Legislative Action Continued During the Week of Oct. 11

capitol building

Several pieces of legislation impacting hospitals were acted upon during the week of Oct.11. In the Senate, votes were taken on legislation to establish a grant program for emergency department-based medication assisted treatment (MAT). In the House, an MHA-supported bill on pharmacy wholesale distributors was reported from committee, and testimony was taken on an MHA-supported bill on background checks and a new package of Certificate of Need (CON) bills.

Senate Bill (SB) 579, which would establish an opt-out grant program for hospitals to establish emergency department-based MAT programs, was reported from committee and passed unanimously by the full Senate. SB 579 was introduced by Sen. Curt VanderWall (R-Ludington) and is supported by the MHA. The Senate Health Policy and Human Services Committee also approved several mental health jail diversion and transportation bills.

In the House Health Policy Committee, members voted to report the pharmacy wholesale distributors bill to the House floor. House Bill (HB) 5072 was introduced by Rep. Ryan Berman (R-Commerce Township) and is a state-level effort to exempt hospitals and other healthcare entities that are under common control from a medication distribution threshold that currently requires registration as wholesalers. The MHA supports the bill, as it would remove the requirement for additional paperwork for hospital pharmacies..

The House Health Policy Committee also took testimony on a new package of CON bills that make no substantive changes to covered services. HBs 507450755076 and 5077 would require CON Commission reports and minutes to be posted online in a timely fashion. The package would also require the Legislature’s Joint Legislative Committee that oversees CON activities to meet annually and review the report. The MHA has confirmed that the Michigan Department of Health and Human Services does not expect the bills to hinder the success of the program.

Another MHA-supported bill was discussed in the House Judiciary Committee. HB 5358, introduced by Rep. Graham Filler (R-Dewitt), would ensure employers have access to general information for background checks. Information like birthdates is important to ensure the identity of people in certain court-related documents and maintain efficient turnaround times for necessary background checks

Members with questions on state healthcare legislation may contact Adam Carlson at the MHA.

Combating the Novel Coronavirus (COVID-19): Week of Oct. 4

MHA Monday Report logo

MHA Monday Report logoThe number of Michiganders hospitalized with COVID-19 has continued to rise, with 1,811 adults and 35 children confirmed as inpatients Oct. 8. An additional 119 adults and six children were hospitalized with illnesses suspected to be COVID-19. Of that number, 485 adults were in intensive care units and 250 were ventilated.

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.

Pfizer Requests Emergency Use Authorization of COVID-19 Vaccine for Children Ages 5-11

Pfizer and BioNTech announced Oct. 7 that they have submitted a request to the U.S. Food and Drug Administration (FDA) for emergency use authorization in children ages 5-11. The FDA will review the evidence to determine whether the shots are safe and effective for this age group, and an independent expert panel will publicly debate the evidence Oct. 26. From that point, advisers to the Centers for Disease Control and Prevention (CDC) will make their recommendation, and the CDC will make a final decision. If regulators agree, shots could be available to the 5-11 age group within a matter of weeks.

The MHA will keep members informed as new details emerge. Those with vaccine questions may contact Ruthanne Sudderth at the MHA.

Nursing Care and Recovery Center Applications Re-opened

The Michigan Department of Health and Human Services (MDHHS) recently released a new policy bulletin to update regulations from November 2020 that allow COVID Relief Facilities and eligible nursing facilities to retain COVID-19-positive residents. Public Act (PA) 231 of 2020 established criteria under which nursing facilities could care for COVID-19-positive residents, with the statute put into effect through MSA Bulletins 20-73 and 20-78. Facilities designated as Care and Recovery Centers or COVID Relief Facilities will need to apply for that designation on a yearly basis.

Nursing facilities that had not applied for either designation before the Dec. 1, 2020, deadline may now apply if they wish to seek accreditation. Like the previous policy, nursing facilities that have applied for COVID Relief Facility designation but have not yet received approval/denial for participation may continue to care for individuals who have tested positive for COVID-19. Members with questions may contact Adam Carlson at the MHA.

Funding Available for Nursing Home Patients Awaiting Transfer

The MDHHS released a template in June to collect information from hospitals about the number of COVID-19-positive nursing facility patients who were retained by hospitals and had less than 72 hours remaining in their isolation period. The MDHHS will provide additional payment to hospitals for qualifying inpatient stays between Jan. 1 and Sept. 30, 2021.

The additional funding was a result of the MHA’s 2020 year-end advocacy efforts that totaled $3.3 million in gross funding for hospitals through Public Act 231 of 2020. The MDHHS will pay hospitals for each qualifying day until the funds are spent and will notify hospitals if the allotted funds for the additional payment are spent prior to the expected eligibility end date. The MHA encourages hospitals to complete and submit the template through the MDHHS File Transfer portal per the department’s instructions to receive the enhanced payment. Although the application period has been open for several months, a significant portion of funding remains available. Members that need a copy of the template may contact Jason Jorkasky 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).

State Budget Signed, Healthcare Policy Bills Advanced

capitol building

capitol buildingThe week of Sept. 27 was highlighted by the governor signing the fiscal year (FY) 2022 state budget, legislative passage of a funding bill for the statewide trauma system, and policy bills in both the House and Senate. In the House Health Policy Committee, the MHA supported a bill to create a grant program for medication assisted treatment (MAT) in emergency departments and a pharmacy wholesalers bill. In the Senate, further testimony was taken on the behavioral health package and several policy bills

The governor Sept. 29 signed the FY 2022 budget, which fully protects traditional hospital funding including the Healthy Michigan Plan, the rural access pool, the obstetrical stabilization fund and maintaining rate increases for Medicaid and critical access hospitals. In addition, the MHA successfully advocated for extending postpartum coverage to a full year for mothers who are beneficiaries of the Healthy Michigan Plan and an additional $3 million in trauma funding to establish systems of care for stroke and heart attack emergencies. The MHA released a media statement thanking the governor and Legislature for passing a budget on time that maintains access to care throughout Michigan.

The Senate also passed House Bill (HB) 5094, legislation to fund the statewide trauma system. The MHA supports the bill and applauds the Legislature’s quick work to pass the bill over the past few weeks. HB 5094, introduced by Rep. Mary Whiteford (R-Casco Township), will now be sent to the governor’s desk and is expected to be signed.

The MHA supported two bills in the House Health Policy Committee the week of Sept. 27. HB 5163, introduced by Rep. Angela Witwer (D-Delta Township), would create an opt-out grant program for MAT in emergency departments. That bill is identical to an MHA-supported version being considered by the Senate. HB 5072, introduced by Rep. Ryan Berman (R-West Bloomfield Township), is a state-level effort to exempt hospitals or other healthcare entities that are under common control from a medication distribution threshold that currently requires registration as wholesalers. It would also exempt from the threshold the distribution of minimal quantities of medications by a licensed retail pharmacy to a licensed practitioner for office use.

In the Senate, further testimony was taken on Senate Bills (SBs) 597 and 598, which would create new specialty integrated plans to replace the current prepaid inpatient health plans and contract with each community mental health services program to deliver physical and behavioral health services to Michigan’s Medicaid population. The MHA-supported bills were introduced by Sens. Mike Shirkey (R-Clark Lake) and John Bizon (R-Battle Creek). Testimony was also heard in the Senate Health Policy Committee regarding several bills on which no votes were held. Those bills included legislation to create licensure for mental health transport organizations and a bill to allow HIV-positive patients to donate organs to other HIV-positive patients.

For more information on state healthcare legislation, contact Adam Carlson at the MHA.

Legislature Passes State Budget That Protects Healthcare Funding

capitol building

Michigan CapitolThe Michigan Legislature approved Sept. 22 the fiscal year (FY) 2022 state budget. The governor has indicated support for the budget that goes into effect Oct. 1, and the agreement protects vital funding sources for patient care in Michigan hospitals and expands access to healthcare services. The MHA published a statement on the passage of the budget Sept. 22.

Specifically, the budget reflects the protection or enhancement of many MHA priorities:

  • Continues enhanced outpatient Medicaid rates. For FY 2022, the increase in rates is projected to result in the continuation of funding that translates to $270 million in net revenue for hospitals.
  • Protects funding for the rural access pool and obstetrical stabilization fund.
  • Continues to maintain funding for disproportionate share hospitals (DSH) and graduate medical education (GME), pursuant to the MHA board-supported multiyear budget agreement.
  • Fully funds the Healthy Michigan Plan.
  • Continues the additional $2.35 hourly wage increase for direct care workers at skilled nursing facilities and enhanced reimbursement for ground ambulance services to reimburse at 100% of the Medicare rate.
  • Continues expanded Medicaid coverage for women up to 12 months postpartum.
  • Adds $3 million in new funding to set up a statewide system of care for stroke and ST-elevated myocardial infarction (STEMI) emergencies within the existing statewide trauma system.

In addition, nearly $10 billion in state and federal funding is still available that will be allocated through a supplemental budget process. The MHA will advocate the state use portions of the funding to address the association’s behavioral health priorities and workforce issues.

Members with questions on the state budget may contact Adam Carlson at the MHA.

Governor Signs Supplemental Hospital Funding into Law

capitol building

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.

Hospital Funding Approved, CRNA Legislation Signed into Law

capitol background

Michigan Capitol BuildingSenate Bill (SB) 27, a supplemental budget bill containing funding for $160 million of COVID-19 relief for Michigan hospitals which accounts for the cost of treating COVID-19 patients, was passed in the Senate and is being sent to the governor for signature. The MHA will work with the Michigan Department of Health and Human Services on the distribution of the funding. The association will keep members apprised of further action on this bill or other supplemental appropriations that impact hospitals.

In addition, Gov. Gretchen Whitmer signed into law July 13 MHA-supported legislation modernizing the scope of practice for Certified Registered Nurse Anesthetists (CRNAs) as Public Act 53 of 2021. Introduced as House Bill 4359 by Rep. Mary Whiteford (R-Casco Township), the new law will allow flexibility for each hospital to choose the anesthesia care model that best fits its location, staffing and resources to offer safe and effective patient care by eliminating the state requirement that a CRNA must work under direct physician supervision.

This change has long been an MHA priority and will eliminate a costly regulation for hospitals while maintaining patient safety. The MHA worked diligently with other stakeholders representing provider groups as the bill was negotiated. The Michigan State Medical Society was neutral on the final version of the legislation signed by the governor, which includes a provision maintaining physician input on patient care and patient-centered care teams.

The MHA testified in support of the legislation in both the House and Senate and applauds the work of both chambers and the governor in passing the law.

The new law, which is set to take effect Oct. 11, brings Michigan in line with 42 other states and the U.S. military. To fully implement the law, the governor must submit a letter to the Centers for Medicare & Medicaid Services to formally exercise the exemption from the federal supervision requirement for CRNAs once the federal declaration of emergency related to the COVID-19 pandemic ends. The MHA will urge the governor to perform this final action when appropriate.

Questions on the budget or the new rules for CRNAs in Michigan can be directed to Adam Carlson at the MHA.

Combating the Novel Coronavirus (COVID-19): Week of June 21

MHA Covid-19 update

The COVID-19 vaccines appear to be effective in protecting against serious illness from the more contagious delta variant of the virus. However, the variant continues to infect many in regions throughout the world, with news reports of renewed lockdowns in Australia and New Zeeland and increasing numbers of cases in U.S. states including Missouri, California, Florida and Texas, where fewer residents are vaccinated. Meanwhile, Michigan’s vaccine dashboard shows more than 61% of residents ages 16 and older have received at least one dose of a COVID-19 vaccine, with nearly 9 million doses administered.

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.

Emergency Orders Rescinded Effective June 22

Several emergency public health orders that have been in place for much of the last 15 months are rescinded as of 12:01 a.m. June 22. The orders rescinded and the dates on which they took effect are:

  1. Gatherings and Face Mask Order (June 1, 2021)
  2. Temporary Restrictions for Entry into Congregate Care and Juvenile Justice Facilities (Oct. 29, 2020)
  3. Mandatory Testing for Michigan Department of Health and Human Services' Juvenile Justice Facility Staff (Sept. 18, 2020)
  4. Mandatory Testing for Michigan Department of Health and Human Services Hospitals and Centers Staff (Sept. 14, 2020)
  5. Exceptions to Temporary Restrictions on Entry into Congregate Care and Juvenile Justice Facilities (June 29, 2020)
  6. Exceptions to Temporary Restrictions on Entry into Certain Facilities (June 3, 2020)
  7. Safe Housing for Housing Unstable Individuals (May 12, 2020)
  8. Handling of Bodily Remains (May 4, 2020)
  9. Safe Housing for Michigan Homeless (April 28, 2020)

While the rescission of the facemask and hospital visitor restrictions would seemingly allow hospitals to stop screening visitors and make their own determinations about masking, the Michigan Occupational Safety and Health Administration (MIOSHA) announced new rules June 22 that essentially defer to the OSHA at the federal level. The OSHA rules currently in place still require healthcare facilities to screen visitors and require masks for employees. However, some exceptions are outlined by the OSHA for well-defined areas where employees are fully vaccinated; a flowchart on the OSHA website provides details. The OSHA also refers healthcare facilities to Centers for Disease Control and Prevention recommendations that continue to urge mask requirements for visitors. The MHA is reviewing the OSHA complete set of rules.

Because the MIOSHA adopted the OSHA rules by reference, the OSHA effective and compliance dates apply. The OSHA COVID-19 Emergency Temporary Standard (ETS) is effective June 21, 2021. The compliance date for the ETS is July 6, 2021, with a few exceptions. Compliance with paragraphs (i) Physical Barriers, (k) Ventilation, and (n) Training is required by July 21, 2021.

As an interim final rule, the new OSHA standard is open for comment. The MHA will submit comments on behalf of its members after a more thorough review of the rule, and members are encouraged to share content for the MHA comment letter with Laura Appel. The MHA will continue to advocate with the MIOSHA for consistency in state and federal rules for healthcare settings and keep members apprised of any developments on this issue. Members with questions may 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 Michigan Department of Health and Human Services Community Health Emergency Coordination Center (CHECC).

State Implements Regulations to Avert Surprise Billing for Health Services

The Michigan Department of Insurance and Financial Services (DIFS) has implemented new regulations following the enactment of surprise billing legislation in 2020. MHA advocacy efforts resulted in significant changes to the legislation before it became law. As passed, Michigan’s surprise billing law generally exempts direct hospital employees from its requirements through its definition of a healthcare provider. In the context of the surprise billing statute, “provider” means an individual who is licensed or authorized as a health professional under article 15 of the Michigan Public Health Code and does not mean a hospital or other health facility. However, hospitals and health systems should be aware of the new regulations and who must comply with them.

The DIFS regulations and the Michigan statute require healthcare providers to inform consumers of the possibility of surprise billing through a disclosure form sent at least 14 days before a scheduled medical service. The form must explain that the consumer’s insurance company may not cover the entire cost or all services and that the patient would be personally responsible for any uncovered costs. As part of the notice, patients must also be given a good faith estimate of the total cost of the care they will receive, enabling them to budget for these expenses in advance or choose alternative care. The law applies to most health plans.

In addition to establishing disclosure requirements, the new law states that payment for out-of-network emergency services must be negotiated between the provider and the patient's insurance company, not with the patient directly. Beginning July 1, certain payment disagreements between out-of-network providers and insurers may go to binding arbitration under the law.

DIFS has established a webpage specific to surprise medical billing that hospitals should reference for additional information.

The MHA is also monitoring federal rulemaking on surprise billing and will keep members informed when those requirements, which are expected to be similar to the state requirements, are scheduled to go into effect.

Members with questions should contact Adam Carlson at the MHA.

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

MHA Covid-19 update

MHA COVID-19 UpdateNearly 61 percent of Michiganders ages 16 and over had received a COVID-19 vaccine as of June 17, supporting the state’s decision to rescind public health orders related to slowing the spread of the disease (see below). Experts continue to urge the public to use caution, especially when around those who have not been vaccinated.

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.

COVID-19 Public Health Orders Ending June 22

Gov. Gretchen Whitmer announced June 17 that COVID-19 public health orders originally established to prevent the spread of COVID-19 will be rescinded June 22. The recission of emergency orders issued by the Michigan Department of Health and Human Services (MDHHS) includes the statewide mask mandate, limitations on gathering capacities, hospital visitor requirements and mandated hospital testing protocols for staff. However, hospitals continue to have the ability to enforce infection control practices within their facilities that require such items as screening upon entry, visitor limitations and mask requirements. In addition, the mask requirement for healthcare employees remains in effect under existing rules of the Michigan Occupational Safety and Health Administration. Hospitals may want to refer to existing CDC guidance on masking in healthcare facilities when reviewing or developing visitor policies.

The MHA issued a statement supporting the announcement, stressing the important role that the COVID-19 vaccine has played in reducing transmission and illness. In addition, the statement specifies that hospitals will continue protocols in their facilities to prevent the spread of infectious disease.

Members with questions may contact Adam Carlson at the MHA.

U.S. Supreme Court Upholds the Affordable Care Act

The U.S. Supreme Court issued a ruling June 17 on California v. Texas that upholds the Affordable Care Act (ACA). In response to the opinion, the MHA issued a statement to media statewide that describes the ruling as a “victory for all who believe in expanding access to healthcare.” The value of the ACA to Michigan is shown in the increase in enrollment for the Healthy Michigan Plan, which has grown over the past year by more than 250,000 beneficiaries who would otherwise have been uninsured at some time during the pandemic.

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).

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

MHA Covid-19 update

MHA COVID-19 UpdateThe Michigan First-Dose Tracker indicates that, as of June 10, 60% of Michiganders ages 16 and over had received a COVID-19 vaccine. By June 12, more than 892,000 cases of COVID-19 had been confirmed in the state since the pandemic began; but more than 852,000 of those Michiganders had recovered from the disease as of June 11.

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.

FDA Extends Shelf Life of Johnson & Johnson (J&J) Vaccine

The U.S. Food and Drug Administration (FDA) announced it is increasing the shelf life of J&J/Janssen’s COVID-19 vaccine by 1.5 months. This extension comes at a time when hundreds of thousands of doses of the vaccine had been set to expire at the end of June.

The announcement extends the vaccine's shelf life from three months to 4.5 months and was based on data from ongoing studies, which demonstrated that the vaccine is stable at 4.5 months when refrigerated at temperatures of 36 to 46 degrees Fahrenheit (2 to 8 degrees Celsius). J&J said vaccine providers should visit its website to check expiration dates of vaccines currently available.

To check the expiration date for a current supply of the vaccine, enter the lot number from the carton or vial at the company’s Expiry Checker webpage or call its automated response system at (800) 565-4008. The J&J COVID-19 vaccine may be administered until 11:59 p.m. ET on the expiry date.

Members are encouraged to use their J&J supply for vaccination at discharge from inpatient or emergency/urgent care settings. If additional doses of this vaccine are needed, providers should use the normal weekly ordering process through the Michigan Care Improvement Registry.

Members with vaccine questions may contact Ruthanne Sudderth at the MHA.

Visitor Screening Requirements Remain in Place

Although there have been many changes to public health orders recently, members are reminded that the requirement that all visitors coming into health facilities be screened for COVID-19 remains in place. This requirement is part of the emergency public health order issued in June 2020, which remains in effect until rescinded. Members with questions may contact Adam Carlson at the MHA.

MDHHS Seeks Healthcare Provider Input on Expanded Vaccine Data Tool

MI Lighthouse is a tool focused on providing granular, community-level vaccine coverage data to local public health departments, built by the University of Michigan and the MDHHS. The current version has been helpful for local public health departments but contains identifiable information. The MDHHS is now looking to expand access to information by building a version of this tool with unidentifiable data for vaccine providers, municipalities and other partners to inform more focused vaccine clinic planning and outreach.

The MDHHS would like to meet with organizations that have a need for statistics on vaccination coverage to inform the planning for building the next version of the MI Lighthouse tool. Organizations that volunteer would be asked to participate in user research interviews and to potentially be the initial testers for the tool. Interested hospitals/health systems should email Kirtana Choragudi at the University of Michigan, with a copy to Sarah Lyon-Callo at the MDHHS.

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).