End of Life Care of 2001

H.B. 5148, P.A. 216, MCL 257.310
Rep. Jason Allen

H.B. 5255, P.A. 219, MCL 333.21534
Rep. Artina Hardiman

H.B. 5258, P.A. 239, MCL 333.5652-5655
Rep. Gene DeRossett

H.B. 5259, P.A. 240, MCL 333.20201
Rep. Gary Woronchak

H.B. 5260, P.A. 231, MCL 333.7333-7333a
Rep. Tom George

H.B. 5261, P.A. 232, MCL 333.16315
Rep. Paul DeWeese

H.B . 5262, P.A . 233, MCL 333.7104,7107, 7109
Rep. Steve Ehardt

H.B . 5263, P.A. 234, MCL 333.16204a
Rep. Clarence Williams

S.B. 660, P.A. 241, MCL 333.16204b-d
Sen. Shirley Johnson

S.B. 661, P.A. 242, MCL 550.1402a
Sen. Mike Goschka

S.B. 662, P.A. 235, MCL 500.2212a
Sen. Dale Shugars

S.B. 781, P.A. 237, MCL 333.5656-5660
Sen. Valde Garcia

S.B. 826, P.A. 243, MCL 333.21766
Sen. Bev Hammerstrom

S.B. 827, P.A .236, MCL 333.7401, 7403, 7407, 7521
Sen. Dale Shugars

S.B. 828, P.A. 238, MCL 28.292
Sen. Alan Sanborn
Effective Date: January 8, 2002

This package of legislation was developed from the recommendations developed by the End of Life Care Commission in accordance with the executive orders of June 11, 1999 and January 24, 2000. The commission was charged with examining end of life care in Michigan and developing ways to improve it. One of the major accomplishments of this package was to repeal the Official Prescription Program and replace it with a system that supports electronic monitoring to make it easier to prescribe palliative medications safely. This legislation also aims to change the perception of palliative care so that patients will receive adequate palliative care even if they are not near death.

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Pain & Symptom Management

Current Status

 

In his 1999 State of the State Address, Governor Engler announced that he would appoint a Michigan Commission on End of Life Care to provide a comprehensive report and recommendations on how to improve humane and dignified treatment at the end of life. The commission was appointed and it issued a report in August of 2001. The legislature developed a package based upon the recommendations developed by the End of Life Care Commission in accordance with the executive orders of June 11, 1999 and January 24, 2000. One of the major accomplishments of this package was to repeal the Official Prescription Program and replace it with a system that supports electronic monitoring to make it easier to prescribe palliative medications safely. This legislation also aims to change the perception of palliative care so that patients will receive adequate palliative care even if they are not near death. The 15-bill package introduced by a coalition of senators and representatives are as follows:

H.B. 5148 - P.A. 216 Driver licenses can have sticker or decal with emergency info; stickers may be paid for by any group. MCL 257.310

H.B. 5255 - P.A. 219 Hospitals notify patients, upon their request, that hospice care available in area. MCL 333.21534

H.B. 5258 - P.A. 239 Disclosure of pain management to certain patients; eliminate "terminal illness" in Dignified Death Act within Public Health Code. MCL 333.5652-5655

H.B. 5259 - P.A. 240 Amends Hospital Patients Rights Law by assuring patients in hospitals entitled to Pain & Symptom services and information about hospices in area. MCL 333.20201

H.B. 5260 - P.A. 231 Repeals Official Prescription Program(OPP); Replaces OPP with electronic system; OK to fax or email Rxs; patient info not accessible through Freedom of Information Act; Consumer Industry Services may study design of paper form that minimizes potential for forgery, report by October 2002. MCL 333.7333-7333a

H.B. 5261 - P.A. 232 Eliminates OPP fund and replaces with Pain Management Education and Controlled Substances Antidiversion Fund, and creates the Controlled Substances Electronic Monitoring Fund. MCL 333.16315

H.B. 5262 - P.A. 233 Allows e-fax transfer of Schedule II prescriptions; updates definitions in Rx section. MCL 333.7104,7107, 7109

H.B. 5263 - P.A. 234 Eliminates the phrase "intractable pain" in Public Health Code; updates Advisory Committee on Pain and Symptom Management. MCL 333.16204a

S.B. 660 - P.A. 241 Eliminates the phrase "intractable pain" and revises to "pain and symptom management" in the Public Health Code. MCL 333.16204b-d

S.B. 661 - P.A. 242 Eliminates the phrase "intractable pain" and revises to "pain and symptom management" in the Blue Cross Blue Shield statute. MCL 550.1402a

S.B. 662 - P.A. 235 Eliminates the phrase "intractable pain" and revises to "pain and symptom management" in the State Insurance Code. MCL 500.2212a

S.B. 781 - P.A. 237 Amends Dignified Death Act in the Public Health Code by eliminating language referring to a 6 month life expectancy; now uses phrase "advanced illness." MCL 333.5656-5660

S.B. 826 - P.A. 243 Requires nursing homes to notify patients and certain other persons of the availability or not of hospice in that facility, in services contract. MCL 333.21766

S.B. 827 - P.A. 236 Deletes references to the OPP and Rx form in the Public Health Code; Establishes electronic reporting system to replace the OPP. MCL 333.7401, 7403, 7407, 7521

S.B. 828 - P.A. 238 State ID cards may have a sticker or decal that designates the person has a do-not- resuscitate order, durable power of attorney for health care or designated patient advocate. MCL 28.292

These bills were signed on January 3, 2002 and became effective on January 8, 2002.

History

Governor Engler signed into law a bi-partisan, bi-cameral five bill package of initial pain management legislation on June 30, 1994. The laws were given immediate effect as Public Acts 232-236.

The first version of pain management bills were introduced by Sen. Fred Dillingham on December 18, 1993 as Senate Bills 960-964. A bi-partisan group of representatives introduced identical companion bills H.B. 5335-5339 in the House on February 15,1994. After being unanimously reported from the Senate Health Policy Committee, the full Senate unanimously passed the Senate package on March 1, 1994. The House Public Health Committee took up and unanimously reported a combination of the House and Senate bills, S.B. 961, 962, H.B. 5335, 5337, 5339. The House overwhelmingly approved the bills on June 8, 1994. The House and Senate gave final approval to the package on June 14, 1994.

On December 9, 1997, after over a year of working on and redrafting a second version of pain management bills, H.B. 4681 - 4686, the House Health Policy Committee adopted a watered down version of the original RLM supported bills. As introduced, the bills would have provided greater access to and coverage of multi-disciplinary pain management for the chronically ill. Although the bills were extremely watered down, RLM did not oppose the committee's action in order to ensure that the bills would not be further delayed in committee. The bills were then quickly taken up for the consideration the following day, December 9, 1997, on the House floor. RLM prepared and supported substitute bills to restore the package to it's original strength.  Within a matter of hours, a massive lobbying effort of insurance, business and labor interests converged on the House and succeeded in defeating the RLM supported substitute bills. The weak bills then passed the House by a unanimous 105 - 0 vote, leaving efforts to restore the bills to their original strength for the Senate.

In April of 1998, efforts by Senator Bill VanRegenmorter and Senator Mike Rogers, including drafting a revised set of bills, began to put the pain management legislation on the front burner again.

On September 29, 1998, Senator Dale Shugars, chair of the Senate Health Policy Committee, held a work group with Right to Life and the numerous special interests involved in the pain management bills to begin working on the bills.

A major confrontation on the Senate floor was avoided between the House originated package and a stronger set of bills Right to Life of Michigan was promoting after leaders in both chambers agreed to form a House/Senate task force on pain management in exchange for RLM not pressing for a vote on the RLM supported substitutes.

Due to mounting pressure to pass pain management legislation by the end of the year, the Senate Health Policy Committee sent the bills to the full Senate on 12/1/98, by a vote of 5-0. The Senate unanimously approved the six-bill package on 12/3/98. The House then concurred in the package on 12/8/98, sending the bills to the governor.

Overview of the Bills

The practical result of the S.B. 961, 962; and H.B. 5335, 5337 and 5339 will be to establish continuing education requirements in pain management in order for professionals to maintain their licenses. The bills also provide coordination of activities between professions regarding pain management and terminal care. They also amend insurance, HMO, and health codes to provide full disclosure to individuals about the nature and availability of hospice benefits covered by their insurance.

H.B. 4681 - 4686 attempt to ensure that patients are able to gain access to pain management specialists. The bills contain absolutely no mandated benefits. Instead, they create an incentive to encourage insurers to enhance and market their benefit package as meeting a high "state recommended standard" for pain management. Insurers will not be required to offer the benefit, but merely disclose within the policy whether it does or does not meet the standard. In choosing to meet the standard, insurers would not have to change the current benefit options for the first six months a patient experiences intractable pain. After six months, however, patients who continue to suffer from intractable pain would be given access to nationally accredited comprehensive multi-disciplinary programs, which specialize in treating patients in pain.

Background Information

Pain management is a relatively new and rapidly growing specialty. It is anticipated that new medications will be released in the next 5-10 years which will be highly effective in the treatment of even the most painful conditions, such as neuropathic pain (pain due to partial nerve injury). Medications released in recent years have improved potency, efficacy, and specificity such that pain can be better controlled with longer lasting duration of effect and with fewer side effects.

Techniques such as spinal cord stimulation and infusion of intra spinal narcotics through internally implanted pumps have been developed within the last 10 years. These pumps allow pain to be well controlled while preserving the patient's mental alertness. Pain clinics staffed by well trained and professional people are now available in most major cities throughout the United States. There are pain clinics in most of Michigan's larger cities.