The MHA received media coverage the week of Feb. 6 regarding a variety of topics, including the fiscal year 2024 executive budget recommendation, the role food insecurity has as a social determinant of health, the new state House Behavioral Health subcommittee and the need for hospitals to make infrastructure updates.
Below is a collection of headlines from around the state that includes interviews or statements from MHA representatives. Included is coverage from a media statement from MHA CEO Brian Peters released a statement published in support of the executive budget recommendation, thanking Gov. Whitmer for her continued commitment to protecting hospitals and supporting healthcare workers.
The new session for the 102nd Michigan Legislature kicked off during the week of Jan. 9 with swearing in ceremonies in both the House and Senate. Michigan Democrats in the majority started the session by introducing legislation to repeal right …
Hospitals interested in learning more about the new Rural Emergency Hospital (REH) designation are encouraged to attend an upcoming webinar from 12:30 p.m. to 2 p.m. ET Jan. 18 hosted by Mathematica and the Rural Health Redesign Center (RHRC) for …
The Michigan Department of Health and Human Services (MDHHS) issued a bulletin Jan. 5 to expand the types of providers who can perform Medicaid-covered, non-physician outpatient behavioral health services. Effective Feb. 4, Medicaid will cover and reimburse outpatient behavioral health …
A recent United States District Court for the District of Columbia ruling allows the Department of Health and Human Services (HHS) to propose a remedy for hospital 340B drug underpayments for calendar years 2018 to 2021. …
Rev. Martin Luther King Jr. once said, “Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.” As we honor Dr. King today and the legacy he created striving for racial equality, the MHA and …
“Blistering attacks on hospitals were a staple in media coverage in 2022. Comparatively, health insurers escaped unscathed. …
The near-term tension between hospitals and insurers will continue as affordability and transparency concerns mount. In tandem, government efforts to shift incentives to value-based payment models will expand as large employers and national plans implement more aggressive risk sharing agreements. The roles of the two sectors will converge in response to market demand. In anticipation, Deloitte, among others, merged its payer and provider practices to prepare its clients for the change. …”
The Michigan Department of Health and Human Services (MDHHS) issued a bulletin Jan. 5 to expand the types of providers who can perform Medicaid-covered, non-physician outpatient behavioral health services.
Effective Feb. 4, Medicaid will cover and reimburse outpatient behavioral health services provided by graduates of board-approved master’s or doctoral-level psychology, social work, counseling or marriage and family therapy educational training programs, so long as they have completed the requirements for a limited or temporary license; regardless of whether the license has been issued.
These staff must be supervised by a Medicaid-enrolled, fully licensed provider of the same profession. Services should be billed to Medicaid under this supervising provider, not the graduate.
This time-limited allowance for new graduates is applicable from the date the individual completed their graduate course work for a period not to exceed one year and does not replace the graduate’s obligation of obtaining the appropriate limited or temporary license from the Michigan Department of Licensing and Regulatory Affairs. It is strictly a mechanism to allow behavioral health providers to provide services while they wait for their license to be issued.
“I don’t like that man. I must get to know him better.” ― Abraham Lincoln
As I put the proverbial pen to paper, the Michigan Legislature has completed the 2021-2022 legislative session and I am very pleased to report that in the lame-duck session, we successfully advanced several MHA-supported bills – and not a single MHA-opposed bill was signed into law. Another job extremely well done by our MHA Advocacy team as we protect access to affordable, high-quality healthcare for all.
Now shifting to the New Year: 2023 will usher in a monumental shift in power in Lansing as Democrats will control all aspects of government in the state for the first time during my 32-year tenure at the MHA. Following last November’s election results, Democrats not only retain power in all areas of the executive branch and a majority in the judicial, but both chambers of the legislative branch flipped to Democratic control. The last time Democrats had control of the Governor’s office and both chambers of the state legislature was 1984.
This change was due to a multitude of factors, including redistricting, ballot proposals, a trickle-down impact from the top of the ballot, candidate viability and record turnout. Earlier this year, the Michigan Independent Citizens Redistricting Commission established new district maps, which had previously been handled by the majority party in the state legislature in conjunction with the governor. Michigan saw a significant increase in the number of competitive districts due to their nonpartisan work. The Michigan midterm election saw record turnout again, with 4.5 million votes cast, including 1.8 million absentee ballots. This is a 2.4% increase from the prior record set in 2018 with 4.3 million votes. Turnout was partially driven by three ballot proposals as well as over 14,000 same day voter registrations, primarily from young Gen Z voters.
The MHA has a long history of being nonpartisan, but moving from divided government to one-party control will always bring about a change in the political dynamics and associated priorities. Our advocacy culture has long been to establish and maintain relationships regardless of leadership role or party affiliation so that in times of need, you have allies you can rely on. Both new Speaker of the House Joe Tate (D-Detroit) and Senate Majority Leader Winnie Brinks (D-Grand Rapids) have established track-records of working closely with the healthcare community to help us fulfill our mission of advancing the health and wellness of individuals and communities. Our MHA Advocacy team as well as our member hospitals and health systems consider them friends. And of course, our close partnership and personal friendships with Gov. Whitmer extend back to her time in the state legislature when she was recognized with an MHA Special Recognition Award at the 2014 MHA Annual Meeting. Our bonds with the governor and her administration grew even stronger as we confronted the COVID-19 pandemic together.
As a result of term limits, the new legislative session will also welcome an astounding 59 first-time legislators to Lansing. Since the Nov. 8 election, we have been busy establishing new relationships and introducing ourselves to many new faces. Most lawmakers only know healthcare through the prism of a consumer, so it is never too early to begin the education process related to this highly complex field. As part of this process, we hosted the Building Bridges event with our partners at the Small Business Association of Michigan, the Michigan Education Association, Michigan Association for Justice and Business Leaders for Michigan that helped us pursue these goals while also offering new legislators the opportunity to connect with their peers and learn how best to serve in Lansing.
Now I have no magic crystal ball so I can not predict what types of legislation we may see introduced and prioritized over the coming months. Having not held a dual-chamber majority for nearly 40 years, we anticipate there is no shortage of issues for Democrats to work on. There is no question we will continue to express the importance of access to care, which Democrats have traditionally strongly supported. Based on public comments and prior legislative track records, it is reasonable to expect continued activity on improving behavioral health, public health, health equity and addressing pharmaceutical pricing. American Rescue Plan Act funds also remain available and we strongly believe these funds should be appropriated quickly to make a difference in addressing the financial and staffing challenges that our member hospitals throughout the state, regardless of size, are experiencing. Those are positives. In reality, we need to also be prepared to address legislative proposals that we find more concerning – such as nurse to patient staffing ratio mandates which sound good in theory but would be impractical if not impossible to implement in practice.
The truth of the matter is that the Democrat majority is very slim, so we expect Republicans will still play an impactful role in healthcare funding and policy development. We certainly appreciate the work they’ve done for hospitals and healthcare over recent years and look forward to continuing those relationships during the new session.
I hope all our elected officials who will take office in January will reflect on the wise words of Abraham Lincoln above and include among their New Year’s resolutions to pause, set aside whatever preconceived notions they may have about the people across the aisle from them and make an earnest effort to truly get to know them. Will this guarantee that we come together and see eye-to-eye on all the issues? Of course not. But hopefully, such an approach will lead to more civility in the political process and better public policy for all Michiganders.
The bottom line: 2023 presents new challenges and opportunities for all who work in Lansing. While many of the players in town may have changed, the playbook for successful advocacy has not. On behalf of our member hospitals, I’d like to express my gratitude for those finishing their years of service, congratulate all those who will be serving in office this upcoming year and look forward to working together to achieving a healthier Michigan.
Michigan’s hospitals are facing a funding crisis, putting communities and families across the state at risk of losing access to high-quality, timely healthcare. Health systems, business and university leaders are urging policymakers to address the crisis to avoid further reduction of available beds and access to care and healthcare services.
Michigan has lost a high of 1,700 staffed hospital beds since 2020 due to lack of staffing. This creates a cascade of problems, from longer wait times in the emergency department, reduced services, particularly in rural areas, and more difficulty transferring patients to the appropriate care setting. Respiratory illnesses are also surging, making problems worse.
“Recently, we have seen a surge in cases of respiratory syncytial virus (RSV), flu and COVID. This puts an additional pressure on emergency departments and our already-strained inpatient bed capacity across Michigan, impacting care statewide. Without funding to address staffing shortages, we run the risk of compromising our ability to provide the same level of exceptional care that we’re accustomed to across the state,” said T. Anthony Denton, senior vice president and chief operating officer, University of Michigan Health System and Michigan Health & Hospital Association board chair.
A 2021 Washington Post-Kaiser Family Foundation survey found that nearly 30% of healthcare workers are considering leaving their profession altogether. The U.S. Bureau of Labor Statistics projects the need for 1.1 million new registered nurses nationwide by 2030, the Association of American Medical Colleges estimates two out of every five active physicians nationwide will be 65 or older within the next 10 years, and the nation faces a projected shortage of more than 3.2 million lower-wage healthcare workers such as medical assistants, home health aides and nursing assistants, according to a Mercer report.
“The overall health and prosperity of Michigan is inextricably tied to the state’s investment in its healthcare and higher education enterprises,” saidDaniel Hurley, CEO of the Michigan Association of State Universities. “Michigan’s public universities, together with our hospital and other healthcare partners, look forward to working with state leaders to ensure a future healthcare workforce that is capable of providing the highest levels of quality care for all Michiganders.”
The healthcare workforce shortage — combined with an aging population, a rise in chronic diseases and behavioral health conditions and advancements in medical care delivery — all contribute to an immediate need for resources that will allow hospitals to continue to provide the care residents need and deserve.
Despite staffing losses attributed to the COVID-19 pandemic, healthcare directly employed nearly 572,000 Michigan residents in 2020, continuing to make it the largest private-sector employer in the state. The 2022 Economic Impact of Healthcare in Michigan report found that direct healthcare workers in Michigan earned $44.2 billion in wages, salaries and benefits, with indirect, healthcare-supported workers earning about $28 billion wages, salaries and benefits.
“With healthcare being the largest private-sector employer, a healthy Michigan economy is directly linked to a properly funded healthcare system,” said Susan Smith, executive director, Economic Development Partnership of Hillsdale County. “Without access to healthcare services to support our communities, ranging from obstetrical units to trauma centers, we cannot remain economically competitive, attract or retain talent, or support placemaking for young families and care for everyone at all stages of life.”
Michigan officials have made recent short-term investments to address the hospital staffing crisis, but additional funding remains unappropriated that if used as intended, can improve hospital capacity and service lines. Michigan also needs a long-term funding solution to address stagnant reimbursement that has yet to respond to inflationary pressures to improve the retention of existing healthcare workers and recruit future workers to ensure that residents continue to have access to healthcare services.
Learn how you can help your local hospital or health system by visiting MiCareMatters.org.
“Hospitals have an immediate need for resources to continue to provide the services residents need and deserve – like ambulances available for lifesaving care,” said JJ Hodshire, president and chief executive officer, Hillsdale Hospital. “As a rural hospital, we excel at being innovative to make the best use of our resources, particularly staff. However, we can only stretch resources for so long. Everyone can agree that access to lifesaving emergency medical care is a basic need for Michiganders and residents should be able to receive specialized care no matter where they live.”
“My colleagues in pediatric units across the state have spent the past month responding to one of the worst respiratory illness surges I can remember as a physician and the biggest challenge to our ability to care for more children was our lack of available staff,” said Dr. Rudolph P. Valentini, chief medical officer, Children’s Hospital of Michigan and group chief medical offer at Detroit Medical Center. “We can’t afford to have another surge of sick, hospitalized children before something is done to improve the health of our hospitals and health systems.”
“Michigan residents deserve quality, accessible healthcare services and without hospital resources to adequately provide that care, Michigan hospitals have and will continue to face difficult decisions about what services they can offer,” said Brian Peters, chief executive officer, Michigan Health & Hospital Association.”
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.
Laura Appel, executive vice president of government relations and public policy, MHA, contributed to the story. The article also references statewide aggregate data compiled by the MHA on the loss of staffed hospital beds and the dramatic increase in contract labor expenses. Shared in a report recently provided to the Michigan Legislature, the state has approximately 1,400 less staffed acute-care inpatient beds now compared to Oct. 2020 and Michigan hospitals are expected to spend $1.1 billion on contract labor compared to $516 million in 2021.
“We are working with the state to try and figure out how to make it through this crisis,” said Appel. “At the same time, I can’t blame (state officials) for their challenges.”
The Legislature returned the week of Sept.19 to continue work on several pieces of legislation that the MHA is currently monitoring. Committees met in both the House and Senate, taking up legislation that included several new bills supported by the MHA in the areas of behavioral health, rural emergency hospitals, speech-language pathologist licensure and telemedicine.
In the House Health Policy Committee, initial testimony was taken on new legislation to make changes to the preadmission screening process for behavioral health patients. House Bill (HB 6355), introduced by Rep. Graham Filler (R-St. Johns) and supported by the MHA, would memorialize the requirement for preadmission screening units operated by the Community Mental Health (CMH) services program to provide a mental health assessment within three hours of being notified by a hospital of the patient’s need. If a preadmission screening unit is unable to perform the assessment within the three-hour time frame, HB 6355 would also allow for a clinically qualified individual at a hospital who is available to perform the required assessment.
Kathy Dollard, psychologist and director of behavioral health for MyMichigan Health, joined the committee to testify in support of HB 6355. “Strengthening our behavioral health system includes strengthening our behavioral health workforce and that can start with creative solutions like providing clinically qualified hospital personnel the ability to conduct pre-admission screenings,” said Dollard. No votes were held on HB 6355 at this initial hearing.
MHA staff also provided testimony during committee on HB 6380. Introduced by Rep. Andrew Fink (R-Hillsdale), HB 6380 would make the necessary changes to state law to allow for Michigan hospitals to pursue a new federal designation of “Rural Emergency Hospital” (REH) status. A REH designation comes with significant requirements such as limiting total beds to 50, maintaining an average length of stay of 24 hours or less and a required transfer agreement with a level I or II trauma center. Hospitals that choose to convert to a REH will receive enhanced federal reimbursement to provide critical emergency and outpatient services, especially in geographic areas.
Lauren LaPine, director of small and rural hospital programs, MHA, and Elizabeth Kutter, senior director of advocacy, MHA, testified in support of the legislation. “HB 6380 provides rural hospitals in our state with the ability to continue providing care in our most rural communities,” said LaPine. No votes were taken on HB 6380.
Initial testimony on two bills that were previously reviewed by MHA’s Legislative Policy Panel also occurred during committee. Senate Bill (SB) 811, introduced by Sen. Curt VanderWall (R-Ludington), would extend the length of time for an individual to complete a temporary Speech-Language Pathologist license and extend the length of time those temporary licenses are valid. The MHA is supportive of SB 811, which did not see any votes this week.
House committee members also took initial testimony on SB 450, which would ensure that visitors of cognitively impaired patients are permitted in healthcare facilities. Introduced by Sen. Jim Stamas (R-Midland), the bill would prohibit the director of the Michigan Department of Health and Human Services (MDHHS) or a local health officer from issuing an order that prohibits a patient representative from visiting a cognitively impaired individual in a healthcare facility. As written, the legislation does not prevent a healthcare facility from implementing reasonable safety measures for visitors and will still allow for facilities to limit the number of representatives per patient. The MHA is neutral on the bill and will continue to monitor any action taken.
The Senate Health and Human Services Committee took initial testimony on SB 1135, which was introduced by Sen. Mike MacDonald (R-Macomb Township). SB 1135 would specify that previous expansions to Medicaid telemedicine coverage also apply to the Healthy Michigan Program and Michigan’s medical assistance program. Most notably, the legislation would require continued coverage for audio-only telemedicine services. The MHA is supportive of SB 1135, which would continue virtual care policies that have proved to be effective and safe during the COVID-19 pandemic.
In the Senate’s Regulatory Reform Committee, testimony was taken on another MHA-supported bill to regulate the sale of kratom in Michigan. Kratom is a substance of concern with opiate-like effects that has no approved medical use in the United States. HB 5477, introduced by Rep. Lori Stone (D-Warren), would create a license for kratom sales and manufacturing, require testing of products and require new safety warnings on kratom substances sold in Michigan. While the MHA prefers a federal Schedule I ban of the drug, the association is supportive of HB 5477, which will help limit adolescent addiction and prevent adulterated products from being on the market.
Members with questions on these bills or any other state legislation should contact Adam Carlson at the MHA.
New legislation to make changes to the screening process for potential admission to inpatient psychiatric care for behavioral and mental health patients was introduced Aug. 17 in the Michigan House of Representatives. Rep. Graham Filler …
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 …
The Centers for Medicare and Medicaid Services (CMS) recently released a final rule to update the Medicare fee-for-service prospective payment system (PPS) for skilled nursing facilities for fiscal year (FY) 2023. Key updates …
Hospitals are encouraged to review their preliminary wage and occupational mix data released May 23 by the Centers for Medicare and Medicaid Services (CMS) and submit any requests for changes to their Medicare Administrative Contractor …
The Michigan Department of Health and Human Services recently released a proposed policy to update Medicaid coverage of telemedicine services after the conclusion of the federal COVID-19 public health emergency. The policy outlines …
The Keckley Report
Game On: FTC Takes on Hospital Consolidation via COPA Dismantling
“The Federal Trade Commission (FTC) issued a scathing 20-page report last Monday criticizing hospital Certificate of Public Advantage (COPA) agreements and urging state lawmakers to suspend their use. …
The FTC has its sights on hospital consolidation: it’s high on the list of industries where its activist’ muscle is likely to be flexed more frequently and effectively. … Like strong bipartisan support for the Hospital Price Transparency Rule, it reflects the FTC’s rejection of hospital claims about inadequate reimbursement by payers including Medicare and Medicaid, price gauging by device, drug and technology suppliers and unfair competition from insurers and niche providers often funded by private investment to optimize profits at the expense of hospitals.
And it offers a solution that’s strong on populist appeal but weak on practical implementation in the current hospital environment: competition vs. consolidation. Regulatory Constraints on hospitals like EMTALA and others are not applied to insurers and retailers who offer a widening range of care management services in direct competition with hospitals. The playing field is increasingly tilted against hospitals.
The MHA responded to several media requests the weeks of Aug. 15 and Aug. 22 which focused on different aspects of healthcare workforce sustainability, ranging from emergency department wait times to efforts to address the …
New legislation to make changes to the screening process for potential admission to inpatient psychiatric care for behavioral and mental health patients was introduced Aug. 17 in the Michigan House of Representatives.
Rep. Graham Filler (R-St. Johns) introduced House Bill (HB) 6355 to amend the Mental Health Code and make the preadmission screening process more efficient. Under the bill, preadmission screening units, whether operated by the Michigan Department of Health and Human Services or Community Mental Health services programs, must provide a mental health assessment within three hours of being notified by a hospital of the patient’s need. If a preadmission screening unit is unable to perform the assessment in a timely manner, HB 6355 would also allow for a clinically qualified individual at the acute care hospital to perform the required assessment. The bill provides for reimbursement to the hospital if hospital staff provide the preadmission screening.
The MHA supports HB 6355 because it addresses the ongoing issue of long wait times for emergency department behavioral and mental health patients. This legislation should help shorten the difficult wait times between the evaluation and beginning services.
HB 6355 was referred to the House Health Policy Committee. Members with questions regarding HB 6355 should contact Adam Carlson at the MHA.
“We must find time to stop and thank the people who make a difference in our lives.” ― John F. Kennedy
We have rightfully spent a lot of time in the past two years thanking the heroes who work in our hospitals and other healthcare settings for the incredible work they have done in the face of extreme challenge.
I want to take a moment now to thank another group of people who have recently helped our cause through their bipartisan actions; our elected officials in Lansing were extremely busy the last week of June passing the fiscal year 2023 state budget, which has since been signed by Gov. Whitmer. Our MHA mission is to advance the health of individuals and communities — and this budget absolutely provides significant help in that regard. While some elements of the new budget represent long-standing MHA priorities, others are new funding items that have the potential to reshape access to care and help our members and the patients and communities they serve.
Our MHA team does a tremendous job advocating for the importance of items such as the Healthy Michigan Plan, graduate medical education of physician residents, disproportionate share hospital funding, maximization of our robust provider tax program and Medicaid payment rates, the rural access pool and obstetrical stabilization fund, and critical access hospital reimbursement rates. Every election cycle, new legislators are welcomed to Lansing and the MHA’s efforts never stop to ensure these decisionmakers are aware of the impact these budget items play in their communities. The bottom line is the financial viability of hospitals is increasingly reliant on these important programs, and the MHA is dedicated to protecting them.
Hospital closures continue to happen across the country. However, they have occurred at a much higher rate in states that have not participated in Medicaid expansion through the Affordable Care Act. Maintaining funding for our expansion program — the Healthy Michigan Plan — has been one of our top priorities, and the pandemic has made the importance of insurance coverage more important than ever. In short, when the pandemic hit and thousands of Michiganders lost their jobs, the Healthy Michigan Plan was there to ensure access to good healthcare.
Our hospitals that treat the highest numbers of uninsured and underinsured patients also qualify for disproportionate share hospital funding, which provides enhanced reimbursement to account for the higher costs of care. This pool is funded through hospital provider taxes that reduce the state’s general fund contribution to the overall Medicaid program.
Small, rural and independent hospitals can often experience financial challenges in a particularly acute way, thus items such as the rural access pool, obstetrical stabilization fund and critical access hospital reimbursement rates also support access to healthcare services in rural areas. Labor and delivery units typically do not contribute to positive margins, but they are extremely important for families and communities. The obstetrical stabilization fund provides additional means for hospitals in rural areas to maintain these services so expectant mothers can avoid driving exorbitant distances for these services. Lastly, the state also included $56 million in new funding to increase Medicaid reimbursement rates for primary care services, which will help individuals on Medicaid receive the necessary primary and preventative care that can help prevent hospitalizations and reduce overall healthcare costs.
Lastly, behavioral health investments have been at the forefront of our advocacy efforts for some time and we were very pleased to see new funding to improve and enhance state behavioral health facility capacity. Michigan lacks adequate capacity to treat patients with behavioral and mental illness and this new funding is an important and necessary step to address the shortage. Included is $50 million to expand pediatric inpatient behavioral health capacity, $30 million to establish crisis stabilization units and $10 million to fund the essential health provider loan repayment program to cover behavioral health professionals.
In total, the budget includes $625 million in new investments for behavioral health funding and investments in workforce. While this will not solve all the issues impacting hospitals, it provides needed resources and demonstrates the commitment of lawmakers to a healthy Michigan. This budget also signifies that our work must continue to advocate for the resources necessary for hospitals and health systems to care for all Michiganders. Once again, on behalf of the entire MHA family, I want to acknowledge and thank both Governor Whitmer, as well as lawmakers in the state House and Senate, for their support of this latest state budget. And I would also encourage anyone who cares about access to quality, affordable healthcare to engage in the process, share your stories and input with those who can make a difference going forward. But also remember to say thank you when they support our cause.