Nov. 7 House HPOL Agenda: licenses, health data center, spending the provider tax, regulate, subsidize

They're back! 

And they brought their friends.

You should tell your friends, and even things up a little between the people and the special interests.

Thursday, November 14, 2024     10:30 AM

AGENDA:

HB 5636 (Rep. Pohutsky) Health facilities; birthing centers; licensing for freestanding birth centers; provide for.

SB 668 (Sen. Hertel) Health occupations; physical therapists; prescription requirement for physical therapy treatment; eliminate, and make other modifications to the practice of physical therapy.

HB 4833 (Rep. Puri) Health; substance use disorder treatment; licensure for substance use disorder service program; modify.

HB 5283 (Rep. Rogers) Records; health; health information exchange for certain entities and data; require health information technology commission to designate.

HB 5284 (Rep. VanderWall) Insurance; other; allocation of revenue under the insurance provider assessment act; modify.

HB 5616 (Rep. Steckloff) Health; pharmaceuticals; allow patients to take unused portion of eye drops or eye ointments after certain procedures for continued patient care; provide for.

HB 5178 (Rep. Rheingans) Health; other; syringe service programs; provide for.

HB 5371 (Rep. Brabec) Human services; medical services; certified community behavioral health clinics; provide certification and funding for.

HB 5372 (Rep. Phil Green) Human services; medical services; certified community behavioral health clinics; provide certification and funding for.

For Re-Referral
HB 5904 (Rep. Paiz) Consumer protection; vehicle leases; requirements for a vehicle lease on the death of the individual leasing the vehicle; provide for.

OR ANY BUSINESS PROPERLY BEFORE THIS COMMITTEE

At least two midwives, owners of birth centers, oppose HB 5636.

One of them says,

“It will not increase healthcare freedom for families and as a midwife and birth center owner in Michigan I feel as though this bill will most likely put most of the states freestanding birth centers out of business.

It is being championed by a group of CNMs who are unwilling to serve families without insurance reimbursement first. They are trying to legislate the entire state to achieve their agenda to have their new birth center covered by insurance.

If we look at other states with licensure we can see that they have less freestanding birth centers. It will also limit who we can serve as midwives, no breech, twins or post dates past 42 weeks. Call your legislator to oppose this bill or attend this hearing to voice your opposition and concerns.”

My reading of the bill shows 9 pages of new regulation. Bold text indicates proposed new language; it begins on page 18. It appears to be written as a wish list entirely structured around Detroit interests.

Not only do bill provisions completely justify the midwife’s concerns for birth centers in the rest of the state, they also insert woke SDOH and promises impossible for law to deliver in Detroit or anywhere else. 

And of course, there are the lobbies and their claims. It's like deja vu - two years ago, I wrote about similar promises in "Of Castles and Healthcare Licensing."

House Bill 5283 would instate a nonprofit entity to handle all of Michigan's health information. This system would be used to transfer information from public health service to public health service, such as school health-clinics, social service clinics or correctional facilities. Further, its future intended use it to build a stronger "healthcare ecosystem" of communication between community healthcare and corporate entities such as hospitals, physicians, payers, employers, pharmacies and laboratories.

The system would also be used to assemble and report on public health statistics at the state level. 

"In meeting its current responsibility to identify strategies to improve the ability to monitor community health status, use reporting and analytics from electronic health data from the health data utility."

It remains to be seen how effective this central database will be for communication in the state of Michigan. My firsthand experience as a healthcare worker interacting with documentation in a central database has been one riddled with errors and extremely time consuming, which does not effectively address the needs of the patient. 

House Bill 5283 would amend Part 25 (Health Information Technology) of the Public Health Code, which created the Health Information Technology Commission in DHHS to facilitate and promote the design, implementation, operation, and maintenance of an interoperable health care information system in Michigan. The bill would change the name of this system to the health data utility and would require the commission to designate a health information exchange to operate the health data utility for the state.

Health data utility would mean a system that is operated by the health information exchange and that does all of the following:
• Facilitates the exchange of clinical and other health data.
• Creates a unified health record for health care patients.
• Allows for the exchange of information using multiple modalities, including query searches and push notifications.
• Increases connections between health care entities, including school-based health centers, social care services, and health facilities or agencies located in a correctional institution

Health information exchange would mean the nonprofit entity that operates an inclusive health information technology infrastructure that serves as a health data aggregator and is enabled to collect, normalize, and share disparate health data content from a diverse set of health data sources.

The commission would have to designate a health information exchange that meets all of the following requirements:
• Is capable of performing all of the following:
o Routing relevant real-time data.
o Providing longitudinal electronic health records.
o Reporting population health data and public health data.
o Delivering health analytics and metrics in the aggregate.

• Complies with all applicable federal and state laws and regulations for a standards based health data exchange.

• Has a governing board with representatives that meet one or more of the following:
o Have expertise in public health.
o Are associated with a governmental agency, hospital, health plan, or pharmacy.
o Are physicians, behavioral health practitioners, or other health care professionals.

• Maintains a high level of cybersecurity standards, which could be demonstrated by accreditation by a national health information security entity recognized by the commission as an accreditation that requires a high level of cybersecurity standards.

• Adheres to health information exchange industry standards for network performance.

The commission also would have to do all of the following, in addition to (or as modification of) its duties provided under the act:

• In meeting its current responsibility to identify critical technical, scientific, economic, and other critical issues affecting the public and private adoption of health information technology, include all of the following regarding the health information exchange:

o Participation with the health information exchange.
o Data sharing through the health information exchange.
o Utilization of the health data utility.

• Monitor the health information exchange by doing all of the following:
o Performing a quarterly review of key operational and performance metrics.
o Reviewing privacy and consent policies as needed.
o Approving secondary data use in compliance with the federal Health Insurance Portability and Accountability Act (HIPAA), including secondary data use for research.

• Instead of (as now) promoting more efficient communication among multiple health care providers, do so with regard to communication in the health care ecosystem, which would include community-based organizations in addition to such health care entities as hospitals, physicians, payers, employers, pharmacies, and laboratories.

• In meeting its current responsibility to identify strategies to improve the ability to monitor community health status, use reporting and analytics from electronic health data from the health data utility.

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• Perform all other activities to implement its responsibilities under the act as directed by any state department. (This provision currently specifies DHHS and the Department of Management, Budget, and Technology.)

Finally, the bill would allow the Healthcare Information Technology and Infrastructure Development Fund, which is administered by the commission, to be used for the designated health information exchange to operate the health data utility.

House Bill 5284 is a closely related Bill to 5283, but instead focuses on the funding for this new program. This bill would alot .5% of DHHS revenue or 3.1 million dollars to the new information exchange for the next year. Then in 2024-25, an additional 10 million dollars per year will be levied on top of that, and the cost will rise by 3% per year. It would be a very good time to be hired on to this project.

House Bill 5284 would amend the Insurance Provider Assessment Act to provide an earmark for administration and compliance, and the operations, of the health information exchange designated under House Bill 5283. Currently, DHHS must expend money from the fund, upon appropriation, only for one or more of the following purposes:
• The amount necessary to continue to support the payment of actuarially sound capitation rates to Medicaid managed care organizations.
• Administrative and compliance costs in accordance with section 15.
• The balance after the above to be transferred to a separate restricted account in the fund and used only as appropriated by the legislature.

Under the bill, DHHS would have to expend the money, upon appropriation, only for one or more of the following purposes:
• The amount necessary to continue to support the payment of actuarially sound capitation rates to Medicaid managed care organizations.
• Administrative and compliance costs in accordance with section 15.
• Beginning in the 2023-24 state fiscal year, and each fiscal year thereafter, to appropriate up to 0.5% of the money received from assessments levied under the act in the 2023-24 state fiscal year to DHHS for administration and compliance of the health information exchange designated under House Bill 5283.
• Beginning in the 2024-25 state fiscal year, $10.0 million, and an additional 3% each state fiscal year thereafter, to be appropriated for the operations of the health information exchange designated under House Bill 5283.
• The balance after the above to be transferred to a separate restricted account in the fund and used only as appropriated by the legislature.

FISCAL IMPACT:
House Bills 5283 and 5284 would increase GF/GP needed as the state share of Medicaid by $3.1 million in Fiscal Year 2023-24, $13.1 million in FY 2024-25, and $13.4 million in FY 2025-26. The earmark of 0.5% for administration and compliance of the health information exchange would repurpose $3.1 million of IPA revenue and $10.0 million for operations of the health information exchange would mean those funds would be repurposed from being used for the state share of Medicaid costs. For FY 2023-24, the federal Medicaid match rate is 64.94% and the state share of Medicaid is 35.06%. These bills would have no fiscal impact on local units of government.

Most recent action.

Apparently no floor votes yet.

Thursday, December 5, 2024     10:30 AM

AGENDA:

HB 5964 (Rep. Conlin) Health occupations; physicians; interstate medical licensure compact; remove sunset.

HB 5938 (Rep. MacDonell) Insurance; health insurers; methods of payments and reimbursements for dental benefits; provide for.

HB 5283 (Rep. Rogers) Records; health; health information exchange for certain entities and data; require health information technology commission to designate.

HB 5284 (Rep. VanderWall) Insurance; other; allocation of revenue under the insurance provider assessment act; modify.

SB 668 (Sen. Hertel) Health occupations; physical therapists; prescription requirement for physical therapy treatment; eliminate, and make other modifications to the practice of physical therapy.

HB 5636 (Rep. Pohutsky) Health facilities; birthing centers; licensing for freestanding birth centers; provide for.

HB 4833 (Rep. Puri) Health; substance use disorder treatment; licensure for substance use disorder service program; modify.

HB 5616 (Rep. Steckloff) Health; pharmaceuticals; allow patients to take unused portion of eye drops or eye ointments after certain procedures for continued patient care; provide for.

HB 5178 (Rep. Rheingans) Health; other; syringe service programs; provide for.

HB 5371 (Rep. Brabec) Human services; medical services; certified community behavioral health clinics; provide certification and funding for.

HB 5372 (Rep. Phil Green) Human services; medical services; certified community behavioral health clinics; provide certification and funding for.

HB 5785 (Rep. Brabec) Health occupations; psychologists; requirements for practice by limited licensed psychologist; modify.

RE-REFERRAL:
HB 5904 (Rep. Paiz) Consumer protection; vehicle leases; requirements for a vehicle lease on the death of the individual leasing the vehicle; provide for.

OR ANY BUSINESS PROPERLY BEFORE THIS COMMITTEE