House Panel Discusses Bills to Codify Telemedicine Access
A package of bills to make telemedicine services more accessible and expand it for Medicaid and Healthy Michigan program recipients was discussed last Thursday by the House Health Policy Committee .

The lead bill, HB 4131 , sponsored by Rep. Tullio Liberati (D-Allen Park), would prohibit health insurance policies in Michigan from denying or restricting coverage for telemedicine services and to require that telemedicine services be treated the same as in-person medical care.

Another focus of the bill would codify federal mandates allowing for wider telehealth services during the pandemic that have either ended or are set to expire.

Sponsored by Christine Morse (D-Texas Township), HB 4213 would revise language concerning the coverage of telemedicine services under Medicaid and the Healthy Michigan program. It would add that those services are also covered under the programs if provided at or contracted through a distant site allowed by the Medicaid Provider Manual.

The pair of HB 4579 and HB 4580 , sponsored by Rep. Natalie Price (D-Berkley) and Rep. Felicia Brabec (D-Pittsfield Township), would require an insurer or the Department of Health and Human Services to provide the same coverage for services provided through telemedicine as if the service was in person.

All four bill sponsors testified on Thursday before the panel. Price took the lead and explained her bill does not impair an insurer’s ability to negotiate prices for services.

"It also isn’t the intent of this legislation to replace necessary in person services with telemedicine," Price said. "This legislation is about expanding access to quality health care, which may not otherwise be able to be provided because of lower telemedicine reimbursement rates, or complete lack of coverage for services delivered in this way."

She went on to say that parity between telemedicine and in-person visits would be most important for uninsured people, those seeking behavioral health and addiction treatment services, and patients who have lost their access to care.

Liberati said that his bill places restrictions on insurance policies so insurers cannot dictate how service is provided, whether that was through in-person visits or telehealth.

Morse said the main issue facing patients or would-be patients who have eschewed seeking care is access to a health provider, and by offering these services over the phone or through video conferencing, that issue could be alleviated.

"We don’t have enough providers. People have transportation issues. People have difficulty obtaining insurance in the first place, or they live in a rural community where they have to drive really far to even get to the doctor if they have a vehicle to do it," Morse said. "So, giving people this opportunity, which is so present in our society, in how we communicate period, just makes sense."

She said her bill would also allow medical providers to offer more care to as many people and as efficiently as possible.

Brabec, who is a clinical psychologist with her own private practice, shared her support of the package through the lens of a provider.

"With that uptick in telehealth use during the pandemic, it’s fair to say that folks became accustomed to that and it was a mode of communication and treatment that was more appropriate for some," she said. "Part of what helps make that accessible is the fact that people are comfortable. There’s a stigma issue that folks have to manage all the time. If we can do things to be able to mitigate some of that, this is a way to do that, and I think that we should."

The bills received supportive testimony from Phillip Bergquist, CEO of the Michigan Primary Care Association; Nick Hemady, the chief medical officer for Honor Health; and Kevin Bonsack, with the Michigan State Medical Society, and several others.

A multitude of associations and physicians submitted cards, all in support of the package. There was no testimony nor cards signaling opposition to the bills.

Rep. Curt VanderWall (R-Ludington) asked about how the state and insurers could control costs, asking if there was a way to justify any additional costs if, for example, it was recommended that several telemedicine appointments in a month occur instead of just one in-person visit every month or several months apart.

Price, speaking from the lens of addiction treatment services, said it was not up to the Legislature to decide whether a certain number of visits were necessary as means of controlling costs. She said that was up to the provider and more so the Department of Licensing and Regulatory Affairs and the accrediting boards, which promulgate rules on the matter.

Morse also said that there are national standards of care that providers need to follow, and in addition to licensing, there was always the threat of malpractice if a doctor was not providing necessary services. She echoed Price in saying that it was not the Legislature’s job to dictate how those providers practice medicine.

The committee did not report the bills but adopted substitutes for HB 4131 and HB 4580. The first substitute to HB 4131 would add that insurers are prohibited from requiring a health care professional to provide services for a patient through telemedicine. Current law provides the same prohibition for requiring face-to-face contact where they might determine telemedicine works well.

The substitute for HB 4580 was not published online at the time of publication, nor was it discussed during the meeting. Brabec did not respond to messages seeking additional clarity.

Senate Health Policy Tees Up Behavioral Health Parity Bill
Legislation that would require insurers to have similar financial requirements between behavioral and physical health coverage is likely to move to the Senate floor next week.

The Senate Health Policy Committee  adopted an S-2 substitute for SB 27 last Wednesday but held off on reporting the bill, which would bring Michigan law into line with federal law that requires parity in behavioral and physical health coverage.

One change in the substitute adopted Wednesday says insurers must follow whatever requirements are more stringent, state or federal law.

Sen. Jim Runestad (R-White Lake), a committee member, asked where state law might be more expansive than federal law now.

Joseph Sullivan, legislative liaison for the Department of Insurance and Financial Services, said the bill mirrors the federal parity law but noted the continuing discussions in Congress about health care law.

"There’s always volatility at the federal level," he said.

Should federal law change, the bill would assure insurers in Michigan must observe parity in coverage, Sullivan said.

As for now, the idea is to cover any gaps that might exist between federal and state law, though Sullivan said that’s unlikely.

A wide array of health groups voiced support for the bill: the Mental Health Association in Michigan, the Michigan Health and Hospital Association, Blue Cross Blue Shield of Michigan, Disability Network of Michigan, the Michigan Nurses Association and the Community Mental Health Association of Michigan.

Sen. Kevin Hertel (D-St. Clair Shores), the committee chair, said he anticipated a vote to report the bill next week.

RESTRAINT/SECLUSION: On a different bill dealing with behavioral health, the committee adopted a substitute but did not report legislation that would allow children’s therapeutic group homes to restrain or seclude children provided they follow statute and administrative rules.

A children’s therapeutic group home is a child caring institution for up to six children, usually on a 24-hour basis, who are diagnosed with a developmental disability or a serious emotional disturbance.

Current law bars these group homes from using restraint and seclusion .

SB 227 would allow them to do so.

Sen. Dan Lauwers (R-Brockway), the bill sponsor, said these homes could help address the lack of inpatient psychiatric beds for children in need but the homes need provisions to protect their staff and other patients.

Heidi Fogarty, assistant director for child and family services at St. Clair County Community Mental Health, said the bill would allow the agency to operate a therapeutic home safely.

"(It) will foster a sense of hope and security among families who have been desperately seeking help for their children," she said.

Health and Human Services Director Elizabeth Hertel told the committee these homes could serve as a step up or a step down from other care options. Seclusion and restraint are a last resort and only acceptable in emergencies, she said.

"Staff need the appropriate tools to respond in a safe way," she said.

The bill will likely be voted out to the Senate floor this week, Sen. Kevin Hertel (D-St. Clair Shores), the committee chair, said.

Drivers Could Be Ticketed For Staying To Close To A Snowplow
Michigan drivers traveling closer than 200 feet from a snowplow on streets in which the speed limit is faster than 35 miles per hour could be ticketed, under legislation by Sen. Sam Singh (D-East Lansing). 

A report titled: "Defensive Driving for Snowplow Operators," affiliated with the Virginia Tech Transportation Institute (VTTI), documented 1,354 vehicle crashes with snowplows from 2012 to 2017. 

Among those crashes, 38.4% were reportedly due to inattention or misjudgment by the snowplow operator, 23.2% were because of "loss of control" and 22.8% were linked to inattention or misjudgment by the other driver. 

"This legislation is asking to make a small change to Michigan laws that will hopefully reduce the growing number of traffic accidents that we are seeing between snow plows and personal automobiles," Singh said earlier this week in testimony before the Senate Transportation and Infrastructure Committee concerning his SB 465. "It’s really when you’re in the same lane, and that’s where we’re seeing some of those accidents, where people don’t realize how close they are to a snowplow." 

Singh said the legislation would not affect a driver’s ability to pass a snowplow in another lane. 

The legislation also details that if a driver is approaching a stopped snowplow, like one waiting at an intersection, they must stop at least 20 feet away from the snowplow and must continue to be stopped until the snowplow is moving again and exits an intersection. 

Singh said the legislation mirrors present-day law in Wisconsin, where the statute has existed for around 20 years. 

According to the Wisconsin Department of Transportation, 17 snowplow-involved crashes were fatal between 1984 and 2004. Although the department says that no snowplow crash information has been gathered since 2004, Singh said Wisconsin’s statute has made a significant impact. 

On Oct. 3, when the Senate panel heard testimony on the legislation, Adam TOUNTAS of the Michigan County Road Commission Self Insurance Pool said he doesn’t have a hard number regarding the degree to which snow plow crashes have increased on local and county roads in Michigan, "but I will tell you that it’s a significant (enough) uptick that we got together and said we should do something about it." 

"If someone’s out plowing the road, we’re in an inclement weather situation, and you have all of the hallmarks of that. You have poor visibility, you have bad traction with your tires, ice, slush, snow . . . and the space cushion that we’re asking for is actually, I don’t want to say it’s the bare minimum, but we think it is the least intrusive," said Tountas, adding how the legislation deals with municipal, government-owned snowplows. 


Left: DCD’s Jake German was happy to host the Hazel Park Leadership Team last week in Lansing to create awareness around the myriad issues facing local governments. Pictured here left to right: Police Chief Brian Buchholz, City Manager Ed Klobucher, State Representative Mike McFall, Deputy City Manager & Treasurer Laci Christiansen, City Attorney Amanda Mason, and lobbyist Jake German.

Right: Senator Mat Dunaskiss fires up the crowd at an event supporting Mark Gunn for Troy City Council at the home of Rocky Raczkowski in Troy.

Jake German joins Mark & Mary Gunn and supporters at his Troy fundraiser last Friday evening.


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