MHA Monday Report Oct. 10, 2022

MHA Monday Report

DIFS Publishes Bulletin on No-fault Reimbursement Following Andary Decision

The Michigan Department of Insurance and Financial Services (DIFS) issued Bulletin 2022-17-INS Oct. 5 in the matter of payment and billing guidance for no-fault automobile insurers and healthcare providers following an order from the Michigan Supreme Court in the Andary v. USAA lawsuit …


MDHHS Releases Proposed Policy to Resume Required Enrollment Activities

The Michigan Department of Health and Human Services (MDHHS) released a proposed policy to rescind remaining waived provider enrollment (PE) requirements implemented by MSA 20-28 and resume required enrollment activities that were waived during the federal COVID-19 Public Health Emergency (PHE) …


CMS Announces 2023 Medicare Premiums and Deductibles

The Centers for Medicare & Medicaid Services (CMS) recently announced the calendar year 2023 Medicare fee-for-service Part A deductible for inpatient hospital services will increase by $44 to a new total of $1,600 …


MHA Creates Workforce Sustainability Communications Toolkit

As hospitals and health systems across Michigan continue to face workforce challenges, the MHA has developed a downloadable communications toolkit focused on workforce sustainability …


Michigan Harvest GatheringsMichigan Harvest Gathering Launches Oct. 10

Food insecurity and health outcomes go hand in hand, as those who struggle to put food on the table are at a higher risk of conditions like diabetes, hypertension and heart disease. In 2020, more than one million Michiganders faced food insecurity – including 300,000 children …


Opportunities for Immunization Grants – Applications Due Nov. 1

The American Academy of Pediatrics (AAP) recently announced multiple grant opportunities for health organizations and AAP Chapters to improve community confidence in vaccines and to support pediatricians in the delivery of on-time vaccinations …


Webinar Dispels Misinformation About Unionization and Outline Legal Guidelines

Healthcare workforce shortages, particularly nursing shortages, are severely hindering the ability to provide patient-centered care. Unionizing to negotiate for policies like staffing ratios is popular but does not consider the complexity of significant workforce shortages …


MHA Race of the Week – Michigan Secretary of State

The MHA’s Race of the Week series highlights the most pivotal statewide races and ballot questions for Election 2022. The series will provide hospitals and healthcare advocates with the resources they need to make informed decisions on Election Day, including candidates’ views and background …


Paul KeckleyThe Keckley Report

The White House Strategy for Nutrition and Hunger: Three Glaring Oversights

“Last Wednesday, the White House hosted the White House Conference on Hunger, Nutrition, and Health in DC—the first since the Nixon administration’s conference in 1969. Noting that food insecurity is an issue in one in four US households and the eroding nutritional value of the food supply chain, the Administration laid out its strategy in a 44-page document featuring 5 pillars of its attention…

The White House Strategy is a great start but the issues of food insecurity and nutritional deficiency require urgent, comprehensive and dedicated attention. The White House says it has secured pledges of $8 billion from the private sector to advance the strategy: that’s a good start, but only a fraction of what’s needed.”

Paul Keckley, Oct. 3, 2022


Logo for MI Vote Matters, Tuesday Nov. 8News to Know

  • A second gubernatorial debate is scheduled for 7 p.m. Oct. 25 on the Oakland University campus between Gov. Gretchen Whitmer and Republican candidate Tudor Dixon.
  • Early in-person voting by absentee ballot at a clerk’s office is currently available.
  • Complimentary MI Vote Matters informational posters and the 2022 Candidate Guide remain available for MHA members.

Laura AppelMHA in the News

Bridge Michigan published an article Oct. 4 which focuses on the staffing challenges impacting behavioral health providers that limit bed capacity. The article begins by reviewing the number of reduced beds at state psychiatric facilities …

DIFS Publishes Bulletin on No-fault Reimbursement Following Andary Decision

The Michigan Department of Insurance and Financial Services (DIFS) issued Bulletin 2022-17-INS Oct. 5 in the matter of payment and billing guidance for no-fault automobile insurers and healthcare providers following an order from the Michigan Supreme Court in the Andary v. USAA lawsuit that effectively reinstated the obligation of auto no-fault insurers to cover benefits for the catastrophically injured as those benefits had been in place prior to June 11, 2019.

The lawsuit was brought by a group of catastrophically patients injured before June 11, 2019, which is prior to passage of changes to Michigan’s auto no-fault law. Auto insurers implemented benefit and payment reductions for all claims including for patients who were injured before the new law took effect. The plaintiffs in Andary sued their insurer to establish that they are entitled to full lifetime no-fault benefits (such as unlimited hours of family attendant care) and claimed the limited reimbursement for medical and other personal injury protection coverage does not apply retroactively.

The bulletin explains the process providers who believe they are due additional reimbursement for claims subject to the Andary decision should follow if a provider believes a reprocessing of a claim is necessary. As outlined in the bulletin, providers are advised to first contact the insurer to request reprocessing of those claims. If a dispute related to a reprocessed claim cannot be resolved directly with the insurer, the provider may contact DIFS for assistance at DIFSComplaints@michigan.gov.

The Michigan Supreme Court also issued a separate order granting USAA’s application for permission to appeal the question of whether the Court of Appeals erred when it:

  • Held that claimants injured before June 11, 2019 are not subject to the reduced reimbursement for care under the new law.
  • Held that application of the new law to claimants injured before June 11, 2019 violates the Contracts Clause of the Michigan Constitution.
  • Remanded the case to the circuit court for discovery to determine if the new law passes constitutional muster.

The MHA is evaluating the DIFS bulletin and have submitted clarifying questions to external legal counsel. Members with questions may contact Laura Appel at the MHA.

Court of Appeals Rules for Providers in ANF Case

The Michigan Court of Appeals ruled 2-1 in favor of providers to declare that statutorily set reimbursement rates for auto accident no-fault claims could not be applied retroactively. The new reimbursements went into effect in July, 2021.

The 2-1 ruling, in Ellen M. Andary, Philip Krueger, & Eisenhower Center, v. USAA Casualty Insurance Company and Citizens Insurance Company of America, called upon the fact that legislative intent did not make it clear that the new rates were intended to be retroactive for cases that had arisen previous to the rates that went into effect, and even if it had, the legislature would be unable to make such a law due to impairments of constitutional contract provisions.

While the case is a victory for providers, especially those caring for auto accident victims from prior to 2019, it is highly likely that the case will be appealed for a final decision at some point before the Michigan Supreme Court. There is not an automatic right to appeal for the defendants, but the Michigan Supreme Court could grant leave to appeal. Under the Court of Appeals ruling, payments to providers for patients with injuries incurred before the effective date of the law return to charges 21 days after this ruling unless there is further court action. The MHA will provide an analysis to members of the policy impact of this decision and will keep members apprised of the legal status of challenges to the amended auto no fault law.

Those with questions may contact Laura Appel at the MHA.

DIFS Utilization Review Decisions Favor Hospitals

The Michigan Department of Insurance and Financial Services (DIFS) issued in early April two important utilization review decisions in favor of hospitals related to auto no-fault insurance reimbursement. Under the new system enacted as part of Public Act (PA) 21 of 2019, hospitals are entitled to more than Medicare reimbursement when the cost of treatment is covered by the auto no-fault insurance system. PA 19 does not adequately define Medicare rates and some auto no-fault insurers have paid less than appropriate amounts for hospital services rendered to auto accident patients. These decisions are extremely helpful in establishing the appropriate methodology to use in determining auto no-fault insurance reimbursement moving forward.

In the case of Hurley Medical Center v. Pioneer State Mutual Insurance Company, DIFS Director Anita Fox found that Medicare “pass-through” payments for graduate medical education, nursing and allied health, and the ancillary adjustment are payable under section 500.3157 of the Michigan Insurance Code. These amounts are payable in addition to the appropriate base payment rate multiplied by the diagnosis related group (DRG) relative weight. The ultimate amount in dispute in this case is $3,500, which the insurer now owes to Hurley Medical Center.

The case of Hurley Medical Center v. Progressive Michigan Insurance Company involved a dispute over the appropriate DRG. Progressive Michigan disputed the DRG, which totaled $58,126 after the amount was multiplied pursuant to PA 19. In response to the bill from Hurley, Progressive paid a DRG-multiplied amount of $26,642. After review, Fox found that Hurley Medical Center billed under the appropriate DRG, more than doubling the amount owed to the hospital. The amount payable to Hurley was reduced by $200 because the multiplied DRG amount exceeded Hurley’s charge for the service by that amount.

In each case, the insurer may appeal the finding to the circuit court. The MHA is tracking further developments in these cases, as well as several other utilization review appeals pending before DIFS. The MHA is also preparing a Utilization Review Appeals Toolkit to guide members through the utilization review (UR) process including the deadlines for filing UR appeals, specific information required for filings, a pre-filing checklist and a sample cover letter for filings. That information is expected to be sent to members by the end of April. For more information about these decisions and other auto no-fault insurance reimbursement issues, contact Laura Appel at the MHA.

MHA CEO Report — Auto No-fault: Our Work Continues

MHA Rounds Report - Brian Peters, MHA CEO

“I pass my life in preventing the storm from blowing down the tent, and I drive in the pegs as fast as they are pulled up.” — Abraham Lincoln

MHA Rounds Report - Brian Peters, MHA CEOYou may have seen recent media coverage noting that the MHA is joining efforts to address and reform Michigan’s auto no-fault insurance law. The reality is our efforts to protect and preserve what we viewed as the best system in the nation for ensuring access to care for auto accident victims dates back decades. Despite those efforts, in 2019, we clearly understood that the political stars were aligning in such a way that substantial reforms were imminent and, hence, our work in the months and years since has pivoted.

I am proud that we led an effort to assist consumers in making educated purchasing decisions in light of those 2019 reforms, and we are pleased that most Michigan drivers to date have seen the wisdom in continuing to purchase unlimited coverage to protect themselves and their families in the event of a catastrophic accident. While this effort was intended to be very visible to the public, some of our other efforts have played out behind the scenes and relate to the regulatory aspects of the new law that impact how hospitals and other care providers are compensated for the important services rendered to accident victims.

The changes to reimbursement that went into effect last July created several significant difficulties for hospitals. In effect, the new law created price controls, something we argued is never a good idea because they inevitably create real inequities. Throughout the no-fault debate, we have argued hospitals and other providers need to be fairly compensated to ensure we have the physical space, the technologies, the staffing expertise, and everything else that is necessary to provide care in the hospital emergency department, intensive care units and in the venues that provide rehabilitative and attendant care. Every step of that process is very important for the physical, mental, and fiscal health and well-being of those auto accident victims and their families.

The impact on post-acute facilities has already been well publicized, as reimbursement inequities are leaving many to reduce their patient load or close their doors entirely. While most of these patients have no immediate needs that require hospitalization, the lack of available alternatives means they increasingly have nowhere else to go; some patients are now being transferred to hospitals at a time when we are short staffed and operating at high capacity. Emerging from yet another COVID-19 surge, hospitals need every available bed for patients requiring acute hospital care.

Also impacting hospitals has been a lack of consistency in payment rates and confusion on payment limitations. Claims processing from insurers has been significantly delayed, and there are serious inconsistencies in reimbursement rates across payers due to confusion over Medicare rates. The definitions from the law passed in 2019 are insufficient, and additional clarity is needed to ensure reimbursement rates are accurate and consistent with the intent of the law. The MHA has spent much time working with the Department of Insurance and Financial Services on the need for a proper definition of Medicare rates to address this problem. The payment inadequacy, discrepancies and delays are at odds with the negotiations that occurred in 2019 and the intent of the law. The law was designed to reduce the cost of auto insurance. Instead, it is creating an unfair and unstable system of reimbursement and threatening access to certain types of patient care.

Many hospitals across Michigan operate on razor thin patient care margins and have done so for many years. In fairness to all involved, when the auto no-fault reform legislation was signed into law back in 2019, no one could have foreseen an impending pandemic and the unprecedented financial stress it would impose on hospitals and the entire healthcare ecosystem. But we clearly see the reality of the situation now.

The MHA is fully supportive of reforms that will address our concerns. It is often said that “politics is the art of the possible.” We will continue to do all that we can to advocate for public policy that ensures access to much-needed care, in the context of a challenging political environment.

On that note, I would be remiss if I didn’t thank the governor, as well as Republicans and Democrats in the state Legislature, for their bipartisan support of House Bill 5523, which will deliver critically needed funding support to address our healthcare workforce crisis. Our elected officials came together and got it right. When it comes to our auto no-fault system, I am optimistic that we will ultimately make things right as well.

As always, I welcome your thoughts.

MHA Monday Report Feb. 28, 2022

MHA Monday Report

MHA Covid-19 update

The current surge of hospitalizations due to COVID-19 has continued its downward trend. The seven-day average of hospitalizations in the U.S. as of Feb. 22 was 53,987, down from 146,534 Jan. 20. Michigan hospitalizations for confirmed and suspected cases of COVID-19 …

capitol backgroundPharmacy Benefit Manager Legislation Signed, Amended Right to Try Act Passes House

Important pharmacy benefit manager legislation was signed by Gov. Gretchen Whitmer the week of Feb. 21 and the Michigan Legislature took up several pieces of legislation that impact hospitals. The Senate Health Policy and Human  …


Register Now for CMS Conditions of Participation Webinar

The Centers for Medicare & Medicaid Services Conditions of Participation recently made significant changes to regulatory standards of telemedicine because of the COVID-19 pandemic. These standards, along with 1135 telemedicine waivers and new tag numbers for critical access hospitals will be …


Media Recap: Auto No-fault & Crain’s Detroit Business Coverage

The MHA received media coverage the week of Feb. 21 on efforts to amend Michigan’s auto no-fault law and from Crain’s Detroit Business advocating for state funding support for midsize vital hospitals and behavioral health. …


The Keckley Report

Paul Keckley

The Health System in Ukraine: Four Systemic Flaws

“This week, all eyes will be on Ukraine, Europe’s poorest country. Since becoming an independent state in 1991 after separating from the Soviet Union, Ukraine has failed to invest in its people, its economy and its health system. As the potential for conflict rises, the preparedness of the Ukrainian health system will garner global attention, especially if armed combat results in civilian casualties.”

Paul Keckley, Feb. 21, 2022


News to Know

The Michigan Health Endowment Fund’s 2022 Behavioral Health Initiative began accepting grant proposals Feb. 23.

Media Recap: Auto No-fault & Crain’s Detroit Business Coverage

MHA CEO Brian Peters

The MHA received media coverage the week of Feb. 21 on efforts to amend Michigan’s auto no-fault law and from Crain’s Detroit Business advocating for state funding support for midsize vital hospitals and behavioral health.

The MHA sent a memo Feb. 16 to the Michigan House of Representatives encouraging the Legislature to focus on improving the auto no-fault law, including quickly addressing payment issues with post-acute care providers, including a proper definition of Medicare rates, and clarifying that the reimbursement rates outlined in law were intended to be minimum amounts. The Detroit News and Michigan Radio published stories on the memo, which was signed by Adam Carlson, senior vice president, advocacy.

Adam Carlson
MHA Senior Vice President Adam Carlson

“Numerous cases have occurred of patients being transferred to hospitals who did not otherwise need hospitalization because of a lack of long term post-acute care providers to care for them in their home or an appropriate facility,” said Carlson. “In addition, it has become increasingly difficult to transfer patients to post-acute settings as the number of providers and staff has diminished. Both of these circumstances is putting unsustainable pressure on hospitals that don’t have the beds or staff to care for patients who shouldn’t be in the hospital.”

Crain’s Detroit Business also published their latest Forum edition, which includes several pieces of content relevant to Michigan hospitals. An article published Feb. 25 reviews the significant challenges facing midsize vital hospitals, particularly independent hospitals not affiliated with a larger health system. MHA CEO Brian Peters is quoted in the article discussing the financial issues impacting those hospitals. Supporting the article is an op-ed submitted by Hillsdale Hospital President and CEO Jeremiah J. Hodshire.

MHA CEO Brian Peters
MHA CEO Brian Peters

“The volume-based approach to reimbursement has always been a problem and that doesn’t go away,” said Peters.

Crain’s also published an op-ed from Peters encouraging more state funding investments to address Michigan’s broken and fragmented behavioral health system.

“The MHA believes an appropriation to fund additional support for pediatric behavioral health, a grant pool to improve behavioral healthcare in emergency departments and recruitment support for behavioral health providers will have significant and lasting improvements in access to care and quality,” said Peters. “This appropriation will help address a major barrier to improving access right now, which is the lack of appropriately trained and educated behavioral health providers available in Michigan to serve our population. It would also help modify the way emergency departments are prepared to temporarily care for patients in behavioral health crises — especially Michigan’s children.”

Members with any questions regarding media requests should be directed to John Karasinski at the MHA.

Peters Talks Auto No-fault with Michigan Radio

MHA CEO Brian Peters

Brian PetersMHA CEO Brian Peters spoke Oct. 14 with Michigan Radio on the new auto no-fault law. Much of the discussion focused on the impact to providers of the mandated Medicare fee schedules that went into effect July 1, 2021.

Peters reinforced the MHA’s commitment to caring for auto accident survivors and the continued years of advocacy on the issue. Peters also reviewed the current political arena and the outlook for future policy changes.

“If not for the pandemic, this would have a tremendous amount of visibility in the public eye,” said Peters. “I really do think there would be a much higher degree of conscientiousness about what’s happening in Michigan right now with the ramifications of the new law.”

“The mantra for many public policy members was, ‘we’re going to do something different and sit back and see how it plays out, and make adjustments if necessary.’ So I think we’re going to have an opportunity to revisit this issue, if things continue to play out as they have in these initial months. The proof will be there that maybe this did not benefit Michiganders in the way that many thought it would.”

Read the article 

MHA Board of Trustees Wraps up Unprecedented Program Year

The MHA Board of Trustees concluded the 2020-2021 program year by holding its first in-person meeting of the year at the MHA offices in Okemos for fully vaccinated attendees. As with every meeting since the onset of the COVID-19 crisis, the board reviewed the latest statewide COVID-19-related data and took a moment to reflect on the daunting toll the virus has taken in lives lost and strain placed on healthcare workers and all Michiganders. It was noted that, since the onset of the pandemic, Michigan hospitals have treated over 450,000 COVID-19 patients in emergency departments and admitted more than 120,000 for inpatient care, including 4,500 children. Despite these sobering statistics, the board celebrated the continued steep decline in COVID-19 hospitalizations and infections, as well as advancements in treatment since the onset of the pandemic; however, members expressed concern about slowing rates of vaccination as more infectious variants continue to spread nationally.

The board welcomed the staff of the Michigan Osteopathic Association (MOA), which represents osteopathic physicians statewide, as new tenants within the MHA headquarters building. MOA CEO and executive director, Kris Nicholoff, addressed the board and noted the longstanding and strong relationship between hospitals and the osteopathic community, which can be further strengthened through the new space-sharing arrangement.

The board also received a report on the status of healthcare funding priorities in the fiscal year 2022 state budget, which continue to be deliberated in the Legislature, as well as recent activities related to the statewide roll-out and provider concerns related to recent reforms to Michigan’s auto no-fault insurance law. Current Health PAC Chair and incoming MHA Board of Trustees Chair Tina Freese Decker provided an update on the status of the 2021 MHA Health PAC campaign, which has been extended through July 31. Freese Decker encouraged eligible individuals and organizations to meet their contribution goals. Information about the MHA Health PAC can be found online. The board also approved type 3 membership and Endorsed Business Partnership for NextJob, a nationwide reemployment solutions company.

The board concluded the meeting by acknowledging outgoing board members Edward Bruff, president & CEO, Covenant Healthcare, Saginaw; James (Chip) Falahee, senior vice president, Legal & Legislative Affairs, Bronson Healthcare Group, Kalamazoo; and David Jahn, president & CEO, War Memorial Hospital, Sault Ste. Marie. The board also recognized outgoing chair Ed Ness, president & CEO, Munson Healthcare, Traverse City, for his leadership during such a challenging program year and extended its best wishes to incoming chair Tina Freese Decker, president & CEO, Spectrum Health, Grand Rapids, for a successful year ahead. For more information about actions of the MHA Board of Trustees, contact Amy Barkholz at the MHA.

Auto No-Fault Utilization Review Rules Examined in Webinar

The MHA hosted a member webinar Feb. 9 to discuss the recently finalized auto no-fault insurance utilization review rules. The presentation was led by Jennifer Benedict and Becky Glitman, partners in the Honigman law firm, with follow-up discussion led by Sally Bailey, nursing services senior director at Michigan Medicine.

A one-page summary of the new utilization review process is available online. To obtain a copy of the presentation slides, contact Sean Sorenson-Abbott at the MHA. Members with questions on the utilization review rules should contact Adam Carlson at the MHA.