Legislative Analysis
Phone: (517) 373-8080
PUBLIC HEALTH CODE AND MENTAL HEALTH CODE FEES
http://www.house.mi.gov/hfa
AND SUNSET PROVISIONS
Analysis available at
House Bills 5003 (H-1) and 5004 (S-4) http://www.legislature.mi.gov
Sponsor: Rep. Christine Morse
Committee: Appropriations
Complete to 9-27-23
SUMMARY:
House Bill 5003 would amend the Mental Health Code to extend the sunset (expiration date)
on the annual license and license renewal fee for psychiatric hospitals and units to October 1,
2027 – currently set to mature on October 1, 2023. Without a removal or extension of the
sunset, the fees would not be collected after September 30, 2023. FY 2022-23 fee amounts,
that otherwise would be eliminated, would be maintained in perpetuity under the bill. The fee
is currently $500 per license and $10 per patient bed.
MCL 330.1139
House Bill 5004 would amend the Public Health Code to include revisions to sunsets, fee
schedules, and technical items. Specifically, the bill would do all of the following:
• Update the definition of “child or youth with special health care needs” by raising the
age from “under 21” to “under 26.”
• Extend the October 1, 2023 sunset on substance use disorder services program
licensing fees to September 30, 2027.
• Update the fee schedule and increase fees for registration and renewal of licensure for
veterinary/dental electron tubes for radiography machines, non-veterinary/non-dental
electron tubes, and non-compliance penalty fees.
• Update the fee schedule and increase fees for inspection, reinspection/reinstatement,
and compliance evaluation of mammography machines.
• Extend the October 1, 2023 sunset on numerous health facility/agency license fees and
quality assurance assessments (QAAP) for nursing homes and hospitals to October 1,
2027.
• Include a base facility licensure fee of $500 for homes for the aged and require a $2,000
application fee for initial homes for the aged licensure applications.
• Eliminate references to specific Healthy Michigan Plan (HMP) statutory hospital
QAAP retainer amounts for fiscal years 2015-16 and 2016-17.
• Retain the FY 2017-18 HMP retention requirement of $118.4 million as a floor amount,
and require the Department of Health and Human Services (DHHS), the State Budget
Office (SBO), and the Michigan Health and Hospital Association to identify an
appropriate retention amount each fiscal year by May 31.
• Remove disproportionate share hospital (DSH) payment rate from the statutorily
defined group of service rates that act as a mechanism to trigger the collection or
elimination of hospital QAAP for each fiscal year. The mechanism requires rates to be
greater than the rates established on April 1, 2002, for hospital QAAP to be collected.
• Extend the October 1, 2023 sunset on ambulance QAAP collections to October 1, 2027.
House Fiscal Agency Page 1 of 4
 • Update various technical references and department/agency titles and eliminate
outdated references and sections.
MCL 333.5801 et seq.
FISCAL IMPACT:
Department of Health and Human Services (DHHS)
House Bill 5004 would have no fiscal impact on DHHS. However, the state would forgo an
estimated $1.5 billion 1 in state restricted QAAP revenue for Medicaid-funded long-term care
facilities, hospitals, and ambulance services if related sunset provisions are not extended or
eliminated prior to the end of FY 2022-23. Additionally, removing disproportionate share
hospital (DSH) payment rates from the hospital QAAP collection mechanism de-couples the
payments and ensures collection continues regardless of variation in DSH rates each fiscal
year. Similarly, removing DSH payment rates from the hospital QAAP collection mechanism
de-couples the payments and ensures collection continues regardless of variation in DSH rates
each fiscal year.
Article 6 of 2023 PA 119, FY 2023-24 appropriations for DHHS, includes $17.0 million Gross
($7.8 million GF/GP) to support costs of expanding Children’s Special Health Care Services
(CSHCS) medical services to eligible adult children up to 26 years of age.
Department of Labor and Economic Opportunity (LEO)
House Bill 5004 would increase eight radiation safety fees by 20.0% of the current fee amounts.
In section 13522 of the Public Health Code, current statute lists the original amounts of these
fees as enacted in 1978. Section 13522(8) allows for an annual increase of up to 5.0 % for these
fees, so current fee amounts reflect this annual adjustment that has been made each year since
1978. Fee increases proposed in the bill would increase revenue to LEO by approximately
$500,000 per year and would have no significant fiscal impact on local units of government.
The table below lists the eight fees that would be increased under the bill, as well as the current
fee amount and the proposed fee amount.
MIOSHA RADIATION SAFETY FEES
Type of Fee 1978 Current Fee Proposed
Statutory Amount Fee
Amount (includes annual Amount
CPI increases)
First veterinary or dental x-ray $45 $87.40 $104.88
machine
Additional veterinary or dental x-ray $25 $48.49 $58.19
machine/electron tube
Non-veterinary or dental x-ray $75 $145.73 $174.88
machine
1
SIGMA; Total FY 2022-23 QAAP collections as of September 14, 2023.
House Fiscal Agency HBs 5003 and 5004 Page 2 of 4
 Follow-up inspection due to $100 $194.36 $233.23
noncompliance in same year
Mammography machine inspection $100 $194.36 $233.23
Mammography machine $100 $194.36 $233.23
reinspection
Mammography compliance $700 $1,306.21 $1,567.45
evaluation
Mammography compliance $300 $559.71 $671.65
reevaluation
Department of Licensing and Regulatory Affairs (LARA)
House Bills 5003 and 5004 would maintain current levels of revenue for fees collected by
LARA, to the extent that LARA would continue collecting revenue generated from fees that
would otherwise sunset. Revenue generated from these fees is deposited into the Health
Systems Fees Fund. LARA estimates that the extension of the sunset provisions under both
bills will preserve $1.5 million in restricted revenue that it would otherwise not collect; $63,700
of this amount would be attributable to House Bill 5003, and $1.4 million to House Bill 5004.
The table below provides information for each of the fee sunsets that affects LARA.
Fee Title Current Fee Fee Post- Projected Revenue
Sunset Loss 2
Psychiatric Hospitals $500 per $0 $63,700
or Units license and $10
per bed
Substance Use $500 $0 $439,300
Disorder Services
Program Annual
License Fee
Freestanding Surgical $500 per $0 $97,300
Outpatient Facilities license
Fee
Hospitals Fee $500 per $0 $343,900
license and $10
per bed
Nursing Homes, $500 per $0 $250,800
County Medical Care license and $3
Facilities, and per bed over
Hospital Long-Term 100 beds
Care Units Fee
Homes for the Aged $6.27 per bed $0 $143,000
Fee
Hospice Agencies $500 per $0 $152,500
Fee license
2
Projections from LARA.
House Fiscal Agency HBs 5003 and 5004 Page 3 of 4
 Hospice Residences $500 per $0 $9,500
Fee license and $5
per bed
House Bill 5004 also would create a new base fee for homes for the aged, which are currently
subject to an annual fee of $6.27 per licensed bed. Under the bill, a base fee of $500 per facility
would be added, and the per bed fee would be in addition to that amount. There are presently
335 homes for the aged operating in Michigan, so LARA would be projected to receive an
additional $167,500 per annum. The bill would also require homes for the aged that apply for
an initial license to remit an initial licensure application fee of $2,000. Revenue from this fee
would depend on the number of new homes for the aged that pursue licensure.
Fiscal Analysts: Kent Dell
Marcus Coffin
Viola Bay Wild
■ This analysis was prepared by nonpartisan House Fiscal Agency staff for use by House members in their
deliberations, and does not constitute an official statement of legislative intent.
House Fiscal Agency HBs 5003 and 5004 Page 4 of 4


Statutes affected:
Substitute (H-1): 330.1139
House Introduced Bill: 330.1139
As Passed by the House: 330.1139
As Passed by the Senate: 330.1139
House Concurred Bill: 330.1139
Public Act: 330.1139
House Enrolled Bill: 330.1139