The number of hospitalizations in Michigan due to confirmed and suspected cases of COVID-19 was the lowest since early November during the week of Jan. 31. However, with 2,882 adults and 70 children hospitalized Feb. 4 with confirmed and suspected COVID-19, some facilities in the state continue to be filled to or near capacity.
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.
Application for Long-term Care Facilities to Care for COVID-19 Patients Extended
As a result of MHA advocacy, the state recently issued new guidance extending the application period for long-term care facilities to care for COVID-19 patients through Feb. 28. The guidance will ease the process of discharging COVID-19 patients from hospitals to nursing facilities. Additionally, in a change from previous policy, long-term care facilities that applied last year and remain in good standing are authorized to retain their status through the new application deadline.
The COVID Recovery Center and the COVID Relief Facility (CRF) programs were established under Michigan Public Act 231 of 2020. These programs were designed to ensure Michigan’s nursing homes were prepared to provide care to individuals who have tested positive for COVID-19 under transmission-based precautions within the guidelines and best practices from the Centers for Disease Control and Prevention. Michigan’s nursing homes must be reviewed by the Michigan Department of Health and Human Services (MDHHS) to ensure they meet the minimum criteria outlined within the legislation and associated MDHHS policies.
Michigan now has 54 Tier-2 CRFs able to take COVID-19 patients from hospitals at discharge if their normal nursing facility isn’t able to accommodate the patient, up from just 27 CRFs in late 2021. Members with questions may contact Adam Carlson.
The state of Michigan held a press conference Jan. 11 to discuss the rapid rise in case numbers, hospitalizations (especially pediatric hospitalizations) and positivity rates. Speakers urged all residents who are eligible to be both vaccinated and boosted as quickly as possible. Representatives from Children’s Hospital of Michigan joined the event to discuss the concerning rise in childhood case rates and hospitalizations.
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.
The U.S. Supreme Court issued decisions Jan. 13 on the Centers for Medicare & Medicaid Services (CMS) and Occupational Safety and Health Administration (OSHA) vaccine mandates. As expected, the court blocked the Biden administration from enforcing the vaccine or test mandate issued under OSHA, but upheld the ability of the CMS to enforce the healthcare worker vaccine mandate.
The Supreme Court has repeatedly upheld the constitutionality of state vaccine mandates in a variety of settings, as well as mandates by private employers. These challenges were different because they presented the question of whether Congress had authorized the executive branch to institute the requirements through the agencies of OSHA and the CMS/Department of Health and Human Services.
Michigan was not one of the 26 states covered by the court injunction to the CMS mandate, and Michigan has no other state-issued prohibitions on enforcing federal or private vaccine mandates. Hence,the mandate and enforcement move forward. The currently posted deadline for completing the first required vaccine dose is Jan. 27, and the second dose is required by Feb. 28. Boosters are currently not part of the mandate.
The MHA responded to a number of media inquiries following the Supreme Court announcement, including from The Detroit News, Detroit Free Press and MiBiz. The association reiterated its long-standing position that mandates of this kind should be left up to local healthcare decision-makers and that hospitals and the MHA have always urged every resident who is eligible to get vaccinated to protect themselves and others. The MHA also stressed that, while the small number of hospital workers who have already ended their employment due to an organization’s mandate did not necessarily worsen the existing staffing shortages, the timing of a nationwide mandate amid this omicron surge could not be worse, as the shortages are more serious than ever. The association assured reporters that hospitals will proceed with compliance and that the MHA and its members will continue to strenuously advocate for staffing assistance from federal and state partners.
Members with questions about deadlines, enforcement or other elements of the mandate are encouraged to review the posted CMS guidance to ensure their organizations are prepared to comply.
MIOSHA: Hospitals May Currently Use CDC Quarantine Guidance Without Penalty
The MHA has continued to work with state regulators on securing updated guidance for hospitals and health systems as it relates to worker quarantine periods. Federal Occupational Safety and Health Administration (OSHA) rules have not yet been fully rescinded to allow for healthcare settings to confidently follow new, less restrictive Centers for Disease Control and Prevention (CDC) quarantine guidance.
However, the Michigan Occupational Safety and Health Administration (MIOSHA) has stated it was told OSHA is in the process of withdrawing the relevant rules and the state agency is preparing to update its rules to align with the revised federal rules. MIOSHA also indicated that, until updates are made at the federal and state levels, it will not issue citations specifically regarding quarantine and isolation requirements if an employer were following the Dec. 23, 2021, updated CDC guidance for healthcare personnel.
An existing OSHA provision recognizes the CDC’s ‘‘Strategies to Mitigate Healthcare Personnel Staffing Shortages.’’ This guidance allows elimination of quarantine for certain healthcare workers as a last resort if the workers’ absence would mean there are no longer enough staff to provide safe patient care, specific other amelioration strategies have already been tried, patients have been notified, and workers are using additional personal protective equipment at all times.
The MHA will continue to keep members apprised of developments on this issue. Members with questions may contact Laura Appel at the MHA.
Long-term Care Facility Capacity for COVID Care Increases
Michigan now has 50 Tier-2 COVID-19 Relief Facilities (CRFs) able to take COVID-19 patients from hospitals at discharge if their normal nursing facility isn’t able to accommodate them. This is an increase from just 27 CRFs late in 2021 and includes an Upper Peninsula facility in Hancock.
In addition, Michigan now has nine facilities designated as Care and Recovery Centers (CRC)s, including one in Escanaba in the Upper Peninsula.
The CRC and the CRF programs were established under Michigan Public Act 231 of 2020. These programs were designed to ensure Michigan’s nursing homes were prepared to provide care to individuals who have tested positive for coronavirus under transmission-based precautions within the guidelines and best practices from the Centers for Disease Control and Prevention. Michigan’s nursing homes must be reviewed by the Michigan Department of Health and Human Services (MDHHS) to ensure they meet the minimum criteria outlined within the legislation and associated MDHHS policies. Members with questions may contact Paige Fults at the MHA.
Red Cross Declares First Ever National Blood Supply Crisis
The American Red Cross declared a national blood supply shortage and operational crisis Jan. 10. This is the first time such a crisis has been declared, and it could impact hospitals’ ability to provide certain types of care or transfusions in the coming days and weeks. This is a result of the current COVID-19 surge causing canceled donation appointments, Red Cross staffing shortages and more.
The Red Cross chief medical officer sent a notification directly to hospital transfusion leaders outlining these operational challenges and how to plan for expected shortages. The Red Cross also urged the public to donate blood as soon as possible.
The MHA will be amplifying to the public the need for blood donors through its social and traditional media channels.
Michigan Sees Surge in Unemployment Fraud
Michigan has seen a recent surge in unemployment fraud claims, according to the MHA Unemployment Compensation Program (MHA UCP). The increase in unemployment fraud is related to identity theft that occurs when the state Unemployment Insurance Agency (UIA) system is penetrated. Over the past several weeks, the MHA UCP has seen fraud in about 15 to 20% of all new claims for its clients.
The MHA UCP has worked closely with the UIA on this issue and has mitigated the impact for clients, who have not been assessed charges on these claims. To learn more about the services available through the MHA UCP, contact Neil MacVicar at the MHA.
Michigan continues to make good progress vaccinating our adult eligible population as Michigan exceeded over six million COVID-19 vaccine doses administered April 16, displaying significant progress in Michigan’s effort to achieve the goal of vaccinating at least 70% of Michigan adults. 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.
MDHHS Issues Multiple Vaccine-Related Alerts
The Michigan Department of Health and Human Services (MDHHS) issued multiple vaccine-related provider communications in the past week.
Vaccine Administration Error Guidance:The MDHHS sent providers several resources and reminders about how to proceed when questions arise about restarting the vaccine process if the second dose timeframe is missed and more. In short, providers should not “start the vaccine process over” with an additional first dose if the second dose timeframe is missed. Please reference guidance from the Centers for Disease Control and Prevention (CDC) for instructions on this and other administration error issues.
Bamlanivimab FDA EUA Revoked:The U.S. Food and Drug Administration (FDA) revoked April 16 the emergency use authorization (EUA) for bamlanivimab, when administered alone, to be used for the treatment of mild-to-moderate COVID-19 in adults and certain pediatric patients who are at high risk of disease progression or hospitalization. MDHHS stated that REGEN-COV as well as bamlanivimab and etesevimab (administered together) continue to be available under EUA.
Sites that are administering monoclonal antibodies can order bamlanivimab and etesevimab, etesevimab to pair with the current supply of bamlanivimab that the site has available, or REGEN-COV from the authorized distributer using the direct ordering process. The MDHHS continues to encourage all providers to consider offering antibody treatments to prevent severe COVID/COVID hospitalizations and is working on additional offerings to assist providers in this effort.
Additional Vaccine Updates
State leadership reported to the MHA a slight improvement in Michigan’s vaccination speed, but a desire to continue to lessen vaccine supply on hand to ensure resources from federal partners remain in place. As of April 23:
2.7 million Michiganders, or 33% of the eligible population, have received complete schedules of COVID-19 vaccines either through two doses of an mRNA vaccine or one Johnson & Johnson dose.
6.3 million doses have been administered in total.
3.8 million people have initiated vaccination, or 47% of the eligible population.
65% of people 65 and older are now fully vaccinated.
Hospitals and health systems are encouraged to consider working with local employers, local industries such as hospitality businesses, or local colleges/universities to offer specific clinics to employees or students of those organizations. Because some employers’ work or shift hours can be irregular, partnering with them to offer clinics at times when their employees are available could improve access for those individuals. The MHA will continue to pursue conversations with the trade groups representing such stakeholders to identify any opportunities for statewide or regional coordination.
There is also still a need for increased vaccine access for homebound individuals. As a reminder for any clinic offering, many local transit authorities around the state have offered free rides to vaccine clinics for individuals in need of transportation. If you’d like to arrange transportation to your clinics, please contact your local transit authority.
The state announced it is seeking vendors to execute mobile vaccinations. Awards will be based on the ability to provide services to one or more of the six site types and multiple awards may be issued. Contractors will also be responsible for rapid response to provide vaccinations (and potentially testing) at locations and community locations when COVID-19 outbreaks occur. Members that may be interested in this contract should review the full announcement for other details about expectations, and be aware that bids are due Wednesday, May 12 by 3 p.m. RFP No. 210000001690 is posted on the SIGMA Vendor Self-Service at Michigan.gov/SIGMAVSS.
On a related note, the state shared some entities in Michigan are using their Meals on Wheels operations via their Area Agency on Aging to deliver vaccinations out in the community and/or to homebound individuals. Members are encouraged to consider these partners if they haven’t already and have capacity to do so.
Pfizer continues to work on smaller quantity packages of their vaccine, to allow smaller provider settings to use their product without risk of waste or storage issues. Those smaller quantities are not yet available; we will keep members apprised of any updates.
Care and Recovery Centers Remain Available for Patients
Hospitals are reminded that the MDHHS has established Care and Recovery Centers (CRC) to care for confirmed COVID-19 positive patients discharging from a hospital requiring isolation until Transmission-Based Precautions are discontinued. Currently, the MDHHS has 14 designated nursing facilities with approximately 300 beds across the state serving as CRCs. Within each CRC exists a designated unit to properly isolate and care for confirmed COVID-19 positive individuals. Hospitals are encouraged to coordinate with CRCs as part of their discharge planning process of confirmed COVID-19 positive hospital patients. Patients admitted directly from the hospital do not need to meet MDHHS Nursing Facility Level of Care. Members with questions may contact Kelsey Ostergren.
mAb Webinar Recap and Recording
The MHA and MDHHS this morning hosted a webinar for health system and hospital leaders to learn more about the overall benefits of, and operational considerations for, increasing the administration of monoclonal antibody therapies for eligible COVID-19 patients.
The webinar highlighted what resources, time, space and support is needed to administer mAb treatment and what the state has in place to assist. Earlier this week, the MDHHS issued an alert on the Michigan Health Alert Network to hospitals and health systems that included the following resources. The MDHHS has set a goal of at least 50% of people who are eligible to receive mAb therapy receive the treatment within 10 days of symptom onset.
A memo from MDHHS Chief Medical Executive Joneigh Khaldun, MD, encouraging hospitals and health systems to increase use of mAb treatment to prevent hospitalizations/death from COVID-19;
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.
The Michigan Department of Health and Human Services (MDHHS) issued a new emergency order the evening of Nov. 15 limiting certain indoor gathering opportunities for three weeks in light of the exponentially increasing COVID-19 cases and hospitalization across the state. The MHA keeps members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.
MDHHS Issues Emergency Order Outlining Restrictions
The MDHHS issued a new emergency order Nov. 15 that attempts to curb community spread of COVID-19 by limiting indoor gathering opportunities at various venues for three weeks. These new restrictions do not place any limits on access to healthcare. The order takes effect at 12:01 a.m. Wednesday, Nov. 18.
Under this order, indoor residential gatherings are limited to two households at any one time. The order is aimed at limiting residential and nonresidential gatherings where COVID-19 spreads rapidly. Bars and restaurants will be open for outdoor dining, carry-out and delivery only. Gyms will remain open for individual exercise with strict safety measures in place. Casinos, movie theaters and group exercise classes will be closed. Professional and college sports meeting extraordinary standards for risk mitigation may continue without spectators; however, all other organized sports must stop. Colleges and high schools may proceed with remote learning, but must end in-person classes. The MDHHS has created an infographic explaining what is closed and what will remain open.
The MHA issued a media statement upon the MDHHS announcement, indicating appreciation for the strong and swift response to the current surge in COVID-19 cases that is stretching hospitals and healthcare personnel thin.
Public Cooperation Urged to Prevent Community Spread
The Michigan Economic Recovery Council held a virtual news conference Nov. 12 featuring its healthcare leader members to urge Michiganders to improve their preventive actions to help stop community spread of COVID-19. Participants included MHA CEO Brian Peters; Ed Ness, president & CEO, Munson Healthcare, and MHA Board Chair; Wright Lassiter, president & CEO, Henry Ford Health System; John Fox, president & CEO, Beaumont Health; and Tina Freese Decker, president & CEO, Spectrum Health. To add an Upper Peninsula perspective, Gar Atchison, market president, Upper Peninsula Health System, also took part in the conference. More than 20 news outlets from around the state joined the event (see related article).
Health system leaders shared the increasing challenges their facilities are having due to staff becoming sick in the community, tightening testing capacity, transfer difficulties as a result of widespread surge and more. When asked about state government action, the health leaders reminded Michigan residents that, if everyone does the right thing, there will be no need to return to the strict shutdowns experienced in the spring. Gov. Gretchen Whitmer held a news conference later that day, sharing updated case numbers and urging public compliance with preventive measures.
The MHA also issued a news release containing current data on hospitalizations. Members are encouraged to continue to engage their trustees and local business networks to emphasize that, by working together, the surge can be stopped. For more information, contact Ruthanne Sudderth at the MHA.
Distribution of Bamlanivimab Monoclonal Antibody
The MDHHS held a conference call with healthcare providers Nov. 12, outlining the process for distributing the newly approved COVID-19 antibody treatment bamlanivimab in Michigan. The state expects to receive 3,240 vials in the initial shipment and will release information on the treatment protocols. The MDHHS is still confirming the allocation strategy and expects to coordinate weekly distributions directly from Amerisource Bergen to hospitals based on the data reported for COVID-19 cases and hospitalizations. The MDHHS stated that it has been in direct contact with hospital pharmacy directors to discuss the distribution process, which will be adjusted weekly based on need. The MHA will provide an update as more information becomes available. Members with questions may contact Paige Fults at the MHA.
New COVID-19 Task Force Named; Pfizer States Vaccine 90% Effective
Though President Donald Trump’s campaign team continues to challenge election results, the Biden/Harris campaign has announced its COVID-19 task force and plan to handle the pandemic. The likely change in administrations is sure to bring change in pandemic response that will impact health systems and hospitals, as well many others. The MHA has begun to review the Biden/Harris plan and will inform members about what is expected to change or remain the same. Some of the key areas the association will watch include:
Supply chain strategy.
National consistency in preventive/containment measures.
In addition, Pfizer announced that its COVID-19 vaccine, long expected to be the first available, is currently showing 90% effectiveness against the virus. According to reports, Pfizer plans to ask the Food and Drug Administration for emergency authorization of the two-dose vaccine by the end of November, after it has collected the recommended two months of safety data. Pfizer also stated that it will have manufactured enough doses to immunize 15 million to 20 million people by the end of 2020.
COVID-19 Vaccine Distribution Plans Reviewed
The MHA held a call Nov. 13 for member hospitals and the MDHHS to discuss plans for distribution of the COVID-19 vaccines to health system and hospitals in the coming weeks. More than 170 individuals joined this important discussion.
The MHA will update and share with members a frequently asked questions document that will capture the lengthy question-and-answer session from the call. The discussion recapped expected shipment and storage requirements for vaccines A and B (expected to be Pfizer and Moderna vaccines), working with local health departments to ensure coordination in specific regions/communities, and much more. The MDHHS will send hospitals a follow-up survey to guide distribution, as well as a form for eventual redistribution among each organization’s locations. Members with questions may contact Ruthanne Sudderth at the MHA.
State Launches COVID-19 Contact Tracing Smart App
The state has officially launched MI COVID Alert, an app that lets users know if they have been in close physical proximity to someone who has tested positive for COVID-19. The app maintains broad privacy for users; it asks users to self-report positive COVID-19 tests and, using smartphone technology, knows what other users may have been exposed. It then alerts those users to a potential exposure. As hospital and health system employees are increasingly impacted by community spread, members are encouraged to have them consider using MI COVID Alert to help maintain maximum awareness of exposure risks. The app is free to download on both iPhone and Android devices via their respective app stores.
Members’ marketing and communications teams should also consider sharing this app on social media sites for communities to see and access. The state has created social media graphics so anyone can easily share information about the app on their social networks.
Given the ongoing challenges with Michiganders’ comfort level with standard contract tracing, this is another more confidential tool providers can urge the public to use to improve exposure awareness.
Operation Warp Speed Releases Playbook for COVID-19 Therapeutics
Operation Warp Speed, the federal government’s operation for planning COVID-19 vaccination and treatment, recently released an initial playbook to assist providers in planning. The playbook comes in anticipation of the likely issuance of emergency use authorizations for at least two monoclonal antibody therapeutic drugs developed to treat certain COVID-19-positive patients. The playbook lays out important information for hospitals and health systems to consider, including administration, details on the two drug options, who should receive the therapeutic and a site checklist. Members are encouraged to review the playbook for additional details.
Revised Clarification on License Exemptions
The Bureau of Professional Licensing within the Michigan Department of Licensing and Regulatory Affairs (LARA) has released a revised version of its guidance document clarifying when exemptions of Michigan licensure apply to health professionals. The most notable update includes flexibility to allow providers from other countries that are licensed and in good standing to practice in the state and permit students in their last year of an accredited program to assist in care for those affected by COVID-19. That flexibility had been lost with the rescission of Executive Order 2020-61.
Although LARA does not require documentation on these individuals, it must be made available in the event the department receives an official complaint about an individual provider. The MHA recommends hospitals continue to follow the updated compliance memo related to proper tracking for all individuals who are eligible for the license exemption. Members with questions should contact Paige Fults at the MHA.
MDHHS Announces New Reimbursement for SNF Care and Recovery Centers
The MDHHS rolled out a new application for skilled nursing facilities that are interested in becoming Care and Recovery Centers (CRCs). Included in that application is an updated reimbursement schedule for CRCs that, upon approval by the department, specialize in the care and treatment of nursing facility patients who have previously tested positive for COVID-19 and have not yet met criteria for discontinuation of Transmission-Based Precautions. The reimbursement schedule now provides payments based on number of beds with a $40,000 – $80,000 preparedness stipend, monthly deposit of $10,000 – $20,000, and a bed premium of $200 per COVID-19 day.
Job Fair for Southeast Michigan Healthcare Scheduled for Dec. 2
As members’ staffing challenges grow, the MHA continues to seek opportunities to assist. The association is a member of the Health Careers Alliance for Southeast Michigan, which is hosting a healthcare job fair from 9 a.m. to noon Dec. 2 and urges any employers in or near that region to participate. Hospitals and health systems can register online as employers; 20 employer slots were available as of Nov. 13. Members with specific questions about participation may contact Sarah Gregory, director of talent development, at the Workforce Intelligence Network.
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.