The number of Michiganders ages 16 and older who have received at least one dose of COVID-19 vaccine reached 69% Oct. 28, according to the state tracker. More than 59% of those ages 12 and up were fully vaccinated as of Oct. 26.
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.
Vaccine for Kids Aged 5-11
An independent panel of experts advising the U.S. Food and Drug Administration recently voted to recommend the Pfizer COVID-19 vaccine be used in children aged 5 to 11. The next and final steps before this vaccine can be administered is approval by the Centers for Disease Control and Prevention (CDC), whose experts are scheduled to meet and vote Nov. 2 and 3. Following their vote, swift action is expected by the CDC director to authorize administration of the vaccine in younger kids. Members are encouraged to watch for updates from the MHA, the state and federal agencies Nov. 3 for details and information about rolling out this vaccine. Members with questions may contact Ruthanne Sudderth at the MHA.
Patient/Provider COVID-19 Vaccine Testimonials, Stories Could Save Lives
As the MHA continues public communication efforts to increase the statewide COVID-19 vaccination rate, hospitals and health systems are encouraged to submit stories, quotes, photos and/or video testimonials from clinicians or patients who are willing to advocate for the COVID-19 vaccines. The use of such stories was encouraged by the MHA Board of Trustees to ensure effective messages reach as many vaccine-hesitant people as possible.
Submissions can include clinicians speaking to the safety and effectiveness of the vaccines, impactful patient stories (i.e., a change of heart regarding vaccination status) or links to existing media coverage that can be shared across social media. Content can be submitted through Google Form or sent directly to Lucy Ciaramitaro at the MHA. These stories and the organizations that submit them will be featured across all MHA communication vehicles to inspire people who are waiting to be vaccinated.
Among the many actions President Joseph R. Biden took on his first day in office Jan. 20 was creating a White House COVID-19 response team to coordinate federal and state efforts to fight the pandemic. With this and other expected action by the new administration, the state of Michigan anticipates improvements in the production, distribution and operations for the COVID-19 vaccine. As the battle against the evolving virus continues, the MHA keeps members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.
Updates Provided as Vaccines Administration Continues
President Biden has indicated he will immediately be activating the federal Defense Production Act to significantly increase the supply of vaccine available to Americans. Gov. Gretchen Whitmer’s administration is working closely with the Biden team to increase Michigan’s weekly allocation of vaccine as soon as possible. The state is mapping details on how to support each of Biden’s points and how this plan can support Michigan’s plan to administer 50,000 or more shots per day.
The U.S. Department of Health and Human Services notified the Michigan Department of Health and Human Services (MDHHS) Jan. 20 that modified vaccine supply kits would begin being included that week with the shipments of the Pfizer vaccine to assist in administering the potential sixth dose of vaccine from vials originally labeled for five doses. In January, the Food and Drug Administration amended the emergency use authorization to reflect the additional dose, and McKesson increased the individual Pfizer ancillary kit contents from a kit that supported 975 doses to a kit supporting 1,170 doses. Members with vaccination supply chain questions can contact Adam Carlson or Rob Wood at the MHA.
The MDHHS is working toward using the Centers for Disease Control & Prevention (CDC) Social Vulnerability Index to identify areas and individuals in Michigan that may have less access to COVID-19 vaccine. The department will be encouraging vaccinating providers to use this data to find and vaccinate these individuals and communities. This work is in the early stages, and updates will be provided during the biweekly MDHHS calls with providers. The MHA will provide details on how to reach vulnerable individuals and communities as they become available.
The MHA will conduct a members-only event from 11 a.m. to noon Jan. 29 for an in-depth discussion on the status of COVID-19 vaccine distribution, coordination, coverage, communication and more. Members will receive participation information prior to the event.
In addition, the association (@MIHospitalAssoc) will host a Twitter chat from 1 to 2 p.m. Jan. 28 to inform Michiganders about the COVID-19 vaccine and promote to the public and media the excellent work of hospitals and health systems in leading this effort. The goal of the virtual conversation is to answer frequently asked questions and give hospitals an opportunity to share their experiences and resources related to the COVID-19 vaccine all in one place. Members may preview the chat questions, and those with Twitter accounts are encouraged to join the event to share about hospitals’ role in Michigan’s COVID-19 vaccine effort and be a source of trusted information about the vaccine itself. Members are asked to confirm their participation with Lucy Ciaramitaro at the MHA by Jan. 26.
Local health departments use an online registry to recruit volunteers for COVID-19 vaccine clinics. Vaccine volunteers do not necessarily need to be licensed health professionals, but do need to complete all training to ensure they can appropriately educate, administer, prepare, handle and report vaccine. Anyone interested in volunteering to assist in vaccine administration is encouraged to register. Training materials are available on both the MDHHS and CDC websites.
MDHHS Issues Updated List of COVID-19 Relief Facilities
The MDHHS issued an updated list of COVID Relief Facilities (CRFs), such as nursing homes and rehab facilities, approved to admit and accept transfers of individuals who remain subject to Transmission Based Precautions for COVID-19. The MDHHS will issue its next updated list the week of Feb. 1.
The CRF designation is defined as part of Public Act 231 of 2020. These facilities may care for COVID-19-positive residents of nursing facilities by retaining or admitting those residents. An appropriate CRF resident is a COVID-19-positive person who does not need the acute-care hospital level of services.
CRFs are designed to care for COVID-19-positive residents in-place with enhanced infection control measures for individuals who have not met criteria for discontinuing Transmission-Based Precautions and have limited access to the state’s Care and Recovery Centers. All CRFs may retain or readmit their own residents. Facilities that meet enhanced requirements may receive new admissions from other facilities or hospital discharges. Many other CRFs can retain their own residents even if they become COVID-19-positive. To request a copy of the list of CRFs accepting new admissions, contact Erin Emerson at the MDHHS. For more information on these facilities, contact Kelsey Ostergren at the MHA.
The 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.
The MHA continues to keep members apprised of developments affecting Michigan hospitals during the pandemic through email updates and the MHA Coronavirus webpage. Important updates are outlined below.
Interim Final Rule Ties COVID-19 Reporting to Medicare Conditions of Participation
The Centers for Medicare & Medicaid Services (CMS) Aug. 24 issued an interim final rule that, among other provisions, makes collecting COVID-19 data and reporting it daily to the Department of Health and Human Services (HHS) a condition of participation (CoP) for hospitals that participate in Medicare. The MHA is disappointed in this rule that seeks to obtain data by penalizing hospitals as they continue to fight against a global pandemic.
The rule takes effect upon publication in the Federal Register, after which comments will be accepted for 60 days. The date the rule will be published is currently unknown.
The rule requires hospitals to daily report data including, but not limited to, number of confirmed or suspected COVID-19-positive patients, intensive care unit beds occupied and availability of supplies and equipment. By making this data reporting a CoP, the potential penalty for a hospital’s noncompliance could be termination from the Medicare program unless appropriate corrective action is taken.
While the MHA works to diminish the negative effects of this rule, hospitals are urged to report data through the HHS TeleTracking portal on a daily basis to avoid potential violation of the rule when it is published. Members needing assistance in meeting the reporting requirements should contact Jim Lee at the MHA.
Raising Awareness of Importance of Flu Vaccinations During Pandemic
The MHA is teaming up with Gov. Gretchen Whitmer and other healthcare organizations to promote flu vaccination during the upcoming influenza season. The potential for a surge of COVID-19 and severe outbreaks of influenza circulating simultaneously could overwhelm the healthcare system. MHA CEO Brian Peters participated in a news conference Aug. 25 to stress the importance of improving flu vaccination rates in Michigan (see related article).
FDA Approval or Authorization Unnecessary for Laboratory Developed Tests
The HHS recently announced that the Food and Drug Administration (FDA) will not require developers to submit a premarket approval application, premarket notification or emergency use authorization (EAU) for laboratory developed tests (LDTs). Laboratories opting to use LDTs would not be eligible for Public Readiness and Emergency Preparedness Act coverage and would remain subject to CMS regulation under the Clinical Laboratory Improvement Amendments of 1988 and its implementing regulations, the HHS said. LDT developers may voluntarily apply for approval, clearance or an EUA, and the FDA will adjudicate those submissions.
LDTs are developed, validated and performed by individual laboratories, including hospital laboratories, when commercial diagnostic tests do not exist or meet clinical needs. The American Hospital Association has urged the agency not to regulate LDTs as medical devices, which would reduce patient access to many critical tests and hinder technological and clinical innovation.
Sept. 9 Twitter Chat to Focus on Mental Health During the Pandemic
A recent Kaiser Family Foundation poll determined that 53% of adults in the U.S. are experiencing poor mental health due to worry and stress over COVID-19. To help educate and encourage conversation around mental health as it relates to COVID-19 and National Suicide Prevention Awareness Month, the MHA will host a Twitter chat from 1 to 2 p.m. Sept. 9. The chat will feature input from guest expert Brian Ahmedani, PhD, director, Center for Health Policy & Health Services Research at Henry Ford Health System (@bahmedani).
Those interested in participating may follow along through the MHA’s Twitter (@mihospitalassoc) or by searching the hashtag #MHAHealthChat over the course of the hour. Additional details will be emailed to MHA members prior to the event. Those with questions may contact Lucy Ciaramitaro at the MHA.