As the year comes to an end, I wanted to provide an update on some legislative and budgetary matters that MAHP has been actively engaged in and monitoring for our member health plans.
MAHP is dedicated to educating lawmakers on our positions whether it’s legislation that we’ve initiated and advocating for, or bills where our member health plans have concerns and suggest policy changes. We have also been raising awareness of the valued and positive attributes of managed care which will become a cornerstone advocacy issue next year.
Below is a quick rundown of some legislative items of interest this year:
Senate Bills 597 & 598 reform Michigan’s Medicaid program to improve access, provide customer choice, and enhance the delivery of behavioral health care services in Michigan. As a MAHP Strategic Plan initiative, these bills were introduced this year by Senate Majority Leader Mike Shirkey and Senator Bizon and passed out of the Senate Government Operations Committee this Fall. They now await action before the full Senate which we anticipate to take place early next year.
Following policy discussions and extensive deliberations before the Senate Government Operations Committee, Senate Bill 714 was introduced and added to this bill package to allocate several financial supports to improve behavioral healthcare delivery in Michigan. Some $348 million in federal Coronavirus Recovery Funds would be used under this bill to enhance mental health services in Michigan. Senate Republican leadership is currently working with Senate Democrats to develop additional suggestions and ideas in an effort to gain bi-partisan support for this much needed reform package.
PBM Legislation & House Health Care Reform Package
Earlier this year the Michigan House hastily introduced and passed a 15-bill packaged creating new mandates and regulations on the healthcare industry. From new insurance mandates on condition-related coverages to caps on cost sharing as well as onerous and harmful unprecedented regulations on Pharmacy Benefit Managers (PBM).
MAHP has been actively working and educating Senate members about the consequences these bills will have on insurance premiums. As a result, the Senate has agreed to take a much more measured and deliberate approach and has been working with MAHP on suggested policy changes. We understand that the PBM reform bill (HB 4348) is the number one priority for the Michigan House and as such, movement on this bill will likely be considered by the Senate at some point next year.
It is our understanding that Senate is considering many of our suggested policy changes to both the PBM and other House bills in the package. The Senate has indicated that they intend to consider many of our changes and work with the House over the break to finalize a draft substitute to the PBM bill prior to taking action.
We believe we have made tremendous progress with Senate members on explaining why the NADAC language is costly, unattainable, and a bad precedent to set in rates. MAHP will be sure to review the changes that may be proposed by the Senate in the coming weeks and ensure health plan members interests are addressed.
Another MAHP Strategic Plan initiative was introduced and passed the Senate this Fall. Senate Bill 447 is an effort by our member health plans to proactively address the lack of competition in Michigan and the contributing factor it has had on health insurance premiums. The legislation empowers employers to request confidential information on claim and utilization data from their health insurers so they can be more informed about costs and trends and informed when shopping for future coverage for their respective employees.
The bill was introduced in the Senate this year and unanimously passed. Senate Bill 447 is currently before the House Insurance Committee where Chair Daire Rendon has indicated it will be the first item on the docket for House Insurance Committee upon their return in January.
Prior Authorization Reform
As an initiative lead by medical providers, legislation (SB 247) was introduced this year that would have dramatically usurp health plans abilities to utilize prior authorizations in a host of situations to control costs and ensure evidence based best practices. After months of conversations, education and advocacy that included meetings with MSMS, MAHP was able to garner several policy changes to the bill to become more comfortable and supportive of the reform. The bill unanimously passed the state Senate on April 29. The bill now awaits a hearing in the House Health Policy Committee.
MAHP believes the bill now makes several changes to the prior authorization process that will be patient (not provider) focused. The changes made at MAHP’s request provide real reform that makes the process easier to navigate for the consumer.
The Fiscal Year 2021-22 budget bill provided funding authorization for a 2.5% actuarial soundness increase to Medicaid composite rates, giving room for potentially additional resources to be dedicated by MDHHS to the Medicaid managed care program beyond the contractual rates that were set this year. MAHP was also successful in getting a number of boilerplate requests from member health plans included in next year’s budget.
To see how the legislature scored on these bills as well as others, please check out the MAHP Legislative Scorecard.back to blog