospital licensed under this article and
20 located in a nonurbanized area may apply to the department to
21 temporarily delicense not more than 50% of its licensed beds for
22 not more than 5 years.
23 (2) A hospital that is granted a temporary delicensure of beds
24 under subsection (1) may apply to the department for an extension
25 of temporary delicensure for those beds for up to an additional 5
26 years to the extent that the hospital actually met the requirements
27 of used the
delicensed beds as described in subsection
(6) during
1 the initial period of delicensure granted under subsection (1). The
2 department shall grant an extension under this subsection unless
3 the department determines under part 222 that there is a
4 demonstrated need for the delicensed beds in the subarea in which
5 the hospital is located. If
the department does not grant an
6 extension under this subsection, the hospital shall request
7 relicensure of the beds pursuant to under subsection
(7) or allow
8 the beds to become permanently delicensed pursuant to under
9 subsection (8).
10 (3) Except as otherwise provided in this section, for a period
11 of 90 days after January 1, 1991, if a hospital is located in a
12 distressed area and has an annual indigent volume consisting of not
13 less than 25% indigent patients, the hospital may apply to the
14 department to temporarily delicense not more than 50% of its
15 licensed beds for a period of not more than 2 years. Upon receipt
16 of a complete application under this subsection, the department
17 shall temporarily delicense the beds indicated in the application.
18 The department shall not grant an extension of temporary
19 delicensure under this subsection.
20 (4) An application under subsection (1) or (3) shall must be
21 on a form provided by the department. The form shall must contain
22 all of the following information:
23 (a) The number and location of the specific beds to be
24 delicensed.
25 (b) The period of time during which the beds will be
26 delicensed.
27 (c) The alternative use proposed for the space occupied by the
1 beds to be delicensed.
2 (5) A hospital that files an application under subsection (1)
3 or (3) may file an amended application with the department on a
4 form provided by the department. The hospital shall state on the
5 form the purpose of the amendment. If the hospital meets the
6 requirements of this section, the department shall so amend the
7 hospital's original application.
8 (6) An alternative use of space made available by the
9 delicensure of beds under this section shall not result in a
10 violation of this article or the rules promulgated under this
11 article. Along with the application, an applicant for delicensure
12 under subsection (1) or (3) shall submit to the department plans
13 that indicate to the satisfaction of the department that the space
14 occupied by the beds proposed for temporary delicensure will be
15 used for 1 or more of the following:
16 (a) An alternative use that over the proposed period of
17 temporary delicensure would defray the depreciation and interest
18 costs that otherwise would be allocated to the space along with the
19 operating expenses related to the alternative use.
20 (b) To correct a licensing deficiency previously identified by
21 the department.
22 (c) Nonhospital purposes including, but not limited to,
23 community service projects, if the depreciation and interest costs
24 for all capital expenditures that would otherwise be allocated to
25 the space, as well as any operating costs related to the proposed
26 alternative use, would not be considered as hospital costs for
27 purposes of reimbursement.
1 (7) The department shall relicense beds that are temporarily
2 delicensed under this section if all of the following requirements
3 are met:
4 (a) The hospital files with the department a written request
5 for relicensure not less than 90 days before the earlier of the
6 following:
7 (i) The expiration of the period for which delicensure was
8 granted.
9 (ii) The date upon which the hospital is requesting
10 relicensure.
11 (iii) The last hospital license renewal date in the
12 delicensure period.
13 (b) The space to be occupied by the relicensed beds is in
14 compliance with this article and the rules promulgated under this
15 article, including all licensure standards in effect at the time of
16 relicensure, or the hospital has a plan of corrections that has
17 been approved by the department.
18 (8) If a hospital does not meet all of the requirements of
19 subsection (7) or if a hospital decides to allow beds to become
20 permanently delicensed as described in subsection (2), then all of
21 the temporarily delicensed beds shall must be
automatically and
22 permanently delicensed effective on the last day of the period for
23 which the department granted temporary delicensure.
24 (9) The department shall continue to count beds temporarily
25 delicensed under this section in the department's bed inventory for
26 purposes of determining hospital bed need under part 222 in the
27 subarea in which the beds are located. The department shall
1 indicate in the bed inventory which beds are licensed and which
2 beds are temporary temporarily
delicensed under this section. The
3 department shall not include a hospital's temporarily delicensed
4 beds in the hospital's licensed bed count.
5 (10) A hospital that is granted temporary delicensure of beds
6 under this section shall not transfer the beds to another site or
7 hospital without first obtaining a certificate of need.
8 (10) (11) A
hospital that has beds that are subject to a
9 hospital bed reduction plan or to a department action to enforce
10 this article shall not use beds temporarily delicensed under this
11 section to comply with the bed reduction plan.
12 (11) (12) As
used in this section:
13 (a) "Distressed area" means a city that meets all of the
14 following criteria:
15 (i) Had a negative population change from 1970 to the date of
16 the 1980 federal decennial census.
17 (ii) From 1972 to 1989, had an increase in its state equalized
18 valuation that is less than the statewide average.
19 (iii) Has a poverty level that is greater than the statewide
20 average, according to the 1980 federal decennial census.
21 (iv) Was eligible for an urban development action grant from
22 the United States department Department of housing Housing and
23 urban development Urban
Development in 1984 and was listed in
49
24 F.R. FR No. 28 (February 9, 1984) or 49 F.R. FR No.
30 (February
25 13, 1984).
26 (v) Had an unemployment rate that was higher than the
27 statewide average for 3 of the 5 years from 1981 to 1985.
1 (b) "Indigent volume" means the ratio of a hospital's indigent
2 charges to its total charges expressed as a percentage as
3 determined by the department of social health and human services
4 after November 12, 1990, pursuant to under chapter
8 of the
5 department of social health
and human services guidelines entitled
6 "medical assistance program manual"."Medical Assistance Program
7 Manual".
8 (c) "Nonurbanized area" means an area that is not an urbanized
9 area.
10 (d) "Urbanized area" means that term as defined by the office
11 Office of federal
statistical policy Federal
Statistical Policy and
12 standards Standards of the United States department Department of
13 commerce Commerce in the appendix entitled "general procedures
and
14 definitions", "General
Procedures and Definitions", 45 F.R.
FR p.
15 962 (January 3, 1980), which document is incorporated by reference.
16 Sec. 21562. (1) A hospital designated as a rural community
17 hospital under section 21561 shall be a limited service hospital
18 directed toward the delivery of not more than basic acute care
19 services in order to assure ensure appropriate access in
the rural
20 area.
21 (2) The rules promulgated to implement this part shall must
22 require that a hospital designated as a rural community hospital
23 under section 21561 shall provide no more than the following
24 services:
25 (a) Emergency care.
26 (b) Stabilization care for transfer to another facility.
27 (c) Inpatient care.
1 (d) Radiology and laboratory services.
2 (e) Ambulatory care.
3 (f) Obstetrical services.
4 (g) Outpatient services.
5 (h) Other services determined as appropriate by the ad hoc
6 advisory committee created in subsection (5).
7 (3) A rural community hospital shall enter into an agreement
8 with the department of social health and human services to
9 participate in the medicaid Medicaid program. As used in
this
10 subsection, "medicaid" "Medicaid" means that
term as defined in
11 section 22207.a
program for medical assistance established under
12 title XIX of the social security act, 42 USC 1396 to 1396w-5, and
13 administered by the department of health and human services under
14 the social welfare act, 1939 PA 280, MCL 400.1 to 400.119b.
15 (4) A rural community hospital shall meet the conditions for
16 participation in the federal medicare Medicare program
under title
17 XVIII of the social security act, 42 USC 1395 to 1395lll.
18 (5) Not later than 3 months after the effective date of this
19 section, the director shall appoint an ad hoc advisory committee to
20 develop recommendations for rules to designate the maximum number
21 of beds and the services to be provided by a rural community
22 hospital. In developing recommendations under this subsection, the
23 ad hoc advisory committee shall review the provisions of the code
24 pertaining to hospital licensure in order to determine those
25 provisions that should apply to rural community hospitals. The
26 director shall direct the committee to report its recommendations
27 to the department within 12 months after the committee is
1 appointed. The ad hoc advisory committee shall be appointed as
2 follows:
3 (a) Twenty-five percent of the members shall be
4 representatives from hospitals with fewer than 100 licensed beds.
5 (b) Twenty-five percent of the members shall be
6 representatives from health care provider organizations other than
7 hospitals.
8 (c) Twenty-five percent of the members shall be
9 representatives from organizations whose membership includes
10 consumers of rural health care services or members of local
11 governmental units located in rural areas.
12 (d) Twenty-five percent of the members shall be
13 representatives from purchasers or payers of rural health care
14 services.
15 (5) (6) A
hospital designated as a rural community hospital
16 under section 21561 shall develop and implement a transfer
17 agreement between the rural community hospital and 1 or more
18 appropriate referral hospitals.
19 Sec. 21563. (1) The department , in consultation with
the ad
20 hoc advisory committee appointed under section 21562, shall
21 promulgate rules for designation of a rural community hospital,
22 maximum number of beds, and the services provided by a rural
23 community hospital. The director shall submit proposed rules, based
24 on the recommendations of the committee, for public hearing not
25 later than 6 months after receiving the report under section
26 21562(5).
27 (2) The designation as a rural community hospital shall must
1 be shown on a hospital's license and shall must be
for the same
2 term as the hospital license. Except as otherwise expressly
3 provided in this part or in rules promulgated under this section, a
4 rural community hospital shall must be licensed and
regulated in
5 the same manner as a hospital otherwise licensed under this
6 article. The provisions of part 222 applicable to hospitals also
7 apply to a rural community hospital and to a hospital designated by
8 the department under federal law as an essential access community
9 hospital or a rural primary care hospital. This part and the rules
10 promulgated under this part do not preclude the establishment of
11 differential reimbursement for rural community hospitals, essential
12 access community hospitals, and rural primary care hospitals.
13 Enacting section 1. The following acts and parts of acts are
14 repealed:
15 (a) Section 20143 of the public health code, 1978 PA 368, MCL
16 333.20143.
17 (b) Section 21420 of the public health code, 1978 PA 368, MCL
18 333.21420.
19 (c) Part 222 of the public health code, 1978 PA 368, MCL
20 333.22201 to 333.22260.
21 (d) Section 8t of 1945 PA 47, MCL 331.8t.
22 (e) Section 47 of the hospital finance authority act, 1969 PA
23 38, MCL 331.77.
24 Enacting section 2. This amendatory act takes effect 90 days
25 after the date it is enacted into law.