Pay Raises For Health Workers Abound In DHHS Budget
A number of workers employed in state human services-related fields will be getting raises under the Fiscal Year 2020 budget approved for the Michigan Department of Health and Human Services by the Legislature Sept. 24.

SB 0139 earned the most Democratic support in the House, where it passed 64-44. The Democrats who crossed over to vote yes with Republicans were Reps. John Cherry (D-Flint), Abdullah Hammoud (D-Dearborn), Jon Hoadley (D-Kalamazoo), Rachel Hood (D-Grand Rapids), Leslie Love (D-Detroit), Laurie Pohutsky (D-Livonia), Karen Whitsett (D-Detroit) and Angela Witwer (D-Delta Twp.).

Rep. Steven Johnson (R-Wayland) voted no with most of the Dems. Reps. Brenda Carter (D-Pontiac) and Larry Inman (R-Williamsburg) did not vote.

The DHHS budget cleared the full Senate 24-14, with Sens. Winnie Brinks (D-Grand Rapids) and Sean McCann (D-Kalamazoo) joining the Republicans in voting yes.

Sen. Erika Geiss (D-Taylor) specifically flagged a $15 million cut in programs that fund medical services and juvenile justice facility maintenance. She also pointed at $15 million needed to get Michigan to comply with the new Lead and Copper Rule, saying those “lack of investments are additional missed opportunities for our children and our communities.”

The Legislature went along with Gov. Gretchen Whitmer’s’s request for $16 million to give direct care behavioral health workers a 25-cent-an-hour raise and $28.2 million for an hourly Medicaid adult home help minimum wage pay raise of 25 cents.

The DHHS conference threw in a $2.1 million increase to fund a 5.5% increase to private agency rates for family preservation program services, as well as a $1.1 million hike to fund a 6.5 percent increase to private agency rates for adoption support services.

The budget adopted Whitmer’s $211.5 million that contains within it a 2.75 percent increase to prepaid inpatient health plans (PIHPs), an estimated 5.75 percent increase for PIHP autism services, and an estimated 2 percent adjustment for Medicaid health plans and Healthy Kids Dental.

All the parties agreed with the administration’s increase of $950,000 General Fund to fund the $2 per night supplemental increase to shelter providers provided for an entire year, with the $2 increase raising the per diem rate to $18.

That, and the administration and Legislature agreed on $956,300 in GF to fund an increase in the annual federal child support collection fee, meaning an increase from $25 to $35 per case once $550 is collected on behalf of the custodial parent.

While the Whitmer administration would have preferred $1.8 million in GF dollars to support new $1,000 one-time incentive payments for relative foster care providers who become licensed foster parents within 180 days of the initial placement, the conference report ended up going with $250,000.

Other areas in the DHHS budget with rate increases included:

– $1.7 million to increase Medicaid neonatal rates to 95 percent of Medicare reimbursement.

– $10.7 million to increase pediatric psychiatric practitioner rates by 15 percent.

– $3.9 million to increase Medicaid private duty nursing rates by 15 percent.

Also, while the DHHS budget didn’t include $10 million in employment and training-related services and supports tied to the Healthy Michigan Plan work requirements, $10 million was included in the budget for the Michigan Department of Labor and Economic Opportunity (LEO) for employment and job training for Healthy Michigan recipients.

Yet, the Community Mental Health Association (CMHA) of Michigan also raised concerns that the DHHS budget “would permit health plans to circumvent the existing public mental health system and contract for services outside of the existing network,” according to a press release that included the signatures from officials representing CMHA of Michigan, HealthWest, West Michigan CMH and Genesee Health System.

“This draconian move would allow health plans to make cost the primary focus, rather than placing the care of patients across Michigan first,” according to the CMH press release, which adds later the budget “destroys the idea of a pilot and moves to a full state carve-in to a privatized system—long before the pilots are completed and fully evaluated.”

In the budget boilerplate, Section 298, language calling for a behavioral and physical health integration pilot in Kent County, was removed. That, and it also allows Medicaid health plans to also contract directly with other behavioral health service providers.

The Senate also had originally required a January 2021 report on progress on a list of measures that, if met, would trigger an October 2022 implementation statewide of integrated care provided through managed care. The conference report adopted that but pushed the trigger back to January 2022 and implementation to October 2023.

The Michigan Health & Hospital Association (MHA) supported the FY 2020 budget, urging Whitmer to sign it. The MHA, in a statement, said the Legislature’s budget would support a “more sustainable, long-term funding environment for hospitals by ensuring Medicaid reimbursements are closer to the cost of providing care.”

That, and the budget’s “maintained support for the Rural Access Pool and Obstetrics Stabilization Fund” meant that that the Legislature “is protecting vital safety net services and care in Michigan’s most remote areas.”

The MHA also noted the budget “fully funding the Healthy Michigan Plan and seeking to improve behavioral health services for pediatric inpatient psychiatric care.”

DHHS Can’t Access 75% Of IT Dollars Without Legislative OK Under Budget
Lawmakers locked away 75 percent of IT funds tied to Michigan Department of Health and Human Services into a line item that “can only be accessed through the legislative transfer process,” as part of the conference committee budget approved for the department Sept. 19.

The Fiscal Year 2020 spending document for the DHHS, SB 0139, earned yes votes from Rep. Abdullah Hammoud (D-Dearborn) and the rest of the panel Republicans, and a pass from Sen. Curtis Hertel Jr. (D-East Lansing).

The budget doesn’t actually reduce IT funding, but did set aside of 75 percent of all IT funding into the restricted contingency line item.

According to the boilerplate language, the DHHS cannot spend funds for the operations, maintenance and improvement of major programs except from specified line items.

The department also cannot spend money on a new child welfare computer system until 30 days after providing a spending plan for the development of a new system to replace the old one.

Department spending on IT items has been under legislative scrutiny, and the House appointed a task force to dive deeper into the problems associated with the department repeatedly burning through its appropriated IT funds.

Elsewhere in the DHHS budget, Gov. Gretchen Whitmer didn’t get $36.2 million toward implementing the Healthy Michigan work requirements that begin Jan. 1, 2020.

The conference also went with the House on shifting $376,700 from Healthy Michigan to go toward Flint drinking water and lead exposure, rather than the governor’s recommended $3.4 million.

The conference did fund the House’s $3.4 million for health care, food and nutrition, lead abatement and other services in communities where lead contamination has caused human health consequences.

In the ongoing tussle with Whitmer over the replacement of the Caro Center, the legislative conference report kept boilerplate language requiring DHHS to use funds for the Caro Center at its current location,indicated “legislative intent” is that the psychiatric facility remain open and operational at its current location. It also stipulated that any capital outlay funding be used at the current location.

The conference’s total $26.4 billion DHHS spending plan is higher than the initial governor, House and Senate recommendations for DHHS for FY 2020, with $4.7 billion of that coming out of the General Fund. The House didn’t win its 3 percent administrative efficiencies reduction in the conference-approved report.

The DHHS budget features a $63.3 million increase in the traditional Medicaid program, a $40.7 million decrease in the Healthy Michigan program, a $170.9 million drop in food assistance due to declining caseloads and $10.4 million decrease in public assistance cases due to declining caseloads.

Other items approved by the conference:

– $4.9 million to fund the supplemental Child Protective Services (CPS) increase from a 2018 supplemental for an entire year.

– $3 million for 68 full time equivalents at the Caro Regional Mental Health Center to address clinical and direct care staff shortages, as requested by the governor.

– $1 million for Kalamazoo Psychiatric Hospital and 15 FTEs to reduce the amount of mandatory overtime for direct care staff.

– $2.7 million to address PFAS contamination, down from the governor’s suggested $5.5 million.

– $226,000 to waive state or local vital record fees for a birth certificate copy for homeless people.

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

New Rules Would Deepen Mental Health Crisis, Rep. Miller Says
An estimated 10,000 licensed professional counselors (LPCs) would be unable to continue their practice if legislation clarifying the requirements for their training is not passed, and quickly, Rep. Aaron Miller (R-Sturgis) told the House Ways and Means Committee Oct 2.

There is already a crisis in access to mental health care and LPCs are “really what I consider to be the frontline of mental health care in this state,” Miller said.

“If you take that away, the crisis that already exists would be—exacerbated is a great word—would only become much greater and you are talking about a huge ripple effect among patients and other healthcare providers,” Miller said. “That’s why sheriffs have rung into me. They rely on the mental healthcare system and they’ve said we need this bill to pass. We need them on the frontline.”

Miller’s HB 4325 clarifies training requirements for LPCs to what he said is current practice. Miller contends it does not expand their scope of practice beyond current practice.

Michael Joy, of the Michigan Counselors Association, estimates some 250,000 patients would be affected.

Miller and Health Policy Committee Chair Hank Vaupel (R-Fowlerville) explained that when LPCs were added to the public health code 30 years ago, the administrative rules adopted to implement that legislation didn’t match the statute.

Legislation was proposed last year to align the two, but the bill died in lame duck.

Since the legislation failed to pass, the Department of Licensing and Regulatory Affairs (LARA) is moving to align them by administrative rules.

Miller said he has worked closely with LARA to adjust his bill and made a number of technical amendments. LARA is being cooperative, he said.

Nonetheless, if LARA’s rules were adopted, entire clinics might have to close, testifiers told the committee.

Joy told the committee LPCs treat people for illnesses like depression, anxiety and trauma. Under LARA’s rules, he’d have to tell patients he couldn’t treat them anymore.

That includes, he said, “women that are sexual assault survivors, kids that have autism, and people that have taken such a long time to come to counseling in the first place. That setback would be devastating.”

But not everyone is happy with Miller’s bill. Judith Kovach, of the Michigan Psychological Association (MPA), said her organization is anxious to see the bill passed, but not with the current wording.

“HB 4325 would change the statutory language to allow anyone with a Master’s degree in any counseling specialty to diagnose and treat mental and emotional disorders,” Kovach said. “The bill states that course work and training in diagnosing and treatment, however the nature and extent of that course work is not specified. As a result, HB 4325, as currently written, would permit an individual with a degree specialization in, for example, college counseling or career counseling to be licensed to treat someone with a disorder as serious as bipolar disorder or schizophrenia.”

Miller said he’s convinced the bill should stand as is.

“There is just a difference in belief between LARA and current practice. I don’t think the language needs to change at all. I think it is ready for prime time,” he said.

Ways and Means Chair Brandt Iden (R-Oshtemo Twp.) said he plans to call a vote on the bill Oct. 8.

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