Bill Summary – FastDemocracy

HOUSE BILL NO. 4893
     July 18, 2023, Introduced by Reps. Rheingans, Wegela, Tsernoglou, Brabec, Neeley, Edwards,
        Dievendorf, Price, Morgan, Young, O'Neal, McKinney, Pohutsky, Weiss, Hope, Stone, Byrnes,
        Hoskins, Wilson, McFall, MacDonell, Paiz and Aiyash and referred to the Committee on
        Insurance and Financial Services.
          A bill to provide for the establishment of a universal and
    unified health care system and to reform the current payment system
    for health care coverage in this state; to create certain boards
    and committees and prescribe their powers and duties; to provide
    for the powers and duties of certain state and local governmental
    officers and agencies; to establish a fund; to provide for the
    promulgation of rules; and to prescribe penalties and provide
    remedies.
                     THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
                                          CHAPTER 1
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       Sec. 101. This act may be cited as the "MIcare act".
       Sec. 102. As used in this act:
       (a) "Ambulance" means that term as defined in section 20902 of
 the public health code, 1978 PA 368, MCL 333.20902.
       (b) "Board" means the MIcare board created in section 302.
       (c) "Department" means the department of health and human
 services.
       (d) "Director" means the director of the department or his or
 her designee.
       Sec. 103. As used in this act:
       (a) "Exchange" means that term as defined in section 1261 of
 the insurance code of 1956, 1956 PA 218, MCL 500.1261.
       (b) "Federal act" means the federal patient protection and
 affordable care act, Public Law 111-148, as amended by the federal
 health care and education reconciliation act of 2010, Public Law
 111-152, and any regulations promulgated under those acts.
       (c) "Fund" means the MIcare fund created in section 410.
       Sec. 104. As used in this act:
       (a) "Health carrier" means any of the following entities that
 are subject to the insurance laws and regulations of this state or
 otherwise subject to the jurisdiction of the director of the
 department of insurance and financial services:
       (i) A health insurer operating under the insurance code of
 1956, 1956 PA 218, MCL 500.100 to 500.8302.
       (ii) A health maintenance organization operating under the
 insurance code of 1956, 1956 PA 218, MCL 500.100 to 500.8302.
       (iii) A health care corporation operating under the nonprofit
 health care corporation reform act of 1980, 1980 PA 350, MCL
 550.1101 to 550.1704.
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       (iv) A nonprofit dental care corporation operating under 1963
 PA 125, MCL 550.351 to 550.373.
       (v) Any other entity providing a plan of health insurance,
 health benefits, or health services.
       (b) "Health care professional" means an individual,
 partnership, corporation, facility, or institution licensed,
 registered, certified, or otherwise authorized by state law to
 provide professional health services.
       (c) "Health care system" means the local, state, regional, or
 national system of delivering health services, including
 administrative costs, capital expenditures, preventive care, and
 wellness services.
       (d) "Health service" means any treatment or procedure
 delivered by a health care professional to maintain an individual's
 physical or mental health or to diagnose or treat an individual's
 physical or mental health condition, including services ordered by
 a health care professional for chronic care management, preventive
 care, wellness services, and medically necessary services to assist
 in activities of daily living.
       (e) "Hospice" means that term as defined in section 20106 of
 the public health code, 1978 PA 368, MCL 333.20106.
       (f) "Hospital" means any of the following:
       (i) That term as defined in section 20106 of the public health
 code, 1978 PA 368, MCL 333.20106.
       (ii) A hospital located outside of this state.
       (iii) That term as defined in section 100b of the mental health
 code, 1974 PA 258, MCL 330.1100b.
       (g) "Integrated delivery system" means a group of health care
 professionals, associated either through employment by a single
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 entity or through a contractual arrangement, that provides health
 services for a defined population of patients.
       Sec. 105. As used in this act:
       (a) "Manufacturers of prescribed products" means any of the
 following:
       (i) A manufacturer as defined in section 17706 of the public
 health code, 1978 PA 368, MCL 333.17706.
       (ii) A caregiver as defined in section 3 of the Michigan
 Medical Marihuana Act, 2008 IL 1, MCL 333.26423.
       (iii) A person that holds a license as a grower, processor,
 provisioning center, or safety compliance facility under the
 medical marihuana facilities licensing act, 2016 PA 281, MCL
 333.27101 to 333.27801.
       (b) "Medicaid" means that term as defined in section 3801 of
 the insurance code of 1956, 1956 PA 218, MCL 500.3801.
       (c) "Medicare" means that term as defined in section 3801 of
 the insurance code of 1956, 1956 PA 218, MCL 500.3801.
       (d) "MIcare" means the universal health care system
 established under this act and designed to provide health care
 coverage through a simplified, public administrative system and
 single claims payment system.
       (e) "MIChild" means the state child health plan in this state
 under title XXI of the social security act, 42 USC 1397aa to
 1397mm.
       (f) "Treatment of autism spectrum disorders" means that term
 as defined in section 3 of the autism coverage reimbursement act,
 2012 PA 101, MCL 550.1833.
       Sec. 107. (1) The director shall coordinate health care system
 reform efforts among executive branch agencies, departments, and
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 offices and shall coordinate with the board.
       (2) The director shall ensure that executive branch agencies,
 departments, and offices responsible for the development,
 improvement, and implementation of this state's health care system
 reform do so in a manner that is coordinated, timely, equitable,
 patient-centered, and evidence-based and that seeks to inform and
 improve the quality of patient care and public health, contain
 costs, and attract and retain well-paying jobs in this state.
       (3) The director shall provide information and testimony on
 the efforts under this act to the senate and house of
 representatives standing committees on health issues on request.
                               CHAPTER 2
       Sec. 201. (1) The health care reform efforts under this act
 must include simplified administration processes and delivery
 reform in order to have a publicly financed and publicly
 administered program of universal and unified health care
 operational after the occurrence of specific events, including the
 receipt of a waiver from the federal health benefit exchange
 requirement from the United States Department of Health and Human
 Services.
       (2) In order to begin the planning efforts, the director shall
 establish a strategic plan that includes time lines and allocations
 of the responsibilities associated with health care system reform,
 to improve health outcomes, to further this state's existing health
 care system reform efforts, and to further all of the requirements
 of this section.
       Sec. 202. (1) As provided in chapter 4, all residents of this
 state are eligible for MIcare, a universal health care program that
 will provide health care coverage through a single payment system.
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 To the maximum extent allowable under federal law and through
 waivers from requirements of federal law, MIcare includes health
 care coverage provided under Medicaid, under Medicare, under
 MIChild, by employers that choose to participate, and to state and
 local government employees including public school employees.
       (2) If the federal act is modified by congressional, judicial,
 or federal administrative action that prohibits implementation of a
 health benefit exchange; eliminates federal funds available to
 individuals, employees, or employers; or eliminates the waiver
 under section 1332 of the federal act, 42 USC 18052, the director
 shall continue, and adjust as appropriate, the planning and cost-
 containment activities provided in this act related to MIcare and
 to creation of a unified, simplified administration and payment
 system, including identifying the financing impacts of such a
 modification on this state and its effects on the activities
 proposed in this act.
       Sec. 205. The director shall supervise and oversee, as
 appropriate, the planning efforts, a continuation of the planning
 necessary to ensure an adequate, well-trained primary care
 workforce; necessary retraining for any employees dislocated from
 health care professionals or from health carriers because of the
 simplification in the administration of health care; consolidation
 of multiple payment sources into a single payment system; and
 unification of health system planning, regulation, and public
 health.
       Sec. 207. The director shall obtain waivers, exemptions,
 agreements, legislation, or a combination of these items to ensure
 that, to the extent possible under federal law, all federal
 payments provided within this state for health services are paid
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 directly to MIcare. MIcare shall assume responsibility for the
 benefits and services previously paid for by the federal programs,
 including Medicaid, Medicare, MIChild, and, after implementation,
 the exchange. In obtaining the waivers, exemptions, agreements,
 legislation, or combination of those items, the director shall
 negotiate with the federal government a federal contribution for
 health care services in this state that reflects medical inflation,
 the state gross domestic product, the size and age of the
 population, the number of residents of this state living below the
 poverty level, the number of Medicare-eligible individuals, and
 other factors that may be advantageous to this state and that do
 not decrease in relation to the federal contribution to other
 states as a result of the waivers, exemptions, agreements, or
 savings from implementation of MIcare.
       Sec. 209. The board, in collaboration with the director, shall
 develop a work plan for the board. The board may include in the
 work plan any necessary processes for implementation of the board's
 duties, a time line for implementation of the board's duties, and a
 plan for ensuring sufficient staff to implement the board's duties.
 The board shall submit the work plan developed under this section
 to the senate and house of representatives standing committees on
 health issues within 3 months after the effective date of this act.
                               CHAPTER 3
       Sec. 301. As a framework for reforming health care in this
 state, the director shall utilize and ensure that the health care
 system in this state satisfies all of the following principles:
       (a) That universal access to and coverage for high-quality,
 medically necessary health services is ensured for all residents of
 this state.
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       (b) That systemic barriers, including, but not limited to,
 cost, inadequate information, transportation needs, and geographic
 distribution of providers, do not prevent residents of this state
 from accessing necessary health services.
       (c) That all residents of this state receive affordable and
 appropriate health services at the appropriate time in the
 appropriate setting.
       (d) That overall costs for health services are contained and
 that growth in health care spending in this state balances the
 health care needs of the population with the ability to pay for
 necessary health services.
       (e) That the health care system in this state be transparent
 in design, efficient in operation, and accountable to the residents
 of this state. The director shall ensure public participation by
 residents of this state in the design, implementation, evaluation,
 and accountability mechanisms of the health care system.
       (f) That primary care be preserved and enhanced so that
 residents of this state have health services available to them,
 preferably within their own communities. Other aspects of this
 state's health care infrastructure, including, but not limited to,
 the educational and research missions of the state's academic
 medical institutions and other postsecondary educational
 institutions, the nonprofit missions of the community hospitals,
 public health and population health missions of public and private
 community health organizations, and the critical access designation
 of rural hospitals, must be supported in such a way that all
 residents of this state have access to necessary health services
 and that these health services are sustainable.
       (g) That care for mental health and physical health is
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 coordinated and integrated, that mental health care be covered at
 parity with physical health care, and that, to the extent
 practical, patients can access mental health and physical health
 care in the same settings.
       (h) That every resident of this state is able to choose his or
 her health care professionals.
       (i) That residents of this state are aware of the costs of the
 health services they receive. For this purpose, the cost of health
 services should be transparent and easy to understand.
       (j) That the health care system recognize the primacy of the
 relationship between a patient and his or her health care
 professionals, respecting the professional judgment of health care
 professionals and the informed decisions of patients.
       (k) That this state's health care system seek continuous
 improvement of health care quality and safety and of the health of
 the residents of this state and reduce morbidity and increase life
 expectancy. For this reason, the director shall ensure that the
 system is evaluated regularly for improvements in access, outcomes,
 and cost containment.
       (l) That appropriate rules and enforcement mechanisms are in
 place to ensure that health care provider work hours and staffing
 ratios support the health and safety of both providers and
 patients.
       (m) That this state's health care system include mechanisms
 for containing all system costs and eliminating unnecessary
 expenditures, including by reducing administrative costs, by
 reducing costs that do not contribute to improved health outcomes,
 and by leveraging the unified payment system to negotiate prices.
 The director shall ensure that efforts to reduce overall health
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 care costs identify sources of excess cost growth.
       (n) That the system must enable health care professionals to
 provide, on a solvent basis, effective and efficient health
 services that are in the public interest.
       (o) That this state's health care system operate as a
 partnership between consumers, employers, health care
 professionals, hospitals, and the state and federal governments.
       Sec. 302. (1) The MIcare board is created as an autonomous
 entity in the department. The board is an independent body with the
 powers and duties as provided for under this act. The department
 shall provide suitable office space for the board and the employees
 of the board.
       (2) The board shall promote the general good of this state by
 doing all of the following:
       (a) Improving the health of the residents of this state as
 measured by rates of disability, disease, and life expectancy.
       (b) Reducing the per-capita rate of growth in expenditures for
 health services in this state across all payers while ensuring that
 access to health services and the quality of health services
 received by residents of this state are not compromised.
       (c) Enhancing the patient and health care professional
 experience during the delivery of health services.
       (d) Recruiting and retaining high-quality health care
 professionals.
       (e) Achieving administrative simplification in health care
 financing and delivery.
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