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Emergency Orders Rescinded Effective June 22
Several emergency public health orders that have been in place for much of the last 15 months are rescinded as of 12:01 a.m. June 22. The orders rescinded and the dates on which they took effect are:
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.
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.
National Immunization Awareness Month (NIAM) highlights the efforts of hospitals and healthcare professionals to protect patients of all ages against vaccine-preventable diseases through on-time vaccination. Held throughout August,NIAM is an opportunity for healthcare providers to ensuretheir patients are up to date on recommended vaccines.
The Centers for Disease Control and Prevention provides online information for both healthcare providers and those they serve. On-time vaccinations can protect entire communities against many serious diseases.
August is National Immunization Awareness Month (NIAM), which highlights the efforts of hospitals and healthcare professionals to protect patients of all ages against vaccine-preventable diseases through on-time vaccination.
During NIAM, the MHA encourages members to ensure their patients are up to date on recommended vaccines. Research has consistently shown that healthcare professionals are the most trusted source of vaccine information for parents and patients.
Educational resources are available from the Centers for Disease Control and Prevention (CDC) to assist providers in emphasizing the importance of vaccination, some of which provide continuing medical education credit. The #HowIRecommend Video Series includes short presentations from experts on how to make effective vaccine recommendations to parents and patients, address common vaccine questions, and take a team-based approach to vaccination.
Individuals have the power to protect themselves and their families against many serious diseases through on-time vaccination. The CDC provides an Interactive Vaccine Guide with information on vaccines recommended during pregnancy and throughout life, including adult vaccines.
Due to a national shortage of testing materials and personal protection equipment for healthcare workers, Michigan residents are encouraged to stay home and not seek 2019 novel coronavirus (COVID-19) testing if they are not exhibiting symptoms or are only mildly sick.
The Michigan Department of Health and Human Services issued guidance to labs across the state to strategically use limited testing resources for those cases involving very sick patients and people who could spread the disease widely.
Michigan hospitals are ramping up their ability to collect COVID-19 samples, but not all hospitals in the state have the equipment required. The country is facing a shortage of sample swabs, masks and other critical items needed to safely collect and complete COVID-19 tests. The MHA has been working in partnership with manufacturers and others across the state to attempt to increase production of some of these items.
People with COVID-19 have reported mild to severe respiratory illness with symptoms of fever, cough, shortness of breath and pneumonia. Those who think they are sick should contact their healthcare provider by phone, email or virtual visit.
People who are mildly sick may be told to stay in quarantine and care for their symptoms until they have had no fever for at least 72 hours, other symptoms have improved and at least seven days have passed since symptoms first appeared. If symptoms worsen, people should seek medical attention, but contact their doctor or the facility they are traveling to first. According to the Centers for Disease Control and Prevention, emergency warning signs include:
Difficulty breathing or shortness of breath.
Persistent pain or pressure in the chest.
New confusion or inability to arouse.
Bluish lips or face.
The MHA has provided sample social media posts that Michigan hospitals can use to reinforce these important public messages. Additional information and resources are available on the MHA’s COVID-19 webpage. Members with questions may contact Ruthanne Sudderth at the MHA.
Note: This article was updated March 15 with new information from the state.
Michigan hospitals and health systems are monitoring developments related to the 2019 Novel Coronavirus (COVID-19) very closely and are working diligently with state and federal agencies to appropriately respond to COVID-19 cases in Michigan. A current summary of the situation in the state is available on the state of Michigan's website.
Gov. Gretchen Whitmer pronounced a state of emergency in Michigan March 10, which allows the state to maximize its resources to manage an outbreak and accelerate coordination and communication among stakeholders. The governor’s office has also released interim recommendations for community mitigation strategies.
The MHA COVID-19 webpage is updated daily with information for hospitals and healthcare providers, and additional resources are available on the MHA Community site, including copies of emails sent to members from the MHA. Additionally, questions on COVID-19 and infectious disease response strategies may be directed to the Michigan Department of Health and Human Services (MDHHS) Community Health Emergency Coordination Center.
Gov. Gretchen Whitmer issued an Executive Order March 14 that restricts visitors in healthcare facilities, including hospitals. Effective immediately, all healthcare facilities and residential care facilities must prohibit any visitors, with the following exceptions:
Visitors necessary for the provision of medical care for a patient.
Visitors who support of activities of daily living for a patient.
Visitors who must exercise of power of attorney or court-appointed guardianship for a patient.
Parents, foster parents or guardians of patients who are 21 years of age or under.
Visitors to a patient who is in serious or critical condition or in hospice care.
Those who are visiting under exigent circumstances.
Visitors performing official governmental functions.
No later than 9 a.m. Monday, March 16, facilities must assess all persons entering their facilities who are not under the care of the facility for COVID-19 symptoms and risk factors. Healthcare facilities must deny entry to any individual with symptoms or risk factors.
Michigan is expecting to receive about $15 million of an $8.3 billion spending package that Congress approved to support the COVID-19 response. However, it appears allocation of that funding to hospitals will be minimal, so it is critical that hospitals tell Congress about their most pressing needs. Hospitals are urged to use a hospital action alert the MHA has developed to tell lawmakers about the need for their assistance in covering such things as personal protection equipment, funding for additional staff and work hours, expanded capacity and more.
Many insurers in Michigan have announced coverage of COVID-19 testing (and in some cases, treatment) at no or reduced cost to patients. A summary of these announcements is available on the America’s Health Insurance Plans website. The governor also announced that Medicaid will cover testing and treatment, and the Centers for Medicare & Medicaid Services issued coverage guidance for Medicare Advantage and Medicare Part D beneficiaries.
In addition, the Centers for Disease Control and Prevention (CDC) has updated its guidance for managing healthcare personnel with potential exposure to patients with the virus. This guidance includes alternative personal protective equipment recommendations in consideration of current supply chain shortages.
Updated information will continue to be published in Monday Report and members will receive emailed communication as often as necessary to ensure they are equipped to respond to potential cases of COVID-19 in their facilities and communities.
The MHA thanks the MDHHS , the American Hospital Association, the CDC, other state and federal agencies and organizations, and the Whitmer administration, state lawmakers and federal lawmakers for their partnership in addressing this public health emergency.
Members with MHA-specific questions should contact the following MHA staff members:
The MHA is working closely with the Michigan Department of Health and Human Services (MDHHS), the American Hospital Association (AHA), the Centers for Disease Control and Prevention (CDC), and other state and federal agencies and organizations to ensure members and other healthcare providers have the necessary information, resources and tools to prepare for the potential of Michigan residents contracting the 2019 Novel Coronavirus (COVID-19).
An MHA webpage dedicated to COVID-19 is being updated in real time to assist members with preparedness efforts. It includes a downloadable communications and preparedness toolkit that contains talking points, sample social media posts, tips for hardening the health system, frequently asked questions and more.
The association is participating in weekly calls and/or webinars with the MDHHS and the AHA, and information from those communications will be shared via the COVID-19 webpage and/or email. In a March 5 webinar, the MDHHS provided guidance on how to identify a case of COVID-19, the proper procedure to test and manage COVID-19 patients, how to prevent the spread of COVID-19 and access to up-to-date resources. The department has made slides and a recording of the webinar available on the MI-TRAIN webpagematerials. Updated information from these and other agency communications will be shared weekly in the Monday Report.
During the week of March 2, actions to mitigate and manage COVID-19 have been taken by the association and at the state and federal levels. The MHA created an internal committee to monitor developments in the COVID-19 outbreak and ensure a continued high level of member communication, service, and staff health and safety.
Gov. Gretchen Whitmer established four task forces to help combat the spread of COVID-19. These groups will focus on state operations, health and human services, education, and the economy and workforce. Also at the state level, the MDHHS has launched a campaign to raise awareness of appropriate hand washing techniques.
President Donald Trump signed an $8.3 billion COVID-19 spending package March 6 to address the prevention and spread of the disease. Included in the package is $2.2 billion to the CDC to support prevention, preparedness and response efforts, with $14.5 million being distributed from the CDC to Michigan. In addition, more than $3 billion will be provided to the Department of Health and Human Services’ Public Health and Social Services Emergency Fund to purchase necessary treatment and medical supplies, as well as providing funding for grants for the construction, alteration or renovation of nonfederally owned facilities. Lastly, the legislation allows the Department of Health and Human Services Secretary to waive certain Medicare telehealth restrictions.
In addition to the resources provided on 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:
The following statement may be attributed to MHA CEO Brian Peters.
Michigan hospitals and health systems are closely monitoring developments related to the 2019 Novel Coronavirus (COVID-19) and are working diligently with state and federal agencies to educate and train their staffs to prepare for the possibility of COVID-19 cases in Michigan.
We recognize the concerns of our communities, staff and patients when dealing with any infectious disease. Hospitals work routinely on emergency preparedness to be ready to react to the spread of infectious disease. We expect every hospital to be able to safely identify, evaluate and treat a patient with COVID-19 should a case present in Michigan.
It is important for the public to know that most people who become infected with COVID-19 will have mild to no symptoms, which can be treated by supportive care and without hospitalization. Hospitals strongly recommend that the public follow the same precautions recommended to prevent spread of flu and the common cold to help prevent spread of COVID-19.
Collaboration and communication within Michigan’s healthcare community is vital to our state’s readiness efforts. The MHA is continually providing updated guidance to hospitals from state and national agencies, including the Michigan Department of Health and Human Services, the Centers for Disease Control and Prevention and the American Hospital Association. Our commitment is to the health and wellness of our patients, staff and communities, and we will continue to work together to ensure we are as prepared as possible to provide care should cases of COVID-19 develop in Michigan.
Joneigh Khaldun, MD, chief medical executive, Michigan Department of Health and Human Services (MDHHS), announced the activation of a state lab to test suspected coronavirus disease (COVID-19) patients Feb. 27.
The new state lab will work with the U.S. Centers for Disease Control and Prevention (CDC) to conduct same-day testing on cases that meet the criteria for investigation. Previously, samples had to be sent directly to the CDC for testing.
Gov. Gretchen Whitmer also activated the State of Michigan Emergency Operations Center (SEOC) to coordinate with state, local and federal agencies to help prevent the spread of COVID-19. The governor, state director of emergency management and homeland security, and other agencies work from the Lansing-based SEOC to direct all state resources in response to emergencies.
During testimony before the Senate Health Policy and Human Services Committee, Khaldun also mentioned that the MDHHS will be launching a media campaign soon to educate the public on ways to prevent the spread of COVID-19.
At the federal level, the American Hospital Association (AHA) urged Congress to provide $1 billion in initial supplemental emergency funding to support emergency preparedness and response efforts for hospitals and health systems for COVID-19.
Members are encouraged to incorporate guidance from the CDC and the AHA in preparing for the possibility of COVID-19 cases in Michigan.
The MHA will continue to closely monitor developments related to COVID-19 and are working diligently with state and federal agencies, including the MDHHS, the CDC and the AHA. Included in these collaborative efforts is the development of a communications toolkit to help members ensure patients and the public receive consistent, fact-based messages.
Questions regarding COVID-19 and infectious disease response strategies should be directed to Brittany Bogan or Rob Wood at the MHA
The MHA is working with various state and federal agencies to provide members with current information on the Novel Coronavirus (COVID-19). The Michigan Department of Health and Human Services recently activated the Community Health Emergency Coordination Center to support the local and state response to the outbreak. The department is providing updated resources for Michigan and working closely with others to actively monitor any potential cases of COVID-19 in the state. As of Feb. 13, no cases of the virus have been substantiated in Michigan. The latest developments in screening, reporting and prevention are available from the Centers for Disease Control and Prevention (CDC) and the American Hospital Association.
The CDC recently released guidance to help healthcare personnel conserve the supply of personal protective equipment. It is preparing for the possibility that the COVID-19 situation in the U.S. could become more serious and is taking steps to ensure there are enough supplies and appropriate guidance to prevent spread of disease, especially among healthcare personnel caring for patients with COVID-19 or similar infectious diseases. The CDC recommends that all hospitals follow interim guidance on infection control to provide the appropriate level of care for a suspected or confirmed case of COVID-19.
While the emergence of new viruses is a concern, annual influenza infections in the U.S. during the last 10 years have caused more than 45 million infections and 60,000 deaths annually. The best prevention for respiratory illnesses, in general, are to wash hands often with soap and water, stay home when ill and get recommended vaccinations. Preliminary development has begun for a COVID-19 vaccine. The MHA provides guidance on healthcare personnel vaccination for influenza and other infectious diseases on its website.
Questions regarding COVID-19 and infectious disease response strategies should be directed to Brittany Bogan or Rob Wood at the MHA.