Committee hears testimony on interstate counseling compact bill, refers HB 4591 to rules

The Michigan House Health Policy Committee considered House Bill 4591 on testimony and then voted to refer the bill to the Committee on Rules.

Kate Dahlstrom, president of NAMI Grand Traverse, testified in opposition to the bill as written, saying she supports the concept but warned of unintended consequences tied to Michigan’s Medicaid reimbursement rates. Dahlstrom urged the committee to ask the Michigan Department of Health and Human Services for a comparison of Medicaid reimbursement for a 60‑minute individual psychotherapy session (CPT 90837) across states before acting on the bill. “I really urge you to ask the department … to provide to you a better comparison,” Dahlstrom said.

Dahlstrom told the committee she found publicly available figures showing average Medicaid reimbursement for CPT 90837 at about $68 in Michigan versus $125 in Massachusetts, $134 in Colorado and $115 in Ohio. She said low rates contribute to therapists declining Medicaid patients or shifting to cash-only practice; she cited local providers, including Pine Rest, as examples that “operate barely in the black and sometimes in the red” while still serving Medicaid patients.

Committee members asked how the compact might affect the workforce. Representative Miermann said the bill could allow counselors to earn revenue from other states while remaining physically in Michigan. Dahlstrom replied that could be possible but warned it risks “losing service,” because therapist time could shift to out-of-state tele‑visits if reimbursement is higher elsewhere.

Representative Preston, speaking for the Upper Peninsula region, said the compact could be “transformational” for border communities that share providers with Wisconsin and urged that cross‑border practice could ease local shortages. Dahlstrom said the underlying problems are both reimbursement levels and an overall shortage of therapists.

Representative Carter asked about state costs to join and remain in the compact. Dahlstrom suggested the compact or its administrators should provide reimbursement comparisons for specific billable services and urged caution, suggesting a pilot approach or additional study before passage.

Representative Thompson and others discussed which entities set reimbursement rates. Dahlstrom said rates for community mental health services are set with input from the department and actuaries but that managed‑care plans such as Meridian and McLaren may set their own payment levels to providers.

After testimony and questions, Representative DeBoer moved to report House Bill 4591 to the Committee on Rules. The committee recorded a tally of 11 yes, 0 no, 4 pass; the motion prevailed and the bill was referred to Rules.

Dahlstrom concluded by offering to assist the committee with data and said NAMI is volunteer‑led and not currently participating in state reimbursement negotiations. “I’d be more than happy to join any task force,” she said.

The committee also read in supporting/neutral cards from the Michigan Health & Hospital Association, the Michigan Mental Health Counselors Association and Memorial Healthcare, who were recorded as not wishing to speak.