Gov. Gretchen Whitmer issued Executive Order (EO) 2020-77 May 7, extending the stay-at-home order to May 28 while allowing some manufacturers to gradually reopen under her “MI Safe Start” plan. The TCF Center in Detroit, which was converted to a field hospital in April to assist Southeast Michigan hospitals with large numbers of patients due to the pandemic, released its final patient May 7; it stands ready to accept patients in the event of a second surge of the virus. Meanwhile, 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 4.
Funding: Federal Emergency Management Agency (FEMA)
Virtual briefings providing an overview of the FEMA Public Assistance Grant Program, which are required as a condition of applying for the grants, are scheduled for 10:30 a.m. and 2 p.m. May 12 and 13. The briefings discuss eligibility requirements and explain the project application and reimbursement processes. The state has now posted for review the FEMA Public Assistance training slides and questions and answers related to the briefings. Representatives from management, emergency response, and accounting/finance/procurement operations are encouraged to participate May 12 or 13. Registration instructions are available on the Michigan State Police Emergency Management & Homeland Security Department webpage.
Funding: Federal Allocation, Extended Deadline for Attestation
The MHA sent a letter to U.S. Department of Health & Human Services (HHS) Secretary Alex Azar II May 6 asking that future distribution of federal hospital relief funds consider COVID-19 caseloads rather than only historical financial data. Because Michigan hospitals have kept costs down, the distribution of the initial allocations of CARES Act funding to the state’s hospitals was disproportionately low.
The Department of Health and Human Services (HHS) announced May 7 that it has extended the deadline from 30 days to 45 days for healthcare providers to attest to receipt of payments from the Provider Relief Fund and accept the Terms and Conditions. The HHS will view hospitals that do not return the payment within 45 days of its receipt as having accepted the Terms and Conditions. Members can visit the HHS Provider Relief webpage for more information on these funds, allocations and more. Members should contact the MHA with any questions or concerns about the attestation process.
The association is encouraged that recently announced allocations are being distributed to many of the hardest hit hospitals and rural providers throughout the nation. The MHA will continue to identify opportunities for financial relief for Michigan hospitals and health systems. Members with questions on federal funding related to COVID-19 may contact Adam Carlson at the MHA.
Medicaid Coverage for Physical, Occupational and Speech Therapy via Telemedicine
The Medical Services Administration (MSA), which oversees the state’s Medicaid program, issued Policy Bulletin MSA 20-22 May 6, allowing for Medicaid coverage of telemedicine visits for physical, occupational and speech therapy. This follows an earlier announcement of a similar Medicare policy. The Medicaid coverage is effective March 1, 2020, in conjunction with the first cases of COVID-19 in the state and will be available only until the MSA notifies providers it has expired. To qualify for payment, services must be delivered with both audio and visual capabilities. Comments on the policy are due June 9, 2020. Directions for submitting comments are included in the bulletin, and providers may email questions about the bulletin to the MSA.
COVID-19 Testing and Testing Supplies
The MHA continues to focus on directing additional testing supplies to members and coordinating needs between state lab directors and hospital lab personnel. Testing must be conducted within state-mandated priority populations that were established April 20. Individuals requesting tests who do not fit one of the priority categories may be accommodated if the testing facility has the capacity after first testing all priority subjects. If they do not have the capacity, that subject may be turned away or referred to another test site. A database of test sites is available online.
The Michigan Department of Health and Human Services (MDHHS) recently shared clarification on how hospitals and other healthcare providers can request specimen collection supplies from the state Bureau of Laboratories (BOL). A link to the BOL instruction was provided to members in the May 6 email update. The state does not have a stockpile of these collection supplies; it is distributing supplies as they are received. Therefore, it is critical that hospitals communicate their needs to the state. In addition, hospitals that are conducting in-house testing are urged to respond daily to the two lab supply questions in EMResource.
Although the Medicare program no longer requires beneficiaries to have a physician order to qualify for payment of a COVID-19 test, such orders are required by private insurers, Medicaid and other programs. Hospitals are urged to continue to provide their communities with information about testing available and requirements, including the state-mandated testing priorities, physician order requirements, their policies for testing uninsured individuals, whether appointments are necessary to receive testing, and other rules and recommendations.
The MDHHS instructs hospitals treating a patient who is homeless to contact the local health department while the patient is still hospitalized so that the local health department can appropriately plan for the safe discharge of that patient, assisting with resources, etc.
Members with questions on COVID-19 testing may contact Brittany Bogan at the MHA.
Elective Procedures, Hospital Visitors, Don’t Delay Care Campaign
The state’s chief medical executive Joneigh Khaldun, MD, issued a letter to healthcare providers May 3 providing additional guidance on EO 2020-17 related to nonessential medical procedures. While the order remains in place until the state of emergency expires, Khaldun strongly encouraged providers to reengage on services and procedures that are important for patient health and well-being. Referring to the verbiage in EO 2020-17, she stated, “This wording is intended to be flexible, preserve clinician judgement, and encourage consideration on an individual basis of which patient services can be safely delayed without resulting in a significant decline in health. EO 2020-17 gives providers broad discretion to apply this standard. I … applaud current efforts to re-engage with patients in the safest way possible and within the scope of Executive Order 2020-17.”
In addition, the MHA spoke with the Department of Licensing and Regulatory Affairs (LARA) May 8 regarding continued member concerns regarding procedures that are permissible while EO 2020-17 remains in place. Representatives from LARA agreed with Khaldun, saying, “a licensed medical provider should use his/her best clinical judgement to determine whether a procedure, emergency or nonemergency, is needed to preserve the health and safety of a patient.” LARA representatives indicated that the health, safety, and welfare of the patient includes consideration of the ability to function, pain management, or compromise of other body mechanics of systems. Additional information from LARA was included in the May 8 update emailed to members.
In other action affecting hospital operations, EO 2020-72 was issued May 3 to extend the previously ordered restrictions on visitors entering healthcare facilities through May 31. Members should consider updating their patient and public communications with this new date.
The MHA announced May 8 its television and social media campaign urging Michiganders to not delay services – especially emergency care – and that hospitals are safe places to receive care. Ads will run on statewide television through June thanks to support and donated time from the Michigan Association of Broadcasters and its member networks (see related news release).
Healthcare Liability Protections
Senate Bill 899, which offers strong and broad protections for healthcare workers and facilities treating COVID-19 patients, was passed by the full Senate May 7 and sent to the House for consideration. The Michigan Association for Justice and the American Federation of State, County and Municipal Employees (AFSCME) oppose the bill, which the House is expected to discuss during the week of May 11. Members with questions may contact Adam Carlson at the MHA.
MDHHS Issues EO on Handling of Bodies
To alleviate the burden on some hospitals and funeral homes caused by COVID-19 deaths in their communities, MDHHS Director Robert Gordon issued an EO May 4 that reduces to 24 hours the amount of time hospitals and funeral directors have to contact individuals with “authority over disposition of the body of a deceased individual” with COVID-19. If a family member or other person with this authority cannot be identified, the county medical examiner will make the necessary decisions. The order also reduces to 48 hours the length of time the authorized individual is given to arrange for disposition of the body. If they do not do so within this timeframe, that person forfeits the right to make the decision.
The order also “relaxes certain licensing provisions for funeral directors, allows funeral directors and medical examiners to authorize embalming, and allows for storage of bodies at a temporary storage facility provided by the Michigan Mortuary Response Team or at an alternate site procured by the license holder.”
The MDHHS issued additional information May 6 to guide steps for maintaining good documentation and record keeping related to final disposition. It includes a section on alternate storage options to ensure that decedents are stored in a respectful and appropriate manner. The MDHHS guidance was attached to the email sent to members May 6. Members with questions may contact Chris Mitchell at the MHA.
Pharmacy Sterile Compounding Accreditation Extended
Hospitals whose pharmacy licenses expire June 30 will not need to submit verification of current sterile compounding accreditation by a Board-approved entity or compliance with United States Pharmacopeia standards with their renewal application. The Joint Commission, National Association of Boards of Pharmacy and the Pharmacy Compounding Accreditation Board agreed that previously accredited sterile compounding entities may have their accreditation or compliance verification extended through the state of emergency in Michigan and for six months thereafter. This allows hospitals to renew their license without an on-site inspection by a Board-approved accreditation or verification entity. However, once the state of emergency in Michigan has ended, hospitals will have six months to undergo an on-site inspection by one of the three organizations and to submit proof of that inspection to the Bureau of Professional Licensing. Members with questions 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: