Webinar Outlines CRNA’s Role in Various Clinical Settings

Michigan legislation modernized the scope of practice for certified registered nurse anesthetists (CRNAs) in 2022, eliminating the state requirement that a CRNA must work under direct physician supervision. CRNAs enhance the ability to deliver care in a multitude of scenarios, particularly in rural areas where anesthesia services may be limited.

The webinar “CRNA’s Role in the Future of Clinical Operations” on Jan. 12, 2023 will showcase the use of CRNAs in three hospitals which differ in size, location and operation. Panelists include Steve Barnett, president and CEO of McKenzie Health System, Robert Casalou, president and CEO of Trinity Health Michigan & Southeast Regions and Jeremiah J. Hodshire, president of Hillsdale Hospital. They will review the CRNA duties and responsibilities in their settings and tactics to build support and operationalize CRNA practice. MHA staff will outline the CRNA’s scope of practice law and answer questions about reimbursement.

The webinar is cosponsored by the Michigan Association of Nurse Anesthetists (MANA) and is open to MHA and MANA members. Chief executives, presidents, compliance officers, nurses and financial, operational and medical team members are encouraged to register.

Questions can be directed to Erin Steward.

Expanded Scope of Practice Creates Opportunities

To optimize cost savings, patient experience and staffing, hospitals and health systems are using multidisciplinary teams working to deliver care. Fortunately, new legislation expanded certified registered nurse anesthetists (CRNAs) abilities to practice without direct physician supervision.

The CRNA’s Role in the Future of Clinical Operations webinar on Jan. 12, 2023 will include panelists Steve Barnett, president and CEO of McKenzie Health System, Robert Casalou, president and CEO of Trinity Health Michigan & Southeast Regions and Jeremiah J. Hodshire, president of Hillsdale Hospital. They will review how their organizations have increased CRNA duties and responsibilities and tactics to build support and operationalize CRNA practice. MHA staff will outline advocacy efforts to expand CRNA’s scope of practice and answer questions about reimbursement.

The webinar is cosponsored by the Michigan Association of Nurse Anesthetists (MANA) and is open to MHA and MANA members. Chief executives and presidents, financial and operational team members, medical, nurses and compliance officers are encouraged to register.

Members with questions should contact Erin Steward at the MHA.

Webinar Outlines CRNA’s Role in the Future of Clinical Operations

Michigan legislation in 2022 modernized the scope of practice for certified registered nurse anesthetists (CRNAs), eliminating the state requirement that a CRNA must work under direct physician supervision. Hospitals can now choose the anesthesia care model that best fits their location, staffing and resources to offer safe and effective patient care.

The CRNA’s Role in the Future of Clinical Operations webinar on Jan. 12, 2023 will include panelists Steve Barnett, president and CEO of McKenzie Health System, Robert Casalou, president and CEO of Trinity Health Michigan & Southeast Regions and Jeremiah J. Hodshire, president of Hillsdale Hospital. They will review the CRNA duties and responsibilities in their settings and tactics to build support and operationalize CRNA practice. MHA staff will outline advocacy efforts to expand CRNA’s scope of practice and answer questions about reimbursement.

The webinar is cosponsored by the Michigan Association of Nurse Anesthetists (MANA) and is open to MHA and MANA members. Chief executives and presidents, financial and operational team members, medical, nurses and compliance officers are encouraged to register.

Members with questions should contact Erin Steward at the MHA.

Final Procedural Step for CRNA Legislation Completed

Legislation enhancing hospital flexibility for anesthesia care went into full effect May 10 following official confirmation from the Centers for Medicare & Medicaid Services (CMS) that it had received the letter of attestation sent by the governor. This was the final step needed for the provisions in House Bill (HB) 4359 to go into full effect in Michigan.

The MHA-supported HB 4359 was signed into law by Gov. Gretchen Whitmer and took effect Oct. 11, 2021. Sponsored by Rep. Mary Whiteford (R-Casco Township), the bill modernizes the scope of practice for certified registered nurse anesthetists (CRNAs) and allows flexibility for each hospital to choose the anesthesia care model that best fits its location, staffing and resources to offer safe and effective patient care by eliminating the state requirement that a CRNA must work under direct physician supervision.

Federal provisions have allowed states to request exemption from physician supervision of CRNAs under 42 CFR 482.852 upon passage of applicable laws and a letter of attestation from the governor to the CMS.

Members with questions on the new law may contact Adam Carlson at the MHA, while questions regarding amending their facility policies should contact Amy Barkholz at the MHA.

Hospital Funding Approved, CRNA Legislation Signed into Law

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

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

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

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

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

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

Healthcare Bills Progress Prior to State Legislative Summer Break

Dr Roper

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

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

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

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

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

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

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

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

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

Michigan Legislature Advances Healthcare Bills

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Adam Carlson, vice president, advocacy, MHA, testified June 17 before the House Policy Committee.The Michigan House and Senate took up multiple pieces of legislation impacting hospitals during the week of June 14. The full Senate voted in favor of legislation to modernize the scope of practice for Certified Registered Nurse Anesthetists (CRNAs), and policy committees addressed legislation to create systems of care for time-sensitive emergencies, regulate pharmacy benefit managers and clarify reciprocity for Canadian health professional licensure.

The full Michigan Senate voted June 17 to support House Bill (HB) 4359, which would modernize the scope of practice for CRNAs in Michigan. The legislation was introduced by Rep. Mary Whiteford (R-Casco Township) and was supported with MHA testimony in both the House and Senate. HB 4359 would bring Michigan in line with 42 other states and the U.S. military, all of which provide flexibility regarding physician supervision of CRNAs delivering anesthesia care. The Senate adopted changes to add definitions and clarifications to what must be included in health facility policies for CRNAs to practice under the legislation. These changes must be confirmed by the House before the bill is sent to the governor’s desk for signature. The MHA will continue to monitor any action on HB 4359.

The Senate Health Policy and Human Services Committee voted to report a bill to create systems of care for time-sensitive emergencies to the Senate floor. Senate Bill (SB) 521 was introduced by Sen. John Bizon (R-Battle Creek) and would direct the Michigan Department of Health and Human Services to create accreditation levels for hospitals that would indicate their ability to treat patients who had strokes or heart attacks. The MHA supported SB 521 in committee, and the bill will next be voted on by the full Senate.

The Senate Health Policy and Human Services Committee also held testimony on HB 4348, which was introduced by Rep. Julie Calley (R-Portland) and would establish licensure and new regulation for Pharmacy Benefit Managers (PBMs). The MHA supports the legislation, which could help to slow the rising cost of prescription medications.

The Health Policy Committee took testimony on SB 416, which was introduced by Sen. Wayne Schmidt (R-Traverse City) and would clarify existing law allowing for limited licensure reciprocity for Canadian health professionals, ensuring that those who have previously taken medical exams could use those when applying for Michigan licensure. In its testimony before the committee, the MHA said this bill would unnecessarily force providers from Canada to potentially retake qualifying exams they had already passed, which is not possible in some cases.

Members with any questions on any of this legislation should contact Adam Carlson at the MHA.

MHA Monday Report June 14, 2021

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

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


MHA Provides Testimony in Senate on Newly Introduced Legislation

The Michigan Legislature addressed several bills impacting hospitals during the week of June 7, including legislation that would create new statewide systems of care for two time-sensitive emergency medical conditions, modernize scope of practice for …


Association Submits Comments on Medicare Post-acute Care Proposed Rules

The MHA recently submitted comments to the Centers for Medicare & Medicaid Services regarding the proposed rules to update the Medicare fee-for-service prospective payment systems for fiscal year 2022 for several post-acute care …


Community Benefit Reporting and the COVID-19 Pandemic Discussed in Webinar

The COVID-19 pandemic has had significant impacts on communities, patients and the hospitals that serve them and has severely affected hospital finances. Questions have arisen regarding how pandemic-related expenses, revenues and …


MHA and MHA Keystone Center Events Focus on Diversity, Equity and Inclusion

To act deliberately and purposefully to ensure outcomes across all patient populations are equitable, leaders should know where disparities exist, ways to prevent disparities and how to create a culture and system that reduces disparities to improve quality and …


Chief Medical Officer Debunks COVID-19 Vaccine Myths on MiCare Champion Cast

The MHA released a new episode of the MiCare Champion Cast, which features interviews with healthcare policy experts in Michigan on key issues that impact healthcare and the health of communities. …


High Reliability Leads to Safe Work Environment

Creating a highly reliable hospital requires a commitment to a just culture, continuous learning and designing care improvement. The webinar High Reliability in the Time of COVID-19, scheduled from noon to 1 p.m. EDT June 24, will review high reliability principles proven …


CyberForce|Q Offers Continuous, Collective Approach to Cybersecurity Assessments

The MHA’s newest Endorsed Business Partner, CyberForce|Q, offers a new approach to cybersecurity for healthcare organizations. CEO Eric Eder described a situation where a rural healthcare system’s CEO shared his organization’s experience …


Headline Roundup: Week of June 6 for COVID-19 in Michigan

The MHA has compiled a collection of media stories that include references to the MHA related to the last COVID-19 surge and vaccines. …

The Keckley Report

Post Pandemic, Affordability Looms as the Big Challenge in Healthcare — This Time, It’s Different

“Pre-pandemic, polls showed healthcare costs were a major concern to U.S. consumers. Post-pandemic, indications are it will re-surface as the industry’s biggest challenge, particularly affordability. But this time, consumers are likely to act differently on their concerns.”

Paul Keckley, June 8, 2021


MHA in the News

Modern Healthcare published an interview with MHA CEO Brian Peters June 7 discussing the new administrative rules requiring implicit bias training for licensure or registration of healthcare professionals in Michigan.

MHA Provides Testimony in Senate on Newly Introduced Legislation

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Alex Chebl, MD, director of the Henry Ford Stroke Center and head of the Division of Vascular Neurology at Henry Ford Health SystemThe Michigan Legislature addressed several bills impacting hospitals during the week of June 7, including legislation that would create new statewide systems of care for two time-sensitive emergency medical conditions, modernize scope of practice for certified registered nurse anesthetists (CRNAs), and remove certain positron emission tomography (PET) scanner services from the Certificate of Need (CON) program.

The Senate Health Policy and Human Services Committee took initial testimony on Senate Bill (SB) 521, introduced by Sen. John Bizon, MD (R-Battle Creek). SB 521 would direct the Michigan Department of Health and Human Services to create accreditation levels for hospitals that would indicate their ability to treat patients experiencing a stroke or ST-elevated myocardial infarction (STEMI). Alex Chebl, MD, director of the Henry Ford Stroke Center and head of the Division of Vascular Neurology at Henry Ford Health System, joined the MHA to provide testimony to the committee supporting this potentially lifesaving legislation. “It is critical all patients throughout the state have access to the best stroke care possible. SB 521 is an essential step to improving the quality of stroke care in the state of Michigan.” said Chebl.

The Senate Health Policy and Human Services Committee also addressed House Bill (HB) 4359, introduced by Rep. Mary Whiteford (R-Casco Twp.). The bill would modernize the scope of practice for CRNAs, who are currently required by the state of Michigan to be supervised by a licensed physician of any specialty when delivering anesthesia care. The MHA supports HB 4359, which would bring Michigan in line with 42 other states and the U.S. military to provide flexibility regarding the physician supervision requirement. The committee reported HB 4359 to the Senate floor, where it awaits a vote.

The full Senate voted on SB 416, which was introduced by Sen. Wayne Schmidt (R-Traverse City) and would ensure that Canadian health professionals who have previously taken relevant medical exams could apply for Michigan licensure. SB 416 is a clarification of MHA-supported legislation passed last session that provided licensure reciprocity to Canadian health professionals who want to work in Michigan. SB 416 will now be sent to the House Health Policy Committee for further action.

The House voted on SB 440, which would remove certain PET scanner services from CON oversight. SB 440 was introduced by Sen. Winnie Brinks (D-Grand Rapids) and would remove a specific technology from CON regulation that is expected to be before the CON commission June 17. The MHA opposed SB 440, which undermines the CON process that ensures high-quality, accessible, cost-effective care for Michigan patients. The House approved the legislation, which will now go to the governor’s desk for final signature.

Members with questions on any of this legislation should contact Adam Carlson at the MHA.

MHA Members Testify Before Senate Committee on CRNA Legislation

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The Senate’s Health and Human Services Policy Committee addressed a pair of bills relevant to hospitals during the week of May 17. The committee took testimony on House Bill (HB) 4359, which would modernize the scope of practice for certified registered nurse anesthetists (CRNAs). The committee also took up Senate Bill (SB) 440, which would remove certain positron emission tomography (PET) scanner services from Certificate of Need (CON) oversight.

Steve Barnett, president and CEO, McKenzie Health, and David Jahn, president and CEO, War Memorial Hospital, provided testimony May 20 to the committee in support of HB 4359. “This legislation will increase access to healthcare for Michigan residents. It will reduce costs for Michigan residents. It will permit CRNAs to practice to the full extent of what their license already provides for – and it will do all of this while maintaining every bit of patient safety,” said Jahn.

The MHA supports HB 4359 that, by modernizing the scope of practice for CRNAs, would allow flexibility for each hospital to choose the anesthesia care model that best fits its location, staffing and resources to offer safe and effective patient care. The bill, sponsored by Rep. Mary Whiteford (R-Casco Township), would also bring Michigan in line with 42 other states and the U.S. military on this issue. This change would eliminate a costly regulation while maintaining patient safety and would put into law a policy that has been allowed and proven effective during the COVID-19 pandemic. Current Michigan law requires a licensed physician of any specialty to supervise a CRNA to deliver anesthesia care.

The committee also voted to report SB 440, introduced by Sen. Winnie Brinks (D-Grand Rapids), to the Senate floor. The MHA supports Michigan’s existing CON process and is opposed to the bill that would, by removing certain full body PET scanner services from CON oversight, undermine the program that ensures high-quality, accessible, cost-effective care for patients in the state. The specific technology this bill seeks to address is expected to be before the CON Commission at its June meeting. The MHA will continue to monitor any action that is taken.

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