Combating the 2019 Novel Coronavirus (COVID-19): Week of April 13
Posted on April 18, 2020
The MHA continued to stay in close communication with hospitals and state and federal officials during the week of April 13 as Michigan entered the second month following its first case of COVID 19. The association hosts regular phone calls and/or webinars with hospital departments statewide, such as data managers, supply chain managers, public relations/communications professionals and, beginning April 21, obstetrics staff in Michigan’s birthing hospitals. In addition, MHA members receive daily updates on the efforts to combat the pandemic, and other updates and resources are available on the MHA COVID-19 webpage. Highlights are summarized below.
The federal government is providing much-needed funding to assist hospitals during the pandemic. The Federal Reserve announced April 9 an additional $2.3 trillion in loans to support the economy, including larger borrowers with up to 10,000 employees or $2.5 billion in 2019 annual revenue. Principal and interest payments will be deferred for one year. The Federal Reserve term sheet specifies that these facilities will be available to "businesses," without addressing or excluding nonprofits.
In addition, the U.S. Department of Health and Human Services has opened its portal to the Coronavirus Aid, Relief, and Economic Security (CARES) Act Provider Relief Fund, where providers must verify they received the initial CARES Act payment. Providers must sign an attestation confirming receipt of the initial $30 billion in CARES Act funds and agree to the terms and conditions within 30 days of payment. Members with questions may contact Jason Jorkasky.
Regulatory Changes Extended
Gov. Gretchen Whitmer signed Executive Order (EO) 2020-49 April 14, extending the relaxation of regulatory requirements contained in EO 2020-13, which is now rescinded. EO 2020-49 extends until May 12 the authority of the Michigan Department of Health and Human Services (MDHHS) and Department of Licensing and Regulatory Affairs (LARA) to waive certain requirements, allowing hospitals and healthcare facilities to more quickly expand capacity to care for COVID-19 patients. In part, the EO allows for issuance of emergency certificates of need to increase care facilities and waivers of licensing and registration requirements for certain healthcare personnel. Members with questions on these changes may contact Adam Carlson.
Transferring Patients to Long-term Care
Both the state and federal governments recently addressed the issue of acute care hospitals transferring patients to long-term care (LTC) facilities.
The MDHHS recently released new guidance for long-term care (LTC) facilities intended to protect residents and healthcare workers. Key points within this guidance include an overview of the MDHHS COVID-19 testing strategy and new direction on personal protective equipment (PPE) use based on facility type and type of care being performed. With this direction, LTC facilities may find that they already have the PPE necessary to safely care for residents and can more easily determine which supplies are still needed.
The MHA sent comments to the Whitmer administration April 17 regarding Executive Order 2020-50, which the governor signed earlier in the week. The EO provides guidance on LTCs’ acceptance of COVID-19 patients and the protection of staff at long-term care facilities. In addition to other input, the association provided general feedback that “transfers out” must be better defined so that patients are not needlessly transferred to hospitals and then again moved as capacity becomes available in alternate care facilities and skilled nursing facilities serving as regional hubs. Members with questions may contact Brittany Bogan or Laura Appel at the MHA.
The Centers for Medicare & Medicaid Services (CMS) clarified that it is waiving a requirement that Medicare patients be hospitalized for three days before transferring to skilled nursing facilities and swing-bed services furnished by critical access hospitals and rural swing-bed hospitals. The statement came in a new COVID-19 FAQ on Medicare billing and is detailed in the Skilled Nursing Facility Services section on page 34, particularly in question 4.
The CMS has also provided supplemental information on transferring or discharging residents between long-term care (LTC) facilities based on COVID-19 status, adding to the list of CMS Emergency Declaration Blanket Waivers. It indicates that certified LTC facilities may transfer or discharge residents between themselves with no additional approval. However, approval from the State Survey Agency is required for a certified LTC facility to transfer or discharge residents to a noncertified location. A copy of the transfer guidance and a graphic explaining the various scenarios are available online.
The MHA hosted a webinar April 17 to discuss a recent request for hospitals to provide additional data to the U.S. Department of Health & Human Services (HHS), including testing, capacity, supplies, utilization and patient flows. The state has requested approval from the Federal Emergency Management Agency (FEMA) to modify its EMResource tracking tool to include the requested data and report it to the HHS. This would negate the need for providers to submit similar information twice.
FEMA had not yet responded to the request as of late April 17, but the MDHHS has updated the fields in the EMResource tool. The MHA webinar discussed those updates and provided education on data definitions and processes. The association is compiling information from the webinar in a frequently asked questions document that will be provided to members. The MHA also continues to work with the MDHHS to develop an appropriate process for reporting data to the HHS in a clear format. Until FEMA approves this plan, hospitals should submit the requested data to the HHS via the options offered in its letter. Members with questions about the data reporting should contact Jim Lee at the MHA.
Updated Guidance and Resources for Testing and Equipment
The MDHHS issued updated COVID-19 testing prioritization requirements April 14. The new requirements include the testing prioritization of individuals with “mild symptoms” into the third-tier priority, stating that these individuals should not be tested unless there are ample testing supplies to first test higher-tier priority individuals, such as those hospitalized, healthcare workers and more.
The MDHHS has also issued “Ventilator Prioritization Guidance” outlining ventilator shortage strategies for hospitals that may have inadequate traditional ventilators. The state issues ventilators using data hospitals upload to the EMResource tool daily.
In a move employed to assist with ventilator shortages, the American Hospital Association (AHA) announced a partnership with the Trump administration to allow hospitals to send ventilators to higher-need areas for COVID-19 care. Titled “Dynamic Ventilator Reserve,” the effort involves a database where providers nationwide can list equipment they have available to lend to others. As the need for ventilators increases for other hospitals, they can access the virtual inventory to determine where ventilators are available. Hospitals and health systems that would like to participate in the virtual network can contact the AHA at (800) 424-4301.
The MHA continues to work closely with group purchasing organization HPS and the state of Michigan to vet potential suppliers of PPE. For more information, members may contact Kevin Crampton at HPS or Rob Wood at the MHA.
The MHA and the MDHHS hosted a call for hospital laboratory contacts April 16 regarding the current state of COVID-19 diagnostic testing. The call revealed variability in access to supplies of specimen collection kits, reagents and test kits, which leads to some labs rationing the number of tests conducted each day. The MHA is working with the MDHHS to most efficiently collect necessary information from labs, support labs in validating secondary options for swabs and transport media, and coordinate/streamline the daily reporting of test results. Members with questions may contact Brittany Bogan.
Medically Necessary Services and Elective Procedures
Due to the need to ensure adequate staff, PPE and resources for addressing COVID-19, many patients have been waiting more than a month for what were deemed “nonessential” services and procedures. Hospitals are reminded that clinicians can deem a service or procedure medically necessary if they feel it impacts the health and safety of a patient.
The AHA and other provider associations April 17 announced a roadmap to guide readiness, prioritization and scheduling for resuming elective procedures. The MHA is reviewing this guidance and recognizes some hospitals may need to consider different factors when resuming certain procedures.
The state Department of Insurance and Financial Services announced April 10 that most Michigan health insurers have agreed to waive cost-sharing requirements for COVID-19 patients for both testing and treatment. The announcement states that these agreements apply to individual and group commercial plans, and employer self-funded plans often conform to changes made by commercial plans. The MHA will continue to monitor these developments.
In addition, the MHA has worked closely with payers to ensure hospitals’ and patients’ needs are addressed. The association received a letter April 15 from the Michigan Association of Health Plans (MAHP) outlining a variety of issues it is committed to working on in partnership with healthcare providers to help manage COVID-19 cost, access and coverage. The MHA will continue to partner with the MAHP, its members and other payers and encourages providers to directly contact the payers they contract with to discuss questions about their COVID-19-related policies, payments, etc.
Expiration of Driver’s Licenses Extended
Due to the closure of Secretary of State offices during the pandemic, the governor issued EO 2020-47 to temporarily delay the expiration of Michigan residents’ driver’s licenses that would normally expire between Feb. 1 and May 31, 2020. Although drivers are urged to renew their licenses online when possible, the order allows those with licenses expiring after Feb. 1 to legally operate vehicles through June 30. Late fees will not be assessed for those who renew licenses that expire after Feb. 1 if the renewal occurs by June 30. Members with questions on this order and how it affects their employees’ commutes may contact Paige Fults at the MHA.
Additional information about all of these topics is available to members on the MHA Community Site and the MHA COVID-19 webpage. If staff members at MHA-member facilities are not receiving necessary information from the MHA, they are asked to check the spam/junk mail folders in their email systems or ask their information technology departments to ensure MHA messages are not being blocked.
Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC). Members with MHA-specific questions should contact the following MHA staff members:
Advocacy and regulatory issues: Laura Appel
Safety and quality: Brittany Bogan
Communications and media: Ruthanne Sudderth
Emergency preparedness: Rob Wood
Posted in: Issues in Healthcare, Member News, Top Issues - Healthcare