Behavioral Health Supplemental Budget, Policy Bills Advance

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capitol buildingThe Michigan Legislature advanced several hospital-related bills during the week of June 13. Most notably, the Senate advanced a $590 million supplemental appropriations bill related to behavioral health. Several other policy bills the MHA is watching also received committee action in the House and Senate.

The supplemental funding bill that includes the MHA’s request to support behavioral health was approved by the state Senate. Senate Bill (SB) 714, introduced by Senate Majority Leader Mike Shirkey (R-Jackson), would appropriate $590 million and includes several MHA-supported one-time line items for behavioral health. Included in the supplemental bill is $100 million in infrastructure grants for pediatric inpatient psychiatric services, $20 million in infrastructure grants for hospital behavioral health intake enhancements, $25 million to prepare for the expansion of the essential health provider loan repayment program, and $30 million to expand the state’s apprenticeship program for new behavioral health staff. The legislation now moves to the House for its consideration as the Legislature continues its work on the fiscal year 2023 state budget.

The House Health Policy Committee took testimony on a package of Certificate of Need (CON) bills that were reintroduced from the 2019-2020 session. Senate Bills (SBs) 181182183 and 190 would remove psychiatric bed capacity from CON oversight, increase the threshold for capital expenditures, increase the number of members on the CON Commission and remove air ambulance services from CON. The bills were introduced by Sens. Curt VanderWall (R-Ludington), Lana Theis (R-Brighton) and Michael MacDonald (R-Macomb Township). The MHA opposes the tie-barred package of bills and provided written testimony to the committee in support of Michigan’s current CON program. No votes were held on the bills.

The House Health Policy Committee also heard testimony on bills to change lead testing requirements for children. House Bills (HBs) 4678 and 4679, introduced by Reps. John Cherry (D-Flint) and Helena Scott (D-Detroit), would require minors to be screened for lead poisoning between the ages of 9 and 12 months and the ages of 2 and 3 years old and would include this information as part of the child’s immunization record. Providers would also be expected to identify high risk factors such as the age of the child’s residence, but it is unclear how penalties would be assessed for the new requirements. The MHA has not yet taken a position on the bills but will continue to monitor any action taken.

In the Senate Health Policy and Human Services Committee, bills to allow Michigan to join the Psychology Interjurisdictional Compact were taken up again. This compact is a legal agreement among states that creates an expedited pathway to licensure for psychologists who wish to practice telepsychiatry across state lines. HBs 5488 and 5489 were introduced by Reps. Bronna Kahle (R-Adrian) and Felicia Brabec (D-Pittsfield Township), respectively, and are supported by the MHA. The bills now go to the Senate floor for a final vote and, if approved, will be sent to the governor desk for final consideration.

The Senate Health Policy and Human Services Committee also took up HB 5163, which was introduced by Rep. Angela Witwer (D-Delta Township) and would create an opt-out grant program for hospitals to establish medication-assisted treatment (MAT) for substance use disorders in their emergency departments. Hospitals provided MAT programs prior to introduction of the bill, and the MHA has already partnered with the Michigan Department of Health and Human Services to implement the first round of grants provided under this legislation. No hospitals would be required to participate in the program. HB 5163 was advanced to the Senate floor for further action.

For more information on these and other state bills related to healthcare, contact Adam Carlson at the MHA.

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

MHA Covid-19 update

MHA Covid-19 updateThe current surge of hospitalizations due to COVID-19 has continued its downward trend. The seven-day average of hospitalizations in the U.S. as of Feb. 13 was 80,185, down from 136,534 Jan. 20. Michigan hospitalizations for confirmed and suspected cases of COVID-19 included 1,896 adults and 71 children as of Feb. 16, down from the Jan. 20 totals of 4,554 adults and 130 children.

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.

Governor Signs Supplemental Budget Dedicating $300 Million to Healthcare Workforce

Gov. Gretchen Whitmer Feb. 16 signed House Bill 5523, a $1.2 billion supplemental funding bill that includes $300 million for healthcare providers for recruitment, retention and training purposes, $225 million of which will be specifically for acute-care and behavioral health hospitals. MHA Board Chair and BHSH System President & CEO Tina Freese Decker provided comments of appreciation for the governor signing the bill in the official announcement. (See related article.)

MDHHS Rescinds Indoor Mask Advisory with Exceptions

The statewide indoor masking advisory that the Michigan Department of Health and Human Services (MDHHS) issued earlier in the omicron surge was rescinded Feb. 16. However, the state continues to recommend masking in healthcare settings and some other high-risk indoor locations.

While hospitalizations have improved significantly recently, the MHA continues to encourage people to voluntarily wear high-quality masks when in indoor public spaces, especially if they are immunocompromised or haven’t yet been fully vaccinated.

The state also announced that it will monitor and act on COVID-19 cycles in the following three key phases:

  • Response — Local and state public health implement rapid response to a surge. The public may be advised to increase masking, testing and social distancing.
  • Recovery — Post-surge. No immediate resurgence predicted. Local and state public health will monitor conditions that could lead to future surges.
  • Readiness — A surge in cases is expected, with implications for severity of illness and hospital capacity. Increased communication to the public regarding possible new risks.

More Data Sought on Pfizer Vaccine for Children 6 Months through 4 Years

The MHA continues to monitor Pfizer’s actions to seek approval for a vaccine for kids aged 6 months through 4 years. Pfizer recently sought federal approval of the vaccine for this age group, but paused its request days later due to efficacy questions related to dosage. It is now awaiting further data about three doses for this age group before renewing its request for approval under emergency use authorization. The association will keep members apprised of any developments on this or related issues. 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 webpageQuestions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC).

Governor Signs Supplemental Hospital Funding into Law

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Gov. Gretchen Whitmer signed a supplemental budget bill July 26, appropriating $160 million in funding for Michigan hospitals that is intended to account for the cost of treating COVID-19 patients throughout the pandemic. Senate Bill (SB) 27, introduced by Sen. Jim Stamas (R-Midland), was passed by the Legislature earlier in July and supported by the MHA.

The press release announcing the bill’s signing quoted MHA CEO Brian Peters, who said, “Michigan hospitals have experienced significant financial hardships while caring for over 125,000 COVID-19 patients over the past 16 months of the pandemic. We want to thank our partners in the Legislature and Gov. Whitmer for passing this supplemental allocation that will help hospitals maintain access to care for Michigan residents throughout our state.”

The MHA will continue to work with the Michigan Department of Health and Human Services on the distribution of the funding. Any questions on SB 27 or other budget-related issues can be directed to Adam Carlson at the MHA.

Healthcare Bills Progress Prior to State Legislative Summer Break

Dr Roper

Michigan CapitolThe Michigan Legislature continued work on bills impacting Michigan hospitals as it goes into the final week before its summer break. Action was taken during the week of June 21 on issues regarding certified registered nurse anesthetists (CRNAs), the fiscal year (FY) 2022 budget, pharmacy benefit managers (PBMs), requirements for Canadian health professionals in Michigan and allowing certain health professionals to train nurse aides. In addition, the Michigan Department of Health and Human Services held a news conference on legislation related to treatment for opioid use disorder (OUD), and the governor signed legislation related to the Certificate of Need (CON) program.

Both the House and Senate took action on House Bill (HB) 4359, voting to support the important legislation that would modernize the scope of practice for CRNAs. The bill was introduced by Rep. Mary Whiteford (R-Casco Township) and will now go to the governor’s desk for signature. The legislation would bring Michigan in line with 42 other states and the U.S. military, all of which provide flexibility regarding physician supervision of CRNAs delivering anesthesia care. The MHA has supported HB 4359 with testimony in both chambers and will continue to advocate for the bill to be signed into law.

Representatives in the House approved House Bill (HB) 4410, which would provide for all funding for the FY 2022 budget year, aside from community colleges and higher education. HB 4410 would protect key hospital priorities, including graduate medical education, disproportionate share hospital funding, rural and obstetrics stabilization pools, critical access hospital funding and Medicaid rate increases. The bill includes new provisions that would make changes to streamline prior authorization timeframes for Medicaid health plans and boilerplate that would prohibit the use of any funds for vaccinations under a mandatory vaccination program. Due to concerns that the vaccine mandate provision could hinder state vaccination efforts, the MHA will work closely with the administration to address potential issues. HB 4410 will now be sent to the Senate for consideration.

The House Health Policy Committee reported Senate Bill (SB) 416 to the floor. The bill was introduced by Sen. Wayne Schmidt (R-Traverse City) and would ensure that Canadian health professionals who have previously taken relevant medical exams could apply for Michigan licensure. SB 416 clarifies legislation supported by the MHA during the last session that provided licensure reciprocity to Canadian health professionals who want to work in Michigan. It will now be sent to the full House for a vote.

The House Health Policy Committee also took testimony on HB 5089, which was introduced by Rep. Ann Bollin (R-Brighton Township) and would allow a registered professional nurse to train nurse aides without a permit for up to four months after the end of the COVID-19 declared state of emergency. The MHA has not taken a position on HB 5089 and no vote was held.

In the Senate Health Policy and Human Services Committee, further testimony was held on HB 4348, which would regulate and establish licensure for PBMs in Michigan. The legislation was introduced by Rep. Julie Calley (R-Portland) and is supported by the MHA to help slow the rising cost of prescription medications. No vote was held in committee on HB 4348.

Dr. Daniel Roper participated in the June 23 event that announced legislation to increase access to lifesaving treatment for opioid use disorder.A news conference was held June 23 to announce the introduction of a bill that would provide funding for a grant program for hospitals to increase access to medication assisted treatment for OUD in the emergency department (ED). The MHA Legislative Policy Panel supports the bill, which is intended to increase access to lifesaving treatment for OUD. Daniel Roper, MD, chief of emergency services and medical director of the ED at Mercy Health Saint Mary's in Grand Rapids, represented one of 19 Michigan hospitals currently providing medications for OUD in EDs during the event, noting that the proposed bill would remove barriers for other providers to offer the treatment. The bill is expected to be introduced before the legislative summer break, and the MHA will keep members apprised of its movement.

Lastly, the governor signed SB 440 into law June 24 as Public Act 35 of 2021. SB 440 was introduced by Sen. Winnie Brinks (D-Grand Rapids) and would remove full-body PET scanner services from CON oversight.

Members with questions on these or other state legislative issues should contact Adam Carlson at the MHA.

State and Federal Lawmakers Act on Important Healthcare Issues

During the week of Sept. 28, Gov. Gretchen Whitmer signed the fiscal year (FY) 2021 budget, and the Senate continued its work on several policy issues important to Michigan hospitals. In federal news, President Donald Trump signed a continuing resolution that, among other things, extends the deadline for repayment of the Medicare accelerated payment loan.

The governor signed the FY 2021 budget Sept. 30, which took effect Oct. 1. The agreement protects vital funding sources for patient care and expands access to healthcare services. In a time when other states have enacted Medicaid reductions, the MHA was successful in advocating for a significant 21.4% increase in outpatient Medicaid reimbursement rates for Michigan hospitals. It is the first such statewide increase since 2002 and will prove vital to Michigan hospitals as they continue to respond to the COVID-19 pandemic.

The state Senate passed the package of legislation relating to surprise medical billing, also known as balance billing, after making several changes while considering the bills on the Senate floor. Notable changes were to allow for the discretion of the Michigan Department of Insurance and Financial Services to send payment disputes to arbitration and to remove language that allowed insurers to send provider payments directly to consumers. Due to those changes, the bills will return to the House for another vote before being presented for the governor’s signature. The MHA remains neutral on this surprise billing legislation. The Senate also unanimously passed MHA-supported Senate Bill (SB) 1021, a bill introduced by Sen. Wayne Schmidt (R-Traverse City) that would allow for Canadian healthcare licenses to be considered valid in Michigan.

In the Senate Health Policy and Human Services Committee, the Amy Barkholz, general counsel, MHA, testified in support of legislation to provide limited liability for healthcare facilities during the COVID-19 pandemic. House Bill (HB) 6159 was introduced by Rep. Roger Hauck (R-Union Township) and would codify language similar to that found in the governor’s executive order protecting healthcare providers from liability during the peak months of the pandemic. The committee also took testimony on HB 4958 and SB 1081, bills that would define and ban nonconsensual pelvic examinations. Those MHA-supported bills were introduced by Rep. Pamela Hornberger (R-Chesterfield Township) and Sen. Paul Wojno (D-Warren).

The president signed a continuing resolution very early Oct. 1 to extend the federal budget through Dec. 11, averting a government shutdown. Among its other provisions, the resolution delays the deadline for hospitals to begin returning federal funds received through the Medicare accelerated payment loan program. This temporary budget deal will extend the time for when repayment begins, when the balance must be repaid in full and when interest begins to accrue on the loans, in addition to lowering the interest rate. Michigan hospitals were slated to begin loan repayment Jan. 1, 2021, but may now wait until one year after the funds were received to begin repaying those loans.

Members with questions should contact Adam Carlson at the MHA.

Combating the Novel Coronavirus (COVID-19): Week of June 29

MHA Covid-19 update

The MHA continues to keep members apprised of developments during the pandemic through email updates and the MHA Coronavirus webpage. Important updates on how the pandemic is affecting Michigan hospitals are outlined below.

State Budget Deficit Deal Contains no Healthcare Cuts

Gov. Gretchen Whitmer and legislative leaders announced June 29 they reached an agreement to resolve the fiscal year (FY) 2019-2020 budget deficit. The deal uses a combination of funding from the state Budget Stabilization Fund, federal Coronavirus Relief Funds (CRF) and cuts to the state budget. No cuts to healthcare were announced in the information provided.

In a joint release, Senate Majority Leader Mike Shirkey (R-Clarklake), House Speaker Lee Chatfield (R-Levering) and the governor spelled out approximately $900 million in spending from the federal funds for schools, hazard pay for teachers, replacement funds for colleges and universities, and new funds for local governments. Together with what was appropriated earlier in June, the state will have allocated $3 billion of its existing CRF. The budget also recognizes the benefit of the enhanced federal Medicaid matching funds, which brings $340 million to the state for the current fiscal year.

The budget agreement includes $490 million in savings to state government. This includes state layoffs, furlough days and budget cuts. The MHA does not believe rural hospitals or labor and delivery funding for small and rural hospitals is at risk. The association will continue its efforts to ensure the appropriations for hospital Medicaid funding remain in place and continue into FY 2021. For more information about the FY 2020 budget agreement, contact Adam Carlson at the MHA.

Additional Allocation and Guidance Announced for Remdesivir

The U.S. Department of Health and Human Services (HHS) announced June 29 an agreement with drug maker Gilead Sciences to allow U.S. hospitals to purchase, through September, up to 500,000 treatment courses of remdesivir, the antiviral drug that has shown encouraging results in treating COVID-19 patients. As with the 120,000 treatment courses donated earlier by the drug maker, the HHS and state health departments will allocate them based on hospitalization data.

Under the agreement, hospitals will pay no more than the wholesale acquisition price for the drug, up to $3,200 per five-day treatment course. To make future allocations of remdesivir, the HHS will be asking hospitals and health systems to submit data every two weeks.

The state of Michigan recently updated guidance for the use of remdesivir, which is available through the June 30 COVID-19 update that was emailed to members. The state is also asking for the completion of a two-part survey during treatment. Part 1 of the survey identifies the patient’s profile and demographics and is due within 24 hours of starting the medication. Part 2 is a patient follow-up survey that captures outcome data. Members with questions may contact Laura Appel at the MHA.

One COVID-19 Data Submission Can Now Fulfill EMResource and NHSN Requirements

The state of Michigan has started the process of uploading COVID-19 data from EMResource into the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN) COVID-19 Module. This process will allow hospitals to enter data in the EMResource system with no duplicate data entry into the NHSN COVID-19 Module.

To facilitate this, hospitals must enter the NHSN ID associated with each facility in EMResource, ensure the mandatory baseline data elements have been entered, and update within 24 hours any EMResource data elements that correspond to the NHSN COVID-19 Module data elements. The upload process will occur daily for data entered by 5 p.m. Hospitals should log into the NHSN system the following day to verify the data was uploaded correctly. Members with questions on the process should contact Jim Lee at the MHA.

AHA Releases New COVID-19 Financial Impact Report

The American Hospital Association (AHA) released a financial impact report June 30 that estimates at least an additional $120.5 billion in financial losses for the nation’s hospitals from July 2020 through December 2020, due in large part to lower patient volumes. These estimates are in addition to the $202.6 billion in losses the AHA estimated between March 2020 and June 2020 in a report released in May. This brings total losses for the nation’s hospitals and health systems to at least $323.1 billion in 2020. The MHA is regularly collecting data from members on the financial impact the pandemic is having on Michigan hospitals. For more information, contact Jason Jorkasky at the MHA.

Delays in Unemployment Insurance Benefits

Some people who filed unemployment claims due to the COVID-19 pandemic have not received their unemployment benefits or are receiving them sporadically. The Michigan Unemployment Insurance Agency (UIA) is experiencing a backlog due to the extraordinary volume of claims received, the surge of fraudulent identity theft claims that recently occurred, and the limitations of work volume that can be completed by the UIA’s adjudication staff. The UIA has announced that it is working to resolve the backlog of claims and has indicated that all claimants who are eligible for benefits will receive them. Members with questions related to unemployment claims may contact Neil MacVicar 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 Michigan Department of Health and Human Services Community Health Emergency Coordination Center (CHECC). Members with MHA-specific questions should contact the following MHA staff members: