Despite slowing rates of infection, the state of Michigan surpassed 50,000 COVID-19 cases May 15. 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. Following are highlights from the week of May 11.
The federal Family First Coronavirus Act provided a temporary 6.2 percentage point increase to the federal medical assistance percentage (FMAP) rate effective Jan. 1, 2020, through the end of the quarter in which the federal emergency expires, at least through June 30. Because of the increased FMAP rate, Michigan hospitals paid $29 million less tax to support supplemental Medicaid payments for the two most recent quarters. The MHA will provide additional information on the enhanced rate changes as it becomes available. Members with questions may contact Vickie Kunz at the MHA.
An extended increase in the FMAP rate is one aspect of the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act that the U.S. House of Representatives introduced May 12. Developed by House Democrats and passed by the full House late May 15, this COVID-19 response package includes several positive items for hospitals and health systems.
The act would increase the FMAP by 14 percentage points from July 1, 2020, through June 30, 2021, returning to 6.2 percentage points for the subsequent year. Some of the additional healthcare-related provisions include:
- $100 billion for hospital and healthcare providers to be reimbursed for healthcare-related expenses or lost revenue directly attributable to the public health emergency.
- $75 billion to bolster testing and contact tracing efforts.
- Modified terms for the accelerated and advanced payments available through the Medicare program.
- Elimination of cost-sharing for COVID-19 treatment in most forms of healthcare coverage.
- Increased research of the impact of COVID-19 on behavioral health, including the impact on healthcare providers.
- Nearly $1 trillion for states and local governments to respond to COVID-19.
- Numerous changes to Medicare, Medicaid and other health programs.
The MHA will continue to express support for passage of this package with the Michigan congressional delegation. Members with questions may contact Laura Appel at the MHA.
As the criteria for those eligible to receive a COVID-19 test has expanded, the state has focused on increased testing among four vulnerable populations: residents in long-term care facilities, residents in assisted living facilities, inmates in prisons and county jails, and the homeless/underserved. At the same time, the state is supporting the launch of several new drive-thru and community-based testing sites in targeted counties, cities and neighborhoods that have been most impacted by COVID-19. A Request for Proposals (RFP) was issued to set up these COVID-19 test sites around the state. The submission deadline for proposals is 11:50 a.m. May 18. A link to the RFP and additional information was sent to members in the May 14 email update. Members with questions may contact Brittany Bogan at the MHA.
Michigan Chief Medical Executive Joneigh Khaldun, MD, has clarified her April 20 memo regarding expanded criteria for COVID-19 testing eligibility. Although the memo allows for asymptomatic healthcare works and first responders, as well as critical infrastructure workers with or without COVID-19 symptoms, there is no requirement for healthcare providers to test any certain population. The expanded criteria are meant to allow for testing of these individuals if testing supplies are available.
The Michigan Department of Health and Human Services (MDHHS) notified the MHA that the state received from the federal government 1,600 vials of the antiviral medication remdesivir May 9 and distributed them to 41 Michigan hospitals, in accordance with an “Interim Emergency Allocation Strategy” developed by the MDHHS. Remdesivir has been authorized for emergency use in the U.S. to potentially shorten the effects of COVID-19. The state received another supply of the drug May 14 and gathered data to determine the hospitals to distribute it to.
The U.S. Department of Health and Human Services (HHS) has set 11:59 p.m. ET May 18 as the next deadline for submitting data to inform the agency's distribution of its limited supply of remdesivir. Hospitals that already use the TeleTracking web portal for their daily reporting need to do nothing differently for this remdesivir data collection, except to ensure these data are submitted by the May 18 deadline. If hospitals encounter issues with accessing the TeleTracking portal or have questions about the data, they should contact TeleTracking Technical Support at (877) 570-6903.
The HHS will allocate all of the donated supply of remdesivir from Gilead in the coming weeks and anticipates that no more will be available in the U.S. until the fall or later. Thus, hospitals that receive an allocation should carefully consider decisions about how the drug is used. Members with questions may contact Laura Appel at the MHA.
Multisystem Inflammatory Syndrome in Children
The MDHHS issued a notice to healthcare providers May 15 regarding the symptoms of multisystem inflammatory syndrome in children (MIS-C), a condition related to COVID-19. Access to the notice was sent to members in the May 15 email update.
The Centers for Disease Control and Prevention (CDC) has provided additional background information on several cases of MIS-C and a case definition for this syndrome. The MIS-C case definition is as follows:
- An individual under 21 years of age presenting with fever, laboratory evidence of inflammation, and evidence of clinically severe illness requiring hospitalization, with multisystem (>2) organ involvement (cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic or neurological); AND
- No alternative plausible diagnoses; AND
- Positive for current or recent SARS-CoV-2 infection by RT-PCR, serology, or antigen test; or COVID-19 exposure within the 4 weeks prior to the onset of symptoms
According to the state, “The CDC recommends healthcare providers report any patient who meets the case definition to local, state, and territorial health departments to enhance knowledge of risk factors, pathogenesis, clinical course, and treatment of this syndrome.” Although some individuals may have symptoms of Kawasaki disease, they should be reported if they meet the MIS-C case definition. The MIS-C diagnosis should also be considered in any pediatric death with evidence of SARS-CoV-2 infection.
Emergency CON Executive Order Extended to June 9
The governor issued Executive Order (EO) 2020-82 May 12, extending emergency Certificate of Need (CON) flexibility for healthcare providers to June 9. Initially, these CON measures were part of EO 2020-49, which was set to expire May 12. The EO relaxes regulatory requirements on hospitals and healthcare facilities that need to expand capacity to care for COVID-19 patients. The order also grants additional flexibility in the Department of Licensing and Regulatory Affairs’ decisions about licensing, registration and workflow requirements to help ensure adequate numbers of care providers. Members with questions may contact Adam Carlson at the MHA.
The Michigan House of Representatives acted on telehealth legislation May 13, passing bills that would expand access and improve reimbursement for telehealth services. The bipartisan package was introduced before the COVID-19 pandemic, but there is renewed urgency given the current necessity for telehealth services (see related article).
Reporting Deaths Due to COVID-19
The MDHHS recently provided guidance for healthcare providers on procedures to follow when someone dies of COVID-19 in their facility. The local health officer should be informed of the death between 8 a.m. and 5 p.m. the day the death occurs, seven days a week. Deaths occurring after 5 p.m. should be reported as soon as possible the following morning, but no more than 24 hours following the death. The MDHHS has provided more information online for reporting deaths from COVID-19.
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: