Combating the Novel Coronavirus (COVID-19): Week of April 27
Posted on May 02, 2020
In an April 30 move disputed by the Michigan Legislature, Gov. Gretchen Whitmer extended the state of emergency through May 28. As the COVID-19 pandemic persists into a new month, the MHA has continued to send regular updates to MHA members on matters related to the pandemic. Additional updates and resources are available on the MHA COVID-19 webpage. Highlights from the week of April 27 are summarized below.
Availability of Emergency and Medically Necessary Care
The MHA continues to work closely with Gov. Gretchen Whitmer’s office on the status of Executive Order (EO) 2020-17, which took full effect March 21 and is now set to expire May 28, with the scheduled end of the emergency declaration. The EO has prevented hospitals, outpatient surgery centers and dentists from conducting “nonessential” services, but allows for emergency care and for clinicians to make medically based decisions to perform services they believe are necessary to preserve the health of a patient.
The Michigan Senate passed a resolution April 29 calling for the governor to rescind EO 2020-17; however, it does not result in any change to the current status of the order. A growing number of members have told the MHA that they feel well prepared to resume additional services, and the association has shared this with the governor’s office. The association expects the governor will soon make amendments to the restrictions in EO 2020-17.
The MHA appreciates the support provided to hospitals and health systems by state legislative bodies and the Whitmer administration throughout the pandemic. All Michigan hospitals have plans, processes and equipment in place to safely resume non-COVID-related services and procedures whenever EO 2020-17 expires.
In the interim, the association and healthcare providers assure residents that hospital emergency rooms are open and safe to serve all patients and that no emergency care should be delayed out of fear of contracting COVID-19. In addition, within the limitations of EO 2020-17, hospital clinicians continue to evaluate patients to ensure they safely receive other nonemergent but important care. During the governor’s latest news conferences, the state’s chief medical executive Dr. Joneigh Khaldun has urged Michiganders not to avoid needed services, especially those that may be serious in nature, and the governor said residents should reschedule care they had delayed. The MHA will continue to work with the state, other stakeholder groups and its members to educate the public about this issue. Hospital public relations directors were recently sent sample news releases to help convey this important message. Members who need additional assistance informing their communities of available services may contact Ruthanne Sudderth at the MHA.
Funding: Health Resources and Services Administration (HRSA)
Registration for the HRSA uninsured reimbursement program opened April 27. This coverage of the uninsured was authorized and funded through the Families First Coronavirus Response Act and the Coronavirus Aid, Relief and Economic Security (CARES) Act. Services will generally be reimbursed at Medicare rates and include testing, treatment and related services. As part of the online process, providers must attest that they have checked the patient’s eligibility for coverage (both private and public) and found the individual to be uninsured. Providers must also agree to the program’s terms and conditions, which include agreeing not to balance bill the patient.
Funding: Federal Emergency Management Agency (FEMA)
As a condition of applying for the FEMA Public Assistance Grant Program, applicants must attend one of the grant program virtual briefings that the Michigan State Police, Emergency Management and Homeland Security Division (MSP/EMHSD) is offering in early May. The briefings will provide an overview of the grant program to discuss eligibility requirements and explain the project application and reimbursement processes. Representatives from management, emergency response, and accounting/finance/procurement operations are encouraged to participate. Dates and registration instructions are available on the MSP/EMHSD webpage.
Included in the April 29 member update email is information private nonprofits can use to expedite access to the Grants Portal and submission of a Request for Public Assistance (RPA). The MSP/EMHSD recommends organizations complete the RPA process no later than May 15. Hospitals will not be penalized or excluded from the program for missing the recommended deadline.
FEMA will cover 75% of costs for eligible assistance protective measures that are eligible under the Public Assistance Program. The remaining 25% is the responsibility of the applicant. The MHA has confirmed with the State Budget Office that a waiver request for the 25% cost share has been submitted to the federal government and will provide more information as it becomes available.
Federal Advocacy on Hospital Funding
The MHA continues to work with Congress on elements of the next round of COVID-19 relief for hospitals and health systems. The association hosted an April 30 call with much of the Michigan congressional delegation to discuss several pandemic-related issues. The delegation indicated their continued support of loan forgiveness for Medicare accelerated payments. They shared that a national letter to congressional leadership urging this loan forgiveness is being circulated for signature by members of Congress until May 4. The MHA followed up with a letter to the delegation outlining the association’s funding priorities. An additional letter will be sent to Department of Health and Human Services (HHS) Secretary Alex Azar highlighting inequities in the federal funding distribution methodologies used to date.
In a May 1 news release, the HHS announced that $12 billion in CARES Act funding will be distributed to the 395 hospitals nationwide that have had the highest numbers of COVID-19 patients. An additional $10 billion will be distributed to rural providers.
Funding for Behavioral Health Care
The MHA sent a letter to the Michigan Department of Health and Human Services (MDHHS) April 27 asking the Michigan Medicaid director to require prepaid inpatient health plans and community mental health agencies to increase payments to psychiatric hospitals and units. The plans have continued to receive regular capitation payments for their enrollees, yet have seen a significant reduction in medical claims spending due to the decline in services. The association sent a similar letter May 1 to the State Budget Office, urging that $5.1 million be allocated for Michigan psychiatric hospitals and units from the state’s retention of funds derived through the recent increase in the federal medical assistance percentage. The MHA will continue to work with the state to address funding issues for hospitals of all kinds.
Centers for Medicare & Medicaid Services (CMS) Updates Waivers and Flexibilities
The CMS updated its waivers and flexibilities for healthcare providers April 30. The updates also provide provider-specific fact sheets. Among the updates is Medicare coverage for previously ineligible healthcare professionals who furnish telehealth services. Other updates relax requirements for coverage for the services of certain healthcare professionals, as well as requirements related to COVID-19 testing. Members with questions about the CMS waivers should contact Laura Appel at the MHA.
Executive Order Issued on Crisis Care Antidiscrimination Practices
The governor issued EO 2020-64 April 29, essentially requiring healthcare providers to ensure their COVID-19 care protocols and lifesaving medical decisions are not impacted by the presence of a patient’s disability. It also states that, for the purpose of this order, ““designated health care facility” means a hospital or an entity used as surge capacity by one or more hospitals.” An element of the EO that may differ from current practice is the requirement that hospitals post their crisis care plan on the internet and make it available by request. EO 2020-64 will expire when the state of emergency has ended.
Minor Work Permits Required During State of Emergency
Some hospitals employ minors in certain positions throughout their facilities, and the closure of schools due to the pandemic may impact young people’s ability to procure the work permit required for that employment. According to the Youth Employment Standards Employment Act, these work permits must be obtained and approved by the minor’s school. The applicable law requires the issuing school to review the work permit “in person” prior to approval. The Michigan Department of Labor and Economic Opportunity, Wage and Hour Division has confirmed this has not been relaxed despite school closures. Public school administrators are often still available, and the minor must contact the school regarding issuance of their work permit. Members with questions on this topic may contact Paige Fults at the MHA.
Additional information on the COVID-19 pandemic 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:
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