MHA Update
Michigan Organization of Nurse Executives
Annual Advocacy Day
March 5, 2014
Chris Mitchell
Senior Director, Advocacy
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Political setting – March 2014
• Term limits for state elected officials, lawmakers lack experience
• 2014 - Election of leaders who will guide the state and country for
next 2 - 8 years
• State budget - surplus revenue, yet potential Medicaid provider
rate cuts
• Federal issues - Sequestration, physician payments, regulatory
costs
• National health reform implementation underway – year 4
• Medicare and Medicaid account for at least half of avg. hospital
revenue
• Over 1.3 million people uninsured in Michigan
• Over 1.8 million people in Medicaid, 167,000 eligible but not
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enrolled and 322,000 people projected to be added in 2014
Election 2014 – Important Dates
• Primary Election: August 5, 2014
• Election Day: November 4, 2014
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Election 2014 - State
• Governor
– Incumbent Gov. Rick Snyder (R) v. Mark Schauer (D)
• Attorney General
– Incumbent Bill Schuette (R) v. Mark Totten (D)
• Secretary of State
– Incumbent Ruth Johnson (R) v. Democratic challenger
(to be determined)
• State Supreme Court (2 incumbents, 1 open seat)
• State Senate (10 open seats)
• State House of Representatives (38 open seats)
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Election 2014 – Federal
• U.S. Senate
– U.S. Rep. Gary Peters (D) v. Terri Lynn Land (R)
• U.S. House of Representatives
– All 14 Michigan seats will be elected (2 open seats)
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2014 State of the State
• “The Victory Lap”
– 35 minutes reflecting on his accomplishments
• Politically safe issues
– Protecting seniors, increasing EC education funding,
attracting more immigrants to Michigan
– Resolution endorsing a Federal Balanced Budget
Amendment
• Health care issues not prevalent in address
– Noted successful passage of Health Michigan plan
– Health Endowment Fund - BCBSM Mutualization
– Mental Health and Wellness Report
• No mention of auto no-fault reform
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FY 2015 State Budget – MHA Priorities
• Maintain Medicaid rates paid to providers
• Restore GME funding to 2010 payment level
– Budgets have carried forward $5m in cuts to GME
• Maintain $40m provided for rural and sole community
hospital pool
– Maintain access for Medicaid beneficiaries in rural areas
• Reauthorize $2b of federal funding to support Health
Michigan plan
– Medicaid Expansion
• Maintain funding for another year of Primary Care/OB rate
increases ($100m GF)
– Federal funding expires after first quarter of FY 2015
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FY 2015 Executive Budget Recommendation
• Fairly straight forward, state budget stabilized, facing a
surplus
• $ 350m for Detroit pensions
• One-time tax rollback for citizens
• Increased funding for early childhood education
• Funding for Mental Health and Wellness report
recommendations
• $36m Small & Rural funding eliminated (one-time)
• $4.3m GME funding eliminated (one-time)
• Reauthorization of $2b of federal funding to support Healthy
Michigan Plan (Medicaid Expansion)
• Partial Continuation of Medicaid primary care rate increases
(50% rate bump)
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Unfinished Business – Resolve HICA Tax Shortfall
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Sunset extends four years
$115 million Medicaid budget hole
Administration backed away from resolution by Oct. 1
Senate Solution: $114.5m GF (RRR/surplus) in SB 608 passed 326. Headed to conference committee
• Many options on the table
• GF savings resulting from Medicaid expansion $125 m
• $1b budget surplus
• $25 Medicaid tax on auto premiums in auto no-fault
reform bill
• Legislative support for executive order reductions difficult
to achieve given state revenue surplus - Medicaid
provider reimbursement reductions remain a threat 9
State Advocacy
• Proactive
– Swing-bed modifications (SB 446)
– CRNA Opt-out (SB 180)
– Standard of Care Protection Act (Provider Shield –
GA)
• On Watch
– Nursing Scope of Practice (SB 2/SB 568)
– CON Reform/Repeal
• Defense
– Auto no-fault reform
– Nurse staffing ratios
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Auto No-fault - Reform and Preserve
• MHA Board priority, protect auto no-fault law
– House Bill 4612 reported from House Insurance
Committee as expected – MHA opposed
– House and Senate Democratic caucuses united in
opposition to HB 4612
– 25 House Republicans opposing HB 4612
– 8-11 Senate Republicans opposing HB 4612
– Speaker of the House, Governor looking for path
to resolve stalemate
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Auto No-fault – Speaker’s Latest Proposal
• $10m hard benefit limit (cap)
• Mandated fee schedule at 125% workers’ comp
– 30-day Prompt payment required
• Caps on attendant care and physical therapy
• Creation of a state-run MCCA, would handle
catastrophic claims
• $25 Medicaid tax per vehicle to resolve HICA
shortfall
• Creation of a low-income auto policy (133% fpl)
• Two-year 10% reduction in auto insurance rates
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Scope of Practice for Advanced Practice Nurses
• SB 2- Sen. Mark Jansen (R-Gaines Twp)
• Would define and create specific licenses for Certified Nurse
Practitioner (CNP), Certified Nurse-Midwife (CNM) & Certified
Clinical Nurse Specialist (CCNS) in Public Health Code
◦ Provide physical examinations and screening
◦ Prescriptive authority after apprenticeship
◦ Diagnosis, treatment and management of acute and
chronic diseases
◦ Ordering, performing and interpreting lab and imaging
studies
• Nov. 13: Passed the Senate 20-18; referred to House Health
Policy Committee
• Next steps??
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Certified Registered Nurse Anesthetists (CRNA)
Issue
• Limited access to anesthesiologists in rural areas has lead to
multiple member requests that MHA advocate for special CMS optout provision from federal supervision requirements for CRNAs
Problem
• Shortage/availability of anesthesiologists
• Surgeons unwilling to provide supervision of CRNAs
• Cost of anesthesiologist vs. volume of care need in rural areas
Option
• Governor attestation to CMS that in consultation with Boards of
Medicine and Nursing, the best interest of the citizens is to opt-out
of physician supervision requirement, consistent with state law
• Flexibility allowed for individual facilities to continue to require
physician supervision of CRNA’s
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• 17 states have opted-out of supervision requirement
Certified Registered Nurse Anesthetists (CRNA)
• MSMS President for 2014 is an anesthesiologist; strongly
opposed to potential changes
• Long, multi-year process in virtually all states, no indication that
Michigan will be different
• Governor’s letter alone not sufficient in Michigan
– Attorney General opinion #6567 (1989), anesthesia may be
delegated, but only under the supervision of a physician
• MHA and Michigan Association of Nurse Anesthetists pursue
legislative fix
– Passage of SB 180 necessary; Michigan Public Health Code
regarding CRNA scope of practice must change
– Sponsored by Sen. Mike Green (R-Mayville), adds
administration of anesthesia by a CRNA to practice of nursing
definition
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• Rep. Foster will introduce a House version this year
Nurse Staffing Ratios
• HB 4311/SB 225 – Rep. Jon Switalski (D-Warren/Sen. Rebekah
Warren (D-Ann Arbor)
• Would require hospitals to create an acuity system and
annual staffing plan including minimum nurse-to-patient
ratios and provide for penalties
• Number one issue for the MNA
◦ Key issue for their annual advocacy day
◦ After massive defeats in last session, back with a
vengeance
• Action not likely this session due to political environment
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