After several weeks of budget-focused negotiations, the Michigan House and Senate have been busy this month taking action on several health care related policy items, including codification of federal Patient Protection and Affordable Care Act provisions into Michigan law, Healthy Michigan Plan reforms, and House and Senate committee action on a package of bills regarding sexual assault under the pretext of medical treatment.
Codification of the Federal Patient Protection and Affordable Care Act: On March 30th, 2023, a judge in the U.S. District Court struck down a critical provision of the Affordable Care Act (ACA) that requires most private health plans to cover a range of preventive services without any cost sharing for their enrollees. Should this ruling hold, millions of individuals could find themselves burdened with increased costs for preventive care and even worse, some may lose access to essential services altogether.
The House and Senate subsequently introduced an eight-bill package, Senate Bills 356-358 and House Bills 4619-4623, which accomplish the following:
- Prohibits insurers from engaging in discriminatory practices based on gender and sexual orientation (HB 4619)
- Prohibits insurers from imposing annual or lifetime limits on benefits (HB 4620)
- Prohibits denial of coverage for pre-existing conditions (HB 4621)
- Requires coverage of dependents up to the age of 26 (HB 4622)
- Requires coverage of preventive services (HB 4623)
- Requires insurers to provide a form explaining the terms and conditions of the policy to applicants and enrollees at the time of application, issuance, and renewal (SB 356)
- Prohibits insurers from rescinding coverage unless the insured performs an act of fraud or makes an intentional misrepresentation of material fact. The insurer would have to give written notice to the insured at least 30 days before the rescission (SB 357)
- Requires insurers to provide at least one level (60%, 70%, 80%, or 90% of full actuarial value) of coverage. The insurer shall also offer coverage at that level as child-only coverage (SB 358)
On Wednesday, June 7, the Senate Health Policy and Human Services Committee heard testimony on Senate Bills 356-358. MSMS President, M. Salim U. Siddiqui, MD, PhD, submitted testimony in support of Senate Bills 356 and 357. The following day, MSMS Board Member and Legislative and Regulatory Committee Chair, Michael Redinger, MD, testified in support of House Bills 4619-4623 in the House Insurance and Financial Services Committee. Senate Bills 356-358 subsequently passed the Senate Health Policy and Human Services Committee along party lines on Tuesday, June 12, and House Bills 4619-4623 are scheduled for a hearing in the House Insurance and Financial Services Committee on Tuesday, June 20.
Healthy Michigan Plan Reform: As a result of the Affordable Care Act’s (ACA) Medicaid expansion allowance which passed in 2010, the Michigan Legislature passed Public Act 107 of 2014. This law created the Healthy Michigan Plan (HMP) to expand Medicaid coverage to adults with income up to 138 percent of the Federal Poverty Level. Today, the HMP provides health care coverage to over one million Michigan citizens. While the HMP is exceeding its goals of reducing the state’s tax burden and uninsured/uncompensated care rate, outdated mandates on enrollee cost-sharing and health risk assessments continue to create barriers to accessing coverage and care for our most vulnerable populations. Further, state cost-saving requirements allow future administrations to terminate the HMP if state savings are reduced, placing over one million Michigan citizens at risk of losing health care coverage.
House Bills 4495 and 4496 aim to address these issues by eliminating cost-sharing requirements for HMP enrollees, repealing the HMP termination provisions, and allowing health plans more flexibility in creating benefit packages that improve health outcomes for enrollees. The bills passed the House Health Policy Committee in late May, with Doctor Michael Redinger, MD, testifying in support. On June 13, 2023, they passed the full House with bi-partisan support by an 80-27 margin. The bills now head to the Senate Health Policy and Human Services Committee for consideration.
Sexual Assault Bills: A six-bill House package introduced in response to the Larry Nassar sexual assault case successfully passed the Senate Civil Rights, Judiciary, and Public Safety Committee on Tuesday, June 13, and the following day, passed the full Senate with bi-partisan support
The first bill in the package, HB 4120, would require the distribution of training materials to individuals designated as mandatory reporters for child abuse or child neglect. Two other bills, HB 4121 and HB 4122, deal with enabling the permanent revocation of the license of a person convicted of sexual conduct under the guise of medical treatment. HBs 4123 and 4124 prohibit an individual from intentionally using their professional authority over another person to prevent or attempt to prevent that other person from reporting certain crimes.
Also, on Tuesday, June 13th, a package of Senate bills advanced out of the House Criminal Justice Committee. Senate Bill 66 requires schools to provide students with information regarding sexual assault and harassment and would encourage related professional development for staff. SB 67 prohibits sexual contact under the pretext of medical treatment, and SB 68 provides sentencing guidelines for such violations. The final bill in the package, SB 73, allows people pursuing civil actions alleging sexual misconduct to remain anonymous under the Freedom of Information Act. The bills now await a vote on the House floor.
Update on Key MSMS Priorities: MSMS is continuing to monitor conversations surrounding nurse practitioner (NP) scope expansion legislation, Senate Bill 279, which allows for full independent practice for NPs without additional training or education requirements. We are continuing to lobby in opposition to the bill, as well as actively advocating for the passage of legislation requiring PAs and APRNs to practice as part of a physician-led patient care team and assume specific responsibilities within the scope of their usual professional activities. The bill, House Bill 4472 sponsored by Representative Farhat, requires PAs and APRNs to maintain appropriate collaboration and consultation, as provided under a written practice agreement, with a patient care team physician.
On the telehealth front, MSMS is continuing to encourage passage of House Bill 4131, legislation which requires payers to cover and reimburse telehealth services the same as if the service were provided in person. MSMS has been engaged in conversations with members of the House Insurance and Financial Services Committee to seek support for the bill, as well as other stakeholders. The sponsor of the bill, Representative Tullio Liberati, has also requested a hearing for the bill which MSMS anticipates could happen in the fall.