State Advocacy Team Summary - Michigan
The Michigan (MI) state advocacy team was led by chapter lead Zach Ryan, Government Relations and Communications Manager with the Hemophilia Foundation of Michigan; and HTC lead, Dave Rushlow, Program Administrator with the Northern Regional Bleeding Disorder Center at Munson Medical Center. The team was also supported by members Kaite Scott, Program Social Worker with the Hemophilia Foundation of Michigan; and Matt Delaney, Government Relations Manager with the National Bleeding Disorders Foundation.
Summary of Achievements
In their first year, the BD SUMHAC MI team successfully:
Engaged with state officials from MI Department of Health and Human Services (DHHS), MI Department of Licensing and Regulatory Affairs (LARA), and the MI House of Representatives
Identified a state champion
Mapped the regulatory landscape of MH/SUD facilities with particular attention to policies related to:
Self-administration of infusion and injection medications
Staff assisted administration of infusion and injection medications
External provider assisted administration of infusion and /injection medications
Patient cherry-picking
Drafted recommendations for state SUD regulations to increase clarity on access policies for the BD community and others with stable, well-managed, non-behavioral health medical conditions.
The team’s accomplishments were also highlighted in a BD SUMHAC article that can be found here.
Regulatory Landscape Mapping
Sorted by landscape area. All regulatory Information is as of July 2024
SUD Facility Information
Self-infusions/ injections
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MI Admin Code Rule 325.1363 Service plan
“(1) Based upon the assessment made of a recipient's needs, a written service plan, which may include both medical and counseling services, must be developed and recorded in the recipient's record.” -
If a person requires infusion/injection medication, the SUD facility must make a plan to meet those needs. However, there is no regulatory language that explicitly states that self-infusions and self-injections are permitted in SUD facilities, making this an unclear area within the current regulations. As part of Phase II, BD SUMHAC will request that language be added to the regulations which clarifies that individuals are permitted to use self-infusion and self-injection medications in SUD facilities.
Staff-assisted infusions/ injections
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MI Admin Code Rule 325.1351: Staff development and training
“Excluding outpatient services, an applicant or licensee shall establish an in-service education program for all staff who treat, monitor, or interact with a recipient for care issues at orientation and at regular intervals as appropriate but at a minimum of every 3 years. The in-service education program must include, at a minimum, all of the following:
d) Medication administration and monitoring.”
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SUD staff are required to be trained in medication administration and monitoring. However, there is no regulatory language that explicitly states that staff must be trained to administer infusion or injection medications, specifically. This means that there is no guarantee that a SUD facility will have a staff member who is trained to administer medications or monitor the administration of medications for patients with a BD on prescribed infusion/injection medications. As part of Phase II, BD SUMHAC will request that language be added to the regulations which clarifies that facility staff training includes training on how to administer and monitor the use of infusion and injection medications for individuals who are unable to self-administer.
External provider-assisted infusions/injections
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MI Admin Code Rule 325.1363: Service plan
“(1) Based upon the assessment made of a recipient's needs, a written service plan, which may include both medical and counseling services, must be developed and recorded in the recipient's record.”
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If a person requires an infusion or injection medication, the facility must make a plan to meet those needs. However, there is no regulatory language that explicitly states that if the facility does not provide injection or infusion services, the facility must provide a referral to a provider who can offer this service, making this an unclear area within the current regulations. As part of Phase II, BD SUMHAC will request that language be added to the regulations which state that external providers or contractors may be used to provide recipient services during the recipient's residential or inpatient stay, including the administration of infusion/injection medications.
Medicaid SUD: Policies to prevent cherry-picking
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Current SUD regulations do not prevent facilities from admitting or denying patients based on perceived medical complexity (i.e., cherry picking). The MI Department of LARA is in the process of updating their SUD admissions guidelines to incorporate the new American Society of Addiction Medicine (ASAM) 4th Edition criteria into Medicaid contracts, which will prevent facilities from denying patients with stable, well-managed, medical conditions from any level of SUD care.
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There is no relevant language in current regulations. As part of Phase II, BD SUMHAC will request that language be added that aligns with the American Society of Addiction Medicine (ASAM) 4th Edition criteria, which will prevent facilities from denying patients with stable, well-managed, medical conditions from any level of SUD care.
MH Facility Information
Use of infusion and injection medication
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MI Admin Code Rule 330.1281: Physician responsibility
(2) The type, duration, and amount of medications and medical treatment shall be ordered by a patient's physician or by a psychiatric hospital physician if the patient's physician is not available.
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There is no regulatory language that explicitly states that individuals are permitted to use infusion or injection medication in MH facilities. However, the regulations do state that the type of medication shall be ordered by a patient’s physician. Based on this language, it can be assumed that if the patient’s physician has ordered an infusion product, it should be permitted in the facility. As part of Phase II, BD SUMHAC will request that language be added to the regulations which clarifies that individuals are permitted to use infusion and injection medications in MH facilities.
Self-infusions/ injections
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MI Admin Code Rule 330.7158: Medication
(5) If an individual cannot administer his or her own medication, a provider shall ensure that medication is administered by or under the supervision of personnel who are qualified and trained.
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There is no regulatory language that explicitly states that self-infusions or self-injections are permitted in MH facilities. However, the language suggests that self-infusions and self- injections are permitted since the language assumes that individuals will self-administer their own medication unless they cannot do so without assistance, and it does not specifically exclude infusions or injections. As part of Phase II, BD SUMHAC will request that language be added to the regulations which clarifies that individuals are permitted to use self-infusions and self-injection medications in MH facilities.
Staff assisted infusions/ injections
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MI Admin Code Rule 330.7158: Medication
(5) If an individual cannot administer his or her own medication, a provider shall ensure that medication is administered by or under the supervision of personnel who are qualified and trained.
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The regulations state that if an individual cannot self-administer medication, then a provider will ensure that it is administered or supervised by qualified and trained personnel. However, the language is not specific to infusions or injections. As part of Phase II, BD SUMHAC will request that language be added to the regulations clarifies that facility staff training includes training on how to administer and monitor the use of infusion medications for staff who are licensed to administer infusions.
External provider assisted infusions/ injections
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There is no regulatory language that explicitly states that if the facility does not provide injection or infusion services, the facility must provide a referral to a provider who can offer this service.
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No language in current regulations. As part of Phase II, BD SUMHAC will request that language be added to the regulations which state that external providers or contractors may be used to provide recipient services during the recipient's residential or inpatient stay, including the administration of infusion/injection medications.
Next Steps for Advocacy
The MI team has determined the following goals for Phase 2:
Submit recommendations to increase access for the BD community in the state SUD regulations.
Draft and submit recommendations to increase access for the BD community in the state MH regulations.
Create a step-by-step plan for the BD community in MI in the event of a denial to a MH/SUD facility.
Seek opportunities to educate MH/SUD facilities on BDs and ways facilities can increase equitable access to care and treatment for the BD community.