House Votes To Put Warnings On Pot For Mothers, Breastfeeders
The House voted overwhelmingly Sep. 10 to put warning labels on recreational and medical marijuana products, to tell pregnant women and breastfeeding mothers that smoking pot can have harmful effects on their infants.

Members voted 105-4 on HB 4126 and HB 4127, sponsored by Rep. Thomas Albert (R-Lowell) and Rep. Daire Rendon (R-Lake City), to require labels in the same way tobacco and alcohol products carry warning labels now.

“There’s been some pretty alarming studies showing that in an unfortunate trend, a lot of women are continuing to use marijuana while they are pregnant,” Albert said. “It is pretty shocking that someone would make that choice and we want to make sure that they have the right information.”

Doctors believe that there could be some long-term developmental issues and it can cause low birth weight, he contended.

The warning would read: “Use by pregnant or breastfeeding women, or by women planning to become pregnant, may result in fetal injury, preterm birth, low birth weight, or developmental problems for the child.”

Rep. Beau LaFave (R-Iron Mountain) is not a fan of the idea.

“If we were to put a warning label on everything that is potentially dangerous, everything including Tim Skubick would have a warning label. When it gets to the point where everything has warning labels on it, the labels themselves become less effective,” LaFave said.

Albert argues the labels have an effect.

“I’ll concede one thing, if somebody is a very hardened drug user, they are not going to look at a warning label,” Albert said. “That is not the demographic that this bill is trying to target. There is plenty of empirical evidence, if you look at what the impact was with alcohol and the alcohol warning labels, you actually saw a difference on moderate alcohol users. It changed their behavior. We are looking at moderate users of marijuana and making sure they have the right information.”

Voting no were LaFave, Rep. Steven Johnson (R-Wayland), Rep. Michele Hoitenga (R-Manton) and Rep. Yousef Rabhi (D-Ann Arbor).

The bills now move to the Senate for consideration.

Work Requirements Apply To 42% Of Healthy MI Participants
About 42 percent of Healthy Michigan beneficiaries are obliged to comply with the state’s new work requirements and will soon receive mail from the state about reporting their compliance starting in January 2020.

The Michigan Department of Health and Human Services mailed more than 270,000 Healthy Michigan participants who are not currently exempt from the requirements, based on the department’s records. According to the DHHS, there were 634,235 total beneficiaries signed up for Healthy Michigan as of Sept. 2.

However, DHHS spokesperson Bob Wheaton said the state is not expecting that the 270,000 will lose coverage – in fact, he said, “many of them are already meeting the work requirements and will continue to do so.”

Shortly after the law was enacted in the summer of 2018, the DHHS said no more than 400,000 of the 680,000 plan participants would be affected.

In February, a report estimated the number of people who could lose coverage at 183,000 able-boded adults, or 27 percent of the plan’s total population.

That study was cited by Gov. Gretchen Whitmer when she announced her intent to work with lawmakers to come up with improvements to the work requirements.

A bill — SB 0362, sponsored by Sen. Curtis Hertel Jr. (D-East Lansing) — gives recipients more time to report their work compliance cleared a House committee, and has the support of Senate Majority Leader Mike Shirkey (R-Clarklake), the sponsor of the Medicaid work requirements.

The DHHS notification letter will notify beneficiaries that beginning Jan. 1, 2020, they will be required to report to DHHS each month 80 hours of work or other eligible activities, such as job training. If they do not report, they could lose their health care coverage.

They are also advised that they will receive more information in December about how to inform DHHS about their work activities. A form is included for beneficiaries to fill out if they meet one of the exemptions from the work requirements — such as being medically frail or a full-time student.

The DHHS notification letters are part of a larger awareness campaign about the coming work requirements that the department announced today.

“We are doing everything in our power so that individuals can comply with this complex and demanding statute,” said DHHS director Robert Gordon, in a statement. “Clear communication is key.”

The state is also implementing a communication plan to get the word out. They are hosting webinars for community partners and providers. There are also paid ads, media outreach, social media posts and additional outreach to community partners and stakeholders who work with people who may be affected.

In October, notifications will also go out to Healthy Michigan participants who do meet the work requirement exemptions.

The work requirements were tagged onto the expanded Medicaid program by the Legislature in 2018, which requires able-bodied people participants to log 80 hours of work-related activities a month, with some exceptions.

Senate Signs Off On Remote Pharmacy Bill
Rural Michiganders could fill their prescriptions at “remote pharmacies,” staffed by a pharmacist available through a live video feed, under legislation that passed the Senate Sep. 5, 32-6.

Sen. Curtis VanderWall’s (R-Ludington) SB 0340 allows for satellite pharmacies—staffed by a pharmacy technician—in remote areas where the nearest physical pharmacy is more than 10 miles away or in a location where state officials agree is an underserved area.

“It puts patients in front of a pharmacist, via a computer screen,” he said. “It improves care in rural Michigan, where now people are traveling 30, 40 miles to get to pharmacy.”

The freshman senator argued the bill allows mom-and-pop pharmacies to expand their reach into rural areas without the costs of hiring pharmacists for each location. The satellite office could have all the products of a regular pharmacy, VanderWall said.

“We’re not educating people when they’re buying their pills through a tele-pharmacy or through the mail,” he said. “This gives people an opportunity to visit a remote pharmacy, speak face-to-face with a pharmacist to talk about side effects or the benefit of the medication they’re on.”

The bill limits the number of distributed prescriptions to 225 a day. During committee testimony on the bill, the Michigan Retailers Association and Cardinal Health voiced their support. The Michigan Pharmacists Association was neutral.

Indiana, Illinois and Wisconsin are among 23 states that enacted similar measures to SB 0340.

The six no votes came from Sens. Winnie Brinks (D-Grand Rapids), Jeff Irwin (D-Ann Arbor), Mallory McMorrow (D-Royal Oak), Jeremy Moss (D-Southfield), Dayna Polehanki (D-Canton) and Sylvia Santana (D-Detroit).

Brinks said her concerns stemmed from a Michigan Campaign Finance Network report and warnings from other pharmacy associations that the bill could open up access to opioids.

MCFN quoted 40-year pharmacist Nancy Lewis, who said the bill didn’t come from the pharmacy profession. Rather, the story paints a picture of the bill pushed by CardinalHealth, which is among the many drug distributors and manufacturers being sued for exacerbating the opioid crisis.

Other groups also expressed concerns about whether the technicians staffing the satellite offices would have the proper controls.

“I’m supportive of the concept in general,” Brinks said. “Since committee, there’s been concerns by a couple groups. I’d prefer to take another look at it to make sure everything is as good as it can be and there’s nothing unusual going on.”

Santana said she was concerned that the technical wording of the legislation could open up locally owned small businesses to competition that could put them out of business. She said she hopes the needed changes are made in the House to address the issue brought forward by a different pharmacist group from Southeast Michigan.

Mental Health Pros Butting Heads Over ‘Scope Of Practice’ Bill
A bill updating the “scope of practice” for licensed professional counselors (LPCs), which has not been changed since the 1980s, has mental health experts from the Michigan Mental Health Counselors Association (MMHCA) and the Michigan Psychological Association (MPA) at odds.

Sponsor Rep. Aaron Miller (R-Sturgis) said after the House Health Policy Committee’s meeting Sep. 5 that he’s a little frustrated about a lack of progress on HB 4325, considering that a similar bill won strong approval from the House last year 95-14 only to stall later in lame duck.

“I think it is fair that the psychologists and psychiatrists see this as a scope of practice issue. I don’t think it is that. I disagree with that notion a little bit, but I think that is where the logjam is, where the disagreement is,” Miller said. “There is language in the bill that says what LPCs are not and it clarifies that they are not psychologists. There’s a list of things that specifically spell out what they are not qualified as, and so I think that is the safety.”

His substitute adopted today also gives the Department of Licensing and Regulatory Affairs (LARA) authority over the licensing process.

The definition for “counseling principles, methods or procedures” was last set in 1989. The bill would replace that term with clinical counseling principles, methods, or procedures and also revise and introduce categories falling under that term.

But Jeffrey Andert, chairperson of the Licensure Committee for the MPA, told the committee that current law does not allow LPCs to provide counseling for a mental disorder.

“As written, the bill would allow any graduate of a counseling program, regardless of specialty, to provide clinical counseling, including diagnosis, psychotherapy and testing,” Andert testified. “For example, a licensee with a degree specializing in career counseling could be licensed to provide clinical counseling and to diagnose and treat mental and emotional disorders. The bill as drafted could be interpreted to mean that all licensees could treat illnesses as serious as schizophrenia or bipolar disorder with as little as one survey course in clinical counseling.”

Andert said the bill specifically allows all LPCs to prevent and treat mental and emotional disorders but does not require that licensees have specific coursework in psychopathology or mental illness.

Andert said access to mental health treatment is too often a problem for Michigan citizens.

“The answer to a shortage of skilled clinicians is not to be found by lowering the education and training standards for potential providers,” he contended.

Dr. Sara Sue Schaeffer, of the MMHCA, said the goal of the bill is to allow only qualified people to be licensed while not disenfranchising any who are qualified. She contended language has been included in the bill to insure those unqualified are not eligible to be licensed.

Schaeffer contended that no one could be licensed unless they have training in a program accredited by the Council for the Accreditation of Counseling and Related Educational Programs (CACREP), which includes training in the diagnosis, treatment and assessment of mental and emotional disorders.

“So no one could be licensed unless they have had that training and all CACREP programs include that training. If the bill were restricted just to those with a specialty in clinical counseling, it would disenfranchise many qualified potential licensees and many qualified LPCs who are currently practicing,” Schaeffer contended.

Specialties have to do with counseling for certain populations, such as a substance abuse population, with a marriage and family population, with a rehab population.

“But the basic core training is the same for all,” she said.

The concept of the bill was approved last year as HB 5776, sponsored by former Rep. Jim Tedder. It passed in the House, but the Senate replaced the language with a scope of practice bill that been under consideration there, and returned it for concurrence.

The bill came up for a vote at 7 a.m. on Dec. 21, after representatives had been up all night trying to finish lame duck business. House members, both Republicans and Democrats, were unhappy with the changes, saying they were substantial and needed further study.

When the board was opened, the Senate’s version garnered only six yes votes, and the rest of the board went red. The floor leader asked that the board be cleared, and work on the bill went no further.

Health Policy has previously taken testimony on Miller’s reintroduction..

Health Policy did not vote on the bill today, but Miller said he believes committee members were receptive and he hopes to move the legislation soon.

Work Requirement Change Would Save DHHS $3M
The Department of Health and Human Services will not need to hire 25 additional call center employees, saving the department an estimated $3 million, if a proposed change to the upcoming Medicaid work requirement policy is signed into law.

Sen. Curtis Hertel Jr.’s SB 0362 moved out of a House committee Sep. 3. It gives able-bodied Medicaid recipients the entire month—as opposed to the first 10 days—to report the number of hours they’ve worked. If recipients miss a month on their reporting, they have 60 days from the end of the month to cough up the information to DHHS.

Hertel told the House Government Operations Committee the bill prevents problems similar to what happened in Arkansas, which activated its work requirements in June 2018. The Senate Fiscal Agency reported that 18,164 recipients lost their Medicaid coverage because confusion or assorted problems with the reporting process.

After the Unemployment Insurance Agency debacle in which thousands were falsely accused of fraud when a new system was put in place, SB 0362 can be seen as a preventive measure that is receiving unanimous support at every level of the process.

The legislation was worked out behind closed doors before it was introduced.

“While Senate Majority Leader (Mike) Shirkey (R-ClarkLake) and myself disagree with the policy of Medicaid work requirements, we both agree that nobody should be unintentionally kicked off from the system and they are meeting the spirit of the law,” Hertel said.

Hertel said the strict 10-day reporting window written in the current law is inefficient in that workers are addressing heavy call volumes in a shortened timeframe, making it harder for the call centers to keep up.

The Michigan League for Public Policy, while opposed to the work requirements, is supportive of the bill.

The bill moved out of the House Government Operations Committee, 5-0, without discussion. The House could move on the bill as quickly as this week and send it to the Senate for concurrence.

‘Major Budget Issue’ If Feds Enforce $195M Psychiatric Repayment On State
The state could face a $195 million hole if the feds require Michigan to pay back improper Medicaid funding for psychiatric facilities dating as far back as 2001.

The state is appealing, but if forced to fully comply, Michigan would have to repay $195.1 million in General Fund dollars over a three-year period. The State Budget Office said reimbursement would create a “major budget issue” if the appeal isn’t successful.

The possible debt is among those the SBO is keeping an eye on as a potential budgetary risk.

Asked what the contingency plan is if the state appeal isn’t successful, SBO spokesperson Kurt Weiss said, “In short, there is no immediate contingency plan.”

In 2018, the Centers for Medicare and Medicaid Services told Michigan it was issuing a disallowance of Medicaid payments made between 2001 and 2009 to two state psychiatric facilities.

It all started as far back as 1995, when the state started using a portion of its disproportionate share hospital (DSH) payments to support state psychiatric facilities. The federal portion of the payment provides a GF savings to the state, according to the SBO.

Federal regulations allow state Medicaid programs to dole out supplemental DSH payments to hospitals serving a high volume of Medicaid enrollees and the uninsured, and federal matching funds are available for these DSH payments up to a state-specific DSH cap.

In 2007, however, the Office of the Auditor General (OAG) concluded the DSH payments to state psychiatric facilities that were not CMS-certified “were improper.”

That made ineligible for match funding the ongoing DSH support of $176.7 million for the Center for Forensic Psychiatry, as well as an $18.4 million DSH payment made to the Huron Valley Center in 2001.

The Center for Forensic Psychiatry is now Medicaid-certified. But Huron Valley – which was under control of the Michigan Department of Corrections (DOC) – has since closed, said Bob Wheaton, spokesman for the Michigan Department of Health and Human Services.

Yet follow-up from CMS on the issue has been “unusually slow”, according to the SBO.

The OAG flagged the DSH payments to the psychiatric facilities in 2007. CMS did not communicate the payments were improper until 2010. A formal notice of disallowance was shared with the state in 2018.

Drug Or Supplement? New Bill Would Regulate Kratom
Kratom — a plant that grows naturally in Thailand, Malaysia, Indonesia, and Papua New Guinea and when powdered can be used to get high — would be regulated under legislation introduced Aug. 20 by Sen. John Bizon (R-Battle Creek).

The U.S. Food and Drug Administration has issued warnings that kratom, also known as Mitragyna speciosa, affects the same opioid receptors in the brain as morphine and appears to have properties that expose users to the risks of addiction, abuse and dependence.

SB 0433 would make it a Schedule 2 drug.

“Right now, it is sold over the counter. There is no restriction on age. We have had a number of people throughout the state that have died because of the use of this and sometimes this was documented as being the only substance that was within the body. In other cases, it was mixed with things like heroin and fentanyl and other substances,” said Bizon, a medical doctor by profession.

“. . . If you were in a drug rehabilitation program and wanted to use it in a medical setting, we could allow the use in a medical setting under professional guidance. But it would take it out of gas stations and move it to where I believe it belongs, in the pharmacies and the medical clinics and places that you have medical control.”

Kratom has its advocates, including the American Kratom Association, which views the substance as a botanical supplement that can alleviate pain and ease depression and anxiety.

A fact sheet on the association’s website contends that “zero deaths have been proven to be caused by kratom.”

Not true, says Bizon.

“We have had five deaths in Kent County in May of this year and I believe that in two of the cases their death certificates listed kratom as the only substance identified in the body. In two of the other cases there were other drugs, fentanyl, heroin and Oxycodone,” he said.

There may be medical uses for the substance. If it stimulates the same receptors in the brain that opioids do, Bizon said, it might be useful in treating opioid addiction.

“In my mind, if there is a medical use for it, regulation would be better than completely banning it,” he said, which is why he chose the route of regulating rather than banning it.

However, the FDA also issued letters to kratom marketers for making “unproven claims about their ability to treat or cure opioid addiction and withdrawal symptoms.”

As a Schedule 2 drug, sale and possession would be illegal without a prescription. If defined as an opiate, Bizon said, possession without a prescription of under 25 grams could result in four years in prison or a $25,000 fine.

Six states have banned kratom: Alabama, Arkansas, Indiana, Vermont, Rhode Island, Wisconsin and the District of Colombia.

Four have chosen to regulate it: Arizona, Nevada, Georgia and Utah.

Bizon said he thinks he will get a good reception from his Republican colleagues.

“Many of them don’t like regulation, but when it comes to the health of the Michigan populace, there seems to be a great deal of support for protecting them,” he said.

The bill was referred to the Committee on Judiciary and Public Safety.

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