An index organized by bills that passed, bills that did not pass and bills that were vetoed

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3 Leading Healthcare The Michigan Health & Hospital Association s Legislative Session in Review provides a brief summary and status update for bills considered in the legislative session that had the potential to impact hospitals and the patients they serve. In this document, you will find: An index organized by bills that passed, bills that did not pass and bills that were vetoed A numerical (by bill number) list of bills that were passed by the House and Senate and signed into law by the governor. Each entry has the bill s number (e.g., HB 4567, SB 123), title, summary, MHA position, date of passage and new public act number A numerical (by bill number) list of bills that were not passed by either the House and/or the Senate. Each entry has the bill s number (e.g., HB 4567, SB 123), title, summary and MHA position A numerical (by bill number) list of bills vetoed by the governor. Each entry has the bill s number e.g., HB 4567, SB 123), title, summary and MHA position A section about Michigan s Certificate of Need program Contact information for MHA Advocacy staff During the legislative session, the MHA and member hospitals were very successful with advocacy efforts, which frequently included efforts to prevent the introduction of legislation disadvantageous to Michigan hospitals and healthcare providers. In an era of budget shortages, the state s Medicaid program did not experience cuts to rates or eligible populations. In addition, most of the significant healthcare bills supported by the MHA were signed into law, while the vast majority of bills the association opposed died in committee. Several notable successes included passage of the Health Insurance Claims Assessment (HICA) until 2020 and the protection of $163 million in funds used by Michigan s Medicaid program to support medical residency. Two other significant funding pools which were protected are a $34 mil ($12 mil GF) small and rural hospital access pool and an $11.8 mil ($3.4 mil GF) obstetrics (OB) stabilization fund for small hospitals providing labor and delivery services. Lastly, numerous bills were amended to reduce the regulatory burden on Michigan hospitals.

4 Table of Contents Please contact a member of the MHA Advocacy team with any questions about the bills, MHA positions or potential for reintroduction of bills in the current legislative session. BILLS THAT PASSED SB 25: Medical Research in TEDF...1 SB 352: SB 468: SB 592: SB 647: SB 753: SB 957: SB 1104: AARP Care Act...1 Pharmacy Technicians Licensure Fix...1 Gift of Life Surgical Center...1 CPR Educational Mandate...1 Telehealth Consent...1 State Retention Modification for Quality Assurance Assessment Program (QAAP)... 2 Medical Liability...2 HB 4423: Speed Limit Restrictions...2 HB 4598: Licensing of Midwives...2 HB 4674: Kevin s Law...2 HB 4843: Minor Drug Offense Exemption...2 HB 4934: Coordination of Benefits Act...3 HB 5105: HICA Extension...3 HB 5400: Advanced Practice Registered Nurses (APRNs)...3 HB 5877: Pyxis Machine Licensing Error Fix...3 BILLS THAT DID NOT PASS SB 4: SB 143: SB 147: SB 212: SB 231: SB 248: SB 288: SB 442: Michigan Religious Freedom Restoration Act...4 Breast Milk Bank Regulation...4 Hospital Chargemaster Transparency...4 Licensing of Genetic Counselors...4 E-cigarette Sales to Minors...4 Auto No-fault Reform...4 Low-cost Auto No-fault (D Insurance)...4 Concealed Carry in Hospitals...5 SB 527: Motorcycle Helmets...5 SB 574: SB 590: SB 608: Nurse Staffing Ratios...5 All Payer Claims Database...5 Physician Maintenance of Certification (Reimbursement)...6 SB 609: SB 741: SB 769: SB 960: SB 1019: SB 1128: Physician Maintenance of Certification (Admitting Privileges)...6 CON Dental CT...5 MAPS Reporting...6 Charitable Property Tax Exemption...6 CRNA Opt Out...6 CON Cone-beam Tomography...6 HB 4206: Breast Milk Bank Regulation...6 HB 4224: Auto No-fault Assigned Claims Changes... 6 HB 4309: Conscientious Objector...6 HB 4431: E-cigarette Child-proof Containers...7 HB 4560: MCCA Road Funding Fix...7 HB 4728: Eliminate CON...7 HB 4812: Biological Drugs...7 HB 5013: Nurse Staffing Ratios...7 HB 5200: Pistol-free Zones...7 HB 5394: Early Primary Care Pilot Program...8 HB 5479, 5480, 5481 & 5482: POLST Package...8 HB 5587: Pharmacist Right to Refuse...8 HB 5592 & 5593: Healthcare Professional Violence...8 HB 5783: Licensing of Genetic Counselors...8 BILLS THAT WERE VETOED SB 987, 988, 989 & 990: HICA Alternative Package...9 CERTIFICATE OF NEED Overview of the Program...10 MHA Position Statement...11 MHA ADVOCACY STAFF...12

5 Bills That Passed SB 25: Medical Research in TEDF This law adds medical research and medical care as targeted industries for the Transportation Economic Development Fund (TEDF). Status: Effective Jan. 9, 2017 (Public Act 500 of 2016) SB 352: AARP Care Act This law creates the designated caregiver act, which would require hospitals, before a patient was discharged, to consult with a designated caregiver, issue a discharge plan describing the patient s after-care assistance needs, and give the caregiver instruction in all tasks described in the plan. MHA Position: Amendments Adopted Status: Effective July 12, 2016 (Public Act 85 of 2016) SB 468: Pharmacy Technicians Licensure Fix This law is a legislative fix to extend the compliance deadline for pharmacies in Public Act 280 of 2014 to Sept. 30, Status: Effective Sept., 2015 (Public Act 133 of 2015) SB 592: Gift of Life Surgical Center This law expands the facilities in which the surgical removal of a human organ may be performed. MHA Position: Neutral Status: Effective April 5, 2016 (Public Act 71 of 2016) SB 647: CPR Educational Mandate This law requires all students be provided instruction in cardiopulmonary resuscitation (CPR) and automated external defibrillators (AEDs) before receiving a high school diploma. Status: Effective March 29, 2017 (Public Act 388 of 2016) SB 753: Telehealth Consent This law prohibits a health professional from providing a telehealth service without first obtaining a patient s consent. (in concept) Status: Effective March 29, 2017 (Public Act 359 of 2016) -1-

6 Bills That Passed SB 957: State Retention Modification for Quality Assurance Assessment Program (QAAP) This law replaces the $93 million state retention in fiscal year with a new retention of $105 million in fiscal year and beyond. Status: Effective June 21, 2016 (Public Act 189 of 2016) SB 1104: Medical Liability This law limits economic damages for medical or healthcare expenses to the amount actually paid by or on behalf of the claimant. Status: Effective April 10, 2017 (Public Act 556 of 2016) HB 4423: Speed Limit Restrictions This law allows state or local authorities to decrease the speed limit in a hospital highway zone by up to 10 miles per hour upon the request of the hospital. Status: Effective Jan. 5, 2017 (Public Act 445 of 2016) HB 4447: Nursing Home QAAP This law extends the sunset on the Nursing Home Quality Assurance Assessment Program (QAAP). Status: Effective Oct.1, 2015 (Public Act 104 of 2015) HB 4598: Licensing of Midwives This law provides for the licensing and regulation of midwives. MHA Position: Amendments Adopted Status: Effective April 4, 2017 (Public Act 417 of 2016) HB 4674: Kevin s Law This law modifies the Mental Health Code s assisted outpatient treatment program to allow friends and community mental healthcare providers to petition the probate court to mandate appropriate outpatient mental healthcare before a serious incident occurs. Status: Effective Feb. 14, 2017 (Public Act 320 of 2016) HB 4843: Minor Drug Offense Exemption This law allows Good Samaritan exemption from criminal penalties for certain drug offenses for minors who present themselves or another person for medical assistance for a prescription drug overdose. (in concept) Status: Effective March 15, 2016 (Public Act 220 of 2015) -2-

7 Bills That Passed HB 4934: Coordination of Benefits Act This law provides for a uniform order of benefits determination under which health insurance plans pay claims. MHA Position: Neutral Status: Effective July 1, 2016 (Public Act 275 of 2016) HB 5105: HICA Extension This bill extends the Health Insurance Claims Assessment (HICA) until Status: Effective March 15, 2016 (Public Act 50 of 2016) HB 5400: Advanced Practice Registered Nurses (APRNs) This law allows APRNs to prescribe and administer pharmacological and nonpharmacological treatments within the parameters of their specialty role. Status: Effective April 9, 2017 (Public Act 499 of 2016) HB 5877: Pyxis Machine Licensing Error Fix This law allows a pharmacy that is owned and operated by a hospital to operate an automated dispensing device in another location affiliated with the hospital. Status: Effective April 9, 2017 (Public Act 528 of 2016) -3-

8 Bills That Did Not Pass SB 4: Michigan Religious Freedom Restoration Act This bill would have allowed for the refusal of services and other actions that act against a citizen s rights if an individual claims that working with or for that citizen would violate his/her religious freedom. Status: Died in Senate Judiciary SB 143: Breast Milk Bank Regulation This bill would have regulated human breast milk banks, companies and cooperatives. MHA Position: Neutral SB 147: Hospital Chargemaster Transparency This bill would have required hospitals to post charge description master on their websites. (in concept) SB 212: Licensing of Genetic Counselors This bill would have required licensing of genetic counselors. SB 231: E-cigarette Sales to Minors This bill would have prohibited the sale of electronic cigarettes or any other oral device that provides vapor nicotine to minors. Status: Died in House Regulatory Reform SB 248: Auto No-fault Reform This bill would have reformed the current auto no-fault law with a provider rate set at 150 percent of Medicare, fraud and abuse provisions, a new catastrophic claims mechanism and a cap on attendant care. Status: Died on the House floor SB 288: Low-cost Auto No-fault (D Insurance) This bill would have provided a low-cost automobile insurance program. Status: Died on the Senate floor -4-

9 Bills That Did Not Pass SB 442: Concealed Carry in Hospitals This bill would have allowed concealed carrying of firearms in hospitals. Status: Died on the Senate floor SB 527: Motorcycle Helmets This bill would have required motorists to wear helmets while operating a motorcycle. Status: Died in Senate Transportation SB 574: Nurse Staffing Ratios This bill would have required development of an acuity system and staffing plan for nurses. SB 590: All-Payer Claims Database This bill would have required health carriers to submit data on the cost of healthcare services rendered by health providers. MHA Position: N/A SB 608: Physician Maintenance of Certification (Reimbursement) This bill would have prohibited insurers or health maintenance organizations from requiring physicians to hold certain certification before paying or reimbursing claims (other than licensure). MHA Position: No position SB 609: Physician Maintenance of Certification (Admitting Privileges) This bill would have prohibited continuing certification requirements for physicians as a basis for license renewal or for hospital admitting privileges. (as introduced) SB 741: CON Dental CT This bill would have eliminated use of cone-beam dental imaging equipment from the certificate of need definition of a covered clinical service. Status: Died on the Senate floor -5-

10 Bills That Did Not Pass SB 769: MAPS Reporting This bill would have required running a Michigan Automated Prescription System (MAPS) report before prescribing or dispending schedule II-V controlled substances to a patient. MHA Position: Neutral SB 960: Charitable Property Tax Exemption This bill would have clarified the definition of a nonprofit charitable institution. (in concept) Status: Died on the Senate floor SB 1019: CRNA Opt Out This bill would have allowed flexibility in choosing anesthesia delivery models by allowing certified registered nurse anesthetists (CRNAs) to provide certain anesthesia services as independent providers. Status: Died in House Health Policy SB 1128: CON Cone-beam Tomography This bill would have eliminated use of cone-beam tomography equipment from the certificate of need (CON) definition of a covered clinical service. HB 4206: Breast Milk Bank Regulation This bill would have regulated human breast milk banks, companies and cooperatives. MHA Position: Neutral Status: Died on House floor HB 4224: Auto No-fault Assigned Claims Changes This bill would have moved a large portion of no-fault claims to the Michigan Assigned Claims Plan and puts a $275,000 cap on benefits for those claims. Status: Died on House floor HB 4309: Conscientious Objector This bill would have allowed healthcare payers, facilities and providers the right to decline to provide or pay for certain healthcare services that violate ethical, moral or religious principles or beliefs. Status: Died in House Health Policy -6

11 Bills That Did Not Pass HB 4431: E-cigarette Child-proof Containers This bill would have prohibited the sale of electronic cigarettes or any other oral device that provides vapor nicotine to minors and requires liquid nicotine to be sold in child-resistant containers. Status: Died in House Regulatory Reform HB 4560: MCCA Road Funding Fix This bill would have allowed funds held by the Michigan Catastrophic Claims Association (MCCA) to be appropriated for highway purposes. Status: Died in House Insurance HB 4583: Interstate Medical Licensure Compact This bill would have provided an expedited pathway for qualified physicians to obtain licenses to practice in multiple states. HB 4728: Eliminate CON This bill would have eliminated the requirement to obtain certificate of need (CON). Status: Died in House Health Policy HB 4812: Biological Drugs This bill would have allowed pharmacists to dispense FDA-designated interchangeable biological drug products. Status: Died on Senate floor HB 5013: Nurse Staffing Ratios This bill would have required development of an acuity system and staffing plan for nurses. Status: Died in House Regulatory Reform HB 5200: Pistol-free Zones This bill would have eliminated pistol-free zones. MHA Position: N/A Status: Died in House Judiciary -7-

12 Bills That Did Not Pass HB 5394: Early Primary Care Pilot Program This bill would have created an early primary care program to place physicians with one year of residency in medically underserved areas. MHA Position: N/A Status: Died in House Health Policy HB 5479, 5480, 5481 & 5482: POLST Package These bills would have revised guidelines surrounding Physician Orders for Life-Sustaining Treatment (POLST). Status: Died on House floor HB 5587: Pharmacist Right to Refuse This bill would have allowed a pharmacist to refuse to dispense a prescription for a controlled substance if there was reason to believe the prescription was not written in good faith or would not be used for legitimate medical purposes. MHA Position: N/A Status: Died in House Health Policy HB 5592 & 5593: Healthcare Professional Violence This bill would have increased penalties for assaulting certain healthcare professionals. Status: Died in House Criminal Justice HB 5783: Licensing of Genetic Counselors This bill would have required licensing of genetic counselors. Status: Died in House Health Policy -8-

13 Bills That Were Vetoed SB 987, 988, 989 & 990: HICA Alternative Package These bills would have created a new version of the Medicaid managed care use tax and changes the Health Care Claims Assessment (HICA) sunset from July 1, 2020, to Jan. 1, MHA Position: Neutral Status: Vetoed by governor Oct. 27,

14 Certificate of Need Overview of Program Certificate of Need (CON) is a state regulatory program intended to balance cost, quality and access issues and to ensure that only needed services and facilities are developed in Michigan. An entity (health facility, physician, group practice, etc.) proposing any of the following types of projects must obtain a CON, regardless of the capital expenditure proposed: Increase in the number of licensed beds or the relocation of licensed beds from one site to another Acquisition of an existing health facility or operation of a new health facility Initiation, replacement or expansion of covered clinical services Short-term nursing care program (swing beds) Any capital expenditure project (construction, renovation, etc.) that involves a health facility The capital expenditure threshold is indexed annually by the Michigan Department of Health & Human Services based on the consumer price index. The current threshold, effective Jan. 1, 2017, is $3,187,500 for clinical service areas. Determinations of whether a project requires CON approval, whether a project complies with applicable requirements, or whether other requirements apply must be obtained in writing from the Michigan Department of Health & Human Services. For more information about how to file a certificate of need application, necessary forms, standard for covered clinical services, contact and meeting information for the state CON Commission, and a listing on CON activity, visit or contact the Michigan Department of Health & Human Services CON Division at (517)

15 Certificate of Need MHA Position Statement on Certificate of Need (Adopted by the MHA Board of Trustees April 8, 2015) The Michigan Health & Hospital Association supports Michigan s Certificate of Need program as a means of maintaining access to cost effective, high-quality care for all of Michigan s residents while restraining the proliferation of unnecessary facilities and services. In furtherance of this position, the association shall: Support CON policy that recognizes and preserves access to a full continuum of high-quality, evidence-based and cost-effective healthcare services for all of Michigan s residents; Support a fair and open process to amend CON standards when appropriate to reflect current standards of care and technological advancements; Advocate working within the Commission s process to amend the CON standards rather than pursuing legislative determinations for individual healthcare projects or services regulated by the CON program; Within the CON Commission process, when instances of member conflict regarding any given CON standard or proposed regulation arise, the association shall remain neutral but shall advocate for a fair and open process; In instances of member conflict arising from a member s pursuit of CON legislation, the association shall engage in advocacy consistent with the principles outlined in this Position Statement but will not advocate against a member; The association shall support preservation of the CON program. -11-

16 Legislative Session in Review MHA Advocacy Staff Brian Peters Chief Executive Officer David Seaman Executive Vice President and Chief Operating Officer Chris Mitchell Senior Vice President, Advocacy (517) Laura Appel Senior Vice President and Chief Innovation Officer (517) Amy Barkholz General Counsel (517) Stacy Dowdy Director, Health PAC & Grassroots Advocacy (517) Paige Fults Director, Advocacy (517) Dillon McGough Director, Government Relations (517) Michigan Health & Hospital Association Capitol Advocacy Center 110 West Michigan Avenue, Suite 1200 Lansing, MI (517)