Legislative

Michigan Legislative

MAHU

  HB 4023  - HEALTH OCCUPATIONS, Health Professionals, Creates pilot program allowing certain military medical personnel to practice under the supervision of a licensed physician or podiatrist. (Farrington, Diana (R), 01/10/19)
(Status: 01/15/2019 - bill electronically reproduced 01/10/2019)

  HB 4044  - INSURANCE, Producers, Modifies license eligibility. (Hoitenga, Michele (R), 01/15/19)
(Status: 01/16/2019 - bill electronically reproduced 01/15/2019)

  HB 4098  - HEALTH FACILITIES, Other, Provides for medication aide training and permit program. (Frederick, Ben (R), 01/29/19)
(Status: 02/05/2019 - bill electronically reproduced 01/29/2019)

  HB 4099  - INSURANCE, Health Insurers, Provides for equal treatment for coverage for orally administered anticancer chemotherapy (Rendon, Daire (R), 01/29/19)
(Status: 02/05/2019 - bill electronically reproduced 01/29/2019)

  HB 4154  - HEALTH, Pharmaceuticals, Requires manufacturers of prescription drugs to file under certain circumstances annual report on the costs associated with prescription drugs. (Vaupel, Hank (R), 02/06/19)
(Status: 02/07/2019 - bill electronically reproduced 02/06/2019)

  HB 4217  - HEALTH, Pharmaceuticals, Requires physician or other licensee who writes prescriptions to electronically transmit to pharmacy under certain circumstances. (Bellino, Joseph (R), 02/20/19)
(Status: 02/21/2019 - bill electronically reproduced 02/20/2019)

  HB 4224  - HEALTH OCCUPATIONS, Health Professionals, Revises definition of bona fide prescriber-patient relationship. TIE BAR WITH HB 4225 (Hoitenga, Michele (R), 02/21/19)
(Status: 03/14/2019 - referred to Committee on Ways and Means, with H-1)

  HB 4225  - HEALTH OCCUPATIONS, Health Professionals, Provides exemption of prescribers to obtain a Michigan Automated Prescription System (MAPS) report before prescribing or dispensing a controlled substance for hospice, and exempts hospice patients from bona fide prescriber-patient relationship requirement for prescribing a controlled substance. TIE BAR WITH HB 4224 (Kahle, Bronna (R), 02/21/19)
(Status: 03/14/2019 - referred to Committee on Ways and Means, with H-1)

  HB 4293  - INSURANCE, Health Insurers, Clarifies dispensing of a 90-day supply of maintenance prescription drugs. (Garza, Alex (D), 03/05/19)
(Status: 03/06/2019 - bill electronically reproduced 03/05/2019)


  HB 4330  - HUMAN SERVICES, Medical Services, Creates universal Medicaid credentialing process. (Vaupel, Hank (R), 03/12/19)
(Status: 03/13/2019 - bill electronically reproduced 03/12/2019)

  HB 4343  - HUMAN SERVICES, Medical Services, Provides for coverage of cranial hair prosthesis under certain circumstances. (Hoadley, Jon (D), 03/13/19)
(Status: 03/14/2019 - bill electronically reproduced 03/13/2019)

  HB 4344  - INSURANCE, Health Insurers, Provides for coverage for cranial hair prosthesis under certain circumstances. (Hertel Jr., Curtis (D), 03/13/19)
(Status: 03/14/2019 - bill electronically reproduced 03/13/2019)

  HJR D  - LEGISLATURE, Sessions, Requires a 2/3 vote of both houses for passage of bills during session held after November election in an even-numbered year. (Sabo, Terry J. (D), 02/07/19)
(Status: 02/13/2019 - joint resolution electronically reproduced 02/07/2019)

  SB 0022  - HEALTH OCCUPATIONS, Physical Therapists, Enact physical therapy licensure compact. (Zorn, Dale (R), 01/15/19)
(Status: 01/15/2019 - INTRODUCED BY SENATOR DALE ZORN)

  SB 0077  - HEALTH FACILITIES, Nursing Homes, Allow electronic monitoring devices in nursing homes under certain circumstances. (Runestad, Jim (R), 01/29/19)
(Status: 01/29/2019 - INTRODUCED BY SENATOR JIM RUNESTAD)

  SB 0111  - HEALTH OCCUPATIONS, Health Professionals, Modify procedure for filing and responding to an allegation against a health professional with the department of licensing and regulatory affairs, and modify the information to be provided to the department during the investigation of a health professional and the procedures for obtaining the information. (Lucido, Peter J. (R), 02/13/19)
(Status: 02/13/2019 - INTRODUCED BY SENATOR PETER LUCIDO)

  SB 0172  - INSURANCE, Insurers, Modify requirements for providing privacy policies to customers. (Stamas, Jim (R), 03/07/19)
(Status: 03/07/2019 - REFERRED TO COMMITTEE ON INSURANCE AND BANKING)

DECEMBER 2018 LEGISLATIVE UPDATE

As our busy season is upon us, so is lame duck.  Our lobbyist, Ryan Burtka, is working around the clock to ensure our Association interests are upheld.  

The most contentious of our issues is HB 6432.  Every bill is expected to pass with the exception of the HB 6538/SB 1224 which modify the regulations for Short Term Limited Duration Insurance plans (STLDI)

HB 6342   (Rep. Webber)   repeal parts of the Health Benefit Agent Act  - This legislation was brought forth by BCBSM.  It amends sections of the Health Benefit Agent Act which currently allows health benefits to be sold on behalf of a health benefits corporation by either a health benefit agent or by an employee of a health benefit corporation or its affiliate as long as he or she does not transact insurance during his or her tenure with the corporation or affiliate.  The bill would modify this provision so that health benefits could be sold on behalf of a health benefit corporation only by a health benefit agent.  The bill also removes a provision that prohibits an employee of a health benefit corporation or affiliate who is licensed as an insurance agent from transacting insurance during his or her employment with the corporation or affiliate. POSITION:  Neutral 

Comments - We worked diligently with BCBSM to get additional language added to protect the agent, including a notification to the current agent if an application is received and a provision that forbids an AOR from being an employee of the corporation or affiliate.  We testified at the House Insurance Committee on the importance of the agent and protecting their vital role. 

HB 6431  (Rep. Vaupel)  Insurance; health insurers; Medigap plans; modify - This legislation was brought forth by BCBSM.  It is a necessary update to the Michigan Statue to comply with recent Federal laws. POSITION: Neutral

HB 6538 / SB 1224 (Rep. Lilly) (Sen. MacGregor)  Short term plans, extend.  This legislation was brought forth by Priority Health.  It would extend the current allowed period of a short term policy in Michigan from 6 months to 12 months and allow for up to 3 renewals. It also stipulates certain benefits that must be included but does stipulate the level of coverage.POSITION:  Neutral

Comments:  We would like to continue our work on a 1332 waiver to stabilize the Michigan market first.  However, if this becomes an affordable option for the uninsured by choice, this could benefit some consumers.

HB 6444

(Rep. Wentworth)  Insurance; producers; agent of the insured obtaining coverage for a consumer through an agent of the insurer; allow under certain conditions  This legislation was brought forth by MAIA and is intended to allow agents to service clients for limited lines obtained through wholesalers from which they may not have an appointment. The example given was cybersecurity insurance.  We amended the bill to exclude Health Benefits since it didn't apply to our industry, but rather is for P&C business. POSITION:  Support as amended

SB 1205/HB 6537 (Sen. Pavlov)/(Rep. Kelly)  Labor; public service employment; claims utilization and cost information compilation; modify.   This legislation was brought forth by MAHP.  It requires carriers to provide detailed claims information to public employers to allow for a more competitive bid process. POSITION:  Support

OCTOBER 2018 LEGISLATIVE UPDATE

In case you missed it, DIFS issued guidance on Association Health Plans (AHPs).  The guidance is reasonable and imposes submission requirements for insurers that plan to offer AHPs.  In addition, it requires issuers of fully insured AHPs to be compliant with all group coverage requirements.  If a carrier had an AHP in place, they have to file the plans and rates with DIFS by Nov. 15, 2018.   Click here to read the bulletin, Bulletin 2018-21-INS.

DIFS also released an RFP for an actuarial firm to conduct the feasibility of a 1332 waiver to the Affordable Care Act in Michigan. MAHU also submitted feedback to DIFS that the study should include the review of a potential reinsurance mechanism as well as modifications to the actuarial value as it relates to the metallurgical tiers in the small group market. Legislation is pending in the Michigan Senate for the state to apply for a waiver if the study comes back favorable. In related news, Democratic Gubernatorial nominee Gretchen Whitmer has included a reinsurance mechanism through a 1332 waiver in her health care plan if elected governor.

A few new bills were introduced that impact our industry.  The bills are currently being reviewed by the MAHU Legislative Committee but we welcome any additional feedback from members.   Links are provided below for your review. 

  1. HB 6432 - Rep. Webber.  This bill will amend the Health Benefit Agent Act to change the requirement for employees of an insurance company, requiring them to be licensed as a health benefit agent.  However, doing so allows them to transact insurance and sell different lines of business and package products.
  2. HB 6444 -- Rep. Jason Wentworth.  This bill would allow for agents to sell an insurance policy from a carrier from which they do not have an appointment by having a written contract with an agent that has an appointment. The impetus behind the bill is that some limited lines, such as cybersecurity insurance, lack a widespread network of appointed agents and an agent could potentially satisfy a niche need for a client on a product with a limited market. There is anecdotal evidence that DIFS is auditing agents and leveling fines for selling insurance without an appointment.
  3. HB 6431 -- Rep. Hank Vaupel. This bill modifies the Medigap policies that would be available in Michigan after January 2020.

Legislative Update – September 2018

Michigan's Fiscal Year 2018 budget included a provision for the Department of Insurance and Financial Services (DIFS) to conduct a study on the possibility of a state 1332 waiver under the Affordable Care Act. The state's fiscal year begins on October 1 and in preparation DIFS has asked MAHU along with other stakeholders that successfully lobbied for the study for input on what should be included. MAHU is currently reviewing what other states have included in their 1332 waivers to include the possibility of a reinsurance or high risk pool and will be submitting suggestions to DIFS by the end of the month.

While the Department of Labor has finalized its rules on Association Health Plans (AHPs) states, including Michigan, have been slow set a regulatory structure. Currently, DIFS has not commented on if or how AHPs will be regulated in the state. State wide associations, carriers, and agents have been working on fully insured AHP options and its possibility that an AHP will be up and running in some form in Michigan by the end of the year without clear guidance from the state.

The November election is right around the corner and the Michigan legislature has less than 20 days of session remaining with a majority of it scheduled for the "lame duck" period in December. With significant turnover in both chambers and the governor's office, depending on the outcome of the election, there could be a large volume of policy bills rushed through at the end of the year. Stayed tuned through November as it likely to be a tumultuous election cycle.

The MAHU Legislative Committee met to determine our legislative priorities for the remainder of this legislative session.  Moving the 1332 Waiver legislation (SB 691) is one of our top priorities.  DIFS is actively soliciting ideas from the carriers about what things they would like to change within the guidelines of the 1332 waiver.  MAHU has prepared our list to submit to DIFS and it in includes: a reinsurance mechanism for the individual market, and removing AV and metal level requirements from the small group market.  For additional information about 1332 waivers, click here.

In addition, DIFS has not provided any guidance regarding Association Health Plans (AHPs), which is not unlike the other states in our region.  However, we feel some rules should exist in that market to protect agents and consumers particularly as is relates to benefits that are excluded in the AHP benefit plans.  MAHU will be providing recommendation re: AHPs to DIFS by the end of this month.  NAHU has compiled a robust website on AHPs.  To access this information, visit https://nahu.org/advocacy/legislative-issues/ahps. 

Legislative Update July 2018
Ryan Burtka, Lobbyist

The August primary election is right around the corner and the political attack ads are flying. In the race for the gubernatorial nomination, Republican Bill Schuette still appears to have a sizeable advantage over current Lt. Governor Brian Calley and State Senator Patrick Colbeck. Calley has been up on television throughout July but it appears his poll numbers haven’t changed much. Colbeck has a strong following in the grass roots and party activist community but lacks the funding to get better recognition statewide. To further emphasize Schuette’s lead, he is the only Republican candidate that has been subject to attack ads from Democrats who appear to be trying to soften him up for the general election or even trying to push to the nomination towards a weaker candidate. On the Democratic side, the nomination is still Gretchen Whitmer’s to lose. Shri Thanadar, has poured in close to $11 million of his own money and polls show that he is within the margin of error of Whitmer. Abdul El-Sayed, is having Bernie Sanders come in and stump for him, and has a strong following from the progressive side of the party. It’s likely to come down to Detroit voter turnout, where Whitmer is underperforming compared to Thanadar and El-Sayed. The safe bet is still on a Schuette vs Whitmer matchup this November but depending on what could be a record turn out on Tuesday and how candidates split votes, it may just be a wild ride.

Other high profile races include the 11th Congressional where Lana Epstein leads the Republicans but with several more prominent names on the ballot, Mike Kowall, Klint Kesto, and Rocky Raczkowski, its anyone’s to take. State Rep. Tim Greimel has locked up most of the traditional Democratic support for that race as well, but well funded Suneel Gupta is out spending him. That seat is still a toss up for this fall.

This primary may also be a bit of a referendum on Detroit Mayor Mike Duggan. After failing to get Detroit House Democrats to vote for his auto no-fault reform package, various political action committees and non-profits associated with the Mayor have funded primary challengers to incumbent legislators and for open seats. These safe Democratic seats often have several primary candidates and the winner in August is almost guaranteed a victory in November. Duggan hopes to get enough of his supporters in office to take another run at auto insurance reform next year.

DIFS Uncertain on How to Regulate AHPs in Michigan

Michigan is still delaying on if the state will regulate AHPs under state law per the Department of Labor rule finalized last month. After repeated questions to the Department, they gave no information and no time line for when an interpretation of the rule would be released. This is troublesome as other states begin to move forward with some sort of regulatory structure for AHPs. One of the selling points of AHPs from the Trump Administration was the federal regulatory structure would allow them to be sold across state lines, unless there was additional regulation from the state. Until there is clear guidance from the state, it may be difficult to establish AHPs in multi-state regions. With only 5 months left in the Snyder administration and the current DIFS Director, Patrick McPharlin, unlikely to return and his chief Deputy Teri Morante, perhaps to retire, the current bureaucracy may be punting on the issue. The guidelines from the federal government have start dates for AHPs in the beginning of next year. Unless the state takes action in the near future it will be difficult to have an AHP product on the market in time.

Legislative Update - June 2018
Ryan Burtka, Lobbyist
KRKM

June saw the legislature wrap up most of their priorities before skipping out of town and onto the campaign trail. Governor Snyder went 8 for 8 in getting next years budget finished in June. The FY19 budget doesn’t have a whole lot of surprises but does include $400,000 for a study on Michigan’s individual market, setting up the potential 1332 waiver legislation. After two unsuccessful ballot initiative drives, the repeal of Prevailing Wage finally had enough signatures to qualify for the ballot this November, however, the conservative legislature ratified the citizen’s initiative and repealed Michigan’s Prevailing Wage Law. There was talk about doing something similar with the recreational marijuana initiative. Polling suggests that the citizen’s initiative will pass this November and there was talk about conservative Republicans adopting and modifying the proposal to more closely regulate marijuana and make it easier to amend in the future. The plan never got off the ground and the deadline passed meaning recreational marijuana will be on the ballot this fall. It’s likely to be joined with other ballot proposals such as paid sick leave, increased minimum wage, voting reforms such as no-reason absentee, and possibly non-partisan redistricting of legislative districts. The legislature has a few token session days this summer but will not resume full time work until September, until then the August 7th  primary will be the main focus and it should give shape to what November will look like.

Medicaid Work Requirements Bill Signed

Michigan is joining a handful of other Republican lead states in enacting work requirements for able bodied adults in the Medicaid program. Sen. Mike Shirkey worked an agreement between the Senate, House, and the Governor to add work requirements to the Health Michigan Program starting in 2020. Significant changes were made to the introduced bill and the final product resembles what other states have done through legislation or executive action for work requirements. Notably, changes were also made to the original Healthy Michigan law which may prove to give some permanence to the expanded Medicaid program. Also, the original “marketplace option” which saw Healthy Michigan enrollees moved to the individual market through the exchange after 4 years was removed and replaced with those individuals needing to meet certain healthy behavior goals in addition to the work requirements. There is about 18 month period for the Michigan Department of Health and Human Services to negotiate a waiver with CMS to enact the requirements and as we have seen in other states, it will likely be challenged in court.

DOL Releases Final Rule on Association Health Plans

 At the very end of June, the Department of Labor released its final rule on Association Health Plans. The 200 page document outlines the possible structures of various versions of an AHP without defining much of anything. The take-aways were definitive timelines for when AHPs can start operating, carriers are prohibiting from sponsoring but may be a TPA, Associations must have a some commonality of business and may cross state lines, and AHPs will not be required to offer the full suite of EHBs. There is still quite a bit of ambiguity on what constitutes a “substantial business purpose” and if AHP’s will be regulated under state law as well. Michigan’s Department of Insurance and Financial Services is currently reviewing the final rule. Other states may also act to regulate. In California and New York, the legislature has introduced bills to require AHP’s to adhere to ACA requirements on EHBs. What remains to be seen is if under Michigan’s new Governor, and new DIFS director, if there is a change on the state role in regulation.

The MAHU PAC, along with grassroots advocacy and Legislative Day, fosters relationships with lawmakers and gives MAHU a strong political voice in Lansing. MAHU PAC supports those legislators who have an understanding of the complex health insurance market and who take an active role in supporting legislation that aligns with MAHU’s strategic goals. 

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