Governor Signs Bill to Codify Licensure Exemptions

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On Dec. 27, Gov. Gretchen Whitmer signed into law Senate Bill (SB) 759, which codifies a licensure exemption provision that has given hospitals regulatory flexibility to appropriately respond to the pandemic, specifically staffing challenges.

The new law took effect immediately and allows licensed, out-of-state providers who are in good standing the ability to render clinical care in Michigan without a Michigan license during an “epidemic-related staffing shortage” as currently identified by the Michigan Department of Health and Human Services.

MHA CEO Brian Peters released a statement Dec. 14 applauding lawmakers for prioritizing the bill. The provision that was previously in place, activated by the Department of Licensing and Regulatory Affairs, was originally set to expire Jan. 11. Members with questions may contact Adam Carlson at the MHA.

Peters Discusses Healthcare Challenges with Becker’s, Michigan Advance

MHA CEO Brian Peters

Brian PetersMHA CEO Brian Peters discussed some of the top challenges facing Michigan hospitals in articles published the week of Oct. 4 by Becker’s Hospital Review and Michigan Advance.

The Becker’s Hospital Review story interviewed several hospital leaders from across the country on the most pressing issues they are facing. Peters touched on the importance of unity in public policy and advocacy and the threat of increasing politicization of healthcare issues.

“For an association, it is imperative that our member hospitals and health systems remain united around our common mission, and advocate in unison for public policy that advances the health of individuals and communities.

Michigan Advance published an article that reviewed the increasing rates of threats and violence experienced by healthcare workers during the pandemic. Clinician burnout and efforts to improve workplace safety through the MHA Workplace Safety Collaborative are mentioned by Peters.

“At the beginning [of COVID-19], our frontline caregivers would see the hero signs, banners and ads on TV and radio; that was uplifting,” said Peters. “Some of that has faded, and unfortunately we see these instances of violence and distrust. We would harken back to the earlier days of the pandemic, when they were rightly hailed as heroes. They still are.”

CEO Report — Incorporating a Federal Advocacy Strategy

MHA Rounds Report - Brian Peters, MHA CEO

“You want a friend in Washington? Get a dog.” – Harry S. Truman

MHA CEO, Brian PetersI have a dog — a beautiful German Shepherd that joined our family in the midst of the pandemic.  I know that many of you have a family dog too, and they are indeed wonderful friends. But as it turns out, the MHA family is also fortunate to have friends in Washington, DC, and never before has that been more important. 

Hospitals and health systems play a key role in their local communities, both as healthcare providers and economic engines. While much of the funding, regulatory, and other public policy decision-making occurs at the local or state level, the truth is that federal politics has become increasingly important, as decisions made at the federal level can have profound impacts on the healthcare delivered in Michigan. The dramatic increase in enrollment for both Medicaid (a shared state/federal program) and Medicare (a strictly federal program) is just one of many reasons why. 

Over the years, the MHA’s engagement at the federal level has increased dramatically, to the point where we have now established meaningful relationships with the entire Michigan congressional delegation and their staffers. These relationships were on display early in the pandemic when we were able to convene conference calls with our delegation — both Republicans and Democrats together on the line at the same time — to listen to our insights and requests and target much-needed assistance to our members who were dealing with a true crisis. We have done all the blocking and tackling that is instrumental to federal advocacy, including routine in-person visits to our delegation members’ DC offices, developing congressional district-specific data and talking points on key issues, coordinating closely with the government relations officers of our member health systems (including those with multistate operations), organizing fundraising events and much more.   

We are fortunate to have a very close partner in this regard: the American Hospital Association.  I’m happy to share that more than 100 of our Michigan community hospitals are also AHA members, a penetration rate that puts Michigan in the very top tier nationally. As a result, our voice is heard clearly as many Michigan healthcare executives are actively involved in the policymaking process of the AHA, serving on various committee and task forces, including the AHA’s Regional Policy Boards. In this manner, we are able to identify needs unique to our region and provide direct input on public policy — and political strategy — to the AHA.  On that note, we are fortunate that Michigan’s own Wright Lassiter, president and CEO of Henry Ford Health System, is now the chair-elect of the AHA Board. 

In addition, the MHA’s political action committee, Health PAC, also has a formal working partnership with the AHAPAC, allowing us to support our members of Congress in this important way.

Recent examples of this partnership in action include our advocacy to protect the Affordable Care Act (ACA), as well as the 340B Drug Pricing Program, and our efforts to combat the COVID-19 pandemic. Several weeks ago, the United States Supreme Court released its opinion in the California v. Texas case that challenged the constitutionality of the ACA. The opinion reversed the Fifth Circuit’s judgement in the matter and upheld the constitutionality of the ACA. The MHA was formally involved in the case, as we joined a number of other state hospital associations in filing an amicus brief with the Supreme Court. We are very pleased with this outcome, which will help to preserve coverage for as many Michiganders as possible — a key MHA priority.

The MHA has also been involved in the federal legal strategy to support the 340B Drug Pricing Program, which is a federal program created by Congress to help provide relief from escalating drug prices to safety-net hospitals and other healthcare providers serving vulnerable patient populations. Over the past year, six drugmakers have stopped providing discount drug prices for pharmacies that contract with 340B providers. The MHA is working with the American Hospital Association Advocacy Alliance for the 340B Drug Program and the 340B Health coalition to protect this vital program. Last fall, the MHA organized a letter to the Michigan congressional delegation that was signed by representatives from 68 of the more than 80 Michigan 340B hospitals to share hospitals’ concern regarding drug manufacturers’ attempts to limit payment to contract pharmacies and other actions that are a significant detriment to 340B hospitals and the services they can provide to eligible patients because of the program. The MHA also joined other state hospital associations earlier this spring in submitting an amicus brief in support of the AHA’s petition to the U.S. Supreme Court for certiorari (a formal request to the court to take up the case) in its appeal of an appellate court decision unfavorable to hospitals on 340B.

Lastly, the MHA has been involved with various aspects of the COVID-19 response at the federal level, from advocating for provider relief funds to providing data and insights on the impact of the pandemic. In May, the MHA worked quickly to get a majority of Michigan’s U.S. House delegation to sign onto a letter urging Department of Health and Human Services (HHS) Secretary Xavier Becerra to extend the deadline for hospitals to use provider relief funds. This joint effort with the AHA and other groups ultimately led to the HHS announcing extended deadlines by which hospitals and other providers that received Provider Relief Fund (PRF) money may use their COVID-19 PRF payments. We also had several MHA members directly involved in submitting statements to Sen. Gary Peters on the impact of healthcare supply chain shortages during the pandemic, which were utilized by the Senate Homeland Security and Governmental Affairs Committee that Sen. Peters chairs.

The MHA is currently working on a comment letter for the recently released federal Occupational Safety and Health Administration (OSHA) Emergency Temporary Standards (ETS). Although the AHA achieved several improvements in the final proposed ETS, a number of issues remain. Because Michigan uses a state plan for OSHA regulation, MIOSHA adopted these rules June 22. The MHA is aware that the federal ETS is under regular review and amendments are possible. Filing comments brings attention to those parts of the rule that require further action.

Laura Appel, MHA senior vice president of health policy and innovation, has done an outstanding job as our point person on federal advocacy for many years now. I can tell you from firsthand experience that she knows her way around the federal policymaking process as well as she knows her way around the maze of offices on Capitol Hill. In addition, MHA Executive Vice President Chris Mitchell is serving as the chairman of the SAGRO (State Association Government Relations Officers) group, representing all the state hospital association advocacy leaders. MHA Chief Medical Officer Gary Roth, DO, is also serving as chairman of the SHAPE (State Hospital Association Physician Executives) group, leading his peers across the country. And for the past year I have had the privilege of serving as the chairman of the AHA State Issues Forum, which is the group of state hospital association CEOs focused on the strategic issues that we all share. Collectively, these engagements are just another indication of the stature and leadership of our association on the national level.

As you can see, our dedication to advocating for our members — and the pursuit of our mission to advance the health of individuals and communities — extends from Lansing to Capitol Hill. I am proud of the strong foundation that we have established in this regard and, given the increased focus on hospitals and healthcare in the national conscience as a result of the pandemic, I am convinced that our work at the federal level will continue to be critical. 

As always, I welcome your thoughts

House Introduces Healthcare Reform Package

New bills were introduced in the House during the week of Feb. 22 that address a wide range of healthcare issues in Michigan. House Bills (HBs) 4345 through 4359 intend to improve prescription drug transparency, expand the scope of certified registered nurse anesthetists (CRNAs), lower out-of-pocket prescription costs and more. Many of the bills in the package were passed in the House Health Policy Committee during 2020 but were not passed in the lame-duck session. Below is a summary of the proposed legislation.

  • HB 4345 was introduced by Rep. Andrew Beeler (R-Port Huron) and would require savings on out-of-network prescriptions to be applied to any insured individual’s out-of-pocket maximum or cost sharing requirement.
  • HB 4346 was introduced by Rep. Sara Cambensy (D-Marquette) and would put a maximum cap of $50 on the total out-of-pocket cost for an insured individual’s 30-day supply of insulin.
  • HB 4347 was introduced by Rep. Angela Witwer (D-Delta Township) and would require drug manufacturers to report certain information to the Department of Insurance and Financial Services.
  • HB 4348 was introduced by Rep. Julie Calley (R-Portland) and would establish a new license for, and regulate the practice of, pharmacy benefit managers.
  • HB 4349 was introduced by Rep. Ryan Berman (R-Commerce Township) and would align Michigan statute with federal law requiring hospitals to list chargemasters online.
  • HB 4350 was introduced by Rep. Stephanie Young (D-Detroit) and would make two exemptions to the Health Care False Claim Act related to kickbacks.
  • HB 4351 was introduced by Rep. Karen Whitsett (D-Detroit) and would amend the Third Party Administrator Act to prohibit certain prescription price nondisclosure contracts.
  • HB 4352  was introduced by Rep. Sue Allor (R-Wolverine) and would prohibit a pharmacy or pharmacist from entering a contract with a pharmacy benefit manager that interferes with a patient’s ability to receive prescriptions that are eligible for the 340B prescription drug program.
  • HB 4353 was introduced by Rep. Bronna Kahle (R-Adrian) and would require any money paid by or on behalf of an insured to contribute to any out-of-pocket maximum or cost-sharing requirement.
  • HB 4354 was introduced by Rep. Daire Rendon (R-Lake City) and would ensure oral chemotherapy treatments are no more restrictive than other forms of anti-cancer treatments.
  • HB 4355 was introduced by Rep. Ann Bollin (R-Brighton Township) and would allow out-of-state providers to deliver telehealth treatments to Michigan residents.
  • HB 4356 was introduced by Rep. Luke Meerman (R-Coopersville) and would allow for contact lens prescriptions through telemedicine.
  • HB 4357 was introduced by Rep. John Roth (R-Traverse City) and would prohibit pharmacy benefit managers from offering gifts in the sale, promotion or other marketing activity for a prescription drug.
  • HB 4358 was introduced by Rep. Abdullah Hammoud (D-Dearborn) and would create new requirements that insurers must meet before removing or reclassifying a covered prescription drug or adding utilization management restrictions.
  • HB 4359 was introduced by Rep. Mary Whiteford (R-Casco Township) and would expand scope of practice for CRNAs.

Several of the bills received their first hearing in the House Health Policy Committee Feb. 25, but no votes were taken. To date, the MHA has taken positions only in support of HB 4352 and 4359, which would protect 340B savings for hospital patients and expand the scope of CRNAs.

For further information on these bills or the positions taken by the association, contact Adam Carlson at the MHA.

Healthcare Continues as Legislative Focus during Lame-duck

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As the Michigan Legislature began its lame-duck session the week of Nov. 30, it took up several bills that would impact hospitals. Legislative action included bills to expand healthcare capacity during the pandemic, make changes to the Certificate of Need (CON) program and improve behavioral health services in Michigan. With only a few days left in this legislative session and a surge of COVID-19 cases, the MHA expects healthcare issues to remain a major focus of legislation passed this month.

In the House Health Policy Committee, members reported Senate Bill (SB) 813 and House Bill (HB) 5615, which would require the Michigan Department of Health and Human Services to produce an annual report of suicides or other deaths of psychiatric patients that occur within 48 hours of discharge. The MHA secured an amendment clarifying that hospitals are not responsible for tracking patients after discharge. The House Health Policy Committee also reported MHA-supported SB 758, which would authorize Michigan to join an interstate licensure compact for psychologists, and SB 826. which would amend Michigan’s mental health code to include physician assistants, nurse practitioners and clinical nurse specialists. Adding these providers to the mental health code would expand their scope of practice to allow for additional care team responsibilities without continual physician oversight, and the MHA supports the bill. Finally, testimony was taken on HB 6325, which would remove certain cardiac catheterization procedures from CON regulation. The MHA submitted a memo in opposition to HB 6325, but no vote was taken in committee. All bills that were reported by House Health Policy await a hearing in House Ways and Means Committee.

In the House Ways and Means Committee, a pair of bills were reported that aim to improve healthcare staffing during the pandemic. SB 1021 would allow the Michigan Department of Licensing and Regulatory Affairs (LARA) to administer health professional licenses to individuals who hold a substantially similar license in Canada. HB 5724 would temporarily lift several licensing and scope-of-practice regulations that had been suspended by Executive Order 2020-61. The MHA continues to support both bills, which now await a full vote on the House floor.

Other pandemic-related bills that received hearings in the House included SB 1185 and HB 5715. SB 1185 would extend a second period of liability protections for providers and healthcare facilities from Oct. 1 through Dec. 31, 2020. The MHA supports SB 1185, which awaits a final vote on the House floor. HB 5715 would allow LARA to temporarily waive all CON requirements for constructing or operating temporary or mobile care sites, as well as all employee fingerprinting requirements. LARA would be granted this authorization through June 30, 2021. The MHA supports HB 5715, which is now before the full House for consideration.

The full Senate passed SB 1160, and it now moves to the House. SB 1160 would amend the CON statute related to swing beds by removing the existing requirement that hospitals provide evidence of difficulty placing patients in skilled nursing home beds during the 12 months prior to the swing bed application. The MHA did not take a position on SB 1160, but will continue to track the legislation during the lame-duck process.

For more information on healthcare issues being addressed by the Legislature, contact Adam Carlson at the MHA.