The Health Resources Services Administration (HRSA) recently opened an application process for $25.5 billion in federal COVID-19 funding for providers. The same application process is used for both Provider Relief Fund (PRF) Phase 4 and American Rescue Plan (ARP) Rural payments.
The PRF Phase 4 funding is open to a broad range of providers with changes in operating revenues and expenses due to the pandemic. ARP Rural funding is open to providers who serve rural beneficiaries of Medicare, Medicaid or the Children’s Health Insurance Program, known in Michigan as MIChild.
Additional information, including eligible provider types and application instructions, is available on the HRSA website. The agency must receive applications by Oct. 26, and members are encouraged to begin the process as soon as possible. Registration for webinars featuring guidance on using the application portal are also listed online. HRSA intends to start distributing the ARP funds by late November and the PRF funds by mid-December.
MHA-member small and rural hospitals are eligible for new funding made available through the American Rescue Plan. The Emergency Rural Health Care program is designed to help broaden access to COVID-19 testing and vaccines, rural healthcare services and food assistance through food banks and food distribution facilities. Rural healthcare is challenged by immediate financial needs stemming from COVID-19 related expenses, and long-term access to — and availability of — rural healthcare services have been further hampered by the pandemic. In response to these challenges, this program offers two tracks of funding to eligible applicants.
Track Two: Impact Grants advance ideas and solutions to solve regional rural healthcare problems to support the long-term sustainability of rural health.
Eligible applicants include public bodies, community-based nonprofits and federally recognized tribes. Facilities and projects supported through this grant must be in rural areas with populations of 20,000 or fewer and must primarily serve rural areas.
The American Rescue Plan Act (ARP) represents one of the largest fiscal advances to state and local government budgets in history. With appropriate strategic planning, these funds, along with the ARP’s other allocations for public health, education, infrastructure and mass transit agencies, can stabilize, revitalize and position communities for not only short-term benefits but a strong long-term future.
The MHA Health Foundation webinar The Impact of the American Rescue Plan on Hospitals and Health Systemswill review how these healthcare organizations are impacted by the ARP funds and what providers can do to best position themselves to benefit from the act.
The webinar is scheduled from 10 to 11 a.m. Sept. 9, and members can register for a connection fee of $195. Members with questions should contact Erica Leyko at the MHA.
The president signed the American Rescue Plan March 11, establishing as law the latest legislation to address the many areas of loss the country has suffered due to the COVID-19 pandemic. It includes $8.5 billion in funding for eligible rural healthcare providers to offset expenses and lost revenues attributable to the pandemic (see related article). The MHA continues to keep members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.
Mass Vaccination Site to Open at Ford Field as Vaccination Eligibility Expands
In a March 11 address, President Joe Biden instructed states to open vaccine eligibility to all adults no later than May 1. The federal government expects a significant increase in vaccine doses in the coming weeks and will make a website available to help anyone find a vaccine appointment near them.
In response to the president’s directive, Gov. Gretchen Whitmer announced that Michigan will open eligibility to adults ages 16 through 49 with certain preexisting conditions March 22 and to any adults 16 and older April 5. This is in addition to all adults ages 50 through 64 becoming eligible March 22. This news is reflected in the state’s official Prioritization Guidance document posted on its vaccine webpage. Officials expect weekly allocations to continue to increase to help meet the increased demand. The MHA will keep members apprised of any additional information relating to the expanded eligibility.
Members are encouraged to prepare for increased calls and website traffic as vaccine eligibility broadens and to provide their communities with details on who they will be able to vaccinate and how to make appointments.
The governor also announced that a mass vaccination site will open March 24 at Ford Field in Detroit. It will have the capacity to administer 6,000 vaccine doses each day to serve residents in the broader southeast Michigan region. The Biden administration, in partnership with the Federal Emergency Management Agency (FEMA), selected southeast Michigan for this major new community vaccination site.
The site, which was selected according to the Centers for Disease Control and Prevention’s priority tool to help those hardest hit and most vulnerable, will operate from 8 a.m. to 8:30 p.m., seven days a week, for eight weeks under the federal government’s vaccination pilot program. The facility will be managed by the state of Michigan with support from FEMA, Wayne County, the City of Detroit, Ford Field, Meijer, Henry Ford Health System and the Detroit Lions.
Federal efforts under development also include a Centers for Disease Control and Prevention (CDC) “equity index” that will rank states based on equity of access/administration of the vaccine in addition to the existing rankings that are based on doses given, speed, etc.
In addition, the CDC will be sending allocations directly to a list of federally qualified health centers across the nation, including those in the Michigan cities of Inkster, Pontiac, Brimley, Gladwin, Flint, Saginaw, Cassopolis, Kalamazoo, Centreville, Ann Arbor and Detroit.
CDC Issues COVID-19 Recommendations for Fully Vaccinated People
The CDC issued new recommendations March 8 for individuals who have been fully vaccinated against COVID-19. The agency considers people to be fully vaccinated two weeks after their second dose of the Pfizer and Moderna vaccines or two weeks after Johnson & Johnson’s Janssen single-dose vaccine.
The recommendations state that those meeting the full vaccination parameters may gather indoors with other fully vaccinated individuals without wearing a mask. In addition, they can gather indoors with unvaccinated people from one other household without masks, unless any of those people or anyone they live with has an increased risk for severe illness from COVID-19.
Fully vaccinated individuals who have been near someone who has the disease are no longer asked to avoid others or get tested unless they have symptoms. However, vaccinated people who live in a group setting and have been in contact with someone who has COVID-19 should quarantine for 14 days and get tested, even if they don’t have symptoms.
Because authorities do not yet know the extent to which vaccines mitigate the transmission of COVID-19, the CDC continues to recommend precautions that include wearing a mask, staying at least six feet apart from others, and avoiding crowds and poorly ventilated spaces. Anyone who has symptoms of COVID-19 should be tested and stay away from others.
The MHA will keep members apprised of any changes in these recommendations. Questions on the COVID-19 vaccine may be directed to Ruthanne Sudderth at the MHA.
COVID-19 Variants in Michigan More Transmissible than Original Virus
The Michigan Department of Health and Human Services (MDHHS) Bureau of Laboratories identified on March 8 the first Michigan case of the COVID-19 variant B.1.351 in a male child living in Jackson County. Case investigation is underway to determine close contacts and whether additional cases are associated with this case.
Cases caused by this variant, which originated in South Africa, were first reported in the United States at the end of January. It is believed to be more contagious, but there has been no indication that it affects the clinical outcomes or disease severity compared to the SARS-CoV-2 virus that has been circulating across the United States for the past year. Scientists are evaluating how well COVID-19 vaccines work against this newer variant, which has been identified in at least 20 other states and jurisdictions in the U.S.
The MDHHS has also provided information about the characteristics of the B.1.1.7 variant that was first discovered in the United Kingdom. This variant has now been identified in multiple Michigan communities after having first been detected in an isolate from a Washtenaw County case Jan. 16. It is approximately 50 percent more transmissible, leading to faster spread of the virus and potentially increasing numbers of cases, hospitalizations and deaths. Members should refer to the MHA’s COVID-19 alert sent Friday, March 12, for details and recommendations on managing variants.
The MHA and the MDHHS are closely monitoring case numbers, positivity rates and hospitalizations. The association will keep members apprised of any concerning data trends related to the variants. Members with data questions may contact Jim Lee at the MHA.
New Regulatory Flexibility Approved for Sharps Containers
The Department of Environment, Great Lakes, and Energy March 9 approved an MHA request to provide regulatory flexibility for hospitals facing a shortage of sharps disposal containers. State regulation currently requires hospitals to replace sharps containers every 90 days or when full, whichever is sooner. Through July 31, 2021, hospitals will now be exempt from the 90-day rule, meaning sharps containers will only be required to be replaced when full. The shortage is due to a production facility fire and increasing demand for the containers due to vaccinations; some MHA members had already received similar exemptions. The MHA will work with state government if additional flexibility is needed. Members with questions may contact Sean Sorenson-Abbott at the MHA.
State Provides Vaccine Communication and Administration Materials
A variety of vaccine materials are available for hospitals and other providers on the MDHHS Provider and Partner webpages for communication and administration purposes. These include toolkits for communicating with patients and communities regarding the safety and effectiveness of the vaccines, which are in the “COVID-19 Vaccine Communication Materials” section of the Partner page; Johnson & Johnson materials, including a Standing Order form for this vaccine; and more.
MDHHS Announces 22 Awardees in State’s Vaccine Pilot Program
The MDHHS and the Protect Michigan Commission have awarded 35,800 doses of COVID-19 vaccine to 22 pilot projects to help enhance the state’s vaccine equity strategy. Three of the awards went to Henry Ford Health System, MidMichigan Health and Schoolcraft Memorial Hospital, and the remainder went to health departments, community-based clinics, agencies on aging and other vaccinators.
The pilot program is designed to help remove barriers to vaccine access for Michiganders ages 60 and older who live in communities with a high Social Vulnerability Index (SVI) and high COVID-19 mortality rates. Participating providers that have additional capacity in their projects may expand vaccination to include people ages 50-59 with disabilities or underlying conditions. The awardees were chosen from more than 70 applications. Additional details on the program are available in the MDHHS news release.
State data through March 4 indicated that Michigan has received more than 3 million doses of COVID-19 vaccine and administered more than 2.5 million vaccinations, marking a significant improvement in protection against the coronavirus in the state. However, nearly 1,300 new cases and 56 deaths were recorded March 6. The MHA continues to keep members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.
Johnson & Johnson Vaccine Authorized for Emergency Use, Provider Materials Available
The Johnson & Johnson (Janssen) single-dose COVID-19 vaccine has received emergency use authorization from the U.S. Food & Drug Administration (FDA) and the Centers for Disease Control & Prevention (CDC) Advisory Committee on Immunization Practices for people aged 18 and older. The MHA issued a media statement on the official launch of a third safe and effective COVID-19 vaccine into circulation in the U.S. Johnson & Johnson (J&J) told the media it intends to deliver 20 million doses of the vaccine to Americans during March and 100 million doses by June.
Michigan received 82,700 doses of the single dose vaccine upon its approval. J&J immediately shipped all available doses and now needs to resume manufacturing; therefore, no new J&J vaccine will be available until the week of March 22. Updates on allocations will be available as that date approaches. A limited number of hospitals received J&J doses and have been advised to use them to pilot an effort to vaccinate patients being discharged from an inpatient or emergency department setting.
The Michigan Department of Health and Human Services (MDHHS) has posted new materials for providers that will be administering the J&J/Janssen vaccine on its Provider Education and Resources webpage, which includes important information on all three currently authorized vaccines. The MHA has also updated its vaccine toolkit, including communications tools, to reflect the addition of the J&J vaccine.
The MHA is aware of ongoing misinformation regarding both the effectiveness of this vaccine and how it was developed (as it relates to use of fetal tissue). Members are encouraged to join the MHA in countering misleading information on their communication channels whenever possible, using appropriate background information and talking points.
State Expands Eligibility for Vaccination to 50 and Older, Other Special Populations
The MDHHS announced March 3 that new groups would soon be eligible for the COVID-19 vaccine. Adults age 50 and older with underlying medical conditions or disabilities, as well as anyone 16 and older who cares for a child with special health needs, will be eligible starting March 8. Any adult age 50 and older will be eligible, regardless of health status, starting March 22. The MHA issued a media statement in support of the expanded eligibility.
Providers or regions that are not yet prepared to open eligibility to these groups are not required to do so, as many vaccination sites still have waiting lists of adults 65 and older. The expanded eligibility simply allows those who see declining numbers of previously eligible individuals to maintain their vaccination rates. The announcement follows the state’s long-held strategy to implement eligibility groups in overlapping waves to ensure vaccination rates remain as high as possible.
The state’s COVID-19 vaccine prioritization guidance has been updated to reflect the expansion. It outlines the eligible groups and timeframes, as well as the state’s goals in following this strategy.
Members with questions on vaccine eligibility should contact Ruthanne Sudderth at the MHA.
COVID-19 Relief Packages Pass U.S. House and Senate
The U.S. House of Representatives voted Feb. 27, largely along party lines, to approve a modified version of the American Rescue Plan Act of 2021, legislation to provide for a roughly $1.9 trillion COVID-19 relief package that includes a number of provisions that affect hospitals and health systems. The House bill included expanded subsidies for certain forms of healthcare coverage and provisions to bolster the nation’s COVID-19 healthcare response with additional resources for vaccines, treatment, personal protective equipment, testing, contact tracing and workforce development. Other healthcare-related provisions would provide funding to the Department of Labor for worker protection activities.
The Senate took up the legislation March 5 and passed, on a party-line vote, its own COVID-19 reconciliation bill the next day. The Senate retained the House’s provisions that affect healthcare, added $8.5 billion for rural health, and enhanced Medicaid funding and financial support for state and local government that will assist Michigan, including its efforts to protect against healthcare cuts. However, the Senate did not incorporate continued suspension of the sequester reduction to hospital Medicare payments or funding for loan forgiveness for Medicare accelerated payments to hospitals. Major changes in the Senate legislation affected an increase to the federal minimum wage, the income level cap for those receiving the $1,400 stimulus checks, and details surrounding expanded unemployment benefits.
The Senate version of the legislation will now return to the House for further deliberation and a vote. The House is expected to pass the bill and send it to President Joe Biden for signature before the expanded unemployment benefits that are currently in place expire March 14.
The MHA will soon contact members with more detail on this legislation and what it means for Michigan providers. Members with questions may contact Laura Appel at the MHA.
State Legislature Approves Federal COVID-19 Funds
The Michigan Legislature March 3 approved a supplemental spending bill that included $2.3 billion for COVID-19-related response activities. The bulk of healthcare-related funding reflects federal money that was sent to the state in December but had not yet been approved by the state Legislature.
The legislation includes $207 million for COVID-19 epidemiology and laboratories, $110 million for immunizations, and $150 million to increase direct care worker wages by $2.25 per hour through September 2021. It has been sent to Gov. Gretchen Whitmer for final approval.
An additional $347 million for COVID-19 epidemiology and laboratories was also included in the bill but is specifically tied to provisions that would eliminate the authority of the MDHHS director to issue pandemic-related orders and is expected to be vetoed. Members with questions may contact Adam Carlson at the MHA.
Remdesivir Add-on Payment to Hospitals Established
The MDHHS released a policy March 4 to establish an add-on payment to reimburse hospitals for remdesivir treatment costs for Medicaid COVID-19 patients discharged between Jan. 1 and Sept. 30, 2021. The MDHHS will reimburse hospitals up to $3,100 per five-day treatment.
The MDHHS will make these payments on a quarterly basis for both Medicaid fee-for-service and managed care patients. Implementation of this policy is pending approval by the Centers for Medicare & Medicaid Services. Members with questions may contact Vickie Kunz at the MHA.