Health Care Law Blog

Earlier this year, the Substance Abuse and Mental Health Services Administration (SAMHSA), a branch of the U.S. Department of Health and Human Services (HHS), finalized updates to the Confidentiality of Substance Use Disorder Patient Records regulation at 42 CFR Part 2 ("Part 2").

The Legislature has delayed the effective date of a key provision in the new controlled substance prescribing laws until March 31, 2019, or until the Michigan Department of Licensing and Regulatory Affairs (LARA) promulgates rules on the subject.

In response to growing concerns about misuse and abuse of opioid medications, Michigan has enacted three statutes amending the Public Health Code.  The new statutes impose specific requirements on physicians, dentists, physician assistants, and nurse practitioners (“prescribers”) who prescribe controlled substances and on pharmacists who fill those prescriptions.

Chemed Corporation and various of its subsidiaries, including Vitas Hospice Services LLC and Vitas Healthcare Corporation (collectively “Vitas”), recently settled allegations brought by the federal government that Vitas violated the False Claims Act by submitting to Medicare false claims for hospice services.

An interesting case is winding its way through the Michigan Court of Appeals that involves the question of whether a layperson, as opposed to a licensed physician, can own a for-profit business that provides medical services.

The Centers for Medicare & Medicaid Services ("CMS") recently extended the temporary moratorium on the Medicare enrollment of new home health agencies ("HHAs"), subunits, and branch locations in Michigan.

The Centers for Medicare & Medicaid Services ("CMS") recently announced that they will delay enforcement penalties related to Phase 2 of their revised nursing home Requirements for Participation (commonly referred to in the industry as the "Mega Rule").

For the past decade, health care has remained one of the most tumultuous and dynamic industries; uncertainty, along with opportunity, are likely to continue in 2017. This three-part series will discuss some of the most important health care trends. This section will focus on some of the largest factors affecting costs and reimbursement in health care: 1) MACRA Implementation; 2) Medicaid Reimbursement; 3) Shifting Payment Models; and 4) Drug Pricing.

On April 14, 2017, the Centers for Medicare & Medicaid Services issued its 2018 Medicare Inpatient Prospective Payment System proposed rule (the “Proposed Rule”). The Proposed Rule was published in the Federal Register on April 28, 2017, and comments will be accepted through June 13, 2017.

The Proposed Rule suggests a number of changes that would affect hospital rates, inpatient quality reporting and readmissions reduction programs. Some of the most significant changes are highlighted below.

Late in the afternoon on March 6, two committees of the U.S. House of Representatives introduced legislation that would replace and repeal significant portions of the Patient Protection and Affordable Care Act, also known as the ACA or Obamacare. The new legislation, titled the American Health Care Act, addresses a number of key complaints that have been raised by employers since the ACA's implementation. Several provisions of the new legislation that are of particular interest to employers are described briefly below.

On January 9, 2017, the Centers for Medicare & Medicaid Services (“CMS”) issued final rules that establish minimum standards for home health agencies (the “Rules”). According to CMS, the Rules are intended to improve the quality of health care services for Medicare and Medicaid patients and strengthen patients’ rights.

The Rules, which were published in the Federal Register on January 13, 2017, come more than two years after a draft proposal was introduced in October 2014. The Rules are mostly adopted as proposed, with a few clarifying changes. The Rules will become effective on July 13, 2017. This means agencies have less than six months to make changes necessary to comply with the revisions.

Recently, the Centers for Medicare & Medicaid Services (“CMS”) issued a final rule (“Final Rule”) updating the Medicare Conditions of Participation (“CoPs”) for long-term care (“LTC”) facilities. It is the first time in over 15 years that substantial LTC CoP revisions have been released.

LTC facilities affected by the Final Rule include skilled nursing facilities for Medicare and nursing facilities for Medicaid, or those facilities that are duly certified. The Final Rule took effect on November 28, 2016, however CMS has planned for a phased implementation. LTC providers must complete the three implementation phases by November 28 in the years 2016, 2017 and 2018, respectively. CMS has estimated that the costs of compliance will be $62,900 in the first phase of implementation, and $55,000 per year for phases two and three.

The march to transform Medicare from a quantity-based to a value-based system continues unabated - and the pace is quickening. Over the past several months, the Centers for Medicare & Medicaid Services (“CMS”) issued several final rules to update certain Medicare reimbursement rates and quality reporting requirements that impact vast numbers of healthcare providers.

The Centers for Medicare & Medicaid Services ("CMS") recently announced the statewide expansion of its temporary moratorium on the Medicare enrollment of new home health agencies ("HHAs"), subunits, and branch locations in Michigan.  As a result of the moratorium expansion, effective as of July 29, 2016, new HHAs in Michigan are precluded from enrolling in Medicare until the moratorium is lifted. The temporary moratorium also precludes the Medicare enrollment of new HHAs in Florida, Illinois, and Texas.  

On July 6, 2016, the Centers for Medicare & Medicaid Services ("CMS") released the 2017 Outpatient Prospective Payment System ("OPPS") Proposed Rule (the "Proposed Rule"). The Proposed Rule explains how CMS plans to implement Section 603 of the Bipartisan Budget Act of 2015 ("Section 603"), which established a new site neutral payment policy for certain off-campus hospital outpatient departments.

Section 603 provides that, as of January 1, 2017, certain items and services provided by off-campus hospital outpatient departments will no longer be reimbursed under the more favorable OPPS, and will instead be paid under another "applicable payment system."

The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) recently announced that it has begun Phase 2 of its HIPAA audit program. This audit phase will impact covered entities and their business associates.

The U.S. Department of Health & Human Services ("HHS") recently issued a final rule that implements the nondiscrimination provisions under Section 1557 of the Affordable Care Act (the "Final Rule"). The Final Rule becomes effective July 18, 2016.

The U.S. Court of Appeals for the Sixth Circuit recently affirmed a district court’s dismissal of a whistleblower lawsuit alleging violations of the False Claims Act based on an individual security breach. The case, United States ex rel. Sheldon v. Kettering Health Network, arose after the relator (or whistleblower) received letters from Kettering Health Network (KHN) informing her that KHN employees, including her now ex-husband, impermissibly accessed her medical records.

On March 31, 2016, the United States District Court for the Northern District of Alabama granted summary judgment for AseraCare in one of the largest False Claims Act (FCA) lawsuits against a hospice provider. In this whistleblower case, the government sought over $200 million, alleging that defendant AseraCare overbilled Medicare for hospice services by falsely certifying that patients were eligible for hospice care.

The litigation began when six AseraCare employees in Alabama, Wisconsin and Georgia (the "relators") filed whistleblower cases under the FCA. The employees alleged that AseraCare knowingly submitted false claims to Medicare by falsely certifying that patients met the Medicare eligibility requirements for the hospice benefit. In order to be eligible for the Medicare hospice benefit, a patient's physician must certify that "the individual's prognosis is for a life expectancy of 6 months or less if the terminal illness runs its normal course." 42 C.F.R. § 418.22(b)(1). The Department of Justice (DOJ) intervened in January 2012.

The Department of Health and Human Services (HHS) Office for Civil Rights (OCR) recently announced that it reached resolution agreements and corrective action plans with two health care entities - a health system and a research institution - in connection with alleged violations of the Health Insurance Portability and Protection Act of 1996 (HIPAA). These cases underscore the importance of ongoing HIPAA compliance vigilance by covered entities and business associates, particularly in light of OCR’s recent announcement that it has commenced Phase 2 of its audit program.

Recent guidance issued by the U.S. Department of Justice (“DOJ”) reveals the government’s renewed focus on individual accountability during corporate investigations. On September 9, 2015, Deputy U.S. Attorney General Sally Quillian Yates issued a memorandum to DOJ attorneys (the “Yates Memo”) that emphasizes the importance of seeking accountability from the individuals who are responsible for corporate wrongdoing.

The Yates Memo outlines six measures that should be taken by federal prosecutors during any investigation of corporate misconduct in order to hold accountable the individuals who are responsible for the conduct. A discussion of each measure appears below.

On July 31, 2015, the Centers for Medicare & Medicaid Services (“CMS”) issued final Medicare payment rules for federal fiscal year 2016 (the “Rules”). The Rules affect hospitals, hospices, psychiatric facilities, and rehabilitation facilities. 

The Department of Health and Human Services (“HHS”) recently released a HIPAA overview called “HIPAA Basics for Providers: Privacy, Security, and Breach Notification Rules” (the “Overview”). The Overview is intended to provide HIPAA Covered Entities such as physicians, hospitals, and other health care providers with a basic overview of HIPAA’s rules and responsibilities. The fact sheet also provides an overview to Business Associates (such as law firms and accounting firms who receive protected health information ("PHI") from Covered Entities). The Overview can be found here.

The Overview explains that the HIPAA Privacy Rule protects individually identifiable PHI, which includes information such as an individual’s past, present, or future physical or mental health condition.

In a first-of-its-kind and closely followed case, a U.S. district court denied a New York health system's (Healthfirst’s) motion to dismiss the U.S. government's and State of New York's complaints in intervention under the federal False Claims Act (FCA) and New York state counterpart. This case represents the first time that the government has intervened in an FCA case based upon an allegation that a party violated the "60 day rule." The 60 day rule came into existence with the passage of the Affordable Care Act (ACA) in 2010 and subjects parties to FCA liability for failing to report and refund an overpayment within 60 days of identification, even if the defendant received the payment through no fault of its own.

The case, Kane ex rel. United States et al. v. Healthfirst et al., involves three hospitals that were part of the Healthfirst health system network and provided care to patients that were part of Healthfirst's Medicaid managed care plan. Healthfirst received payments from the New York State Department of Health (DOH) in return for services provided to Medicaid eligible enrollees.

The government's allegations stem from overpayments to Healthfirst as a result of a software glitch. Healthfirst was first questioned about the possible overpayments by the New York State Comptroller's office in 2010. The health system tasked Kane, an employee and the eventual whistleblower in the case, to look into the payments. Five months later Kane emailed Healthfirst management a spreadsheet listing over 900 claims totaling more than $1 million that contained an erroneous billing code that may have led to the overpayments.

A very long legal battle may be nearing its final chapter after the U.S. Court of Appeals for the Fourth Circuit upheld a $237 million judgment against Tuomey Healthcare System in South Carolina. The judgment is an enormous sum for the regional health system and hospital, with even one of the Court of Appeals judges calling it a "death sentence." A three-judge panel heard the case at the Court of Appeals, so Tuomey could still seek reconsideration from all the judges of that Court or take the case to the U.S. Supreme Court. It may also opt to find a new partnership to keep the hospital afloat.

The Affordable Care Act ("ACA") authorizes the innovative payment model referred to as direct primary care, and more commonly known as “concierge medicine.” Under the direct primary care model, patients can access comprehensive coverage of basic healthcare services for a flat monthly fee.  Such services generally include guaranteed same-day or next-day visits with no waiting times. Concierge medicine is becoming increasingly popular in states where it is allowed.

The DHHS Health Resources and Services Administration (“HRSA”) has finally published the new National Practitioner Data Bank (“NPDB”) Guidebook.  The original Guidebook had not been updated since September 2001. 

The updated April 2015 NPDB Guidebook is available here.

The new Guidebook extensively covers the changes resulting from the 2013 merger of the NPDB and the Healthcare Integrity and Protection Data Bank (“HIPDB”).  The HIPDB was a separate data bank that received and disclosed reports of final adverse actions by federal and state agencies and health plans against practitioners, entities, providers, and suppliers.  After the merger, there were significant changes in the entities eligible to query and report, as well as the individuals and entities subject to reports. 

The February issue of the American Health Lawyers Association’s AHLA Connections features a list of the top ten issues that will impact healthcare law in 2015. We summarized the first five topics in a previous blog. (Miss our summary of the first five? Please click here.)

Here are the remaining trends to think about: 

The Office of the National Coordinator for Health IT (ONC) released a report on January 29 that identifies optimal healthcare information exchange and implementation standards to enable a nationally interoperable health data information exchange system by 2017 (i.e. standards so that you can have your health records sent and read by all your doctors).

In healthcare, interoperability of IT systems allows providers to share data among different practitioners, insurers, billing and scheduling systems and health information exchanges. Interoperability has the potential to improve the quality of patient care by providing access to accurate, timely information in one location, save time previously used searching for information, and make critical medical information instantly available for clinical decisions.

Under the 2009 economic stimulus legislation’s electronic health records (EHR) incentive payment program, the ONC was directed to establish a governance mechanism for the nationwide health information network. Since that time, however, the ONC has been under increasing criticism about the lack of interoperability of EHRs despite the significant public investment.

The Medicaid program, a public insurance program serving approximately 66 million low-income Americans, is at risk for losing participating providers who claim they are not being compensated fairly for their services. On January 19, 2015, the Supreme Court heard arguments in Armstrong v. Exceptional Child Center, a case that could impact the rights of healthcare providers to sue states for higher Medicaid payments. Five private companies brought suit against the director of Idaho’s health department, arguing that the state unfairly reimbursed them at rates set in 2006, despite the fact that higher rates have since been approved by the Centers for Medicare and Medicaid Services (“CMS”).

Federal law provides that state Medicaid programs must ensure payments are “sufficient to enlist enough providers,” but states have discretion to decide what that means. 42 U.S.C. § 1396a(a)(30)(A) (the “Medicaid Statute”).  Central to this case is whether providers have a cause of action that allows them to seek enforcement of a federal statute.

On Friday, October 17, Governor Rick Snyder signed the Right to Try Act, which allows patients to try experimental drugs and other treatments before they have been approved by the Food and Drug Administration (FDA). The law gives patients with advanced illnesses access to drugs that successfully cleared Phase 1 of an FDA approval. Phase 1 testing seeks to establish a drug's safety and profile and evaluates possible side effects. It involves 20-80 volunteers and lasts approximately one year.

As is well known by now, transitional relief from the Patient Protection and Affordable Care Act's Employer Mandate in 2015 is available for certain applicable large employers that sponsor non-calendar year health plans. This transitional relief allows the employer to avoid penalties for those months of 2015 that predate the first day of the non-calendar plan year. What is not so well-known, however, are the requirements that must be met in order for the employer to be entitled to receive the transitional relief.

On October 3, 2014, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a proposed rule to amend the safe harbors to the anti-kickback statute as well as the civil monetary penalty (CMP) rules. While much of the proposed rule codifies changes to the anti-kickback statute safe harbors already established by the Affordable Care Act (ACA) and Medicare Modernization Act of 2003 (MMA), it also proposes two new safe harbors and makes technical corrections to an existing safe harbor. The OIG also proposes to narrow the definition of "remuneration" in the Beneficiary Inducement CMP laws as well as codify and interpret the gainsharing CMP rules set forth in section 1128A(b) of the Social Security Act.

The proposed changes to the safe harbors and CMP laws would give providers greater flexibility to enter into beneficial arrangements with the assurance that they will not be subject to penalties under these laws. The proposed rule reflects the OIG's continued effort to adapt its regulations to the changing health care landscape.

For more details on these proposed changes, please visit our newsletter article, which provides an in-depth analysis of the proposed rule. If you have any questions on the proposed rule and how you are affected, please contact an attorney in our Health Care Practice Group.

Julie C. LaVille authored this article as a Law Clerk.

"It's a war we're in." That's how John Halamka, the chief information officer of Boston-based Beth Israel Deaconess Medical Center, described the current state of affairs between the health care industry and the hackers and identity thieves who are trying to steal patient records.

A recent Boston Globe article detailed the threat and provided some interesting - and sobering - statistics and information:

• There is high demand for health records, and a single health record may be worth $50 according to the FBI
• Criminal intrusions into health care systems have risen 100 percent in the past four years
• Of 614 total identity theft breaches in 2013, 269 (43.8 percent) were in health care (the most of any industry)
• Despite being the subject of the most attacks, a recent study by BitSight Technologies found that health care providers are the slowest in any industry to respond to data breaches.

Hackers are motivated to target health records in order to facilitate identity theft, financial fraud and illegal drug use. The Boston Globe article, in particular, highlighted two recent incidents involving cyber-security breaches:  (1) Chinese hackers seized the personal information of 4.5 million patients at a Tennessee-based hospital network, and (2) federal officials disclosed on September 4 that a hacker managed to install malicious software on HealthCare.gov.

The Department of Health and Human Services (HHS) Office for Civil Rights (OCR) recently announced that it reached a resolution agreement with a health care system in connection with alleged violations of the Health Insurance Portability and Protection Act of 1996 (HIPAA). Pursuant to the settlement, Parkview Health System, Inc. (Parkview) agreed to adopt a corrective action plan (CAP) to address deficiencies in its compliance program and to pay $800,000. 

As explained by OCR in a news release, Parkview, a covered entity under the HIPAA Privacy Rule, took custody of medical records of approximately 5,000 to 8,000 patients while assisting a retiring physician to transition patients to new providers, and while considering the purchase of some of the physician’s practice. Subsequently, Parkview employees, with notice that the physician was not at home, left 71 cardboard boxes full of medical records unattended and accessible to unauthorized persons on the driveway of the physician’s home. The physician complained, prompting the HHS investigation.

A recent decision by the Michigan Court of Appeals holds that a health facility or agency can be sued for taking or threatening disciplinary action against an employee for reporting or intending to report malpractice by a health professional. Employers should carefully review existing policies and practices, or if necessary, adopt appropriate policies, to protect against potential wrongful termination lawsuits.

Due to regulatory and reimbursement constraints, health care providers are increasingly merging, affiliating, and acquiring other health care entities. In these transactions, the Medicare providers must identify whether a Medicare change of ownership (“CHOW”) will occur. Although it may appear, from a business standpoint, that a change of ownership will occur, the transaction may not necessarily be considered a CHOW for Medicare. Essentially, if the person or entity with ultimate responsibility for the provider changes, typically there will be a Medicare CHOW. Sometimes, but not always, this will be indicated by whether there has been a change in the taxpayer identification number.

CHOWs impact the Medicare provider agreement involved in the sale. Unless the buyer takes steps to affirmatively reject the seller's provider agreement, in a Medicare CHOW, the seller's provider agreement is automatically assigned to the buyer. This provides billing advantages for the buyer without having to enroll as a new Medicare provider, go through the initial enrollment process, and be re-surveyed or re-accredited, which takes several months.  

In March of 2014, the Office of the Inspector General ("OIG") released the "OIG Compendium of Priority Recommendations." The recommendations offered are designed to help current programs for the Department of Health and Human Services ("HHS") run more effectively. The recommendation discussed twenty-five "opportunities" which, if addressed, would help to eliminate fraud and waste among HHS programs. The “opportunities” include the following:

On May 7, 2014, the Centers for Medicare and Medicaid Services (“CMS”) issued a Final Rule to reform Medicare regulations identified as “unnecessary, obsolete, counterproductive or excessively burdensome” to hospitals and other health care providers. The changes are part of the Obama administration’s “regulatory lookback” in connection with Executive Order 13563, “Improving Regulation and Regulatory Review.” The Final Rule makes a number of clarifications and revisions to policies set forth in both the May 16, 2012 final rule and the February 7, 2013, proposed rule. CMS estimates the reforms could save providers nearly $660 million annually and $3.2 billion over five years.

Below is a brief summary that highlights some of the issues CMS is attempting to address. Please refer to the Final Rule, or contact us, to explore the full extent of the changes in more detail.

Approximately 9 million people in the United States are covered by both Medicare and Medicaid, including seniors with low income and younger people with disabilities. These so-called "dual eligibles" often have complex and costly health needs, and lawmakers have been seeking ways to reduce costs while maintaining and improving care for this segment of the population. Traditionally, coverage and care for dual eligibles has tended to be fragmented and expensive given the challenges posed by separate entities (Medicare and Medicaid) with separate coverage policies.

A number of states, including Michigan, have been working with the Centers for Medicare and Medicaid Services (CMS) to develop proposals to address these challenges, based on new authority in the Affordable Care Act. Through this initiative, 15 states were granted federal funding to help them better coordinate care for dual eligibles. Each of the states, including Michigan, was awarded up to $1 million to help develop new strategies and programs addressing these challenges.

On Thursday, April 3, 2014, the Obama administration announced that it was taking steps to bring its Medicare rules in line with the United States Supreme Court's ruling in US v. Windsor. Specifically, the Department of Health and Human Services (“HHS”) announced that same-sex marriages would be recognized for determining Medicare entitlement and eligibility.

Have you heard? Gov. Snyder signed four bills significantly changing the procedure for investigating and disciplining licensed health professionals under the Public Health Code on April 3. The four statutes take effect on July 1, 2014.

These important changes make it even more crucial for a health professional to consult with legal counsel experienced with the disciplinary process whenever he or she is contacted by the Bureau of Health Care Services (BHCS). 

Learn more about the changes. Read the article here. 

As health care providers continue to increase their use of technology, they are asked more and more frequently to enter into software or other IT contracts.  While many health care providers sign these agreements without reviewing them, doing so can create unwanted liability and unexpected problems. 

These issues were the topic of a recent State Bar of Michigan Health Care Law Section Webinar entitled “Software Licenses: What You Don’t Know Can Hurt You.” Sam Frederick from Foster Swift was a featured speaker.  His presentation discussed important revisions that should be made to software provisions, as well as the consequences for relying on certain boilerplate provisions. In addition, health care providers must require that their software vendors with access to protected health information sign Business Associate Agreements.  While many software agreements have business associate-like provisions included in them, they often do not meet all of the required elements under HIPAA.  This exposes the health care provider to liability.

In summary, health care providers should have their attorney review any software or IT contracts presented to them and require that their vendors execute Business Associate Agreements.  For assistance with this matters, please contact Sam Frederick at (517) 371-8103 or sfrederick@fosterswift.com 

Any disciplinary sanction against a health professional’s license can have serious collateral consequences, such as termination from provider networks, loss of malpractice insurance or substantially increased rates, medical staff investigations and proceedings, adverse employment actions, and reports to the National Practitioner Data Bank. A recent Michigan Court of Appeals decision highlights an added risk that many health professionals and their attorneys may not have known. A relatively minor licensing sanction was used, with devastating effect, as evidence in an unrelated malpractice action.

A dentist was sued for malpractice following a root canal procedure in Holder v Schwarcz. The jury awarded $67,500 in damages and the trial court granted $151,555 in case evaluation sanctions. The dentist had been involved in an unrelated licensing investigation relating to root canals for another patient. The licensing action was resolved through a consent order. In a consent order, a health professional does not admit any allegations in the licensing complaint, but agrees that the board’s disciplinary subcommittee may treat them as true and enter a sanction for violating the Public Health Code. The sanction imposed against the dentist in the licensing action included probation for one year, a requirement for ten hours of continuing education, and a $5,000 fine. The sanction was fairly typical for a licensing case alleging negligent care.

On Jan. 2, 2014, the Department of Health and Human Services (“HHS”) issued a proposed rule related to the Administrative Simplification requirements of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”).  Specifically, it delayed the date by which health plans must certify compliance with certain operating rules imposed by the Affordable Care Act (“ACA”).   

The ACA required the Secretary of HHS to adopt operating rules related to claims status, eligibility, electronic funds transfers ("EFT") and health care payment and remittance advice transactions ("ERA").  Health plans (and other covered entities) were required to comply with the claims status and eligibility operating rules by Jan. 1, 2013 and the EFT and ERA operating rules by Jan. 1, 2014.  Additionally, health plans were required to file a statement with HHS certifying that the health plan is in compliance with the operating rules.  This certification statement was due by Dec. 31, 2013. 

On Dec. 27, 2013, final rules were published in the Federal Register by the Office of Inspector General and the Centers for Medicare & Medicaid Services. These rules amend regulations protecting certain arrangements involving the donation of electronic health records (EHR) software or information technology and training services related to such EHR software from the Anti-Kickback Statute and Stark law. The final rules are nearly identical to one another and make five primary changes to the EHR provisions:

A recent Michigan Court of Appeals decision offers a glimmer of hope to health professionals who face the unenviable prospect of appealing adverse decisions made by licensing boards. Since 1994, the Public Health Code has required that appeals by licensed health professionals from adverse licensing decisions be filed in the Michigan Court of Appeals. Over the past two decades, there have been very few cases where the Court of Appeals held that a decision by a licensing board was legally incorrect or factually unsupported.

Omnicare Inc., the nation's largest dispenser of prescription drugs in nursing homes, announced on October 23, 2013, that it has agreed to pay $120 million to settle a whistleblower lawsuit alleging kickbacks to nursing homes.

The whistleblower in the case, an Ohio pharmacist named Donald Gale, worked for Omnicare from 1993 until 2010. The lawsuit, filed in federal court in Cleveland in 2010, accused Omnicare of giving discounts for prescription drugs to nursing homes for certain Medicare patients in return for referrals of other patients at higher prices paid for by the federal government.

The Michigan Medicaid expansion saga has seemingly come to an end, as the Republican-led state Senate narrowly approved Medicaid expansion on Tuesday, August 27 in a 20-18 vote. Eight Republicans joined 12 Democrats to pass a bill that will bring billions of dollars in federal dollars to Michigan to implement a major element of the Patient Protection and Affordable Care Act. Under this bill, approximately 400,000 additional Michigan residents will be eligible for Medicaid coverage.

The vote came after lengthy debate in the Senate on the measure, and passed after "eleventh hour" legislative maneuvering. The Michigan House, which previously passed a Medicaid expansion bill, will likely approve the Senate version of the bill next week. If passed, it will be sent to Governor Snyder's desk for his signature.