The normally scheduled summer legislative break has concluded, as active business within the legislature has resumed. While there are any number of variables that may affect the items on the legislative calendar, based on preliminary discussions with key legislative contacts the following items are likely to be addressed early in the fall.
- Senate Leadership Announcement
While not a policy related development, it has been reported that core of the leadership team for the Senate Republicans has been tentatively determined should, as is anticipated, Republicans maintain majority in 2018. This agreement is based on the probable incumbent members as well as at least six of the probable incoming members of the Republican caucus, so this slate is highly probable but still subject to change. Under the arrangement, Mike Shirkey (R-Clark Lake) would be Senate Majority Leader, Pete MacGregor (R-Rockford) would be Majority Floor Leader, Jim Stamas (R-Midland) would be Appropriations Chair, and Margaret O'Brien would be Speaker Pro Tem. This is a leadership team with strong ties to the physician community and, in particular, the ascendancy of Senator Shirkey from Chair of Senate Health Policy to the Senate Majority Leader offers continued opportunities to work with him and his staff.
- Prescription Drug Diversion/Opioids
The priority for the House Health Policy Committee this fall is finalizing the opioid abuse/prescription drug diversion package. Addressing the opioid epidemic is a priority for the administration as well as both chambers of the legislature. While nearly all of the bills have been amended in some way to accommodate the concerns of MSMS, Senate Bills 166 and 274 contain language that is objectionable to the best interests of patient care and physician workflow. Specifically, Senate Bill 166 would require that a physician conduct a MAPS query prior to the prescribing of any controlled substance. This language is overly broad and likely to create hardship for prescribers in excess of any benefit that might be realized in terms of reduced drug diversion. Senate Bill 274 places limits on the duration of prescriptions physicians can prescribe for acute pain. While Senate Bill 274 would have the effect of potentially reducing the excess supply of opioids in medicine cabinets, the rigid framework of the bill is likely to create unintended consequences for patients. Under the bill as written, there is no possible exception for a doctor prescribing medications to a patient even if the drug were lost or stolen. MSMS is working with the House Health Policy Committee to further amend these bills to be consistent with the MSMS objectives to reduce diversion while minimizing imposition on physician workflow.
- Auto No-Fault
The inability of the legislature to enact reforms relative to auto no-fault remains a particularly frustrating obstacle for Republican leadership in the House and the Senate. Leadership in both chambers have made commitments to the insurance industry to help tackle many of the structural elements of no-fault that are perceived to contribute to the relatively high premiums in Michigan for the minimal levels of coverage required to drive legally. Inaction on this topic has led to competing proposals by various factions within the legislature. Of note is the proposal by Mayor of Detroit, Mike Duggan, which would eliminate the unlimited medical benefit for drivers under his "D-insurance" product. Additionally, the factions within the insurance industry have finally united within a singular advocacy entity to further their cause. It is anticipated that there will be a press conference to release a proposal to reform auto no-fault in the coming days. The centerpiece of the proposal will be a fee schedule on medical providers set at 150 percent of Medicare. The proposal also will address other issues related to family provided attendant care, creation of a fraud authority, and how the assigned claims facility is administered.
The Coalition for Protecting Auto No-fault (CPAN), a coalition committed to the preservation of no-fault benefits for the survivor community and on behalf of physicians and other medical providers, has offered proposals for balanced reform. In addition to seeking rate relief for drivers, CPAN has offered a series of regulatory changes that seek to hold insurers similarly accountable for their practices that lead to increased premiums for drivers. Specifically, CPAN is seeking greater transparency of the entity that administers the Michigan Catastrophic Claims Association, a fraud authority that can address fraud committed by disreputable insurers as well as medical providers that bill illegally. CPAN is also seeking relief for the unfavorable ruling that came as a result of the Covenant v. State Farm court case. In Covenant, the court held that physicians and other providers do not have a direct cause of action to recover payment from an insurer. Payment must be obtained via the relationship with the patient; however, the current auto no-fault statute prohibits the ability of a physician or other provider to prospectively assign claims. This is a significant impediment to the ability of physicians and other providers to provide and then bill and collect payment for services rendered. In addition to addressing these issues, CPAN has offered a much more favorable fee schedule set at 185 percent of the current Workers' Comp fee schedule, with an ongoing inflationary adjustment.
These competing proposals provide renewed engagement on the part of legislators, but also offer significant opportunities for confusion and distortion of the impact of the various aspects of the legislative package. Such factors have led to a stalemate on this issue in the past. However, Speaker of the House Tom Leonard has indicated that he has made reform a priority. Furthermore, public scrutiny of this issue has increased due to significant media coverage on this issue. As this issue moves through the legislative process, MSMS will continue to work to assure that patients and physicians are treated fairly under no-fault.
- Maintenance of Certification
In addition to actively working with the legislature regarding issues we anticipate to be priorities, MSMS is also pursuing legislation as directed by the House of Delegates and the MSMS Board. Maintenance of Certification has been the topic of a hearing in the House Health Policy Committee. MSMS is working with individual members of the Committee to generate the necessary support for the bills to move out of Committee and onto the floor for further debate. At this point, many of the Committee members are attempting to sort out the conflicting positions of BCBSM, some medical specialties that are opposed to MOC reform, and the largest chorus of physician groups that oppose the encroachment of MOC into the practice of medicine. Efforts are underway to activate local physicians to meet with and lobby legislators on the Health Policy Committee to garner the sufficient votes necessary to pass the bill.