HOUSE BILL NO. 5475

February 22, 2024, Introduced by Rep. Schriver and referred to the Committee on Government Operations.

A bill to amend 1939 PA 280, entitled

"The social welfare act,"

by amending sections 55, 66a, 109, and 109e (MCL 400.55, 400.66a, 400.109, and 400.109e), section 55 as amended by 2015 PA 90, section 109 as amended by 2022 PA 98, and section 109e as added by 1996 PA 124.

the people of the state of michigan enact:

Sec. 55. The county department shall administer a public welfare program, as follows:

(a) To grant general assistance, including medical care and care in the county medical care facility, but not including hospitalization and infirmary care except for care in the county medical care facility or a county infirmary existing on January 1, 1981, to any person an individual domiciled in the county who has a legal settlement in this state. General assistance may also be granted to a person an individual who has a legal settlement in this state but no domicile in the county and a recoupment may be made when if appropriate in the manner provided in cases of emergency hospitalization under this act. In a temporary emergency, general assistance may be given to indigents without a settlement in this state as the county department considers necessary, including, if other funds are money is not available for the purpose, all necessary expenses in transporting an indigent to his or her domicile in this state, or in another state or nation, when if information reasonably tends to show that the person individual has a home available in his or her place of domicile in this state or a legal residence in another state or nation. A legal settlement in this state is acquired by an emancipated person individual who has lived continuously in this state for 1 year with the intent to make it his or her home and who, during the 1-year period has not received public assistance, other than assistance received during and as a direct result of a civil defense emergency, or support from relatives. Time spent in a public institution shall is not be counted in determining settlement. A legal settlement shall be is lost by remaining away from this state for an uninterrupted period of 1 year except that absence from this state for labor or other special or temporary purpose shall does not occasion loss of settlement.

(b) To administer categorical assistance including medical care.

(c) To supervise and be responsible for the operation of the county infirmary and county medical care facility. In a county having a population of 1,000,000 or more that maintains a county infirmary or county hospital or a joint infirmary and hospital providing for mental patients, the institution and the admissions to the institution are subject to the control of a board to be known as the board of county institutions. The board shall consist of 5 members appointed by the county board of commissioners, except that in a county having a board of county auditors, 3 members of the board of county institutions shall must be appointed by the county board of commissioners and 2 members shall must be appointed by the board of county auditors. Each member of the board shall hold office for a term and receive compensation as the county board of commissioners provides by ordinance. In relation to the administration of the institutions, the board has and succeeds to all powers and duties formerly vested by law, general, local or special, in the superintendents of the poor in the county and the board of county institutions as constituted on April 13, 1943. The board of county institutions of the county may also maintain outpatient facilities for the treatment of needy persons individuals suffering from mental disorders. The board also has the same powers as are given to the county board in section 78.

(d) To furnish in all cases, insofar as when practicable, care and treatment that will tend to restore needy persons individuals to a condition of financial and social independence.

(e) To require that each applicant shall furnish proof satisfactory to the county board that the applicant is entitled to the aid, assistance, or benefit sought.

(f) To investigate, in respect to each application for any form of public aid or assistance, the circumstances of the applicant, both at the time of application and periodically during the receipt of aid or assistance.

(g) To maintain adequate social and financial records pertaining to each recipient of aid or assistance and, so far as is when practicable, engage in the prevention of social disabilities.

(h) Except as otherwise provided in this subdivision, to investigate, when if requested by the probate court or the family division of circuit court, matters pertaining to dependent, neglected, and delinquent children and wayward minors under the court's jurisdiction, to provide supervision and foster care as provided by court order, and to furnish the court, on request, investigational service in respect to the hospitalization of children under the program of services for children and youth with special health care needs established under part 58 of the public health code, 1978 PA 368, MCL 333.5801 to 333.5879, which services shall must include the follow-up investigation and continuing observations. If the county is a county juvenile agency as defined in section 2 of the county juvenile agency act, 1998 PA 518, MCL 45.622, the county department's obligations under this subdivision are limited to public wards within the county's jurisdiction under the youth rehabilitation services act, 1974 PA 150, MCL 803.301 to 803.309, and county juvenile agency services as that term is defined in section 117a.

(i) To assist other departments, agencies, and institutions of the federal, state, and county governments, when if requested, in performing services in conformity with the purposes of this act.

(j) To assist in the development of sound programs and standards of child welfare, and promote programs and policies looking toward the prevention of to prevent dependency, neglect, and delinquency and other conditions affecting adversely the welfare of families and children.

(k) To create within the county department a division of medical care. The county board may appoint a properly qualified and licensed doctor of medicine as the head of the division and an advisory committee. The advisory committee shall consist of 1 doctor of medicine, nominated by the county medical society; 1 dentist, nominated by the district dental society; and 1 pharmacist, nominated by the district pharmaceutical association, to assist in formulating policies of medical care and auditing and reviewing bills. "Medical As used in this act, "medical care" as used in this act means medical care rendered under the supervision of a licensed physician in an organized out-patient outpatient department of a hospital licensed by the department of community health licensing and regulatory affairs under article 17 of the public health code, 1978 PA 368, MCL 333.20101 to 333.22260, 333.22121, or home and office attendance by a physician, osteopathic physician and surgeon, or podiatrist licensed or otherwise authorized to engage in practice under article 15 of the public health code, 1978 PA 368, MCL 333.16101 to 333.18838; and when if prescribed by the physician, osteopathic physician and surgeon, or podiatrist, diagnostic services requiring the use of equipment not available in his or her offices, if the services do not require overnight care, dental service, optometric service, bedside nursing service in the home, or pharmaceutical service. The private physician-patient relationship shall must be maintained. The normal relationships between the recipients of dental, optometric, nursing, and pharmaceutical services, and the services furnished by a physician, osteopathic physician and surgeon, podiatrist, or a chiropractor licensed or otherwise authorized to engage in practice under article 15 of the public health code, 1978 PA 368, MCL 333.16101 to 333.18838, and the persons furnishing these services shall must be maintained. This section does not affect the office of a city physician or city pharmacist established under a city charter, a county health officer, or the medical superintendent of a county hospital. This section permits the use of a case management system, a patient care management system, or other alternative system for providing medical care.

(l) To cause to be suitably buried the body of a deceased indigent person individual who has a domicile in the county, when if requested by the person's individual's relative or friend, or of a stranger, when if requested by a public official following an inquest.

(m) To administer additional welfare functions as are vested in the department, including hospitalization.

(n) To act as an agent for the state department in matters requested by the state department under the rules of the state department.

(o) To provide temporary general assistance for each family found ineligible for family independence assistance by reason of unsuitable family home as provided in section 56.

Sec. 66a. The county social welfare boards shall make provision for hospitalization which that is necessary and not more advantageously provided to the recipient under other law or provided under other sections of this act for every person found in their respective counties under rules of financial eligibility established by the boards and shall be reimbursed 100% by the this state for the monthly net cost of the hospitalization for nonresidents of the this state. The county department, in its discretion, may direct that the patient be conveyed to the university hospital at Ann Arbor or any other hospital for hospitalization. As used in this act, "hospitalization" means medical, surgical, or obstetrical care in the university hospital or in a hospital licensed under article 17 of Act No. 368 of the Public Acts of 1978, as amended, being sections 333.20101 to 333.22190 of the Michigan Compiled Laws, the public health code, 1978 PA 368, MCL 333.20101 to 333.22121, together with necessary drugs, x-rays, physical therapy, prosthesis, transportation, and nursing care incidental to the medical, surgical, or obstetrical care, but shall does not include medical care as defined in section 55. Before a patient shall be is admitted except in an emergency, to any hospital other than the university hospital, a definite agreement, statement, or schedule of charges, expenses, and fees to be received by the hospital and physicians or surgeons performing necessary services under this act shall must be filed with the county department of the county in which the hospital is located and approved by the county department, except as provided for in section 66i. The hospital shall, at the conclusion of the treatment, make a report of the treatment and an itemized statement of the expenses of the treatment to the county department which that issued the order, but charges for special nurses shall must not be made without the consent of the county social welfare director. The expenses for sending the patient home or to other institutions after being discharged from the hospital may be paid by the hospital and charged in the regular bill for maintenance unless different instructions have been received from the county department which that issued the order for admission.

Sec. 109. (1) The following medical services may be provided under this act:

(a) Hospital services that an eligible individual may receive consist of medical, surgical, or obstetrical care, together with necessary drugs, X-rays, physical therapy, prosthesis, transportation, and nursing care incident to the medical, surgical, or obstetrical care. The period of inpatient hospital service shall must be the minimum period necessary in this type of facility for the proper care and treatment of the individual. Necessary hospitalization to provide dental care must be provided if certified by the attending dentist with the approval of the department. An individual who is receiving medical treatment as an inpatient because of a diagnosis of mental disease may receive service under this section, notwithstanding the mental health code, 1974 PA 258, MCL 330.1001 to 330.2106. The department must pay for hospital services according to the state plan for medical assistance adopted under section 10 and approved by the United States Department of Health and Human Services.

(b) An eligible individual may receive physician services authorized by the department. The service may be furnished in the physician's office, the eligible individual's home, a medical institution, or elsewhere in case of emergency. A physician must be paid a reasonable charge for the service rendered. The department must determine reasonable charges. Reasonable charges must not be more than those paid in this state for services rendered under title XVIII.

(c) An eligible individual may receive nursing home services in a state licensed nursing home, a medical care facility, or other facility or identifiable unit of that facility, certified by the appropriate authority as meeting established standards for a nursing home under the laws and rules of this state and the United States Department of Health and Human Services, to the extent found necessary by the attending physician, dentist, or certified Christian Science practitioner. An eligible individual may receive nursing services in an extended care services program established under former section 22210 of the public health code, 1978 PA 368, MCL 333.22210, to the extent found necessary by the attending physician when the combined length of stay in the acute care bed and short-term nursing care bed exceeds the average length of stay for Medicaid hospital diagnostic related group reimbursement. The department shall not make a final payment under title XIX for benefits available under title XVIII without documentation that title XVIII claims have been filed and denied. The department must pay for nursing home services according to the state plan for medical assistance adopted according to section 10 and approved by the United States Department of Health and Human Services. A county must reimburse a county maintenance of effort rate determined on an annual basis for each patient day of Medicaid nursing home services provided to eligible individuals in long-term care facilities owned by the county and licensed to provide nursing home services. For purposes of determining rates and costs described in this subdivision, all of the following apply:

(i) For county-owned facilities with per patient day updated variable costs exceeding the variable cost limit for the county facility, county maintenance of effort rate means 45% of the difference between per patient day updated variable cost and the concomitant nursing home-class variable cost limit, the quantity offset by the difference between per patient day updated variable cost and the concomitant variable cost limit for the county facility. The county rate must not be less than zero.

(ii) For county-owned facilities with per patient day updated variable costs not exceeding the variable cost limit for the county facility, county maintenance of effort rate means 45% of the difference between per patient day updated variable cost and the concomitant nursing home class variable cost limit.

(iii) For county-owned facilities with per patient day updated variable costs not exceeding the concomitant nursing home class variable cost limit, the county maintenance of effort rate must equal zero.

(iv) For the purposes of this section: "per patient day updated variable costs and the variable cost limit for the county facility" must be determined according to the state plan for medical assistance; for freestanding county facilities the "nursing home class variable cost limit" must be determined according to the state plan for medical assistance and for hospital attached county facilities the "nursing class variable cost limit" must be determined according to the state plan for medical assistance plus $5.00 per patient day; and "freestanding" and "hospital attached" must be determined according to the federal regulations.

(v) If the county maintenance of effort rate computed under this section exceeds the county maintenance of effort rate in effect as of September 30, 1984, the rate in effect as of September 30, 1984 must remain in effect until a time that the rate computed under this section is less than the September 30, 1984 rate. This limitation remains in effect until December 31, 2025 or until a new reimbursement system determined by the department replaces the current system, whichever is sooner. For each subsequent county fiscal year, the maintenance of effort rate may not increase by more than $1.00 per patient day each year.

(vi) For county-owned facilities, reimbursement for plant costs must continue to be based on interest expense and depreciation allowance unless otherwise provided by law.

(d) An eligible individual may receive pharmaceutical services from a licensed pharmacist of the individual's choice as prescribed by a licensed physician or dentist and approved by the department. In an emergency, but not routinely, the individual may receive pharmaceutical services rendered personally by a licensed physician or dentist on the same basis as approved for pharmacists.

(e) An eligible individual may receive other medical and health services as authorized by the department.

(f) Psychiatric care may also be provided according to the guidelines established by the department to the extent of appropriations made available by the legislature for the fiscal year.

(g) An eligible individual may receive screening, laboratory services, diagnostic services, early intervention services, and treatment for chronic kidney disease under guidelines established by the department. A clinical laboratory performing a creatinine test on an eligible individual under this subdivision must include in the lab report the glomerular filtration rate (eGFR) of the individual and must report it as a percentage of kidney function remaining.

(h) An eligible individual may receive medically necessary acute medical detoxification for opioid use disorder, medically necessary inpatient care at an approved facility, or care in an appropriately licensed substance use disorder residential treatment facility.

(2) The director must provide notice to the public, according to applicable federal regulations, and must obtain the approval of the committees on appropriations of the house of representatives and senate of the state legislature, of a proposed change in the statewide method or level of reimbursement for a service, if the proposed change is expected to increase or decrease payments for that service by 1% or more during the 12 months after the effective date of the change.

(3) As used in this act:

(a) "Title XVIII" means title XVIII of the social security act, 42 USC 1395 to 1395lll.

(b) "Title XIX" means title XIX of the social security act, 42 USC 1396 to 1396w-6.1396w-7.

(c) "Title XX" means title XX of the social security act, 42 USC 1397 to 1397n-13.

Sec. 109e. (1) As used in this section:

(a) "Abortion" means the intentional use of an instrument, drug, or other substance or device to terminate a woman's pregnancy for a purpose other than to increase the probability of a live birth, to preserve the life or health of the child after live birth, or to remove a dead fetus. Abortion does not include the use or prescription of a drug or device intended as a contraceptive.

(b) "Health care professional" means an individual licensed or registered under article 15 of the public health code, Act No. 368 of the Public Acts of 1978, being sections 333.16101 to 333.18838 of the Michigan Compiled Laws.1978 PA 368, MCL 333.16101 to 333.18838.

(c) "Health facility or agency" means a health facility or agency licensed under article 17 of Act No. 368 of the Public Acts of 1978, being sections 333.20101 to 333.22260 of the Michigan Compiled Laws.the public health code, 1978 PA 368, MCL 333.20101 to 333.22121.

(2) A health care professional or a health facility or agency shall not seek or accept reimbursement for the performance of an abortion knowing that public funds money will be or have has been used in whole or in part for the reimbursement in violation of section 109a. of Act No. 280 of the Public Acts of 1939, being section 400.109a of the Michigan Compiled Laws, as added by Act No. 59 of the Public Acts of 1987.

(3) A person who violates this section is liable for a civil fine of up to $10,000.00 per violation. The department of community health and human services shall investigate an alleged violation of this section and the attorney general, in cooperation with the department of community health and human services, may bring an action to enforce this section.

(4) Nothing in this This section restricts does not restrict the right of a health care professional to discuss abortion or abortion services with a patient who is pregnant.

(5) This section does not create a right to an abortion.

(6) Notwithstanding any other provision of this section, a person shall not perform an abortion that is prohibited by law.

Enacting section 1. This amendatory act does not take effect unless Senate Bill No.____ or House Bill No. 5477 (request no. 01038'23) of the 102nd Legislature is enacted into law.