State Permanently Yanks Nassar’s Medical License, Docks Him $1M

The state April 6 permanently revoked the medical license of Larry Nassar and fined him $1 million, making it the largest fine ever issued by a health professional or occupational board in the history of the Michigan Department of Licensing and Regulatory Affairs (LARA), according to the department.

Nassar, the former physician for Michigan State University and team doctor for U.S.A. Gymnastics, has been sentenced to federal prison on child pornography possession charges. He was sentenced to state prison on numerous counts of criminal sexual conduct, stemming from his sexual abuse of hundreds of women, often under the guise of medical treatment.

The state’s Board of Osteopathic Medicine and Surgery initially revoked Nassar’s license on April 25, 2017, based on LARA’s order summarily suspending Nassar’s license and an administrative complaint filed in January 2017.

The permanent revocation stems from Nassar’s convictions, outlined in January 2018 administrative complaint filed by the Attorney General’s office on behalf of LARA.

The $1 million fine is to be paid to the state after all restitution, criminal fees and fines, and civil judgments Nassar is ordered to pay have been fully satisfied.

Supreme Court Asked To Review Healthy Kids Dental Contract

MCNA is taking its fight challenging Michigan’s procurement process of the Healthy Kids Dental contract to the state’s Supreme Court.

MCNA filed March 29 an appeal seeking to reverse the Michigan Court of Appeals decision dismissing the dental provider’s lawsuit against the state over what it calls the “unlawful award” of a $659 million Healthy Kids Dental contract to Blue Cross Blue Shield.

“We are taking this fight to the state’s highest court because the citizens of Michigan deserve a full accounting of how taxpayer dollars are being spent, and to shine a light on a deeply flawed and highly political bidding process that has undermined Michigan’s stated commitment to transparency and competitive bidding,” said Carlos Lacasa, MCNA’s vice president and general counsel.

“It is our hope that when Supreme Court justices review the facts of this case, they’ll see the fatal flaws in the state’s procurement process, which favors political clout over experience and results,” he added.

MCNA filed two lawsuits in January. The first alleges the state’s Department of Technology, Management and Budget showed “blatant favoritism” in awarding the contract and the second alleges multiple violations of the Freedom of Information Act.

The state sought to dismiss the case, but Ingham County Judge William Collette said at a February hearing he wanted more information and ordered a state official be deposed over the contract award. Collette’s decision came after an attorney for the state admitted, but couldn’t explain why, the state allowed BCBS to change its bid.

In mid-March, however, the Michigan Court of Appeals dismissed MCNA’s lawsuit without explanation.

MCNA has added prominent lawyers Clifford Taylor, a former chief justice of the Michigan Supreme Court, and John Bursch, former Michigan solicitor general, to its legal team as it prepares to argue its case before the state Supreme Court.

“The primary legal issue is straightforward and of great importance to Michigan taxpayers,” Bursch said. “The Court of Appeals said that MCNA has no right to seek judicial review of state procurement decisions. But Michigan law says that an aggrieved party may appeal ‘any’ decision of ‘any’ state agency.

“MCNA simply wants its day in court. Without that day, no court will ever be able to look beyond the curtain in a procurement decision,” he added. “Taxpayers are entitled to that transparency.”

Shirkey Gaining Support On Healthy Michigan Boilerplate Change

Two key lawmakers said today they are supportive of Sen. Mike Shirkey’s attempt to effectively require beneficiaries of Healthy Michigan to pay more in co-pays and annual premiums if they don’t move out of the expanded Medicaid program to the individual insurance market after four years.

Both chairs of the appropriations subcommittees overseeing the Department of Health and Human Services (DHHS) budget said they like the idea of inserting a provision in the Fiscal Year 2019 spending plan to clarify that Michigan’s 2013 Healthy Michigan law required recipient buy-in and that’s not what they see is happening.

Instead, Rep. Ned Canfield (R-Sebewaing), a medical doctor by profession, said two-thirds of recipients don’t pay their contributions and 60 percent don’t pay their fair share of co-pays.

“I don’t think that was the intent of the law these men and women thought they were passing,” Canfield said. “I believe the Legislature that passed Healthy Michigan did a brilliant job of displaying how we can help people and then help them out of Medicaid.”

Healthy Michigan is the 2013-passed Medicaid expansion program pushed by Gov. Rick Snyder that only passed a reluctant Republican-controlled Legislature after then-Rep. Shirkey and Sen. Roger Kahn (R-Saginaw) required DHHS to get two waivers.

The first required the expanded population of those making between 100 and 133 percent of the federal poverty level to contribute 2 to 5 percent of their income for service. The second required this population to pay up to 7 percent of their income after four years or find insurance on the health exchange.

But a reluctant Centers for Medicare and Medicaid Services under President Barack Obama was among the reasons the waiver ended up getting implemented in a way that nobody is getting moved off the benefit, Shirkey said.

“I believe the Department had some headwind, but I also believe it’s not in the nature of the Department to design a system by which people go off the benefit,” Shirkey said.

The result is that the program is not running consistent with statute and either the program needs to change or the statute. Neither Shirkey or Sen. Pater MacGregor (R-Rockford), chair of the Senate DHHS Appropriations Subcommittee, said they’re interested in changing the statute.

“What we passed in 2013 and what we’ve implemented is running in opposite directions,” MacGregor said. “Something needs to change.”

For MacGregor, the point is not about saving the state money, it’s about encouraging able-bodied recipients to begin training for the numerous skilled trades available in Michigan’s job market.

“I see this as a win-win,” he said.

He also noted Healthy Michigan was designed to push recipients to lead healthier lives. He’s not sure that’s being pushed either.

Shirkey said he understands that as it’s currently being run, moving the expanded Medicaid population to the health insurance exchange would cost more money, but that’s because the program isn’t being run the way the law intended.

“The department has to resubmit the waiver so it aligns with the statute,” Shirkey said.

Sen. Curtis Hertel (D-East Lansing), a Democratic member on the DHHS Appropriations Subcommittee, said he’s not convinced Shirkey is barking up the right tree with the boilerplate addition.

Hertel commended Shirkey for the courage it took to move the Healthy Michigan program in 2013, but the law is written vaguely and is open to interpretation.

“If you don’t believe the Department is following the statute, there’s a process for that and that’s the courts,” Hertel said. “This is up for interpretation, but I don’t think a new legislature can interpret the meaning of an old Legislature and then try to put in boilerplate what a different law means.”

While Shirkey was in the room when the law was written, that doesn’t mean it’s “his baby,” Hertel said.

“So while I have an enormous amount of respect for Sen. Shirkey and the work he did on the law, I think saying that his interpretation is the right interpretation gives him a lot more power than I’m comfortable with him having,” he said.

Asked about earlier this month about Shirkey’s concerns and if the state intended for this to unfold the way it has with the way it crafted the waiver, DHHS spokeswoman Lynn Suftin said the transition to the exchange is being implemented in compliance with federal law.

In addition, Sutfin said Shirkey “has made us and the Governor’s office aware of his concerns and our legal teams are reviewing.”

Analysis: State Saves $2.5M From 3K People Keeping Healthy MI Coverage

Of the 13,550 people warned they could be moved from Healthy Michigan to a plan on the federal health insurance exchange, 27 percent of them have jumped through the hoop necessary to keep their Healthy Michigan coverage.

If the rest of that original group of people do not complete their health risk assessment (HRA), one analysis has the state paying potentially up to $6.4 million more in costs associated with moving those folks to the commercially-priced health insurance exchange market.

If all 13,550 people from that original cohort had opted against the HRA, that could’ve cost the state $8.9 million if they had all moved over to the federal insurance exchange, meaning at this point the state has staved off $2.5 million it might have had to pay otherwise.

The $6.4 million cost estimate—calculated with help from the Michigan Association of Health Plans’ analysis of health insurance exchange premium prices—is on track with what the Michigan Department of Health and Human Services has already asked for in additional spending this year.

The state requested $6 million for this year to cover what it says is half of the year’s costs in the transition. Of that, $345,000 would come from the General Fund. The Legislature has not yet considered the supplemental request.

However, another 1,451 letters were issued in March to people who have been on Healthy Michigan for at least one year and who had not completed the HRA. And the state expects to send out about 1,500 letters each month, said DHHS spokesperson Lynn Suftin.

As of March 22, there have been 3,777 people who were contacted in the first group who have done the HRA, meaning they keep their Healthy Michigan coverage.

Due to a variety of factors, it’s going to cost the state more to have this population of Healthy Michigan beneficiaries move over to the marketplace than to just stay on Healthy Michigan.

But to figure out how much that could be, MIRS sought out estimates of the average cost of a Healthy Michigan plan, as well as the costs of plans provided on the federal exchange.

Dominick Pallone, executive director of the MAHP, analyzed the non-tobacco prices for health insurance products sold on the individual market exchange, based on a list of plans provided by the Michigan Department of Insurance and Financial Services.

From that, the aggregate average of monthly premiums was estimated at $385.25 per month, according to Pallone’s analysis.

In comparison, Pallone said a rough composite estimate of Healthy Michigan is around $330 per member, per month.

From there, the difference between Healthy Michigan and a commercial plan on average would be roughly $55 per month in additional costs for taxpayers, Pallone said.

So that $55 multiplied by 12 months and by the number of people from that original group of people notified—9,773 people—who have not completed an HRA produces the estimate of $6.4 million.

The state’s match rate for Medicaid is 6 percent, so about $387,010 of those estimated costs would need to come straight from the GF.

But that $6.4 million gross cost estimate is a moving target, given the fact that people may be completing their HRAs and thus able to stay with Healthy Michigan—albeit with more cost-sharing.

That, and a new batch of people newly eligible for the transition to the exchange will be contacted each month by DHHS.

So the number of people who complete their HRAs will impact how much it will cost to transition folks over to the federal exchange.

It’s not clear yet how many people will complete their HRAs. It’s also not clear how many people will eventually become eligible to transition over to the marketplace from Healthy Michigan.

The Healthy Michigan program has more than 687,000 people enrolled in total.

Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.