Combating the Novel Coronavirus (COVID-19): Weeks of June 28 and July 5

MHA Covid-19 update

MHA COVID-19 UpdateAccording to a new report from The Commonwealth Fund, the country’s rapid rollout of COVID-19 vaccines and continuing vaccination efforts have saved about 279,000 lives and avoided 1.25 million hospitalizations in the United States. Approximately 67% of Americans had received at least one dose of vaccine as of July 7.

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.

Children’s Health Leaders to Discuss Vaccines for Children in July 16 Webinar

The MHA will host a 45-minute webinar and discussion on COVID-19 vaccines for children, as well as the status of other scheduled vaccines for children, from 7:30 to 8:15 a.m. July 16 featuring remarks from several leaders in children’s healthcare in Michigan. The MHA has extended an invitation to this conversation to the Michigan Academy of Family Physicians and the Michigan chapter of the American Association of Pediatrics.

The agenda will include:

  • Brief overview of polling data related to individuals’ personal physicians as the trusted voice on vaccine choices.
  • COVID-19 vaccines for children, as well as comments on side effects and multi-inflammatory syndrome in children (MIS-C).
  • Status of other regularly scheduled vaccines in children, which have significantly declined during the pandemic.
  • Feedback and questions from participants.

The goal of the webinar is to increase awareness and preparedness with as many clinicians as possible before patients younger than 12 are eligible for COVID-19 vaccines and before school resumes and children are behind on other vaccines.

Members who have not yet registered may contact Ruthanne Sudderth at the MHA for registration instructions. Questions may be directed to Ruthanne or Laura Appel at the MHA.

Regulatory Flexibility for Sharps Containers Extended Through Oct. 31

The Department of Environment, Great Lakes, and Energy (EGLE) recently approved an MHA request to extend regulatory flexibility for hospitals facing an ongoing sharps container shortage. State regulation currently requires hospitals to replace sharps containers every 90 days or when full, whichever is sooner. Hospitals will continue to be exempted from the 90-day rule through Oct. 31, 2021; this will allow hospitals to replace sharps containers only when they are full.

The shortage was created by a production facility fire and increased demand for the containers due to vaccinations. The regulatory relief for MHA members was set to expire July 31 but was extended by EGLE for an additional three months.

The MHA will continue to monitor the situation and work with members to determine if additional exemptions should be requested. Questions on the extended exemption can be directed to Sean Sorenson-Abbott at the MHA.

State COVID-19 Data Dashboard Updates Will Occur Twice a Week

The state recently announced that its COVID-19 data dashboards will now be updated only on Tuesdays and Fridays instead of the former practice of updating them five days per week. However, providers are still required to enter their COVID-19 data into EMResource every day.

The state is reporting that, as of July 9, there are 211 confirmed adult COVID-19 hospitalizations and nine confirmed pediatric COVID-19 hospitalizations. More than 62% of adults 16 and older in Michigan had received at least one dose of vaccine as of July 9.

Michigan Announces Financial, Scholarship Prizes for Vaccinated Residents

Gov. Gretchen Whitmer June 28 announced the “MI Shot to Win Sweepstakes,” which may be entered by residents who get a COVID-19 vaccine. The sweepstakes includes $5 million in cash prizes for residents 18 and older and nine $55,000 college scholarships for vaccinated residents ages 12-17.

The goal of this public private partnership — also supported by the Protect Michigan Commission, Meijer, the Michigan Chamber of Commerce and the Michigan Association of United Ways, among others — is to help Michigan get at least 70% of residents vaccinated as soon as possible. Other states that have implemented similar prize programs have seen significant growth in vaccination rates. As the delta variant spreads in the U.S., reaching herd immunity levels is critical to preventing further outbreaks and deaths. In recent weeks, an average of 45,000 individuals in Michigan have initiated vaccination each week. As of July 7, 62 percent of state residents 16 and older have been given at least one dose.

The cash prizes for adults will be awarded via a $1 million drawing, a $2 million drawing, and 30 days of daily $50,000 drawings to anyone who has gotten at least one dose of the vaccine and registers for the contest.

The MHA will keep members apprised of the success of this incentive program. Members with questions may contact Ruthanne Sudderth at the MHA.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the Michigan Department of Health and Human Services Community Health Emergency Coordination Center (CHECC).

Combating the Novel Coronavirus (COVID-19): Week of Feb 8

MHA Covid-19 update

MHA COVID-19 UpdateAs of Feb. 10, the state’s COVID-19 Vaccine Dashboard indicated nearly 1.5 million doses of vaccine have been administered in Michigan to protect residents from the disease. While the virus continues its assault across the globe, the MHA keeps members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Governor’s Proposed Budget Protects Hospital Priorities, Funds COVID-19 Needs

The Executive Budget Recommendation presented to the Michigan Legislature Feb. 11 fully protects hospital and healthcare priorities and includes new funding for pandemic-related needs including testing, vaccine operations and more (see related article).

Vaccination Supply Shortages Discussed

The MHA continues to host monthly calls with the Michigan Department of Health and Human Services (MDHHS) and supply chain leaders at member hospitals. During the Feb. 8 call, the groups discussed a shortage of some types of vaccination supplies and efforts at the state level to address them. The MDHHS reminded hospital leaders that it has a limited supply of syringes available to assist with administering the sixth dose of the Pfizer vaccine that is sometimes available in a vial. A shortage of sharps containers is expected to continue for a few months. Hospitals that need additional vaccination supplies are encouraged to contact their local healthcare coalitions.

The group also discussed an alert from 3M about counterfeit N95 masks that have been found in several states. Members are encouraged to check their inventory and contact 3M at (800) 426-8688 if they have the counterfeit masks. Facilities that face a significant N95 shortage due to this fraud should contact their healthcare coalition to help fill emergency supply gaps. Members with questions may contact Adam Carlson at the MHA.

Federal Pharmacy Vaccine Program Adds Doses to State Supply

Through a federal program announced Feb. 2, COVID-19 vaccine is being sent directly to Meijer and other pharmacies to administer doses to priority populations. The doses being sent to these pharmacies are in addition to states’ existing allocation sent to hospitals and health departments. The additional doses are being sent to community pharmacies as an additional access point and are separate from the pharmacy program responsible for vaccinating long-term care facility residents/staff. The federal government has also announced it will begin sending some doses directly to federally qualified health centers.

The MHA has communicated with the state about the need to ensure any pharmacy receiving vaccine directly from the federal government is following state prioritization guidelines. State officials will work with their federal partners to communicate these priority group requirements to any pharmacy receiving vaccine directly from the federal government.

All vaccine providers in Michigan are expected to follow current priority groups for vaccinations. The vaccines should currently be administered to the following population groups:

  • Phase 1A (healthcare workers and long-term care residents).
  • Phase 1B groups A and B (first responders, pre-K through grade 12 educators, childcare workers, corrections workers and workers in other congregate care settings).
  • Phase 1C group A (residents age 65 years and older).

The state is also working to vaccinate veterans. Providers should not yet begin to vaccinate those under 65 with underlying conditions (phase 1C group B). The state’s vaccine prioritization document provides complete details about these categories. The priority groups follow federal guidance closely and are unlikely to be changed.

Vaccination Data Required

It continues to be important for providers to enter and update data on employee and patient COVID-19 vaccinations in the state EMResource portal each Wednesday. In addition, members should report race and ethnicity data on those receiving vaccinations in the Michigan Care Improvement Registry, as a primary goal for the state is to ensure there is no disparity in vaccination rates across races and ethnicities. Members facing challenges in collecting this data or with other data-related questions should contact Jim Lee at the MHA.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC).

 

Combating the Novel Coronavirus (COVID-19): Week of July 13

MHA Covid-19 update

coronavirus updateAs the state experiences a steady rise in the number of COVID-19 cases, Gov. Gretchen Whitmer has extended the official state of emergency in Michigan through Aug. 11. The MHA continues to keep members apprised of developments during the pandemic through email updates and the MHA Coronavirus webpage. Important updates on how the pandemic is affecting Michigan hospitals are outlined below.

HHS Announces Next Tranche of Funds for Hospitals with High COVID-19 Caseloads

The U.S. Department of Health and Human Services (HHS) announced July 17 that it will distribute $10 billion to hospitals with high numbers of COVID-19 patients, beginning the week of July 20. This is the second tranche of high-impact funds from the federal Coronavirus Aid, Relief, and Economic Security (CARES) Act.

Using data hospitals submitted on COVID-19-positive inpatient admissions for the period Jan. 1 to June 10, 2020, the HHS based this distribution on a formula for hospitals with over 161 COVID-19 admissions during that period, equating to one admission per day, or that experienced a disproportionate intensity of COVID-19 admissions (exceeding the average ratio of COVID-19 admissions/bed). The HHS also considered previous high-impact payments when determining each hospital’s payment in this distribution. Hospitals will be paid $50,000 per eligible admission.

The MHA and American Hospital Association have been advocating for additional hospital financial relief at every opportunity. This funding comes at a critical time, as cases of COVID-19 in Michigan are again rising. However, since not all hospitals will meet the threshold for receiving high-impact funds, securing additional funds for all hospitals and loan forgiveness for Medicare advance payments remain among the association’s top priorities.

Members with federal advocacy questions may contact Laura Appel at the MHA.

Changes Made in Federal Requirements for COVID-19 Reporting

The U.S. Department of Health and Human Services (HHS) announced July 13 it would discontinue the use of the National Healthcare and Safety Network COVID-19 Module for hospitals starting July 15. Instead, hospitals will be required to enter COVID-19 information daily into the HHS Teletracking portal. The department has updated its guidance and frequently asked questions (FAQs) to reflect the data fields that will be collected and their definitions, including new data elements.

The MHA is currently working with the state of Michigan to modify the state’s EMResource data collection system to allow the state to submit data on behalf of Michigan hospitals and to expedite the state and federal government approval process. Until the state of Michigan receives approval from the federal government, hospitals must enter COVID-19 information daily into both the HHS Teletracking portal and EMResource to be eligible to receive future distribution of resources, including pharmaceuticals and more.

The association will notify members when the state receives approval from the federal government to submit data on behalf of hospitals, which will allow providers to make daily entries into only the EMResource system. Members with questions may contact Jim Lee at the MHA.

State Works with MHA on Ending Relaxation of Scope of Practice, Immunity Provisions

The governor issued Executive Order (EO) 2020-150 to rescind EO 2020-61, which had allowed healthcare practitioners to temporarily practice beyond the scope of their license, with limitations. The governor referenced stable and manageable COVID-19 hospitalization rates and hospital resources as the reason for rescinding the expansion of scope, which also removed certain important immunity provisions that protected healthcare facilities and entities during the pandemic, effective July 13.

The MHA discussed the EO with the Michigan Department of Licensing and Regulatory Affairs (LARA), and the department issued a memo July 17 that outlines flexibility and license requirements that remain in place under EO 2020-150. The memo is available via the July 17 email update to members and also provides a timeline for returning to normal order for scope of practice. LARA is allowing providers an extended compliance deadline of 11:59 p.m. Aug. 31 before enforcing the updated supervision and other requirements. In addition, the EO extends the suspension of certain licensing and certification requirements for healthcare professionals, life support and first aid workers, and 911 operators.

Meanwhile, the MHA is working with the Legislature on Senate Bill 899, which would secure important immunity protections similar to those afforded in EO 2020-61. Members with questions on the memo from LARA may contact Paige Fults at the MHA.

MIOSHA Hospital State Emphasis Program and Requests for Voluntary Inspections

The Michigan Occupational Safety and Health Administration (MIOSHA) recently announced its Hospital State Emphasis Program, which focuses on inspecting hospital facilities for appropriate personal protective equipment and staff safety related to COVID-19.

Since the initial announcement, the MHA has shared a letter with leadership at the Department of Labor and Economic Opportunity suggesting opportunities for achieving good outcomes for patient care and worker safety. The MHA continues to work with MIOSHA to clarify areas of a FAQs document the agency is preparing.

While a limited number of MHA members are expected to be contacted for inspection under the State Emphasis Program, members may use MIOSHA in a consulting manner by request. Michigan employers may request a voluntary MIOSHA inspection of their workplace (full or partial) without the attachment of fines or penalties. These on-site consultations are conducted by occupational safety consultants or industrial hygienists through the Consultation Education and Training Division. Prior to the start of this type of inspection, employers must agree to correct all serious violations found during the voluntary inspection. For more information about the Hospital State Emphasis Program, contact Laura Appel at the MHA.

Governor Updates Mask Requirement

Gov. Gretchen Whitmer July 17 issued an updated executive order (EO 2020-153) requiring masks to be worn in public places and businesses and providing some clarification for how the requirement should be interpreted and enforced. Essentially, the new order provides clarity about law enforcement officers wearing masks, who is not required to wear a mask, and exceptions for removing a mask.

Healthcare settings are not mentioned specifically in the updated order; however, members continue to be advised to make their best effort to comply with the mask requirement enforcement for patients and visitors in their facilities, while prioritizing patients’ individual health and circumstances.

State Discusses Supply Chain Issues with MHA Members

The MHA continues to host calls for hospital supply chain contacts as needed. During a recent call, the state indicated it is working to increase the supply of key personal protective equipment, with a goal of having a 90-day supply on hand. Nitrile gloves will continue to be in short supply, and hospitals should follow conservation recommendations of the Centers for Disease Control and Prevention as much as possible.

MHA member HPS, a group purchasing organization, said that most of its vendors have an ample supply of personal protective equipment and related items available. The organization encourages groups that are not current HPS members to consider partnering with HPS as it adds additional contracts for personal protective equipment during the summer. Members with questions may contact Kevin Crampton at HPS.

Opportunities Available for Pooling Lab Tests for Asymptomatic Individuals

The MHA and the Michigan Department of Health and Human Services (MDHHS) host weekly calls with laboratory directors regarding COVID-19 testing capacity and the increasing demand for screening of asymptomatic populations. Those calls prompted a July 16 call for Michigan laboratories interested in pooled testing strategies for COVID-19, along with leaders from the state Bureau of Laboratories (BOL).

The statewide testing strategy has expanded to include more asymptomatic individuals to protect the safety of employees, students, patients and others. While this is a positive step, it has also placed further strain on an already limited supply of COVID-19 diagnostic tests. Pooling samples of asymptomatic individuals preserves limited testing resources but requires additional validation because the Food and Drug Administration (FDA) has approved the current diagnostic tests only for individuals suspected of having COVID-19.

To streamline additional studies, the FDA released in June template updates regarding the validation of diagnostic tests for developers that intend their analysis to be used for pooling patient samples or for screening asymptomatic individuals not suspected of having COVID-19. In addition, the FDA has made available new testing FAQs with information regarding the screening of asymptomatic individuals.

Labs that plan to begin their own validation studies are encouraged to share the information with the Michigan BOL. Members with questions, or those who wish to join the MHA calls with the laboratory directors, may contact Brittany Bogan at the MHA.

Healthcare Heroes Acknowledged via Social Media

From April through June, the MHA ran a social media campaign recognizing the heroic workers on the front lines of COVID-19 working throughout its member hospitals and health systems. The effort highlighted more than 250 healthcare professionals — nurses, physicians, environmental service workers and others — from communities across the state and thanked them for their dedication to fighting COVID-19 and caring for patients. Using information supplied by member hospitals, the campaign ran on the MHA’s Facebook, Twitter and Instagram accounts, and several video samples of the posts were included in related articles on the MHA Newsroom webpage. More than 431,000 people shared, liked and/or commented on the posts. Members with questions may contact Ruthanne Sudderth at the MHA.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC). Members with MHA-specific questions should contact the following MHA staff members:

Combating the Novel Coronavirus (COVID-19): Week of June 29

MHA Covid-19 update

The MHA continues to keep members apprised of developments during the pandemic through email updates and the MHA Coronavirus webpage. Important updates on how the pandemic is affecting Michigan hospitals are outlined below.

State Budget Deficit Deal Contains no Healthcare Cuts

Gov. Gretchen Whitmer and legislative leaders announced June 29 they reached an agreement to resolve the fiscal year (FY) 2019-2020 budget deficit. The deal uses a combination of funding from the state Budget Stabilization Fund, federal Coronavirus Relief Funds (CRF) and cuts to the state budget. No cuts to healthcare were announced in the information provided.

In a joint release, Senate Majority Leader Mike Shirkey (R-Clarklake), House Speaker Lee Chatfield (R-Levering) and the governor spelled out approximately $900 million in spending from the federal funds for schools, hazard pay for teachers, replacement funds for colleges and universities, and new funds for local governments. Together with what was appropriated earlier in June, the state will have allocated $3 billion of its existing CRF. The budget also recognizes the benefit of the enhanced federal Medicaid matching funds, which brings $340 million to the state for the current fiscal year.

The budget agreement includes $490 million in savings to state government. This includes state layoffs, furlough days and budget cuts. The MHA does not believe rural hospitals or labor and delivery funding for small and rural hospitals is at risk. The association will continue its efforts to ensure the appropriations for hospital Medicaid funding remain in place and continue into FY 2021. For more information about the FY 2020 budget agreement, contact Adam Carlson at the MHA.

Additional Allocation and Guidance Announced for Remdesivir

The U.S. Department of Health and Human Services (HHS) announced June 29 an agreement with drug maker Gilead Sciences to allow U.S. hospitals to purchase, through September, up to 500,000 treatment courses of remdesivir, the antiviral drug that has shown encouraging results in treating COVID-19 patients. As with the 120,000 treatment courses donated earlier by the drug maker, the HHS and state health departments will allocate them based on hospitalization data.

Under the agreement, hospitals will pay no more than the wholesale acquisition price for the drug, up to $3,200 per five-day treatment course. To make future allocations of remdesivir, the HHS will be asking hospitals and health systems to submit data every two weeks.

The state of Michigan recently updated guidance for the use of remdesivir, which is available through the June 30 COVID-19 update that was emailed to members. The state is also asking for the completion of a two-part survey during treatment. Part 1 of the survey identifies the patient's profile and demographics and is due within 24 hours of starting the medication. Part 2 is a patient follow-up survey that captures outcome data. Members with questions may contact Laura Appel at the MHA.

One COVID-19 Data Submission Can Now Fulfill EMResource and NHSN Requirements

The state of Michigan has started the process of uploading COVID-19 data from EMResource into the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN) COVID-19 Module. This process will allow hospitals to enter data in the EMResource system with no duplicate data entry into the NHSN COVID-19 Module.

To facilitate this, hospitals must enter the NHSN ID associated with each facility in EMResource, ensure the mandatory baseline data elements have been entered, and update within 24 hours any EMResource data elements that correspond to the NHSN COVID-19 Module data elements. The upload process will occur daily for data entered by 5 p.m. Hospitals should log into the NHSN system the following day to verify the data was uploaded correctly. Members with questions on the process should contact Jim Lee at the MHA.

AHA Releases New COVID-19 Financial Impact Report

The American Hospital Association (AHA) released a financial impact report June 30 that estimates at least an additional $120.5 billion in financial losses for the nation’s hospitals from July 2020 through December 2020, due in large part to lower patient volumes. These estimates are in addition to the $202.6 billion in losses the AHA estimated between March 2020 and June 2020 in a report released in May. This brings total losses for the nation’s hospitals and health systems to at least $323.1 billion in 2020. The MHA is regularly collecting data from members on the financial impact the pandemic is having on Michigan hospitals. For more information, contact Jason Jorkasky at the MHA.

Delays in Unemployment Insurance Benefits

Some people who filed unemployment claims due to the COVID-19 pandemic have not received their unemployment benefits or are receiving them sporadically. The Michigan Unemployment Insurance Agency (UIA) is experiencing a backlog due to the extraordinary volume of claims received, the surge of fraudulent identity theft claims that recently occurred, and the limitations of work volume that can be completed by the UIA’s adjudication staff. The UIA has announced that it is working to resolve the backlog of claims and has indicated that all claimants who are eligible for benefits will receive them. Members with questions related to unemployment claims may contact Neil MacVicar at the MHA.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the Michigan Department of Health and Human Services Community Health Emergency Coordination Center (CHECC). Members with MHA-specific questions should contact the following MHA staff members:

Combating the Novel Coronavirus (COVID-19): Week of May 18

MHA Covid-19 update

MHA COVID-19 UpdateThe MHA has continued to keep members apprised of developments during the COVID-19 pandemic through regular email updates and the MHA Coronavirus webpage. Important updates on how the pandemic is affecting Michigan hospitals are outlined below.

Executive Order 2020-17 Rescinded, Other Restrictions Eased

Gov. Gretchen Whitmer announced May 21 that she is rescinding Executive Order (EO) 2020-17 effective May 29. This EO was issued in March and banned “nonessential” medical procedures in hospitals, ambulatory surgery centers and dentists’ offices. The MHA issued a media statement in support of her action and will continue to run statewide television and social media ads urging people not to delay care and assuring that hospitals are safe places to receive services.

The governor also announced during a May 21 news conference that auto dealerships, retailers and veterinarians can open to the public, by appointment only, effective May 29, and that, effective immediately, groups of 10 or fewer people may gather outside of their homes. Whitmer announced May 18 that the Upper Peninsula (Region 8) and 17 counties in northern lower Michigan (Region 6) will be permitted to partially reopen their economies May 22, in accordance with the “Safe Start” recommendations developed by the Michigan Economic Recovery Council.

Liability Protections for Healthcare Workers, Facilities

The MHA testified May 19 via videoconference before the state House Judiciary Committee to advocate for Senate Bill (SB) 899, which offers strong and broad liability protections for healthcare workers and facilities treating COVID-19 patients. The MHA and members have identified this as an important element to operating within pandemic and emergency situations. A variety of other healthcare groups submitted cards of support for the bill, including the Michigan State Medical Society and the Healthcare Association of Michigan, which represents long-term care facilities.

SB 899 originally passed the Senate May 7. The MHA will continue to work with members of the House of Representatives as the legislation progresses to support healthcare personnel responding to the COVID-19 pandemic. Members with questions may contact Adam Carlson at the MHA.

Laboratories and Testing

The Michigan Department of Health & Human Services (MDHHS) announced May 18 that the Laboratory Emergency Response Network (MiCLERN) hotline will be taken offline at 5 p.m. ET May 22. The announcement stated that this is due to “recent changes to COVID-19 prioritization criteria and stabilized testing capacity that no longer requires prior issuance of Person Under Investigation (PUI) identifiers for MDHHS Bureau of Laboratory (BOL) testing of COVID-19 specimens.” The state clarified that COVID-19 specimens that are sent to the state laboratory no longer require a PUI form, but should still include the State of Michigan Test Requisition form (DCH-0583) and two unique identifiers.

Hospitals in need of swabs and transport media for testing are reminded to report their needs to the BOL by sending an email to MDHHSLab@michigan.gov using the subject line “EM COVID-19 Supplies,” per recent guidance shared with members in the May 6 email update. Members with questions should contact Brittany Bogan at the MHA.

MVC Offers Resources for Resuming Non-COVID Procedures

The Michigan Value Collaborative (MVC) represents a partnership among 87 Michigan hospitals and 40 physician organizations that aims to improve the health of Michigan through sustainable high-value healthcare. Supported by Blue Cross Blue Shield of Michigan, the MVC helps its members better understand their performance using robust multipayer data, customized analytics and at-the-elbow support.

To assist hospital systems with prioritizing the restart of surgical services with the least impact on caring for remaining COVID-19 patients, the MVC has designed reports that display resource utilization metrics at a statewide and member hospital level for 17 elective surgical procedures. More information is available by contacting the MHA Keystone Center.

Pharmacy Refill Order Extended

The governor signed EO 2020-93 May 19, extending a previous order giving pharmacists increased operational capacity. It also expands access to prescriptions for patients. The order allows pharmacists to dispense emergency refills of prescriptions for up to a 60-day supply and requires insurers to cover early refills for up to a 90-day supply during the pandemic. It also allows pharmacists to dispense COVID-19 treatments according to government-approved protocols. EO 2020-93 took immediate effect and will expire at 11:59 p.m. June 16, 2020. Members with questions may contact Paige Fults at the MHA.

EMResource Now Tracking Psychiatric Facility Data

The state of Michigan recently launched a new module in EMResource targeted toward freestanding psychiatric facilities. The data collected in this new module requests data on beds, COVID-19 patients, staffing and personal protective equipment availability. Psychiatric facilities are required to report this information weekly by 11:59 p.m. ET every Friday. The MHA is seeking clarification from the state on whether this data will also be posted to its COVID-19 data website alongside existing health system/hospital data on related measures, or on any other public website. Members with questions may contact Jim Lee at the MHA.

Multisystem Inflammatory Syndrome in Children

A Clinician Outreach and Communication Activity webinar on the clinical characteristics of Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 is now available online. The Centers for Disease Control & Prevention (CDC) hosted the webinar May 19. The MDHHS reported that, since April 1, there have been 28 identified cases in Michigan, and treatment with intravenous immunoglobulin and steroids is proving to be effective. The CDC issued a Health Advisory May 14 and recommends healthcare providers report any patient who meets the case definition to local and state health departments to enhance knowledge of risk factors, clinical course, and treatment of this syndrome.

Healthcare Workers Still Permitted to Cross Closed Canadian Borders

The U.S. Department of Homeland Security May 19 reissued its order closing the United States – Canadian ground border through 11:59 p.m. ET June 22. Healthcare workers will continue to be permitted to cross to report to work.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. If staff members at MHA-member facilities are not receiving necessary information from the MHA, they are asked to check the spam/junk mail folders in their email systems or ask their information technology departments to ensure MHA messages are not being blocked.

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:

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

MHA Covid-19 update

Gov. Gretchen Whitmer issued Executive Order (EO) 2020-77 May 7, extending the stay-at-home order to May 28 while allowing some manufacturers to gradually reopen under her “MI Safe Start” plan. The TCF Center in Detroit, which was converted to a field hospital in April to assist Southeast Michigan hospitals with large numbers of patients due to the pandemic, released its final patient May 7; it stands ready to accept patients in the event of a second surge of the virus. Meanwhile, the MHA has continued to send regular updates to MHA members on matters related to the pandemic. Additional updates and resources are available on the MHA COVID-19 webpage. Following are highlights from the week of May 4.

Funding: Federal Emergency Management Agency (FEMA)

Virtual briefings providing an overview of the FEMA Public Assistance Grant Program, which are required as a condition of applying for the grants, are scheduled for 10:30 a.m. and 2 p.m. May 12 and 13. The briefings discuss eligibility requirements and explain the project application and reimbursement processes. The state has now posted for review the FEMA Public Assistance training slides and questions and answers related to the briefings. Representatives from management, emergency response, and accounting/finance/procurement operations are encouraged to participate May 12 or 13. Registration instructions are available on the Michigan State Police Emergency Management & Homeland Security Department webpage.

Funding: Federal Allocation, Extended Deadline for Attestation

The MHA sent a letter to U.S. Department of Health & Human Services (HHS) Secretary Alex Azar II May 6 asking that future distribution of federal hospital relief funds consider COVID-19 caseloads rather than only historical financial data. Because Michigan hospitals have kept costs down, the distribution of the initial allocations of CARES Act funding to the state’s hospitals was disproportionately low.

The Department of Health and Human Services (HHS) announced May 7 that it has extended the deadline from 30 days to 45 days for healthcare providers to attest to receipt of payments from the Provider Relief Fund and accept the Terms and Conditions. The HHS will view hospitals that do not return the payment within 45 days of its receipt as having accepted the Terms and Conditions. Members can visit the HHS Provider Relief webpage for more information on these funds, allocations and more. Members should contact the MHA with any questions or concerns about the attestation process.

The association is encouraged that recently announced allocations are being distributed to many of the hardest hit hospitals and rural providers throughout the nation. The MHA will continue to identify opportunities for financial relief for Michigan hospitals and health systems. Members with questions on federal funding related to COVID-19 may contact Adam Carlson at the MHA.

Medicaid Coverage for Physical, Occupational and Speech Therapy via Telemedicine

The Medical Services Administration (MSA), which oversees the state’s Medicaid program, issued Policy Bulletin MSA 20-22 May 6, allowing for Medicaid coverage of telemedicine visits for physical, occupational and speech therapy. This follows an earlier announcement of a similar Medicare policy. The Medicaid coverage is effective March 1, 2020, in conjunction with the first cases of COVID-19 in the state and will be available only until the MSA notifies providers it has expired. To qualify for payment, services must be delivered with both audio and visual capabilities. Comments on the policy are due June 9, 2020. Directions for submitting comments are included in the bulletin, and providers may email questions about the bulletin to the MSA.

COVID-19 Testing and Testing Supplies

The MHA continues to focus on directing additional testing supplies to members and coordinating needs between state lab directors and hospital lab personnel. Testing must be conducted within state-mandated priority populations that were established April 20. Individuals requesting tests who do not fit one of the priority categories may be accommodated if the testing facility has the capacity after first testing all priority subjects. If they do not have the capacity, that subject may be turned away or referred to another test site. A database of test sites is available online.

The Michigan Department of Health and Human Services (MDHHS) recently shared clarification on how hospitals and other healthcare providers can request specimen collection supplies from the state Bureau of Laboratories (BOL). A link to the BOL instruction was provided to members in the May 6 email update. The state does not have a stockpile of these collection supplies; it is distributing supplies as they are received. Therefore, it is critical that hospitals communicate their needs to the state. In addition, hospitals that are conducting in-house testing are urged to respond daily to the two lab supply questions in EMResource.

Although the Medicare program no longer requires beneficiaries to have a physician order to qualify for payment of a COVID-19 test, such orders are required by private insurers, Medicaid and other programs. Hospitals are urged to continue to provide their communities with information about testing available and requirements, including the state-mandated testing priorities, physician order requirements, their policies for testing uninsured individuals, whether appointments are necessary to receive testing, and other rules and recommendations.

The MDHHS instructs hospitals treating a patient who is homeless to contact the local health department while the patient is still hospitalized so that the local health department can appropriately plan for the safe discharge of that patient, assisting with resources, etc.

Members with questions on COVID-19 testing may contact Brittany Bogan at the MHA.

Elective Procedures, Hospital Visitors, Don’t Delay Care Campaign

The state’s chief medical executive Joneigh Khaldun, MD, issued a letter to healthcare providers May 3 providing additional guidance on EO 2020-17 related to nonessential medical procedures. While the order remains in place until the state of emergency expires, Khaldun strongly encouraged providers to reengage on services and procedures that are important for patient health and well-being. Referring to the verbiage in EO 2020-17, she stated, “This wording is intended to be flexible, preserve clinician judgement, and encourage consideration on an individual basis of which patient services can be safely delayed without resulting in a significant decline in health. EO 2020-17 gives providers broad discretion to apply this standard. I … applaud current efforts to re-engage with patients in the safest way possible and within the scope of Executive Order 2020-17.”

In addition, the MHA spoke with the Department of Licensing and Regulatory Affairs (LARA) May 8 regarding continued member concerns regarding procedures that are permissible while EO 2020-17 remains in place. Representatives from LARA agreed with Khaldun, saying, “a licensed medical provider should use his/her best clinical judgement to determine whether a procedure, emergency or nonemergency, is needed to preserve the health and safety of a patient.” LARA representatives indicated that the health, safety, and welfare of the patient includes consideration of the ability to function, pain management, or compromise of other body mechanics of systems. Additional information from LARA was included in the May 8 update emailed to members.

In other action affecting hospital operations, EO 2020-72 was issued May 3 to extend the previously ordered restrictions on visitors entering healthcare facilities through May 31. Members should consider updating their patient and public communications with this new date.

The MHA announced May 8 its television and social media campaign urging Michiganders to not delay services – especially emergency care – and that hospitals are safe places to receive care. Ads will run on statewide television through June thanks to support and donated time from the Michigan Association of Broadcasters and its member networks (see related news release).

Healthcare Liability Protections

Senate Bill 899, which offers strong and broad protections for healthcare workers and facilities treating COVID-19 patients, was passed by the full Senate May 7 and sent to the House for consideration. The Michigan Association for Justice and the American Federation of State, County and Municipal Employees (AFSCME) oppose the bill, which the House is expected to discuss during the week of May 11. Members with questions may contact Adam Carlson at the MHA.

MDHHS Issues EO on Handling of Bodies

To alleviate the burden on some hospitals and funeral homes caused by COVID-19 deaths in their communities, MDHHS Director Robert Gordon issued an EO May 4 that reduces to 24 hours the amount of time hospitals and funeral directors have to contact individuals with “authority over disposition of the body of a deceased individual” with COVID-19. If a family member or other person with this authority cannot be identified, the county medical examiner will make the necessary decisions. The order also reduces to 48 hours the length of time the authorized individual is given to arrange for disposition of the body. If they do not do so within this timeframe, that person forfeits the right to make the decision.

The order also “relaxes certain licensing provisions for funeral directors, allows funeral directors and medical examiners to authorize embalming, and allows for storage of bodies at a temporary storage facility provided by the Michigan Mortuary Response Team or at an alternate site procured by the license holder.”

The MDHHS issued additional information May 6 to guide steps for maintaining good documentation and record keeping related to final disposition. It includes a section on alternate storage options to ensure that decedents are stored in a respectful and appropriate manner. The MDHHS guidance was attached to the email sent to members May 6. Members with questions may contact Chris Mitchell at the MHA.

Pharmacy Sterile Compounding Accreditation Extended

Hospitals whose pharmacy licenses expire June 30 will not need to submit verification of current sterile compounding accreditation by a Board-approved entity or compliance with United States Pharmacopeia standards with their renewal application. The Joint Commission, National Association of Boards of Pharmacy and the Pharmacy Compounding Accreditation Board agreed that previously accredited sterile compounding entities may have their accreditation or compliance verification extended through the state of emergency in Michigan and for six months thereafter. This allows hospitals to renew their license without an on-site inspection by a Board-approved accreditation or verification entity. However, once the state of emergency in Michigan has ended, hospitals will have six months to undergo an on-site inspection by one of the three organizations and to submit proof of that inspection to the Bureau of Professional Licensing. Members with questions may contact Paige Fults at the MHA.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpageIf staff members at MHA-member facilities are not receiving necessary information from the MHA, they are asked to check the spam/junk mail folders in their email systems or ask their information technology departments to ensure MHA messages are not being blocked.

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:

Combating the 2019 Novel Coronavirus (COVID-19): Week of April 20

MHA Covid-19 update

COVID-19 UpdateAs Gov. Gretchen Whitmer extended the stay home, stay safe order for an additional two weeks, with relaxation of some of the former restrictions, the MHA has continued to send regular updates to MHA members on ways the pandemic affects them. Additional updates and resources are available on the MHA COVID-19 webpage. Highlights from the week of April 20 are summarized below.

Healthcare Funding

The U.S. Department of Health and Human Services (HHS) has provided information on additional allocations of funding through the federal Coronavirus Aid, Relief, and Economic Security (CARES) Act. Distribution of $20 billion from Provider Relief Fund was expected to begin as early as April 24 to Medicare facilities and providers impacted by COVID-19. This is second portion of the $50 billion allocated from the fund for general distribution; $30 billion was sent to providers in early April. In addition, hospitals in areas that have been particularly impacted by the outbreak will share $10 billion in targeted funds. An additional $10 billion will be distributed among rural health clinics and hospitals that have been affected. More information was emailed to members in the April 22 member update.

To receive future funds from the CARES Act, the HHS requires additional reporting from hospitals. The information necessary to submit the data did not reach some hospitals, creating significant confusion. As a result of requests from the MHA, other state hospital associations and the American Hospital Association, the HHS extended the submission deadline from 11:59 p.m. EDT April 23 to 3 p.m. EDT April 25. Hospitals that continue to have difficulty submitting data should contact technical support at HHS vendor TeleTracking at (877) 570-6903, leaving a message if necessary. Additional information on the requested data, including the definition of "confirmed COVID-19 diagnosis" in this instance, was emailed to members in the April 23 member update.

The Families First Coronavirus Response Act that the president signed March 18 included a provision to increase by 6.2 percentage points the Federal Medical Assistance Percentage, which determines the rate of federal matching funds for Medicaid and other government programs. This increases Michigan’s federal match rate from 64.06% to 70.26%, effective from Jan. 1, 2020, until the end of the quarter in which the federal emergency is terminated. The MHA has worked with the state of Michigan to maximize these savings for member organizations, resulting in an annual net savings of $54 million while the enhanced rate is in effect.

Included in the $484 billion Paycheck Protection Program and Health Care Enhancement Act that the president signed April 24 is $75 billion for hospitals nationwide for healthcare-related expenses or lost revenues that are attributable to the COVID-19 outbreak. An additional $321 billion is allocated to the small business lending program, which may be accessed by small and rural hospitals.

Other sources of hospital funding include a second application opportunity for Distance Learning and Telemedicine Grants offered by the U.S. Department of Agriculture. Rural hospitals are encouraged to apply for this funding to improve or initiate telehealth services in their communities (see related article). Applications are due by July 13.

In addition, the Federal Communications Commission (FCC) announced a COVID-19 Telehealth Program that will provide $200 million in funding as part of the CARES Act. While the funding lasts or until the pandemic ends, this program will provide immediate support to eligible healthcare providers by funding their communications and information services and devices necessary to provide critical connected care services. Interested hospitals should reference the FCC frequently asked questions and register for an FCC Registration Number before submitting an application. Additional guidance on the application process is available in the FCC Public Notice.

Two federal grants have been awarded to the Michigan Department of Health and Human Services (MDHHS) Behavioral Health and Developmental Disabilities Administration (BHDDA) to help ease the emotional effects of the pandemic on Michiganders. The Substance Abuse and Maternal Health Services Administration will provide $2 million to assist Michiganders living with mental health and/or substance use disorders and less severe mental illness, including healthcare professionals. The state intends to partner with five Community Mental Health Services Programs that were identified as having the greatest need related to COVID-19. A second grant from the Federal Emergency Management Agency will provide BHDDA with $372,000 to roll out a short-term emergency program providing crisis counseling to certain individuals. More information will be shared on these opportunities as it becomes available.

Testing for COVID-19

The MDHHS updated guidance for COVID-19 testing prioritization effective April 21 to include all healthcare workers, first responders, and critical infrastructure workers, regardless of whether they are experiencing symptoms. The MDHHS encourages healthcare providers to expand the amount of COVID-19 testing and announced that testing capacity can be assisted by NxGen Laboratories, Grand Rapids, using a testing method that has received Food and Drug Administration Emergency Use Authorization, supplies specimen collection materials and offers results within 48 hours. The announcements for testing prioritization and the expanded ability to process tests are included in the April 21 update that was emailed to members.  

The state of Michigan is working with a company called Castlight to publish COVID-19 test sites on the state’s coronavirus webpage. The state’s Community Health Emergency Coordination Center reviews the information on the site, confirms requests submitted by the public before they go live, and submits updates/corrections daily. The MHA urges hospitals to check the site to ensure their test sites are accurately accounted for. Missing and/or corrected information should be emailed to byrnek1@michigan.gov and puskark1@michigan.gov, including the name of the testing facility, the address and phone number of the testing site, and a brief description of the site’s testing procedure and requirements.

Hospital Data Reporting

New statewide data related to the novel coronavirus pandemic was unveiled April 23 on the state of Michigan’s coronavirus webpage. Using data that hospitals submit to the state’s EMResource portal, the MHA developed a report for the state webpage detailing information on patient census, personal protective equipment and bed occupancy rates (see related article).

Resuming Healthcare Services and Procedures

The MHA Board of Trustees discussed at its April 22 meeting some potential outcomes of hospitals beginning to safely resume time-sensitive procedures for non-COVID-19 patients (see related article). As the number of hospitalized COVID-19 patients slowly declines, some hospitals are finding capacity for procedures that were delayed under the governor’s Executive Order (EO) 2020-17. Clarification from the governor’s office confirms that authorized clinicians may use their medical judgement to determine which additional services may be resumed during Michigan’s state of emergency.

Tools for Healthcare Worker/Patient Emotional Support

The MDHHS released three documents intended for use by frontline healthcare workers and the patients they serve, focused on emotional health and well-being. They are available on the MDHHS website:

Resources for Filling Healthcare Jobs

Through a partnership of the MDHHS and the Michigan Department of Labor and Economic Opportunity, a healthcare jobs portal will soon be launched. Healthcare employers that have not previously used Pure Michigan Talent Connect (PMTC) may post open positions using the COVID-19 On Demand Hiring Intake Form. Employers with an existing PMTC profile may log into their account and follow the current post-a-job process.

The MHA also provides a job portal where hospitals can both post their staffing needs and list available staff to be shared with other facilities. Members with questions about this site may contact Sam R. Watson at the MHA.

In addition, MHA endorsed business partner Merritt Hawkins recently provided insight on physician recruiting efforts during the pandemic. The article includes information on how the interview process has evolved and ways to conduct parts of the process virtually. Members can get additional information from Benjamin Jones at Merritt Hawkins.

Racial Disparities

The pandemic has disproportionately impacted communities of color across the state. For example, while African Americans represent 13.6% of Michigan’s population, they account for 40% of the deaths from COVID-19. Therefore, the governor has created the Michigan Coronavirus Task Force on Racial Disparities to study the causes of racial disparities in the impact of COVID-19 and recommend actions to immediately address them. The MHA, which has placed a growing focus on health equity and social determinants of health, strongly supports the creation of the task force. The group is chaired by Lt. Gov. Garlin Gilchrist, and several leaders of Michigan hospitals will serve as members.

Additional information about all of these topics is available to members on the MHA Community Site and the MHA COVID-19 webpage. If staff members at MHA-member facilities are not receiving necessary information from the MHA, they are asked to check the spam/junk mail folders in their email systems or ask their information technology departments to ensure MHA messages are not being blocked.

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:

Advocacy and regulatory issues: Laura Appel

Safety and quality: Brittany Bogan

Communications and media: Ruthanne Sudderth

Emergency preparedness: Rob Wood

MHA Works with State to Provide COVID-19 Data

New statewide data related to the novel coronavirus pandemic was unveiled April 23 on the state of Michigan’s coronavirus webpage. Using data that hospitals submit to the state’s EMResource portal, the MHA developed a report for the state webpage that shows the supply of personal protective equipment (PPE) on hand, current census of COVID-19 patients, current census of COVID-19 patients in the intensive care unit, and bed occupancy rate regardless of COVID-19 status. The information is also available in a searchable dashboard format.

Shortly after the data was posted to the website, the MHA hosted a media call to brief reporters and demonstrate the data that is available for health systems and independent hospitals across the state. Several media outlets participated in the call, along with staff from Michigan hospitals. During the question-and-answer period, reporters received clarification that data from all Michigan acute-care hospitals is included, the possibility of including additional data points is being evaluated, and the factors that are included when determining how many days’ worth of PPE a hospital or system has on hand.

The data will be updated Monday and Thursday afternoons until further notice, using data that has been submitted to EMResource by 1 p.m. the previous day. Hospitals are encouraged to update their information in the portal daily to ensure their data is properly reflected. For more information on the data, contact Jim Lee at the MHA. Questions regarding media coverage of the information may be directed to Ruthanne Sudderth at the MHA.