Home2019-01-17T20:58:16+00:00

COMPLIANCE CORNER: Suggestion For Medicare Providers

Erin Diesel Roumayah, Esq.
Wachler & Associates, P.C.

In June, the Office of Medicare Hearings and Appeals (OMHA) publicly implemented an expanded Settlement Conference Facilitation program. SCF is an alternative dispute resolution process which provides appellants and the Center for Medicare and Medicaid Services an opportunity to discuss a mutually agreeable resolution for claims appealed to the Administrative Law Judge (ALJ) or Medicare Appeals Council levels of appeal. This program applies mediation principles to resolve eligible Medicare appeals in an expedient and efficient manner. Through this program, an OMHA senior attorney or program analyst trained in mediation techniques acts as a neutral facilitator between the appellant and CMS in a one-day mediation, to negotiate a lump-sum settlement on eligible appeals.

OMHA has significantly modified the eligibility criteria for appellants and appeals under the expanded program. This program was first released in the summer of 2014 and was restricted to Medicare Part B providers and suppliers. Nearly two years later, given wide support and interest in the program, it was expanded to Medicare Part A providers. As of December 31, 2017, OMHA resolved 70,785 appeals through the various phases of the SCF program. Notably, this is the equivalent of almost an entire year’s disposition capacity for all of […]

LEGAL LEANINGS: Mental Health Parity

By ERICA MORRIS, GREGORY MOORE AND RUSSELL KOLSRUD
Mental Health Parity Really Does Mean Equal Benefits
By Erica Morris, Gregory Moore and Russell Kolsrud

In Danny P. v. Catholic Health Initiatives, 891 F.3d 1155 (9th Cir. 2018), the Ninth Circuit clarified the full extent of the “parity” required in the federal mental health parity law1 which has been in place since 2008.

In Danny P., the Ninth Circuit held that a particular group health plan (the Catholic Health Initiatives Medical Plan—Blue Cross Blue Shield) was prohibited from denying the same or equivalent room and board coverage in behavioral health facilities that it provided in non-behavioral health facilities, overturning the district court’s decision in favor of the plan. Specifically, the Court held the plan could not be permitted to deny inpatient room and board costs at a behavioral health inpatient residential treatment facility while simultaneously allowing coverage for non-behavioral health (medical and surgical) inpatient room and board costs at a skilled nursing facility.

The plan at issue was a self-funded group health benefit plan covering Catholic Health Initiatives employees and their dependents, and provided for coverage of “mental health services,” bed, board, and general nursing care, ancillary services provided at skilled nursing facilities, and also provided coverage for […]

LANSING LINES

He’s Running As A Doctor But Can’t Practice . . . Does It Matter?
Matt Longjohn’s chief selling point in his Michigan 6th Congressional district run is that he’s a medical doctor. But he can’t practice medicine in Michigan because he isn’t professionally licensed in this state or in Illinois, where he formerly worked.

Longjohn, the Democrats’ nominee in the southwest Michigan district, has made a career on the administrative side of health care, most significantly as the first-ever National Health Officer for the 2,700 YMCAs in the United States when he worked in Chicago.

In campaign materials, he refers to himself as Dr. Matt Longjohn, MD, and uses the squiggly heartbeat signal to punctuate the point. But according to the Department of Licensing and Regulatory Affairs, he’s never been licensed as a health professional in Michigan.

And whether he’s allowed to describe himself as such under the Michigan Public Health Code is an open question in the legal community.

The Public Health Code (333.16261) reads “an individual who is not licensed or registered under this article shall not use an insignia, title or letter . . . to induce the belief that the person is licensed or registered in this state.” Asked if that means Longjohn is in violation […]

Drugmakers Play The Patent Game

By SARAH JANE TRIBBLE
David Herzberg was alarmed when he heard that Richard Sackler, former chairman of opioid giant Purdue Pharma, was listed as an inventor on a new patent for an opioid addiction treatment.

Patent No. 9861628 is for a fast-dissolving wafer containing buprenorphine, a generic drug that has been around since the 1970s. Herzberg, a historian who focuses on the opioid epidemic and the history of prescription drugs, said he fears the patent could keep prices high and make it more difficult for poor addicts to get treatment.

“It’s hard not to have that reaction of, like … these vultures,” said Herzberg, an associate professor at the University at Buffalo.
James Doyle, vice president and general counsel of Rhodes Pharmaceuticals, the Purdue subsidiary that holds the patent, said in an email statement that the company does not have a developed or approved product and “therefore no money has been made from this technology.”
“The invention behind the buprenorphine patent in question was developed more than a dozen years ago,” he wrote. “If a product is developed under this patent, it will not be commercialized for profit.”
Yet, the patenting of a small change in how an existing drug is made or taken by patients is part of a tried-and-true […]

Dems Call For Immediate PFAS Hearings; They Won’t Happen

House Democrats called on Republicans to hold hearings this week, specifically in the Natural Resources and Oversight committees, to have the Department of Environmental Quality present what it knows about PFAS contamination and how extensive the problem is in Michigan.

Eight Democrats, led by Minority Floor Leader Christine Greig (D-Farmington Hills), held a press conference Sept. 4 to demand the hearings and that lawmakers take immediate action to strengthen water quality standards for perfluoroalkyl and polyfluoroalkyl substances (PFAS), a diverse group of compounds resistant to heat, water and oil. Such chemicals have been used in hundreds of consumer products and industrial applications including carpeting, apparels, upholstery, food paper wrappings, fire-fighting foams and metal plating.

The chairs of those committees, Rep. Gary Howell (R-North Branch) and Rep. Joseph Graves (R-Linden), called the press conference “political” and said hearings won’t be happening in early September. Howell said he is committed to holding hearings, but will wait until after the election.

“It is a pattern of indifference. That’s why we need the public pressure right now to call for hearings, call for oversight, and get back to an empowered DEQ that understands the issue, listens to the scientific data, listens to the public health concerns, and actually takes action,” Greig said […]

Toxic Déjà Vu – PBBs And Now PFAS

By GERALD NATZKE, JR., DO
Do you remember Polybrominated Biphenyls (PBBs) sowing fear and disease into the lives of Michigan citizens approximately 43 years ago? Those PBB’s entered the larger food chain through a single error made by a Gratiot County chemical company worker when a ton of Firemaster (a toxic fire retardant) was added to cattle feed. PBB’s were ingested by cattle throughout this area and spread throughout Michigan and the Midwest, producing one of the largest chemical poisonings in the Western world. Another much larger and more dangerous toxic chemical exposure has been discovered. This family of toxins, through ignorance, and poor oversight has been introduced to Michigan’s and U.S. citizens in multiple insidious ways. These chemicals are called Per- and Polyfluoroalkyl Substances (or PFAS and PFOS).

U.S. Rep. Dan Kildee said that “the seriousness of PFAS contamination cannot be overstated.” Frankly, like the PBB issue in the ‘70s the PFAS poisoning ushers in another era of ecologic crisis. These perfluorinated compounds are linked to cancer, liver damage, birth defects, infertility, thyroid and autoimmune disease, neurologic disorders and hypercholesterolemia. According to Kildee at a recent meeting with physicians, these compounds have been found in more than 30 sites throughout Michigan and are entering aquifers and […]

I’m Voting For Healthcare Interoperability In November. How About You?

By EWA MATUSZEWSKI
We know that “Fix the Damn Roads” is a critical imperative for one of Michigan’s gubernatorial candidates—and hopefully for both. But is “Fix the damn interoperability problem with electronic health records” another? The intersection of healthcare and politics is obviously not new. I would contend it’s more visible—and viscious—than ever. Still, the focus tends to be on access to care and delivery of care, and I understand that. Interoperability of EHR hardly pulls at the heartstrings or incites passionate conversation from either side of the aisle. Accordingly, it doesn’t garner much attention from the consumer media either. That is why it is important for healthcare decision makers to individually and collectively raise awareness of the issue, not just in the healthcare community, but with our elected officials.

To make sure we’re clear on the topic (and in case some politicians are reading this,) interoperability in this context refers to the ability to share and interpret patient data and information electronically across systems and devices among hospitals, insurers, clinics and private practice physicians.

I’ve said it before, and I’ll say it again: there ought to be a law. While I disdain the proliferation of excessive laws that seemingly aim to control our every move, legislation embraced […]

Updated Opioid Laws Enact More Stringent Reporting And Usage Requirements

By JESSE A. MARKOS, ESQ.
Wachler & Associates, P.C.
The Michigan Opioid Laws include a 10-bill package of legislation passed in December, 2017, to help curb Michigan’s increasing substance abuse and drug diversion problem. The majority of these provisions came into effect on June 1, 2018 and healthcare providers must become familiar with and incorporate these provisions in to their practice to ensure they are compliant with the changes.

Healthcare providers use the Michigan Automated Prescription System (MAPS) to review a history of any Schedule 2-5 controlled substances that a patient has legally obtained. Not only does MAPS list the prescriber and type of controlled substance that has been prescribed, but it also lists the location of the pharmacy it has been dispensed at. MAPS data assists healthcare providers in identifying evidence of potential diversion such as: obtaining controlled substance prescriptions from more than one provider, filling prescriptions early, filling prescriptions at multiple different pharmacies, and filling prescriptions at distant pharmacies. In the past, providers were not required to register for or use MAPS, although it was highly encouraged and likely to be considered the standard of care when prescribing a controlled substance. Nevertheless, while it was largely considered the standard of care to run and review a […]

IRS: The Good, Bad and Ugly for Health Care Providers

By RALPH LEVY
In early August, the Internal Revenue Service issued proposed regulations that provide guidance to owners of pass-through businesses as to eligibility for a federal tax deduction of 20 percent of the income generated by the businesses. This deduction was part of the Tax Cuts and Jobs Act (TCJA). Although the stated purpose of the proposed regulations is to provide clarity on eligibility for and the means to compute the deduction, this guidance is lengthy and complex. However, for healthcare providers, there are two important takeaways.

Takeaway No. 1: Guidance on whether a healthcare business is a “specified service trade or business.”

One of the important limitations to the pass-through deduction in the TCJA is that owners of pass-through businesses that conduct a specified service trade or business (SSTB) and whose income exceed the so-called income limitation ($207,500 for single taxpayers and $415,000 for married taxpayers who file jointly) are not entitled to claim the 20 percent deduction. The TCJA provides that a SSTB includes a trade or business that involves the performance of services in the health field.

The proposed regulations provide guidance as to what types of businesses involve the performance of health services:

The performance of services in the field of health means the […]

LANSING LINES

Lyon’s Attorneys Seek To Dismiss Criminal Case
As expected, attorneys for Michigan Department of Health and Human Services Director Nick Lyon are asking the Genesee County Circuit Court to quash the bind over from district court and dismiss all criminal charges.
In court filings Sept. 10, defense attorneys John J. Bursch, Larry Willey and Charles “Chip” Chamberlain Jr. say Genesee County District Judge David Goggins’ made his “decision by closing (his) eyes to numerous principles well-settled in Michigan law” and that his decision to send Lyon to trial on two counts of involuntary manslaughter and misconduct in office is the first in the state’s history to hold a director criminally liable for subordinates.

“The families of Mr. (Robert) Skidmore and Mr. (John) Snyder desire justice, as do the people of Flint,” Bursch wrote. “But that desire cannot be satisfied subjecting Director Lyon to a trial for criminal charges that fail as a matter of law. That would be the exact opposite of justice.”

A 9 a.m. Sept. 26 hearing was set, but it’s unclear if Circuit Judge Joseph J. Farah will hear the defense’s motions that day.

The state had not filed a response as of Sept. 10.

The state argued at a preliminary examination that Lyon’s failure to notify the […]

LETTER

Editor:

Just A Few Questions
How can it be expected that all physicians and all citizens will succumb to the idea of socialized medicine without inquiring as to why they should? Is it somehow mandatory that we U.S. citizens duplicate the socialist-lite bloated welfare states that are the examples of how the rest of the “advanced” world’s approaches healthcare? How is it always correct to increasingly subvert the medical profession by employing ever more restrictive regulatory shackles? Isn’t it interesting to witness how the left-leaning elites write a check with money they do not have that comes from our bank accounts so that they can snoot and virtue signal? Isn’t social justice great when some elites can redistribute wealth to achieve equal outcomes in a world of humanity with individual cultures and aspirations? It seems I read somewhere that God created each person as unique and in His own likeness.

As the cadre of newly enlightened devotees to the alleged equality of their social justice platform prescribe socialized medicine for all of us, will this not steal coveted freedoms from physicians and citizens? Critical thinking versus emotional feel-good stuff?

You know, let these great new falsely pious warriors have at it. But leave the rest of the doctors and […]

PFAS Firefighting Foam Still Used Because It Works Better

The firefighting foam linked to the group of chemicals known as PFAS—which is believed to be harmful to infants, toddlers and pregnant women—is still being used because firefighters say the alternative extinguishing products don’t work as well.

Detection of PFAS has led to the creation of the Michigan PFAS Action Response Team, a multi-agency organization dedicated to understanding the far-reaching effects of the chemical and educating the public on the threat it poses.

The discovery of high concentrations of PFAS in the drinking water near Camp Grayling, Kent County and Parchment has spurred public and political concern. Most recently, U.S. Reps. Debbie Dingell (D-Dearborn), Fred Upton (R-St. Joseph) and Tim Walberg (R-Tipton) are pulling together a public meeting on the subject.

House Democrats are working with the League of Conservation Voters in demanding Republican legislative leaders hold hearings on the issue.

“It’s reason for concern because it’s an issue of public health,” said Katie Parrish, communications director for the Michigan League of Conservation Voters.

The Michigan PFAS Action Response Team has asked State Fire Marshal Kevin Sehlmeyer to survey over 1,000 fire departments to identify the amount of PFAS in firefighting foam, according to the Michigan Department of Licensing and Regulatory Affairs.

Although the survey has not been completed, the response […]

In Trump’s First Year, Nation’s Uninsured Rate Unchanged

By PHIL GALEWITZ
Despite Republican resistance to the federal health law, the percentage of Americans without health insurance in 2017 remained the same as during the last year of the Obama administration, according to a closely watched report from the Census Bureau.

However, the uninsured rate did rise in 14 states. It was not immediately clear why, because the states varied dramatically by location, politics and whether they had expanded Medicaid under the federal health law. Those states included Texas, Florida, Vermont, Minnesota and Oregon.

The uninsured rate fell in three states: California, New York and Louisiana.

An estimated 8.8 percent of the population, or about 28.5 million people, did not have health insurance coverage at any point in 2017. That was slightly higher than the 28.1 million in 2016, but did not affect the uninsured rate. The difference was not statistically significant, according to the Census report.
About 17 percent of Americans were uninsured in 2010, the year the Affordable Care Act was enacted. The Census numbers are considered the gold standard for tracking who has insurance because the survey samples are so large.

Analysts credit the health law with helping drive down the number of uninsured. But also a factor: The proportion of people without insurance typically falls as […]

McCain’s Complicated Health Care Legacy: He Hated the ACA. He Also Saved It.

By EMMARIE HUETTEMAN
There are many lawmakers who made their names in health care, seeking to usher through historic changes to a broken system.

John McCain was not one of them.

And yet, the six-term senator from Arizona and decorated military veteran leaves behind his own health care legacy, seemingly driven less by his interest in health care policy than his disdain for bullies trampling the “little guy.”

He was not always successful. While McCain was instrumental in the passage of the Americans with Disabilities Act in 1990, most of the health initiatives he undertook failed after running afoul of traditional Republican priorities. His prescriptions often involved more government regulation and increased taxes.

In 2008, as the Republican nominee for president, he ran on a health care platform that dumbfounded many in his party who worried it would raise taxes on top of overhauling the U.S. tradition of workplace insurance.

Many will remember McCain as the incidental savior of the Affordable Care Act, whose late-night thumbs-down vote halted his party’s most promising effort to overturn a major Democratic achievement — the signature achievement, in fact, of the Democrat who beat him to become president. It was a vote that earned him regular — and biting — admonishments from President Donald Trump.
McCain […]

How Rival Opioid Makers Sought To Cash In On Alarm Over OxyContin’s Dangers

By FRED SCHULTE
As Purdue Pharma faced mounting criticism over deaths linked to OxyContin, rival drugmakers saw a chance to boost sales by stepping up marketing of similarly dangerous painkillers, such as fentanyl, morphine and methadone, Purdue internal documents reveal.

Purdue’s 1996-2002 marketing plans for OxyContin, which Kaiser Health News made public this year for the first time, offer an unprecedented look at how that company spent millions of dollars to push opioids for growing legions of pain sufferers. A wave of lawsuits demanding reimbursement and accountability for the opioid crisis now ravaging communities has heightened awareness about how and when drug makers realized the potential dangers of their products.

The Purdue documents lay out how the company and its biggest competitors were jockeying for market share. Some of those drugmakers’ sales promotions downplayed or ignored the risks of taking opioids, or made false claims about their safety, federal regulators have asserted in warning letters to the companies.

Purdue first offered OxyContin as a remedy for moderate to severe cancer pain in 1996. Within three years, the company viewed the cancer market as too limited, with $261 million in potential annual sales versus $1.3 billion for a broader range of chronic pain care, the company’s marketing reports said.

“That was […]

No One Knows How Many Lose Coverage From Healthy MI Work Reqs

The state still doesn’t have an exact figure on the number of Healthy Michigan recipients who could lose health coverage because of the work requirements recently enacted by the Legislature.

However, the Michigan Department of Health and Human Services said it doesn’t expect more than 400,000 of the roughly 680,000 Healthy Michigan recipients to be affected by the 80 hours-per-month requirement that came with Sen. Mike Shirkey’s (R-Clarklake) SB 0897, signed into law by Gov. Rick Snyder in June.

That 400,000 number is based on subtracting from the total program population the number of people who are already meeting those hours, or are exempt from other work requirements posed by food assistance and cash assistance programs, DHHS spokesperson Bob Wheaton said.

Yet, Wheaton said the number impacted by the requirements could still be less than 400,000, because some may be exempt from the work requirements and some may already be working.

But the DHHS hasn’t been able to calculate how many people might be kicked off their health coverage for not complying with work requirements, a question posed to the state by House Minority Leader Sam Singh (D-East Lansing) July 31 during a public hearing on the DHHS’ proposed Healthy Michigan waiver.

Singh argued that because the state doesn’t have […]

Physician Practices Should Incubate Future Physicians

By EWA MATUSZEWSKI
In the waning days of summer, I allow myself to meander at bit, including in my columns.

First off is an issue that has a bit of a back to school connection, and that is that primary care physician practices and their teams should be incubators for future physicians. While training in an ambulatory setting is preferable to a hospital setting, such an environment generally doesn’t reflect the value of the ongoing relationship that is developed between the PCP and patient—a relationship that can reinforce healthy behaviors and provide health strategies that help prevent or manage chronic conditions and co-morbidities.

When residents are trained day in and day out in this setting, they are also afforded a unique mentoring experience, with “teacher” and “student” not only jointly providing care, but with the resident learning communication (listening) skills with the patient and the patient’s family from the physician mentor. Such practice-based training is also imperative for population health, with residents seeing patients in their medical home, rather than in acute situations in a hospital setting.

Now I want to revisit a training approach that does not take place in a physician’s office, or even a traditional health setting, but is primary care training, nonetheless. I think it […]

COMPLIANCE CORNER: Private Equity In MI Healthcare Entities

By REESA N. BENKOFF & DUSTIN WACHLER
Michigan healthcare providers contemplating a relationship with private equity investors must be aware of various legal considerations relative to such arrangements. Increasingly, private equity investors are becoming more interested in investing in healthcare entities. Such investments often present lucrative opportunities for healthcare providers, yet these arrangements implicate a myriad of legal issues. This article will focus on health law issues, however other legal issues including, without limitation, corporate, tax and real estate matters, must be considered when evaluating private equity investment in healthcare entities.

Michigan laws include a legal doctrine commonly referred to as the corporate practice of medicine (CPOM) doctrine. CPOM laws restrict who can own and control certain healthcare entities and employ certain healthcare providers. Specifically, Michigan law requires entities that provide professional medical services to be organized as professional corporations (PCs) or professional limited liability companies (PLLCs). Michigan PCs and PLLCs engaged in the practice of medicine may only be owned by individuals licensed to provide the professional medical services rendered by the entity, or by entities directly or indirectly solely owned by such licensed individuals (1). Further, all officers of PCs and managers of PLLCs must be licensed to provide the professional medical services […]

LEGAL LEANINGS: HIPAA And The Opioid Crisis

By KIMBERLY J. RUPPEL
With the ever-growing opioid crisis and the president’s call to action to address that crisis, primary care, pain management and behavioral health providers in particular may be faced with privacy issues dealing with a patient’s family, friends or others in relation to treatment for opioid abuse. What can a provider disclose to others in the aftermath of an overdose in order to assist a patient’s recovery efforts and prevent future incidents? What information can a provider share about a patient’s condition and treatment in such a situation?

The Health Insurance Portability and Accountability Act (HIPAA) prohibits disclosure of a person’s protected health information (PHI) to family members, friends or others involved in the patient’s care (or payment for care) without patient consent except for certain defined situations.

In the event an individual is disoriented, unconscious or otherwise incapacitated, a medical provider may provide information to others without the patient’s permission so long as sharing that information is: (1) in the best interest of the patient; and (2) the information shared is directly related to the patient’s care. Thus, a provider may exercise his or her judgment to advise family or others that an opioid overdose occurred, describe the patient’s condition and how the […]

LANSING LINES

Health Org: Prosecuting Lyon Could Cause ‘Threat’ Nationwide
A non-profit organization representing health agencies and public health professionals says holding state Department of Health and Human Services Director Nick Lyon criminally responsible for actions done in his professional responsibility could “cause a threat to public health nationwide.”

A second nonprofit organization disagreed with criticism of criminal accountability for the Flint water crisis.

The two statements came in amicus curiae briefs filed by the Association of State and Territorial Health Officials (ASTHO) and Community Based Organizing Partners (CBOP), respectively, just two days before Lyon learns if he will head to trial on felony criminal charges for decisions he made during Flint’s Legionnaires’ disease outbreaks in 2014 and 2015.

“This prosecution greatly concerns ASTHO and its members, who fear that the criminalization of professional, discretionary decision making will harm, not help, public health,” ASTHO’s attorney Jeffrey Muth, of Grand Rapids, says in a court filing. “. . . In seeking to punish public health officials for their administration of their professional responsibilities, this case could cause a threat to public health nationwide.”

Flint-based CBOP’s brief from East Lansing Attorney Mark A. Totten stated: “Several voices—the well-connected, who neither live in Flint nor experienced this horror—have publicly criticized the idea of criminal accountability […]

ON MEDICINE: The Death Of Private Practice, Maybe Not

By ALLAN DOBZYNIAK, MD
Is there any life remaining in the longstanding and cherished method of healthcare delivery by staunchly independent, patient-centric physician entrepreneurs? Do those physicians relishing the autonomy of small businesses aligned around patient care still exist? Are the market and political forces evolving in ways not permitting independence for such physicians, and is their demise inevitable?

When examining the history of healthcare in the United States, at some point predicting that the private practice of medicine would be in peril now seems inevitable. Tax-exempt policy toward employer-based health insurance, the expensive cost-plus Medicare and Medicaid payment policy at the outset of those programs in the 1960s and first-dollar (no deductible) health insurance policies could not help but result in healthcare cost inflation. These are symptoms of what Justice Louis Brandeis dubbed the problem of “Other People’s Money.” With advances in technology and an aging demographic added to the mix, the seeds of healthcare inflation have long been sown.

Of course as these myriad poor decisions stoked inflation, action by the same decision makers who created the problems was deemed necessary. The result was pricing controls disguised within various schemes, a regulatory onslaught, burgeoning numbers of mandates and the two programs delivering the coup de gras, […]

Trump Loosens Restrictions On Short-Term Health Plans

By JULIE APPLEBY
Insurers will again be able to sell short-term health insurance good for up to 12 months under final rules released Aug. 1 by the Trump administration.

This action overturns an Obama administration directive that limited such plans to 90 days. It also adds a new twist: If they wish, insurers can make the short-term plans renewable for up to three years.

The rule will “help increase choices for Americans faced with escalating premiums and dwindling options in the individual market, said James Parker, a senior adviser to Health and Human Services Secretary Alex Azar.

But the plans could also raise premiums for those who remain in the Affordable Care Act marketplace — and the short-term coverage is far more limited.
“We make no representation that it’s equivalent coverage,” Parker said.

The Trump administration’s approach is expected to please brokers and the insurers that offer the coverage.

“To restore these to 364 days — as originally drafted — is exactly what we are looking for,” said Jan Dubauskas, general counsel for the IHC Group, speaking before the final rule was released. The IHC Group is an organization of insurance carriers headquartered in Stamford, Conn.

She said she expects IHC to offer 12-month versions as soon as the rule goes into effect, […]

Medicaid Work Requirement Bill Signed

Able-bodied, adult Healthy Michigan recipients would need to work 80 hours a month or be in a job training program after Jan. 1, 2020 in order to keep their Medicaid coverage unless they fall under a handful of exemptions, under legislation Gov. Rick Snyder signed June 22.

Sen. Mike Shirkey’s (R-Clarklake) SB 0897 also strips Healthy Michigan recipients who chronically lie on their monthly work reports to lose their coverage for a year. The Department of Health and Human Services would receive an extra $5 million a year under the bill for the additional auditors needed to track these recipients.

The bill also restates in law a provision that legislative Republicans didn’t get in the original Healthy Michigan waiver to the federal government. It allows people to stay on Healthy Michigan for 48 months, after which they need to set aside 5 percent of their income for healthcare while also pledging to engage in healthy behaviors to stay in the program.

If the President Donald Trump administration doesn’t approve the federal waiver that would be needed to implement these policies, Healthy Michigan would end.

Snyder framed the bill signing as the preservation of his Healthy Michigan program, which has enrolled 670,000 Michiganders as of the most recent numbers.

“I am committed […]

New Mental Health Parity Proposal

There should be no “discrimination of coverage” between mental health benefits and those paid out by insurance companies for physical health, says Rep. Martin Howrylak (R-Troy).

He introduced two bills in mid June,HB6109, and HB 6191, calling the mental health parity, requiring insurers to offer the same coverage for mental health services as traditional medical care.

“The big picture is that mental health treatment should be not subordinated to physical health because they are inextricably linked,” Howrylak explained. “They both represent heath care needs of individuals.”

He used the example of disorders like bulimia and anorexia. Left untreated, they obviously can lead to very significant health problems later on.

“If I were an insurance company, I would rather nip it in the bud because I would know that I might have to spend a little more money today but in the long run I’m going to save money,” he said. “If people are doing well mentally, they are most likely going to be doing better than they would otherwise physically. It is very antiquated to treat them separately and it is something that is not consistent with modern science.”

The issue is not new in Michigan.

Wendy Block of the Michigan Chamber of Commerce, which has opposed previous such proposals, said […]

ON POINT…WITH POs: Certification Overload

By EWA MATUSZEWSKI
In last month’s column, I asked the question, “Why do physicians with a career history of providing high quality care have to continue to take board re-certification examinations every six years?” I guess the topic of certifications in general has me in a bit of a huff these days. Not physician certifications, necessarily; rather, the plethora of certifications that have sprouted in recent years for healthcare roles not directly related to personal, clinical care.

I recently came across a post on LinkedIn that noted 149 patient advocates were now certified through a board I won’t name, following the inaugural national certification exam for professionals working as patient advocates. I’m an advocate for advocacy in most forms, and certainly for patient advocates. Yet does an examination make them more qualified or effective than their non-certified patient advocate colleagues in the field? I use this only as an example, not to highlight the legitimacy of this particular board and/or certification.

In general, I believe there is mission creep when it comes to board certifications for professionals who work in the healthcare community yet are not providing direct clinical care. Is the goal of having an educated healthcare workforce being hijacked by non-profit or for-profit companies set up […]