Combating the Novel Coronavirus (COVID-19): Dec. 21 through Jan. 8

MHA Covid-19 update

MHA COVID-19 UpdateDuring the holiday season and into the new year, activity has continued related to the novel coronavirus and vaccines to protect against it, including the emergency use authorization and subsequent distribution of the Moderna vaccine. The MHA keeps members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Legislation, Policies Enacted to Fight COVID-19

The Michigan Department of Health and Human Services (MDHHS) announced Jan. 6 that additional Michiganders can be vaccinated against COVID-19 beginning Jan. 11, including residents 65 and over; police officers, first responders, front-line state and federal workers and jail and prison staff; and pre-K-12 teachers and childcare providers. The MHA issued a media statement following the announcement.

Joneigh Khaldun, MD, the state’s chief medical executive, advised that seniors and essential workers should contact their local health department (LHD) to seek an appointment for the vaccine. Hospitals that have operational capacity and enough vaccine to vaccinate seniors are encouraged to do so, as many LHDs lack the capacity to serve this large population. The MHA advises all hospitals to issue local media/social media information making clear whether they will vaccinate seniors and essential workers and any details on how to make an appointment to receive the vaccine.

In a Jan. 8 news conference, Gov. Gretchen Whitmer announced that her administration would like all Michigan K-12 schools to prepare to offer in-person learning on or before March 1. A rationale document was issued as part of the announcement, which includes explanations of the risks and safety of in-person learning, impact on those kept at home and their parents/guardians, and more. Members should be aware of this policy change as it may positively impact staffing challenges.

The governor signed Senate Bill (SB) 748 Dec. 30, providing supplemental appropriations for various priorities. While the governor vetoed some items, the MHA’s priorities on healthcare funding were approved. The items the governor and Legislature agreed upon included $10 million to reimburse Michigan hospitals for temporary staffing needs during COVID-19, $17 million to reimburse hospitals for the high cost of remdesivir treatments for patients, and $3.3 million to reimburse hospitals for holding and caring for nursing home patients beyond when they need hospital care. The MHA will work with policymakers as these funding items are implemented and keep members informed on how they may access these reimbursements.

The governor also signed into law two bills the MHA supported and advocated for during the legislative lame-duck session. SB 1258 amended Public Act 238 of 2020 to provide additional flexibilities regarding updated federal guidelines on timing for COVID-19-positive employees and potential exposures. The MHA will continue to seek further clarification from the MDHHS regarding similarities between COVID-19 symptoms and vaccine side effects. SB 1021 makes permanent in state law the flexibilities that allow Canadian health professionals to practice in Michigan.

The period for the governor to sign several bills reforming Michigan’s Certificate of Need (CON) process expired Jan. 6, effectively vetoing the bills. The legislation included several reforms that would have increased covered capital expenditures from $3.3 million to $10 million, added two members to the commission, and removed air ambulance as a covered service in June 2021. The MHA took a neutral position on an additional provision that was vetoed, which would have removed inpatient psychiatric services from CON in counties with populations less than 40,000. Members with questions on state legislation should contact Adam Carlson at the MHA.

Vaccine Distribution Updates

Vials of the Pfizer vaccine often contain a sixth dose that can be used to protect against COVID-19. However, the initial supply kits provided with the vaccine contained only five needles, which has caused some hospitals to experience needle shortages. The American Hospital Association has advised Operation Warp Speed (OWS) officials of these shortages, and OWS plans to increase the number of needles, syringes and other supplies in the kits to correspond with the available dosages in the vials. Members experiencing vaccine supply kit shortages should contact Adam Carlson at the MHA for assistance.

In an apparent response to a letter from the governors of eight states, including Michigan, the transition team for President-elect Joe Biden said it plans to release to states most of the COVID-19 vaccine being held by the federal government once Biden’s administration is in place after Jan. 20. The current stance of the U.S. Department of Health and Human Services and the Centers for Disease Control & Prevention is to hold back 50% of all vaccine supply to later ship second doses to providers. The Biden team states that it will work with manufacturers to ensure second doses are available for Americans. The MHA will work with its state and federal partners and elected officials to identify how this will affect hospitals’ vaccine allotments in Michigan and procedures for ordering doses. The association will provide updates as it obtains more information.

The MDHHS recently indicated that hospitals wishing to set up vaccine clinics at external venues need to follow the guidelines of the Centers for Disease Control and Prevention for quality assurance, storage, electrical, etc. Hospitals do not need to submit COVID-19 vaccine provider enrollment applications for sites that afford space to run mass vaccination efforts, such as hospital-owned/affiliated parking lots or properties or community-based venues. Any off-site clinic should provide guidelines that allow hospitals to do the required data entry, maintain cold storage and prevent wasted vaccine.

The MHA is working with the state and other partners to help hospitals overcome barriers and use opportunities in the vaccination process. To support those advocacy efforts, members are urged to complete a five-minute vaccine barrier survey by 5 p.m. Jan 11. Each hospital’s vaccine coordinator who leads the organization’s COVID-19 vaccine efforts should complete the survey.

The MHA is working daily with state officials to improve vaccine communication, information, transparency, coordination of roles and more. In addition, the association will work more closely with the Michigan Association for Local Public Health to ensure information is consistent across all health departments and hospitals/health systems. Members with vaccine questions may contact Ruthanne Sudderth at the MHA.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC). Members with MHA-specific questions should contact the following MHA staff members:

Combating the Novel Coronavirus (COVID-19): Week of Dec. 14

MHA Covid-19 update

As hospitals across Michigan and the nation begin vaccinating their personnel against COVID-19, the MHA keeps members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Hospitals Immunizing Staff Against COVID-19

Pfizer began shipping its COVID-19 vaccine from its global warehouse in Michigan Dec. 14 and continued to deliver it to hospitals across the country throughout the week. Healthcare providers began inoculating staff members soon after the vaccine arrived. The MHA joined Gov. Gretchen Whitmer and the Michigan Department of Health and Human Services (MDHHS) in recognizing the start of this significant step and thanking healthcare workers for being first in line to receive the vaccine.

As the Pfizer vaccine was being delivered to hospitals, the Food and Drug Administration continued its process toward of evaluating the Moderna vaccine. The second vaccine was approved for emergency use the evening of Dec. 18, and initial shipments to hospitals began Dec. 20. Inoculations with the new vaccine could begin as soon as Dec. 21.

However, the MHA and its members were disappointed to learn that the U.S. Department of Health and Human Services (HHS) will reduce the originally announced allocations of the Pfizer vaccine to many states, including Michigan, during its second week of distribution. The MHA issued a media statement Dec. 18 relaying the negative impact of the delay on Michigan hospitals and will continue to seek more timely and accurate information from the HHS, as well as additional vaccine.

The MDHHS clarified Dec. 18 that hospitals will be able to request both Pfizer and Moderna vaccine. The state will continue to send weekly surveys to hospitals to determine the amount of vaccine needed the following week, which will allow hospitals to request both types of vaccine. The MHA has created a side-by-side comparison of some of the key storage, shipment and administration features of the Pfizer and Moderna vaccines, and the state will continue to post updated resources and tools on its provider education webpage, as well as additional details on its provider information document. The CDC has posted a webpage with tools and information on the Pfizer product, including interim clinical considerations. A key CDC recommendation is that the vaccine be administered alone and that providers allow 14 days between administering this vaccine and other vaccines.

While the vaccinations are widely seen as the beginning of the end of the pandemic, it will take time to inoculate everyone who wants a vaccine. Michiganders are urged to continue to mask up, practice social distancing, get their flu shots and practice hand hygiene as they await their opportunity to be vaccinated. The state provides a COVID-19 Vaccine Dashboard with information about how many providers in each county are enrolled in the vaccine program, where shipments have gone and more, with a time delay of about 24 hours.

Members with questions on matters relating to COVID-19 vaccines should contact Ruthanne Sudderth at the MHA.

Congress Agrees on National COVID-19 Relief Package

News outlets reported the evening of Dec. 20 that congressional leaders had reached bipartisan agreement on providing financial relief to U.S. residents and businesses struggling due to the pandemic, including making grants available to healthcare providers. The legislative text was still being crafted that night, and voting is expected to take place Dec. 21.

MHA Requests Order Allowing HCP Experiencing Vaccine Side Effects to Work

The MHA sent a letter Dec. 17 to MDHHS Director Robert Gordon and Chief Medical Executive Joneigh Khaldun, MD, urging them to issue an order that ensures healthcare personnel (HCP) who recently received COVID-19 vaccines are not unnecessarily removed from the workforce because of vaccine side effects that mimic COVID-19 infection. The letter requested the order exclude known vaccine side effects from the definition of COVID-19 symptoms Public Act (PA) 238 of 2020, which requires that employees displaying the principle symptoms of COVID-19 not report to work until 10 days after the principal symptoms of COVID-19 first appeared. The principle symptoms of COVID-19 include known side effects of both the Pfizer and Moderna vaccines. PA 238 further gives the director or chief medical executive of the MDHHS the power to issue an order modifying the definition of COVID-19 symptoms. The MHA noted that, without an order from the MDHHS exempting symptoms from a known vaccine administration, there could be unnecessary staff absences due to the inoculations.

The MHA encouraged the state to consider recently issued official CDC guidance on handling HCP who have received COVID-19 vaccines and experience mild side effects as it makes decisions on this issue. The CDC guidance urges healthcare facilities to evaluate any personnel who have symptoms but recently received vaccine and allow HCP to continue working as appropriate, depending on the nature and severity of the symptoms. This guidance applies only to symptoms such as fever and fatigue and not to those that are not known side effects of the vaccines, such as cough and loss of taste/smell.

MDHHS Order Relaxed but Extended to Jan. 15

The MDHHS announced Dec. 18 that it is extending to Jan. 15 a public health order that will keep restaurants and bars closed to indoor dining, but will reopen many other indoor venues where patrons can wear masks while inside. The governor and the MDHHS indicated the orders that have been in place since November have contributed to an improvement in Michigan’s COVID-19 year-end surge.

The new order reopens in-person learning at high schools and indoor entertainment venues. Casinos, bowling centers and movie theatres will be allowed to reopen with total capacity capped at 100; food and drink concessions closed; and social distancing requirements in place. The order takes effect Dec. 21.

OBRA Electronic System Again Delayed

The MDHHS Office of Specialized Nursing Home/Omnibus Budget Reconciliation Act (OBRA) Programs recently announced an additional delay in changing the submission of forms 3877 and 3878 from a paper process to an electronic one. The “go live” implementation date of the online system has been delayed from Jan. 19 to at least April 2021 (see related article).

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC). Members with MHA-specific questions should contact the following MHA staff members:

Combating the Novel Coronavirus (COVID-19): Week of Dec. 7

MHA Covid-19 update

Developments with the novel coronavirus are occurring quickly, as the first shipments of the Pfizer COVID-19 vaccine have gone out and the federal government continues to grapple with legislation to assist American businesses and residents. The MHA keeps members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Healthcare Community Urged to Contact Congress on COVID-19 Relief

As the 116th U.S. Congress is entering its final weeks, a COVID-19 relief package is still being negotiated. A bipartisan group of senators led by Sens. Joe Manchin (D-WV) and Mitt Romney (R-UT) is proposing more than $900 billion in aid for state and local governments, small businesses and healthcare providers. Transportation, unemployment, education, vaccine distribution, and testing and tracing are also included in the package. Funding for healthcare providers includes $35 billion allocated to the Provider Relief Fund (PRF), with $7 billion for rural providers and $1 billion for tribes, tribal organizations, urban Indian health organizations and health service providers to tribes. The plan also includes improvements to PRF reporting guidelines, such as clarification that PRF can be used for staffing, including child care staff, and health systems are allowed flexibility to move targeted PRF distributions within their system. It is possible the bipartisan package could be formally introduced Dec. 14.

Hours before funding for the federal government expired Dec. 11, Congress approved a one-week funding extension to Dec. 18. The extension provides negotiators with several more days to agree to a Continuing Resolution for all government funding and a COVID-19 relief package. Members are asked to contact their U.S. House representative and Michigan Sens. Debbie Stabenow and Gary Peters to encourage the following support for hospitals in the end-of-year package:

  • Provide more COVID-19 relief, including additional money for the PRF, federal liability protections, support for front-line healthcare workers, coverage for the uninsured, and accelerated payment forgiveness.
  • Eliminate cuts to the Medicaid disproportionate share hospital program in the next fiscal year.
  • Extend the congressionally enacted moratorium on the application of the Medicare sequester cuts until the public health emergency ends.

Members are also asked to urge that the following provisions be excluded from any package that reaches the House or Senate for a vote:

  • Problematic proposals under consideration related to surprise medical billing, including any “agreement” that takes money from providers without protecting patients.
  • Any provisin that would require new, unrealistic and burdensome Occupational Safety and Health Administration standards.

With strong advocacy from the healthcare community, Congress could pass a COVID-19 Relief Package before adjourning for the year. For more information about end-of-year federal activity, members may contact Laura Appel at the MHA.

Pfizer Vaccine Approved and Being Shipped, Priority Groups Finalized

The U.S. Food and Drug Administration (FDA) issued an emergency use authorization determination for the Pfizer COVID-19 vaccine late Dec. 11 and shipments began leaving Kalamazoo Dec. 13.

The Michigan Department of Health and Human Services (MDHHS) had provided additional information about COVID-19 vaccination plans for the state earlier Dec. 11, including priority groups for vaccination administration. The MDHHS slides from the news conference are available online.

The MDHHS is following the recently issued Centers for Disease Control and Prevention recommendations for prioritization of distribution and administration of COVID-19 vaccines. CDC recommendations are based on input from the Advisory Committee on Immunization Practices (ACIP). In addition, multiple health systems and the MHA took part in a stakeholder meeting in November to provide input on Michigan’s priority groups.

  • Phase 1A includes paid and unpaid individuals serving in healthcare settings who have direct or indirect exposure to patients or infectious materials and are unable to work from home, as well as residents of long-term care facilities.
  • Phase 1B includes some workers in essential and critical industries, including workers with unique skill sets such as nonhospital or nonpublic health laboratories and mortuary services.
  • Phase 1C includes people at high risk for severe COVID-19 illness due to underlying medical conditions and people 65 years and older.
  • Phase 2 is a mass vaccination campaign for all adults.

The MDHHS vaccination plan includes additional prioritization guidance within these categories. It was stressed that vaccination in these phases will likely overlap. The timing of the start of vaccination in a phase is dependent on guidance from the CDC and the ACIP, the supply of vaccine from the manufacturer, how vaccine is allocated from the federal level to Michigan and the capacity to administer the vaccine to populations.

The MHA will continue to provide updates on vaccine distribution as they become available. Members who receive updates directly from the MDHHS are encouraged to share that information with the MHA for vetting or broader distribution. Members with questions and information may contact Ruthanne Sudderth at the MHA.

MDHHS “Pause” Extended to Dec. 20

The MDHHS announced Dec. 7 that it was extending to Dec. 20 its Nov. 18 emergency order limiting indoor gatherings and requiring mask wearing. Previously set to expire at midnight Dec. 8, the extended order slightly relaxes some of the previous order’s restrictions; for example, it allows for in-person instruction of certain trade/vocational programs, with protections in place.

The MDHHS announcement comes on the heels of the MHA’s Dec. 7 letter, published on behalf of MHA-member chief medical officers, urging the state to continue some degree of protection so that the slight progress in hospitalizations achieved since Nov. 18 does not regress. The MHA also issued a statement recognizing the order extension following the MDHHS announcement and has conducted media interviews with outlets from across the state. Links to some of the media coverage is available in a related article.

Data Tracking COVID-19 Patients, New Reporting Requirements

  • Hospitals have asked for clarification on how to count patients who are no longer in COVID-19 isolation for reporting into the state’s EMResource portal or the national TeleTracking portal. According to guidance from the U.S. Department of Health and Human Services (HHS), COVID-19 patients should continue to be counted in the COVID-19 daily census and COVID-19 ICU census regardless of their isolation status or change in location (e.g. transferred out of a COVID-19 unit). Once a patient has been identified as COVID-19-positive, they should always be counted in your daily COVID-19 census until discharged or expired. Only the data field that pertains to hospital onset COVID-19 patients should take into account the change in COVID-19 isolation status.
  • The HHS recently released new COVID-19 reporting guidance for hospitals. The influenza data fields will be mandatory (except psychiatric and rehabilitation facilities) starting Dec. 18. In addition, beginning Jan. 8, 2021, new therapeutic fields will be mandatory each Wednesday. These fields will be designated with generic identifiers (currently using only the letters A and B) to provide flexibility to the HHS on new therapeutics. Therapeutic A has been designated for Casirivimab/Imdevimab and therapeutic B has been designated for Bamlanivimab data collection.

Members with questions on data should contact Jim Lee at the MHA.

COVID-19 Webinar Series Available for All Hospitals

A weekly Mi-COVID19 webinar series began Dec. 9 that aims to continue collaboration and share COVID-19-related lessons learned with stakeholders and experts across multiple disciplines to support Michigan hospitals and providers in caring for COVID-19 patients. The series is hosted by the Mi-COVID19 Initiative, part of the Michigan Hospital Medicine Safety Consortium.

These webinars will be held from noon to 1 p.m. each Wednesday and are currently scheduled through Feb. 24. Webinar topics and registration information are available online.

CME/CE credit is being offered for each webinar. The University of Michigan Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The University of Michigan Medical School designates this live activity for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

For information on future webinars, webinar recordings and COVID-related resources, visit the Mi-COVID19 Initiative webpage. To share COVID-19-related resources, contact the Mi-COVID19 leadership team.

An additional series of education webinars for providers on COVID-19 vaccine is available from the MDHHS. Three 30-minute presentations will be offered from noon to 12:30 p.m. on the following dates and can be joined via the appropriate link:

  • Dec. 14: An Update on the Pfizer COVID-19 Vaccine
  • Dec. 21: An Update on the Moderna COVID-19 Vaccine
  • Dec. 22: Talking Points for Common COVID-19 Vaccine Concerns

No registration is required for these three webinars, and no continuing education credits are offered. Recordings will be made available for those who are unable to attend.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC). Members with MHA-specific questions should contact the following MHA staff members:

Combating the Novel Coronavirus (COVID-19): Weeks of Nov. 23 and Nov. 30

MHA Covid-19 update

COVID-19 patients continued to fill Michigan hospitals throughout the Thanksgiving holiday and into December, while drug companies Pfizer and Moderna applied for emergency authorization of their respective COVID-19 vaccines from the Food and Drug Administration (see related article). The MHA keeps members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Nursing Home Application Deadline Extended; CRC Bulletin Issued

The state announced Nov. 30 that it is extending the deadline from Dec. 1 to Dec. 15 for long-term care (LTC) facilities to become care and recovery centers (CRCs) and COVID relief (CR) facilities. The MHA has advocated for this extension to ensure LTCs do not transfer residents to hospitals without medical indication simply to avoid being out of compliance with new law requirements. While this is a positive step, the MHA will continue to advocate for more permanent solutions to transfer issues and the number of LTCs approved as CRCs and CR facilities.

The MDHHS also issued a bulletin for hospital-based CRCs. Bulletin Number MSA 20-78 supplements Bulletin Number MSA 20-73, which established operational requirements for nursing facilities to operate as CRCs during times of a public health emergency and provides a pathway for Michigan hospitals to establish hospital-based CRCs to support the safe care and isolation of COVID-19-positive individuals. Details about requirements for hospitals seeking designation as a CRC, how to apply and more are available in the bulletin.

Quarantine Duration Requirements Addressed

The MHA hosted its weekly call of hospital/health system chief medical officers Dec. 4, which was joined by representatives of the MDHHS. Among the topics discussed was quarantine requirements and the new guidance from the Centers for Disease Control and Prevention (CDC) advising the public that shorter quarantine periods of 7-10 days may be acceptable, depending on their access to testing and their symptoms or lack thereof.

According to Public Act 238 of 2020, healthcare workers who are exposed to COVID-19 but test negative and are not symptomatic are still able to report to work. Employees’ quarantine needs apply to how they spend time outside of work. There remains in state statute a 14-day quarantine provision for employees who test positive for COVID-19. The MHA is working with state officials and legislators to amend Public Act 238 of 2020 to bring quarantine times for employees who test positive in line with the CDC guidance. Additional information on the statute and administration rules is available from the Michigan Occupational Safety and Health Administration (MIOSHA), as discussed below.

Healthcare facilities and professionals may get questions from patients/community members on this change in quarantine guidance. The state announced its recommendation that the public continue to use the 14-day quarantine as a best practice, but if that is not feasible, the 10-day recommendation should be followed. The state did not endorse a seven-day quarantine with a negative test as a safe alternative.

MIOSHA Emergency Rules Clarified

The MHA hosted a call Dec. 1 with representatives from MIOSHA regarding its emergency rules that, among other items, emphasize the use of a remote workforce and proper use of personal protective equipment.

MIOSHA provided an overview of the rule set and answered questions, emphasizing the agency’s reliance on CDC guidelines in developing the rules and the availability of the free MI Symptoms app to assist employers. Questions or requests for the meeting materials should be directed to Adam Carlson at the MHA.

New Uses of Surge Capacity Beds May Require Certificate of Need Approval

Temporarily licensed surge capacity beds that have already been approved by the Bureau of Community and Health Systems (BCHS) may continue to be used if the following criteria are met:

  • An originally required emergency certificate of need (CON) approved by the MDHHS remains in effect.
  • The facility has maintained the BCHS-approved surge capacity so that it can be used within 48 hours if needed.
  • The facility has not notified the BCHS since the original approval that it has voluntarily surrendered the surge capacity.

If facilities with existing BCHS-approved surge capacity beds want to operate these beds in a different location, manner or use than originally requested, they must contact the MDHHS CON program, as applicable, and the Michigan Department of Licensing and Regulatory Affairs (LARA) State Licensing Section to determine whether new approval is required. Such requests must include a detailed narrative description of the proposed new use, space and floor plans of the area showing the new bed locations. If the proposed space deviates from current BCHS physical plant regulatory requirements, such as minimum square footage, hand sink locations or number of patients/residents to a room, the facility must include a narrative description of how those issues will be addressed to ensure patient/resident safety and care needs.

If the state has questions or concerns on a proposal as submitted, the Health Facilities Engineering Section engineer assigned to the facility will follow up as needed to address those concerns.

All applications not previously approved must apply to both the MDHHS and LARA as applicable and required. Both BCHS-HFD and Appendix E forms are required when applying. Members with questions may contact Paige Fults at the MHA.

BCBSM Provides Update on Coverage for COVID-19 Care and Testing

Blue Cross Blue Shield of Michigan (BCBSM) recently announced that it will continue to waive cost-sharing for its members diagnosed and treated for COVID-19 through March 31, 2021. This extension of a temporary benefit, originally set to expire Dec. 31, means members will not pay out-of-pocket costs — copays, deductibles or coinsurance — for the medical care and pharmacy costs associated with COVID-19. Members with feedback or questions are encouraged to contact Jason Jorkasky at the MHA.

Judge Denies Injunction for Bars, Restaurants Ordered Closed by MDHHS

A federal judge Dec. 2 denied a motion for preliminary injunction seeking to end the temporary MDHHS-ordered closure of bars and restaurants intended to prevent further spread of COVID-19. The MHA submitted an amicus or “friend of the court” brief in support of the temporary emergency measures enacted by the MDHHS. The MHA also issued a media statement supporting the order, which is effective from Nov. 18 through Dec. 8.

The ruling on Michigan Restaurant and Lodging Association v. Gordon was issued by Judge Paul Maloney of the U.S. District Court for the Western District of Michigan. It states that the motion was not granted to plaintiffs because it found the MDHHS’ reasoning for the order convincing and that groups tend to linger more in those settings than transitional environments like a food court or airport dining area.

Maloney further stated that, because the Michigan courts have not yet had an opportunity to evaluate the state issues and these challenges must be adjudicated before the federal claims can be considered, he scheduled a Dec. 17 certification hearing and will accept briefs from the parties to determine which legal questions to pass on to the state courts for further consideration. The MHA’s brief in support of the MDHHS provided medical evidence of the effectiveness of face covering and social distancing in curbing the spread of infection and reducing strain on the healthcare system. There are several other legal challenges in federal and state court against state and local public health orders requiring face coverings, social distancing measures and cooperation with contact tracing. Members with questions about the ruling may contact Amy Barkholz at the MHA.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC). Members with MHA-specific questions should contact the following MHA staff members:

Combating the Novel Coronavirus (COVID-19): Week of Nov. 16

MHA Covid-19 update

MHA COVID-19 UpdateAs the Thanksgiving holiday approaches, the number of hospitalizations due to COVID-19 continues to rise. The MHA keeps members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Vaccine Studies Show 95% Effectiveness

Moderna announced Nov. 16 that the latest trials and studies of its COVID-19 vaccine show 95% effectiveness, and Pfizer updated its findings Nov. 18, announcing its vaccine also shows 95% effectiveness. Moderna’s results stem from its Phase 3 clinical trial of 30,000 individuals, and Pfizer’s efficacy rate resulted from a final analysis of its trial with more than 41,000 volunteers. Both vaccines use messenger RNA (mRNA) technology to cause the effective immune response. A key difference between the vaccines is that Moderna’s vaccine can be safely stored in freezers at about 25 degrees Fahrenheit (minus 4 degrees Celsius), a temperature easily reached by a normal freezer. The Pfizer vaccine requires ultracold storage only achieved by specialized freezers or dry ice.

Pfizer applied with the Food and Drug Administration for emergency use authorization of its vaccine Nov. 20, and Moderna expects to soon apply for the authorization. Although distribution dates are not yet certain, the Michigan Department of Health and Human Services (MDHHS) has advised that providers should be prepared to accept vaccine by early December to ensure expedient distribution and administration when shipments begin. Members with questions may contact Ruthanne Sudderth at the MHA.

Provider Relief Fund Further Clarified

The U.S. Department of Health and Human Services (HHS) has issued two important clarifications related to Provider Relief Fund (PRF) reporting.

The HHS had previously stated that providers could claim only the value of depreciation for COVID-19-related capital purchases with useful lives of more than 12 months. However, after urging from the American Hospital Association and the MHA, the agency stated that expenses for capital equipment, facilities projects and inventory may be fully expensed in cases where the purchase was directly related to the prevention, preparation for and response to COVID-19. Examples of such purchases include:

  • Upgrading heating, ventilation and air conditioning systems to support negative pressure units.
  • Retrofitting COVID-19 units.
  • Enhancing or reconfiguring intensive care unit capabilities.
  • Leasing or purchasing temporary structures to screen and/or treat patients.
  • Leasing permanent facilities to increase hospital capacity.

The HHS also clarified that providers’ reporting of net patient revenue should NOT include payments received from or made to third parties that relate to care not provided in 2019 or 2020.

For more information on the PRF, contact Jason Jorkasky at the MHA.

COVID-19 ICU Best Practices Follow-Up Webinar Offered Nov. 24

A Nov. 11 COVID-19 webinar titled “ICU Management & Treatment of COVID-19 Patients” was hosted under the MI-COVID19 registry continuous quality improvement initiative and provided meaningful discussion for participants. As a result, a follow-up webinar has been scheduled for noon to 1 p.m. EST Nov. 24. Objectives include:

  • Summarizing the latest COVID-19 intensive care unit (ICU) guidelines and recommendations.
  • Discussing best practices for management of critically ill COVID-19 patients.
  • Identifying resources and creating a network for ICU leaders in Michigan to advance the care of critically ill COVID-19 patients.

Members may register online, and questions should be emailed to covid19clinicalsupport@umich.edu.

CDC Offers Education on Telehealth and Health Equity Dec. 8

The Centers for Disease Control and Prevention (CDC), through its Clinician Outreach and Communication Activity division, will host an educational event via Zoom from 2 to 3 p.m. EST Dec. 8 that will focus on telehealth and health equity. Details and access information for the event are available online. Presenters from Kaiser Permanente and the Veterans Health Administration will discuss how telehealth has affected health equity in their patient populations before and during the COVID-19 pandemic.

Topics will also include challenges and opportunities related to telehealth implementation. Presenters will share strategies to expand access that can reduce disparities and improve culturally responsive care to help achieve health equity within each organization. In addition, presenters from the CDC will share telehealth strategies that incorporate the CDC’s frameworks for Addressing Health Equity in Public Health Practice.

In associated news, the MHA recently released its Pledge to Address Racism and Health Inequities that was approved by the MHA Board of Trustees at its Nov. 4 meeting (see related article).

COVID-19 Relief Facility Application Now Open

The state has released the application for being designated a COVID-19 Relief (CR) Facility, which are designed to allow eligible Nursing Facilities to retain COVID-19-positive residents. These facilities will meet criteria established in Senate Bill 1094 to care for COVID-19-positive residents who become ill and do not require hospital-level care. The purpose of the CR Facilities is to provide care in place with enhanced infection control measures for individuals with confirmed COVID-19 who have not met the criteria for discontinuation of Transmission-Based Precautions and have limited access to the state’s Care and Recovery Centers. All approved CR Facilities may retain, or readmit after acute care, their own COVID-19-positive residents.

Facilities must meet certain criteria to qualify for CR Facility designation or admission of new COVID-19-positive residents, as detailed in Bulletin Number MSA 20-73 from the Medical Services Administration. The bulletin also provides a list of documents and details applicants should have prepared before applying.

Completed applications should be submitted by 5 p.m. Dec. 1. The MDHHS, in partnership with the Michigan Department of Licensing and Regulatory Affairs, will review applications as they are received. Notification of application status will be contingent upon the volume of applications received. However, it is estimated that facilities seeking CR Facility designation may expect to be notified about the determination within one to two weeks of application submission. Questions about CR Facilities may be submitted to the MDHHS via email.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC). Members with MHA-specific questions should contact the following MHA staff members:

Combating the Novel Coronavirus (COVID-19): Week of Nov. 2

MHA Covid-19 update

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.

Opportunity Set for Hospitals to Discuss Vaccine Distribution with State

The MHA continues to interface with the Michigan Department of Health and Human Services (MDHHS) on both COVID-19 and flu vaccine planning.

The MDHHS Immunizations Division and Michigan Chief Medical Executive Joneigh Khaldun, MD, have invited hospitals to discuss COVID-19 vaccine distribution. MHA members are encouraged to identify a chief medical officer, COVID-19 vaccine director and/or other staff member within their organization to participate in this conversation from 8 to 9 a.m. Nov. 13 via Zoom. The MHA will also provide hospitals with a summary and next steps following the meeting. For instructions to join the meeting, contact the MHA by Nov. 12.

The state is finalizing its COVID-19 stakeholder work group, and the MHA has worked to ensure that the association, a small/midsize hospital and a large health system are represented.

Members with vaccine-related questions should contact Ruthanne Sudderth at the MHA.

Provider Relief Fund Reporting Requirements Clarified

The U.S. Department of Health and Human Services (HHS) recently issued a clarification to its Oct. 22 reporting requirements for providers that received Provider Relief Fund payments. Specifically, the Oct. 22 guidance stated that recipients must report their use of PRF payments by submitting the following information:

  1. Healthcare-related expenses attributable to COVID-19 that another source has not reimbursed and is not obligated to reimburse, which may include General and Administrative or healthcare-related operating expenses.
  2. PRF payment amounts not fully expended on healthcare-related expenses attributable to COVID-19 are then applied to patient care lost revenues, net of the healthcare-related expenses attributable to COVID-19 calculated under Step 1. Recipients may apply PRF payments toward lost revenue, up to the amount of the difference between their 2019 and 2020 actual patient care revenue.

As urged by the MHA and the American Hospital Association, the HHS now states that healthcare-related expenses will not be netted against patient care lost revenue in Step 2.

Members with questions on the reporting requirements may contact Jason Jorkasky at the MHA.

Progress Made on COVID-19-related Legislation

Gov. Gretchen Whitmer signed House Bill (HB) 6293 Nov. 5, allowing nonclinicians to order COVID-19 tests. The legislation largely codifies Executive Order 2020-104, which was invalidated by the Michigan Supreme Court ruling in October. The legislation extends the flexibility on ordering COVID-19 tests through June 30, 2021. To request a list of Executive Orders that have been codified in law or otherwise re-authorized by the administration, contact Sean Sorenson-Abbott at the MHA.

The Michigan Senate passed Senate Bill (SB) 1185, also known as the “pandemic health care immunity act,” Nov. 5. The governor signed identical language into law Oct. 28 (HB 6159), but Sen. Curt VanderWall (R-Ludington) introduced SB 1185 to potentially expand the liability time period beyond March 9 through July 15, should additional protections be necessary. The MHA supports the legislation and will continue to monitor SB 1185.

Nov. 11 Webinar to Discuss COVID-19 ICU Best Practices

A webinar will be held from noon to 1 p.m. EST Nov. 11 to discuss best practices of the treatment and management of COVID-19 patients in preparation for a resurgence of the disease through the fall and winter. Hosted by the Mi-COVID19 registry continuous quality improvement initiative, the webinar will feature panelists from Henry Ford Health System, Michigan Medicine, MidMichigan Health and Spectrum Health. Online registration is required to participate.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC). Members with MHA-specific questions should contact the following MHA staff members:

Combating the Novel Coronavirus (COVID-19): Week of Oct. 26

MHA Covid-19 update

Michigan, the U.S. and much of the world continue to experience increasing numbers of COVID-19 cases, and the Michigan Department of Health and Human Services revised and extended its epidemic order Oct. 29 to contain the spread of the coronavirus. 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.

Polling Shows Michiganders Understand COVID-19 Precautions, Visiting Hospitals is Safe

A statewide survey done by EPIC-MRA conducted on the MHA’s behalf indicates that 91% of Michigan voters agree that Michiganders taking responsibility to wear masks, wash their hands and socially distance would help hospitals fight the virus. The survey also found that 85% of Michigan voters feel comfortable and safe visiting a healthcare facility for routine checkups, medical screenings and emergency room care. (See related news release.)

Information Blocking Rule Deadline Delayed

Due to the ongoing challenges providers are experiencing with the COVID-19 pandemic, the Office of the National Coordinator for Health Information Technology (ONC) released Oct. 29 an Interim Final Rule that extends the compliance dates to meet information blocking and Conditions and Maintenance of Certification from Nov. 2 to April 5. This is welcomed news as the MHA has been engaged with members on the issues and challenges this rule would have with sharing patient information. The extension of various compliance dates in this Interim Final Rule can be found on the ONC Fact Sheet.

Hospitals are encouraged to continue working toward compliance with the Information Blocking Rule, as the ONC stated this is only a delay and it intends to continue moving forward with these rules and regulations. Members with questions can contact Jim Lee at the MHA.

MIOSHA Releases FAQs on Emergency Rules

The Michigan Occupational Safety and Health Administration (MIOSHA) recently released several frequently asked questions (FAQs) regarding its Emergency Rules issued Oct. 14. The rules largely represented the codification of Executive Orders 2020-153, 2020-184 and 2020-190, which set requirements on employers for following COVID-19 protocols such as mask wearing and employee screenings. Of particular note, the FAQs seek to clarify the record-keeping requirements set forth in the emergency rules, especially as they pertain to those working in the health field.

The MHA continues to work with MIOSHA on additional FAQs and clarifications to the rule set. Members with questions should contact Adam Carlson at the MHA.

COVID-19 Meeting Invitation from Legislative Leadership

Senate Majority Leader Mike Shirkey and Speaker of the House Lee Chatfield extended an invitation to Gov. Gretchen Whitmer, Senate Minority Leader Jim Ananich, House Minority Leader Christine Greig, MHA Chief Medical Officer Gary Roth, DO, and the chief medical officers listed in the Oct. 22 joint statement on COVID-19 policies for a discussion regarding the impact of COVID-19 on Michigan. The MHA will provide additional information when it is available. The united message of the MHA and its members remains that following COVID-19 prevention efforts is vital to breaking the cycle of this disease. Members with questions should contact Adam Carlson at the MHA.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC). Members with MHA-specific questions should contact the following MHA staff members:

Combating the Novel Coronavirus (COVID-19): Week of Oct. 19

MHA Covid-19 update

MHA Coronavirus UpdateThe number of COVID-19 cases is climbing, and Michigan hospitals are again experiencing an influx of patients battling the disease. 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.

Hospitals, Businesses Call for Collective Action to Avert More COVID-19 Deaths

The MHA released a joint statement to statewide media Oct. 22 that was signed by physician leaders of hospitals and healthcare systems throughout Michigan. The letter includes 28 signatures that represent 110 of Michigan’s 137 hospitals plus MHA Chief Medical Officer Gary Roth, DO. The goal of the statement is to make clear that, regardless of state law, executive orders or local public health directives, hospitals and healthcare systems across the state are standing as a united front in policies and interventions that will help fight the spread of COVID-19. It also emphasizes that the recent jump in COVID-19 cases across Michigan puts the state’s entire healthcare system at risk of another capacity crisis and asks the public to take the necessary steps to prevent the spread of this deadly disease.

Several media outlets across the state have reported on the letter and healthcare providers’ united stance to stave off COVID-19. Members that were not included on the statement and would like the signature of their facility’s physician leader added to the MHA website copy should contact Lucy Ciaramitaro at the MHA.

In addition, members of the Michigan Economic Recovery Council (MERC) sent a letter Oct.. 21 to Gov. Gretchen Whitmer, Senate Majority Leader Mike Shirkey and House Speaker Lee Chatfield, urging collective action to prevent additional deaths from COVID-19. As a member of the MERC, MHA CEO Brian Peters joined leaders from the healthcare, labor, higher education and business communities in stressing the need for clearly defined, mandatory standards that govern mask usage, workplace practices, public gathering and certain social activities that can be deployed with discipline. The letter indicates that success in suppressing spread of COVID-19 will maintain the health of Michigan’s economy and support the education of the state’s children.

HHS Revises Provider Relief Fund Usage and Reporting Requirements

The U.S. Department of Health and Human Services (HHS) issued Oct. 22 revised federal Provider Relief Fund (PRF) usage and reporting requirements. These new requirements come on the heels of problematic requirements the HHS issued Sept. 16 that would have resulted in many hospitals being required to return PRF payments to the federal government. The HHS indicated in its announcement that it modified the PRF usage and reporting requirements in response to advocacy efforts by stakeholders, which included efforts by the MHA, the American Hospital Association and others.

The HHS also notes in its reporting document that, if recipients do not expend PRF payments in full by the end of calendar year 2020, they will have an additional six months in which to use remaining amounts toward expenses attributable to COVID-19, but not reimbursed by other sources, or to apply toward lost revenues in an amount not to exceed the difference between 2019 and 2021 actual revenue.

Finally, the HHS revised the definition of “Reporting Entity,” as delineated on Page 2 of the usage and reporting requirements document.

Questions on revised PRF reporting requirements should be directed to Jason Jorkasky at the MHA.

House Republicans Unveil COVID-19 Plan

Michigan House Republicans announced their “Comeback Roadmap” Oct. 20, providing a proposed structure that would govern public health response activities in Michigan. The plan would provide for state level public health orders when COVID-19 cases are high, then delegate those decisions to counties that see lower COVID-19 cases, hospitalizations and positivity rates, among other metrics. The Republicans are expected to introduce legislation to codify this plan in the coming weeks and committee hearings could occur on the proposal thereafter. The MHA will monitor this proposal as additional action is taken. Members with questions may contact Adam Carlson at the MHA.

MDHHS Vaccine Plan Published

The Michigan Department of Health & Human Services (MDHHS) recently submitted its interim draft COVID-19 Vaccination Plan to the federal government.

The plan identifies gaps and lessons learned from the implementation of other vaccines and uses those experiences to improve preparedness for the COVID-19 vaccine. The state will use the 2020-2021 seasonal flu campaign as a full-scale exercise for the COVID-19 vaccine effort.

Under the interim draft, the initial distribution of COVID-19 vaccine will go to critical populations. This includes all people working in a healthcare setting, and hospitals will be among the first to receive vaccine distributions. Vaccine allocation is covered in Section 7 of the plan, which begins on page 32. Section 8 addresses COVID-19 Vaccine Storage and Handling and begins on page 36. Members with questions or comments on the interim draft should contact Laura Appel at the MHA.

Bills Signed to Codify Executive Orders on Liability and Nursing Homes

The governor signed legislation Oct. 22 to codify protections that were originally established in previous executive orders (EOs). House Bill (HB) 6159 is specific to healthcare providers and provides broad liability protections from March 29 through July 14 for healthcare entities and professionals working to respond to the pandemic. The language in this bill closely mirrors the language in subsection 8 from the now-rescinded EO 2020-61. In addition, the governor signed the MHA-supported package of bills (HBs 6030, 6031,6032, 6101) providing broad liability protection to employers that includes further protections to healthcare providers and reinstates many of the provisions in previous EOs, such as language providing quarantine exceptions for healthcare workers.

The governor also signed Senate Bill (SB) 1094 to provide additional guidelines on establishing regional nursing home “hubs” (now referred to as Care and Recovery Centers) and prohibit nursing homes from admitting COVID-19-positive patients without verification of their ability to handle those patients. This bill codifies EO 2020-169, which reflected the recommendations and work of the Nursing Home Task Force. Members with questions on either piece of legislation may contact Adam Carlson at the MHA.

Eligible Facilities May Apply for Designation as Care and Recovery Centers

The MDHHS has moved to a rolling deadline for eligible nursing facilities to apply for the Care and Recovery Center (CRC) designation. Recognizing the limitations that SB 1094 imposes on a hospital’s ability to discharge nursing home residents, hospitals with affiliated nursing homes or networks that include eligible nursing facilities may want to consider applying for the CRC designation.

The purpose of CRCs is to provide care for individuals with confirmed COVID-19 who have not met criteria for discontinuation of Transmission-based Precautions. CRCs operate when hospitals need to discharge residents to manage bed availability and provide an alternative for nursing facilities that do not have the capacity to safely care for residents. Facilities that wish to operate a CRC must have the capacity to designate a distinct area for COVID-19 isolation, be able to dedicate staff to the CRC, and meet other established standards. Specific criteria and other details are available in MSA Policy 20-66 and the CRC operational guidance and protocols. Members with questions on the CRC designation may contact Brittany Bogan at the MHA.

MDHHS Issues EO Updating Nursing Home Visitation Requirements

MDHHS Director Robert Gordon issued an Emergency Order Oct. 21 that updates and further expands requirements for residential care facilities, while also permitting indoor visitation in these facilities in certain circumstances.

Under the order, visitation rules are linked to the risk level of the county and the occurrence of positive COVID-19 cases involving residents or staff within the prior 14 days. Local health departments also can determine that indoor visitation may be unsafe. A health evaluation must be conducted, and some visitors will be required to receive COVID-19 testing prior to entry, while facemasks will always be required. Lastly, visits will be allowed by appointment only and visitors per scheduled visit will be limited to two people or fewer. Members with questions may contact Brittany Bogan at the MHA.

Legislation Advances to Allow Nonclinicians to Order COVID-19 Tests

The Michigan Legislature recently finalized House Bill 6293, which would allow nonclinicians to order COVID-19 tests until June 30, 2021. The legislation codifies the governor’s EO 2020-14, which was in question due to the Oct. 2 Michigan Supreme Court ruling on emergency executive power. The bill now goes to the governor, who is expected to approve it. The MHA supports this important legislation that ensures healthcare providers can quickly and effectively order needed COVID-19 tests and will keep members informed when it becomes law. Members with questions may contact Adam Carlson at the MHA.

Exemption of Michigan Licensure during Time of Disaster

There have been many questions raised about out-of-state healthcare providers since the Supreme Court nullified Gov. Gretchen Whitmer’s extended State of Emergency. Therefore, the MHA worked with the Bureau of Professional Licensing (BPL) within the Michigan Department of Licensing and Regulatory Affairs (LARA) to update the document BPL Clarification: Exemption of Michigan Licensure Time of Disaster, which was originally released March 16.

Per MCL 333.16171 of the Public Health Code, LARA still has the authority to allow out-of-state, Canadian and health providers who have been retired within the last five years to continue to assist during a time of disaster. While the state of emergency has been rescinded, LARA strongly believes COVID-19 qualifies as a disaster and developed updated guidance.

Health systems must keep complete documentation of these individuals, as it must be made available in the event the department receives an official complaint about an individual provider. The MHA has also updated its compliance memo on the topic with the recommendations related to proper tracking. Members with questions should contact Paige Fults at the MHA.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC). Members with MHA-specific questions should contact the following MHA staff members:

Combating the Novel Coronavirus (COVID-19): Week of Oct. 12

MHA Covid-19 update

The MHA is keeping members apprised of pandemic-related developments affecting Michigan hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Legislative Updates on Replacing Executive Orders

The state Legislature and Whitmer administration have been working to codify in statute, rule or other administrative order various COVID-19-related regulations in response to the Michigan Supreme Court Oct. 2 ruling that limited the governor’s authority to issue executive orders. As Gov. Gretchen Whitmer has been integrally involved in these negotiations, she is expected to approve various bills as the Legislature passes them (see related article). For assistance in identifying the executive orders that have been replaced, contact Adam Carlson at the MHA .

MHA, Public Health Officials Urge Residents to Intensify Prevention Efforts

At an Oct. 13 news conference, MHA CEO Brian Peters joined the Michigan Department of Health and Human Services (MDHHS) and the Michigan Association for Local Public Health to provide COVID-19 data updates and urge residents to strengthen their efforts to prevent both COVID-19 and the flu. Peters noted that COVID-19 hospitalizations have recently surged more than 80% and that, without the public’s help to stop the spread, Michigan’s healthcare system could be overwhelmed. (See related article.)

LARA Resident-related Infection Prevention and Control Scenarios

To help address inconsistencies in how state surveyors are assessing the use of personal protective equipment, particularly in nursing homes, the Michigan Department of Licensing and Regulatory Affairs Bureau of Community and Health Systems (BCHS) has created an internal guide titled “Resident-Related Infection Prevention and Control Scenarios.” The guide was developed in partnership with the MDHHS Epidemiology division and will act as a tool for BHCS staff to improve their consistency on Centers for Disease Control and Prevention (CDC) recommendations, as many nursing homes have adopted the CDC recommendations as part of their infection control programs. The guide will be continuously updated as changes to the recommendations occur. Members with questions may contact Paige Fults at the MHA.

COVID-19 Vaccine Distribution FAQs Developed

Following the MDHHS’s release of the COVID-19 vaccine provider agreements Oct. 9, the MHA received many questions on the form. Therefore, the association developed and the MDHHS approved a frequently asked questions (FAQ) document to assist members in completing the agreement, which were to be submitted to the MDHHS by Oct. 16. The MHA will update the FAQs as the vaccine distribution program progresses. Members with questions should contact Ruthanne Sudderth at the MHA.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC). Members with MHA-specific questions should contact the following MHA staff members:

Combating the Novel Coronavirus (COVID-19): Week of Oct. 5

MHA Covid-19 update

MHA COVID-19 UpdateWith the Oct. 2 Michigan Supreme Court ruling that the legal basis for Gov. Gretchen Whitmer’s COVID-19-related executive orders is unconstitutional, a greater degree of uncertainty surrounds the ways Michigan hospitals, businesses and residents are responding to the challenges of the continuing pandemic. The MHA is keeping members apprised of this and other pandemic-related developments affecting Michigan hospitals through email updates and the MHA Coronavirus webpage. The Supreme Court ruling and additional important updates are outlined below.

MHA Evaluating Impact of Supreme Court Striking Down Governor’s State of Emergency Powers

The Michigan Supreme Court’s ruling declaring the legal basis for the governor’s COVID-19-related executive orders unconstitutional was in response to a request from the U.S. District Court for the Western District of Michigan. The lower court asked for a review of the constitutionality of two Michigan statutes Whitmer relied on in issuing her executive orders, the Emergency Management Act (EMA) of 1976 and the Emergency Powers of the Governor Act (EPGA) of 1945. The Michigan Supreme Court unanimously ruled the governor lacked authority to issue or renew executive orders under the EMA after April 30, 2020, without concurrence by the Legislature. By a 4-3 margin, the court ruled the EPGA also violated the Michigan Constitution.

The current executive orders (EOs) remain in effect until at least Oct. 23 because, under Michigan Court Rules, orders of the Michigan Supreme Court are not effective sooner than 21 days, allowing the opportunity for a party to request a rehearing. However, this was not a routine appeal from the Michigan Court of Appeals or through the Michigan state courts. Because this was a certified question from the federal court, the U.S. District Court will now need to issue an opinion in the federal case that prompted the Supreme Court’s ruling, Midwest Institute of Health v. Governor. The timing for this decision is unknown.

The MHA posted a statement on the ruling on its website, encouraging all Michiganders to continue to be extremely vigilant about following COVID-19 prevention guidance, including masking, physical distancing, washing hands frequently and receiving flu vaccines.

It is anticipated that many of the healthcare-related orders will be implemented through state regulatory agencies and local/county government agencies. Michigan Department of Health and Human Services (MDHHS) Director Robert Gordon issued an Emergency Order Oct. 5 that mandates masks in public places and limits gathering sizes. The MHA is reviewing the order and will alert members if its effects are expected to be different than those experienced under the governor’s orders. The association will also apprise members of any additional state-level announcements as they become available.

An updated list of the governor’s EOs that impact members is available on the MHA website to ensure hospitals are aware of potential items the healthcare community may need have addressed; all EOs and MDHHS orders are available on the state's COVID-19 webpage.

CMS Revises Reporting Requirements

The Centers for Medicare & Medicaid Services (CMS) issued new guidance on COVID-19 reporting requirements and a workflow process that outlines how the CMS will enforce hospital compliance. Hospitals are encouraged to read the revised guidance and note the following changes from previous requirements:

  • Mandatory supply-related data reports are now required once per week.
  • Psychiatric (except those that are distinct-part psychiatric hospitals) and rehabilitation hospitals will be required to report only once per week.
  • Beginning Nov. 1, remdesivir and staffing-related data will be optional.
  • Additional reporting requirements will begin Nov. 1 for certain data on influenza patients.

Hospitals are also required to provide data into the state’s COVID-19 data portal, EMResource. Hospitals may choose to allow the state to enter data into the U.S. Department of Health and Human Services’ TeleTracking COVID-19 portal on their behalf. Members with questions about this process or the CMS guidelines may contact Jim Lee at the MHA.

Medicare Advance Payment Repayment Update

WPS, the Medicare Administrative Contractor (MAC) for most of Michigan, recently released information regarding the CMS’ instructions to MACs to implement the provision of the Continuing Appropriations Act of 2021 delaying the Medicare advance payment repayment timeline. Changes to the repayment terms are as follows:

  • The repayment period has been extended, and the automatic recoupment will begin one year after the date the accelerated or advance payment was issued.
  • During the first 11 months after repayment begins, repayment will occur through an automatic recoupment of 25% of the provider/supplier Medicare payments.
  • At the end of the 11-month period, the recoupment rate will increase from 25% to 50%. The automatic recovery at the 50% recoupment rate will continue for six months.
  • If the total amount of the accelerated/advance payment is not recovered within 29 months from the date the payment was made, a demand letter for the outstanding balance will be issued. The demanded amount will be subject to a 4% interest rate.

The MHA will continue to work with the Michigan congressional delegation and the American Hospital Association to further improve these processes. Members with questions may contact Jason Jorkasky at the MHA.

Governor Announces Broadband Internet Grants

The governor announced Oct. 8 during the North American International Cyber Summit that $12.7 million in funding is available to increase broadband internet access across Michigan. As telehealth and remote work have gained popularity during the COVID-19 pandemic, this effort to improve internet access is welcomed by members – especially those in rural areas.

According to the announcement, more than 1,243,000 Michigan households do not have a permanent, fixed broadband connection at home, resulting in $1.8 billion to $2.7 billion in potential economic benefit left unrealized among disconnected households.

The new broadband projects were selected through the Connecting Michigan Communities (CMIC) grant program and are expected to extend access to more than 10,900 households, businesses and community anchor institutions in Michigan. A list of counties/areas impacted by these awards is available on the CMIC Broadband Grant webpage. Recommendations for the second round of CMIC grant awards totaling $5.3 million will be announced soon, and the governor recently signed a state budget that includes an additional $14.3 million in grant funding for a third round of projects in 2021.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC). Members with MHA-specific questions should contact the following MHA staff members: