At first glance, the exercise of examining the Michigan’s legislative “lay of the land” might seem unwarranted headed into 2022. In the middle of a legislative session where both the governorship and the makeup of both the state House and Senate remain unchanged, one might assume a degree of steadiness and stability persists that would render a full examination of the political landscape unnecessary.
Of course, as has been the case in recent years, 2022 will be anything but ordinary.
It starts with COVID-19.
With vaccination rates plateauing, new and concerning variants continuing to emerge, and hospitalization rates seemingly always reaching new peaks, it’s safe to assume the ongoing global pandemic will continue to dominate the legislature’s attention and funding allocation decisions through 2022 and beyond—yet to be allocated federal COVID funding from the American Rescue Plan Act all but guarantees that’s a certainty.
In total, nearly $10 billion in federal relief funds have yet to be appropriated, with Michigan’s legislature having discretion over how to spend approximately $5.7 billion of that total figure.
That is not to suggest there have not been efforts to start allocating these funds. In November of 2021, Governor Whitmer’s budget office called on Michigan’s legislature to approve $2.5 billion in supplement spending, with a large portion of expenditures earmarked for specific COVID relief measures to be financed with American Rescue Plan dollars. More specifically, Governor Whitmer has called for $300 million to bring screening and testing to Michigan’s schools, $367 million for increased testing and contract tracing measures, and an additional $97 million to bolster vaccination rates.
However, officially appropriating those funds will require cooperation from Governor Whitmer – something that’s been especially difficult to come by this legislative cycle. And with the state having until 2024 to spend much of these federal relief funds, coupled with the broad discretion lawmakers have over how the funds are ultimately allocated, there’s a good chance this will be a protracted fight through 2022 and beyond.
Complicating matters further is the fact that the skirmishes over relief funding are taking place in an election year and against the backdrop of changing and uncertain political maps in Michigan.
While election cycles always create an environment of heightened tension and uncertainty, it’s safe to assume those straining conditions will be especially heightened in 2022, the inaugural election year in freshly drawn—and still uncertain—legislative districts.
And it is possible those districts will look dramatically different than they have in years past with a new, independent, citizen-led commission now responsible for drawing Michigan’s congressional and state legislative districts.
Created in 2018 following a voter-approved constitutional amendment, the Michigan Independent Citizens Redistricting Commission is still working through the task of finalizing the political geographic boundaries that will persist for the next 10 years.
That process has been turbulent and uncertain to say the least.
What is certain is that the end result will generate a chaotic 2022 election cycle. Up to half of all seats in the state House and Senate could have new representatives headed into 2023 because of redistricting and term limits, according to analysis conducted by Bridge Magazine. Even more compelling, it’s highly likely a number of incumbent legislators will be pitted against one another in newly drawn districts.
Suffice to say, there will be a lot to contend with outside of the confines of the State House when it comes to engaging with the legislature in the coming year.
MSMS 2021 Accomplishments and 2022 Goals
Despite the unique challenges associated with this legislative term outlined above, the Michigan State Medical Society made great strides on promoting legislative action that’s in the best interest of Michigan’s physicians and they patients they serve. Work continues with MSMS’ most important priorities, including prior authorization reform, scope of practice issues, and telehealth parity, with a great deal of time and effort also devoted to advocating for and against a myriad of other issues that affect Michigan physicians and patients.
Here is a recap of the work the MSMS Government Relations team has done on these issues and where things presently stand at the midpoint of this current legislative session:
Prior Authorization
This past spring, MSMS made significant progress in the fight for prior authorization reform when Senate Bill 247 unanimously passed through the Senate.
If enacted, Senate Bill 247 would bring new transparency, fairness and clinical validity requirements to the prior authorization processes insurers use to bog down patient care, ensuring patients throughout the state receive timely coverage decisions and the care they need.
The bill has since moved on to the House of Representatives for consideration, and MSMS continues to fight hard for its passage. To that end, MSMS hosted a House Lobby Day in October in an effort familiarize House members with the legislation and the need for prior authorization reform. That effort was a great success, generating important support from members on both sides.
Telehealth Parity
To minimize spread and exposure to COVID-19 and preserve continuity of care for the patients they serve, Michigan’s physicians were quick to adopt telehealth medicine at the start of the COVID-19 pandemic, and its widespread adoption has emerged as one of the silver linings of the global pandemic. Telemedicine has proven to be a powerful tool for maintaining safe access to care in a convenient, cost-effective manner.
That transition was made easier by payers initially agreeing to remove some of the regulatory and administrative barriers that had previously limited telehealth use. Unfortunately, those actions have proven to be only temporary, with payers now reverting to pre-pandemic rates.
MSMS and physicians across the state believe that’s the wrong approach and will be calling on the state lawmakers to ensure telehealth serviced remain available and fully covered. Legislation dictating permanent equitable rates is expected to be introduced in the coming weeks.
Feminine Hygiene Product Tax Exemption
For far too long, Michigan women have been subjected to unnecessary and discriminatory sales and use taxes for feminine hygiene products. Thankfully, that will be no longer the case, thanks in part to hard work from MSMS members and staff.
For years now, efforts have been made to repeal the tax on essential menstrual products including tampons. In 2021, those efforts took the form of Senate Bill 153 and House Bill 5267. Both bills were supported by the Michigan State Medical Society, with Doctor Nita Kulkarni—a Flint obstetrician—being an especially instrumental advocate in pushing for their passage. With help from the MSMS Government Affairs Team, Doctor Kulkarni crafted and delivered testimony in support of this critical legislation when the bills were being considered in committee.
“Michigan must move away from viewing these products as a luxury,” said Doctor Kulkarni. “That designation couldn’t be further from the truth. Feminine hygiene products are essential items for maintaining women’s health and wellbeing and they should be treated as such. These taxes are unfair and especially burdensome on lower-income women forced to choose between menstrual supplies and other necessities.”
Those costs are nothing to scoff at according to research conducted by the American Association of University Women of Michigan indicating that the average woman may spend more than $4,800 on menstrual products over the course of a lifetime, including nearly $288 in state sales tax alone.
Thankfully, this critical legislation passed through both chambers and was signed into law by Governor Whitmer on November 5, 2021. The new law will take effect in February 2022.
Filter First
MSMS stands with a broad range of advocacy groups in calling for the passage of Senate Bills 184 and 185—bipartisan legislation first introduced in February 2021 that would provide the funds necessary for Michigan’s schools and daycare centers to install and maintain water filtration systems, ensuring children have access to safe drinking water.
“This is the kind of commonsense legislation everyone should be able to get behind and support,” said Dr. Kulkarni. “Exposure to lead can seriously hamper a child’s health and development, and the unfortunate reality is our children are particularly vulnerable to lead exposure in our schools being that water sits stagnant in pipes during weeks and vacations, diluting the effectiveness of corrosion control chemicals.”
Presently, Michigan relies on the flawed “test and tell” method to monitor for the occurrence of lead in drinking water, which only confirms the presence of lead without preventing or reducing exposure. Bypassing this slow and costly method by simply installing filtered drinking water stations will ensure children are better protected sooner and in a more cost-effective manner.
Senate Bills 184 and 185 were subject to a hearing in the Committee on Environmental Quality on October 26, with testimony largely positive and in favor of the bills. MSMS has and will continue to be supportive of this legislation and urge lawmakers to take action.
Narcan/Substance Use Disorder Treatment
Every year, Michigan endures thousands of needless and tragic overdose deaths. In response to this growing overdose epidemic, MSMS continues to support policies and initiatives to prevent these heartbreaking occurrences.
Introduced in June 2021, House Bill 5163 and Senate Bill 579 would expand the availability of medications for opioid use disorder in emergency departments.
While Senate Bill 579/House Bill 5166 would expand access to naloxone—a lifesaving overdose reversal drug—by allowing community-based organizations to administer it.
“These bills will expand access to care for our patients with substance use disorders. We hope that this additional access will help us to intervene and to save more lives,” said Jayne Courts, MD. “MSMS is pleased to support these bills.”
To that end, MSMS submitted a card of support regarding the Senate Bills to the Senate Health and Human Services Committee on September 9, 2021. The bills have now unanimously passe the Senate and have been sent to the House Committee on Health Policy where they presently await further action.
House Bills 5163 and 5166 have made the opposite journey, passing the House on October 14, 2021 and now await action in the Senate Committee on Health Policy and Human Services.
MSMS will continue to support both bill packages and encourage lawmakers to press forward in the New Year.
Protections for Emergency Room Personnel
Medicine—and emergency medicine in particular—has always been a high-stress undertaking, and that’s okay. That’s just the nature of the job when human lives are on the line.
What is not okay is the added stress that comes with fielding assault and threats of violence while trying to administer life-saving care, which has become a much more common occurrence in a COVID-19 world marred by heightened fear and anxiety.
To battle back against that reality—and protect the brave, hard-working health care providers working to provide critical, quality care—the Michigan Statement Medical Society supports House Bill 5084—legislation that expands the crime of assaulting a person performing certain job-related duties to include emergency room personnel.
The legislation was born out of a call coordinated by MSMS with Representative Ben Frederick and several front-line physicians during the height of the pandemic. After hearing the harrowing accounts from these physicians, Representative Frederick agreed that emergency room personnel should not face extra threat and stress while undertaking their duties and acted to introduce this legislation.
House Bill 5084 has been referred to the House Committee on Government Operations where it awaits further action.
Behavioral Health Integration
MSMS is always seeking ways to make life better for the patients our member physicians serve, and for decades now, there has been an obvious opportunity on the table to do just in Michigan by integrating state payments for behavioral health services with Medicaid physical health services.
Thankfully, there is once again a fresh opportunity to achieve behavioral health integration in Michigan in the form of Senate Bills 597 and 598 and House Bills 4925-4929.
Introduced by Senate Majority Leader Mike Shirkey, Senate Bills 597 and 598 would formally and fully integrate Medicaid’s physical and behavioral health services.
“Our system can and must be patient-centered and outcome-based, said Senate Majority Leader Shirkey. “The trauma suffered during the COVID-19 pandemic magnified and amplified the weaknesses in our current mental health system. The science shows when mental health and physical care are addressed and evaluated together, it leads to better outcomes for both.”
On the other side of the legislature, the House package sponsored by Representative Mary Whiteford simplifies and streamlines the administrative burden associated with the state’s mental health system by creating one single oversight entity.
“Michigan will save an estimated $300 million in administrative costs by making this change,” said Representative Whiteford. “These savings will go directly to provide more services to our neighbors, family and friends in need of behavioral health care.”
MSMS has been a vocal participant in the development of these legislative packages and has played a critical role shaping and improving these bills throughout the process, stressing the key role primary care plays in the delivery of efficient, effective, and coordinated behavioral health services.
On the Senate side, the Senate Committee on Government Operations reported the bills favorably and they now await action by the full Senate. While the House continues to gather stakeholders’ comments in an effort to improve the package. A hearing has yet to scheduled.
CME Requirements for Lead Poisoning Identification and Treatment
House Bill 5414 is legislation MSMS opposes that would mandate licensed medical professionals to take Continuing Medical Education (CME) courses on lead poisoning identification and treatment as a condition of license renewal, focusing on screening and treatment needs of children six years old and under.
While there’s no question that it’s important for a particular subset of health care providers to be able identify and treat lead poisoning, compulsory continuing education for all licensed medical professional is not the way to ensure our children our kept safe. Although MSMS supports early and periodic screening and diagnosis and treatment program, the organization opposes all attempts to introduce compulsory content of mandated CME in the state of Michigan. Ultimately, the bill is a one-size-fits-all approach that would require even specialties that do not treat children to receive the training.
HB 5414 currently resides in the House Health Policy Committee.
E-Prescribing
The date by which Michigan prescribers will be required to electronically transmit all prescriptions for controlled and non-controlled substances has been pushed to January 1, 2023, to align with Medicare’s extended enforcement date.
Federal and state statute allow for a waiver to be issued if a prescriber cannot meet the electronic prescribing requirements under the respective governing laws. Rules promulgated by the Michigan Department of Licensing and Regulatory Affairs (LARA) addressing the process for obtaining a waiver and the related eligibility criteria are expected to be finalized by the end of 2021. MSMS actively participated in the public comment process, submitting a letter on LARA’s proposed rules which included several suggested changes that LARA incorporated.
Medicare’s electronic prescribing waiver process was included in the 2022 Medicare Physician Fee Schedule, which was finalized in November.
It has been an exciting and successful legislative session thus far for MSMS, but much like the member physicians we serve, our good work is never complete. With consistent, hard work, we are hopeful that 2022 brings more positive change for Michigan’s physicians and the patients they serve.
