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 Novel Coronavirus (COVID-19): Week of April 27

MHA Covid-19 update

In an April 30 move disputed by the Michigan Legislature, Gov. Gretchen Whitmer extended the state of emergency through May 28. As the COVID-19 pandemic persists into a new month, 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. Highlights from the week of April 27 are summarized below.

Availability of Emergency and Medically Necessary Care

The MHA continues to work closely with Gov. Gretchen Whitmer’s office on the status of Executive Order (EO) 2020-17, which took full effect March 21 and is now set to expire May 28, with the scheduled end of the emergency declaration. The EO has prevented hospitals, outpatient surgery centers and dentists from conducting “nonessential” services, but allows for emergency care and for clinicians to make medically based decisions to perform services they believe are necessary to preserve the health of a patient.

The Michigan Senate passed a resolution April 29 calling for the governor to rescind EO 2020-17; however, it does not result in any change to the current status of the order. A growing number of members have told the MHA that they feel well prepared to resume additional services, and the association has shared this with the governor’s office. The association expects the governor will soon make amendments to the restrictions in EO 2020-17.

The MHA appreciates the support provided to hospitals and health systems by state legislative bodies and the Whitmer administration throughout the pandemic. All Michigan hospitals have plans, processes and equipment in place to safely resume non-COVID-related services and procedures whenever EO 2020-17 expires.

In the interim, the association and healthcare providers assure residents that hospital emergency rooms are open and safe to serve all patients and that no emergency care should be delayed out of fear of contracting COVID-19. In addition, within the limitations of EO 2020-17, hospital clinicians continue to evaluate patients to ensure they safely receive other nonemergent but important care. During the governor’s latest news conferences, the state’s chief medical executive Dr. Joneigh Khaldun has urged Michiganders not to avoid needed services, especially those that may be serious in nature, and the governor said residents should reschedule care they had delayed. The MHA will continue to work with the state, other stakeholder groups and its members to educate the public about this issue. Hospital public relations directors were recently sent sample news releases to help convey this important message. Members who need additional assistance informing their communities of available services may contact Ruthanne Sudderth at the MHA.

Funding: Health Resources and Services Administration (HRSA)

Registration for the HRSA uninsured reimbursement program opened April 27. This coverage of the uninsured was authorized and funded through the Families First Coronavirus Response Act and the Coronavirus Aid, Relief and Economic Security (CARES) Act. Services will generally be reimbursed at Medicare rates and include testing, treatment and related services. As part of the online process, providers must attest that they have checked the patient’s eligibility for coverage (both private and public) and found the individual to be uninsured. Providers must also agree to the program’s terms and conditions, which include agreeing not to balance bill the patient.

Funding: Federal Emergency Management Agency (FEMA)

As a condition of applying for the FEMA Public Assistance Grant Program, applicants must attend one of the grant program virtual briefings that the Michigan State Police, Emergency Management and Homeland Security Division (MSP/EMHSD) is offering in early May. The briefings will provide an overview of the grant program to discuss eligibility requirements and explain the project application and reimbursement processes. Representatives from management, emergency response, and accounting/finance/procurement operations are encouraged to participate. Dates and registration instructions are available on the MSP/EMHSD webpage.

Included in the April 29 member update email is information private nonprofits can use to expedite access to the Grants Portal and submission of a Request for Public Assistance (RPA). The MSP/EMHSD recommends organizations complete the RPA process no later than May 15. Hospitals will not be penalized or excluded from the program for missing the recommended deadline.

FEMA will cover 75% of costs for eligible assistance protective measures that are eligible under the Public Assistance Program. The remaining 25% is the responsibility of the applicant. The MHA has confirmed with the State Budget Office that a waiver request for the 25% cost share has been submitted to the federal government and will provide more information as it becomes available.

Federal Advocacy on Hospital Funding

The MHA continues to work with Congress on elements of the next round of COVID-19 relief for hospitals and health systems. The association hosted an April 30 call with much of the Michigan congressional delegation to discuss several pandemic-related issues. The delegation indicated their continued support of loan forgiveness for Medicare accelerated payments. They shared that a national letter to congressional leadership urging this loan forgiveness is being circulated for signature by members of Congress until May 4. The MHA followed up with a letter to the delegation outlining the association’s funding priorities. An additional letter will be sent to Department of Health and Human Services (HHS) Secretary Alex Azar highlighting inequities in the federal funding distribution methodologies used to date.

In a May 1 news release, the HHS announced that $12 billion in CARES Act funding will be distributed to the 395 hospitals nationwide that have had the highest numbers of COVID-19 patients. An additional $10 billion will be distributed to rural providers.

Funding for Behavioral Health Care

The MHA sent a letter to the Michigan Department of Health and Human Services (MDHHS) April 27 asking the Michigan Medicaid director to require prepaid inpatient health plans and community mental health agencies to increase payments to psychiatric hospitals and units. The plans have continued to receive regular capitation payments for their enrollees, yet have seen a significant reduction in medical claims spending due to the decline in services. The association sent a similar letter May 1 to the State Budget Office, urging that $5.1 million be allocated for Michigan psychiatric hospitals and units from the state’s retention of funds derived through the recent increase in the federal medical assistance percentage. The MHA will continue to work with the state to address funding issues for hospitals of all kinds.

Centers for Medicare & Medicaid Services (CMS) Updates Waivers and Flexibilities

The CMS updated its waivers and flexibilities for healthcare providers April 30. The updates also provide provider-specific fact sheets. Among the updates is Medicare coverage for previously ineligible healthcare professionals who furnish telehealth services. Other updates relax requirements for coverage for the services of certain healthcare professionals, as well as requirements related to COVID-19 testing. Members with questions about the CMS waivers should contact Laura Appel at the MHA.

Executive Order Issued on Crisis Care Antidiscrimination Practices

The governor issued EO 2020-64 April 29, essentially requiring healthcare providers to ensure their COVID-19 care protocols and lifesaving medical decisions are not impacted by the presence of a patient’s disability. It also states that, for the purpose of this order, ““designated health care facility” means a hospital or an entity used as surge capacity by one or more hospitals.” An element of the EO that may differ from current practice is the requirement that hospitals post their crisis care plan on the internet and make it available by request. EO 2020-64 will expire when the state of emergency has ended.

Minor Work Permits Required During State of Emergency

Some hospitals employ minors in certain positions throughout their facilities, and the closure of schools due to the pandemic may impact young people’s ability to procure the work permit required for that employment. According to the Youth Employment Standards Employment Act, these work permits must be obtained and approved by the minor’s school. The applicable law requires the issuing school to review the work permit “in person” prior to approval. The Michigan Department of Labor and Economic Opportunity, Wage and Hour Division has confirmed this has not been relaxed despite school closures. Public school administrators are often still available, and the minor must contact the school regarding issuance of their work permit. Members with questions on this topic 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 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: