President Joe Biden issued an executive order Jan. 28 directing the U.S. Department of Health and Human Services to consider opening the HealthCare.gov website for a special enrollment period for coverage under the Affordable Care Act (ACA). The special enrollment period is expected to be open from Feb. 15 through May 15, 2021. Because the Michigan health insurance marketplace is federally facilitated, this will allow Michiganders who need healthcare coverage during the pandemic to enroll.
The same executive order directs federal agencies to reconsider rules and other policies that may limit Americans’ access to healthcare and consider actions that will protect and strengthen that access. Agencies are directed to consider policies that may undermine protections for people with pre-existing conditions, including complications related to COVID-19; demonstrations and waivers under Medicaid and the ACA that may reduce coverage or undermine the programs, including work requirements; policies that undermine the Health Insurance Marketplace or other markets for health insurance; and policies that make it more difficult to enroll in Medicaid and the ACA. For more information, contact Laura Appel at the MHA.
With the Oct. 2 Michigan Supreme Court ruling that the legal basis for Gov. Gretchen Whitmer’s COVID-19-related executive orders is unconstitutional, a greater degree of uncertainty surrounds the ways Michigan hospitals, businesses and residents are responding to the challenges of the continuing pandemic. The MHA is keeping members apprised of this and other pandemic-related developments affecting Michigan hospitals through email updates and the MHA Coronavirus webpage. The Supreme Court ruling and additional important updates are outlined below.
MHA Evaluating Impact of Supreme Court Striking Down Governor’s State of Emergency Powers
The Michigan Supreme Court’s ruling declaring the legal basis for the governor’s COVID-19-related executive orders unconstitutional was in response to a request from the U.S. District Court for the Western District of Michigan. The lower court asked for a review of the constitutionality of two Michigan statutes Whitmer relied on in issuing her executive orders, the Emergency Management Act (EMA) of 1976 and the Emergency Powers of the Governor Act (EPGA) of 1945. The Michigan Supreme Court unanimously ruled the governor lacked authority to issue or renew executive orders under the EMA after April 30, 2020, without concurrence by the Legislature. By a 4-3 margin, the court ruled the EPGA also violated the Michigan Constitution.
The current executive orders (EOs) remain in effect until at least Oct. 23 because, under Michigan Court Rules, orders of the Michigan Supreme Court are not effective sooner than 21 days, allowing the opportunity for a party to request a rehearing. However, this was not a routine appeal from the Michigan Court of Appeals or through the Michigan state courts. Because this was a certified question from the federal court, the U.S. District Court will now need to issue an opinion in the federal case that prompted the Supreme Court’s ruling, Midwest Institute of Health v. Governor. The timing for this decision is unknown.
The MHA posted a statement on the ruling on its website, encouraging all Michiganders to continue to be extremely vigilant about following COVID-19 prevention guidance, including masking, physical distancing, washing hands frequently and receiving flu vaccines.
It is anticipated that many of the healthcare-related orders will be implemented through state regulatory agencies and local/county government agencies. Michigan Department of Health and Human Services (MDHHS) Director Robert Gordon issued an Emergency Order Oct. 5 that mandates masks in public places and limits gathering sizes. The MHA is reviewing the order and will alert members if its effects are expected to be different than those experienced under the governor’s orders. The association will also apprise members of any additional state-level announcements as they become available.
An updated list of the governor’s EOs that impact members is available on the MHA website to ensure hospitals are aware of potential items the healthcare community may need have addressed; all EOs and MDHHS orders are available on the state's COVID-19 webpage.
CMS Revises Reporting Requirements
The Centers for Medicare & Medicaid Services (CMS) issued new guidance on COVID-19 reporting requirements and a workflow process that outlines how the CMS will enforce hospital compliance. Hospitals are encouraged to read the revised guidance and note the following changes from previous requirements:
Mandatory supply-related data reports are now required once per week.
Psychiatric (except those that are distinct-part psychiatric hospitals) and rehabilitation hospitals will be required to report only once per week.
Beginning Nov. 1, remdesivir and staffing-related data will be optional.
Additional reporting requirements will begin Nov. 1 for certain data on influenza patients.
Hospitals are also required to provide data into the state’s COVID-19 data portal, EMResource. Hospitals may choose to allow the state to enter data into the U.S. Department of Health and Human Services’ TeleTracking COVID-19 portal on their behalf. Members with questions about this process or the CMS guidelines may contact Jim Lee at the MHA.
Medicare Advance Payment Repayment Update
WPS, the Medicare Administrative Contractor (MAC) for most of Michigan, recently released information regarding the CMS’ instructions to MACs to implement the provision of the Continuing Appropriations Act of 2021 delaying the Medicare advance payment repayment timeline. Changes to the repayment terms are as follows:
The repayment period has been extended, and the automatic recoupment will begin one year after the date the accelerated or advance payment was issued.
During the first 11 months after repayment begins, repayment will occur through an automatic recoupment of 25% of the provider/supplier Medicare payments.
At the end of the 11-month period, the recoupment rate will increase from 25% to 50%. The automatic recovery at the 50% recoupment rate will continue for six months.
If the total amount of the accelerated/advance payment is not recovered within 29 months from the date the payment was made, a demand letter for the outstanding balance will be issued. The demanded amount will be subject to a 4% interest rate.
The MHA will continue to work with the Michigan congressional delegation and the American Hospital Association to further improve these processes. Members with questions may contact Jason Jorkasky at the MHA.
Governor Announces Broadband Internet Grants
The governor announced Oct. 8 during the North American International Cyber Summit that $12.7 million in funding is available to increase broadband internet access across Michigan. As telehealth and remote work have gained popularity during the COVID-19 pandemic, this effort to improve internet access is welcomed by members – especially those in rural areas.
According to the announcement, more than 1,243,000 Michigan households do not have a permanent, fixed broadband connection at home, resulting in $1.8 billion to $2.7 billion in potential economic benefit left unrealized among disconnected households.
The new broadband projects were selected through the Connecting Michigan Communities (CMIC) grant program and are expected to extend access to more than 10,900 households, businesses and community anchor institutions in Michigan. A list of counties/areas impacted by these awards is available on the CMIC Broadband Grant webpage. Recommendations for the second round of CMIC grant awards totaling $5.3 million will be announced soon, and the governor recently signed a state budget that includes an additional $14.3 million in grant funding for a third round of projects in 2021.
The MHA continues to keep members apprised of developments affecting Michigan hospitals during the pandemic through email updates and the MHA Coronavirus webpage. Important updates are outlined below.
Requirements Clarified on Quarantines for Ill Employees
Executive Order (EO) 2020-166, which mandated a 10-day home quarantine period for an individual who exhibited any COVID-19 symptoms, was recently rescinded and replaced with EO 2020-172.
The previous order had provided no exception for a subsequent negative COVID-19 test or an alternative medical explanation for the symptoms. EO 2020-172 clarifies the symptoms of COVID-19, stipulates that two or more symptoms must be present to require quarantine, and allows an employee to avoid quarantine if their symptoms can be explained by another medical or physical condition. In addition, healthcare professionals and workers at specifically defined healthcare facilities are exempted from a requirement to stay at home for 14 days following close contact with someone who is COVID-19 positive.
Although the new EO does not address all the MHA’s concerns, it provides beneficial clarity. Members with questions should contact Amy Barkholz at the MHA.
Dr. Birx Meets with Governor, Healthcare Leaders in Michigan
A small group of healthcare leaders were invited to meet Sept. 2 with Deborah Birx, MD, the response coordinator of the White House Coronavirus Task Force. Birx came to Michigan to meet with the governor in Lansing and with healthcare leaders at St. Mary Mercy Livonia about Michigan’s efforts to fight COVID-19 and the continuing challenges that could be aided by additional federal action.
Part of the conversation with the healthcare group focused on growing concerns over inadequate lab and testing supplies for diagnosing both COVID-19 and other conditions. The MHA expressed several concerns related to lab supplies and other issues that were also outlined in a letter to Birx.
Birx provided input on a range of issues, including urging hospitals to be “efficient” in their use of lab supplies for COVID-19 testing, offering praise for how Michigan and Detroit, specifically, have managed COVID-19 outbreaks and the public health response, and more.
The MHA will keep members apprised of any additional communication from the White House Coronavirus Task Force in follow-up to this meeting.
Visitor Restrictions for Residential Care Facilities Updated
The Michigan Department of Health and Human Services (MDHHS) issued an order Sept. 10 that will allow outdoor visits at residential facilities while continuing to require precautions to protect against COVID-19. Residential facilities are not required to allow visitors under this order, which takes effect Sept. 15; it simply allows the visits if they meet the requirements and wish to allow guests.
The order is based in part on recommendations from the governor’s Nursing Home Preparedness Task Force and creates exceptions to the governor’s order that temporarily restricts visits at healthcare, residential, congregate care and juvenile justice facilities. The MDHHS also considered the flattening of the COVID-19 curve and the impact of the visitor restrictions on residents of these care facilities in issuing the order. Residential facilities are required to ensure that outdoor visitation areas allow for at least 6 feet of separation between all people and provide adequate protection from weather elements. Someone trained in infection control must also be within sight range for compliance reasons.
Facilities must meet certain criteria, including having had no new COVID-19 cases originate at the facility within the previous 14 days. Additional requirements and a description of the facilities the order affects can be found in the emergency order.
Authorized Use of Remdesivir Expanded
The Food and Drug Administration recently expanded the authorized use of remdesivir for treating COVID-19 patients. Remdesivir can now be used for all hospitalized COVID-19 patients, confirmed or suspected, whether the patient is on oxygen, off oxygen or intubated. This is a departure from the previous policy that restricted such treatment to those who required oxygen. For additional details, members can review the complete authorization letter issued Aug. 28.
Webinar Recording to Focus on PPE Strategies and Trends
The Department of Health and Human Services (HHS) Assistant Secretary for Preparedness and Response will hold a webinar Sept. 24 on personal protective equipment (PPE) preservation strategies, trends and lessons learned. Although the HHS webinar appears to be at maximum capacity, recordings of the event will be available upon request. The COVID-19: Optimizing Healthcare Protective Equipment and Supplies webinar will include public and private sector presenters on optimizing supplies of respirators and PPE, including crisis capacity strategies, respirator and mask testing programs, disinfection and decontamination procedures, and acquisition and distribution policies. An online flyer provides more information on the topics to be covered and how to receive the recording.
CMS Releases Guidance for Reporting Requirements for Labs and Long-term Care Facilities
The Centers for Medicare & Medicaid Services (CMS) released COVID-19 reporting requirements Sept. 8 for laboratories and long-term care facilities. The new guidance complements a Sept. 2 interim final rule. Laboratories are expected to comply with the new requirements by Sept. 23. Those not in compliance will be subject to civil monetary penalties. The CMS also released new enforcement information for long-term care facility reporting requirements.
The MHA continues to work with both the MDHHS and the HHS to streamline the reporting process. Members with questions on data reporting should contact Jim Lee at the MHA.
Recording COVID-19 Federal Payments on the Medicare Cost Report
A recently updated CMS COVID-19 FAQs clarifies that COVID-19 Provider Relief Fund payments and Paycheck Protection Program loan forgiveness funds from the Small Business Administration should not be recorded as offsets to expenses on the Medicare cost report. This information is particularly important for critical access hospitals’ and other hospitals’ cost-based Medicare reimbursements, which would have been reduced if COVID-19 funding were to offset costs. The answers specific to Cost Reporting begin on page 98 of the document. Members with questions should contact Laura Appel.
President Donald Trump recently issued two executive orders (EOs) that are expected to positively impact hospitals and other healthcare providers as they continue to fight COVID-19.
An executive order issued Aug. 3 aims to improve rural healthcare and extend some of the temporary regulatory flexibilities for telehealth. It directs the Secretary of the U.S. Department of Health and Human Services (HHS) to review several temporary COVID-19-related policy changes to determine which of those measures should be continued beyond the public health emergency. In addition, the EO instructs the HHS Secretary to announce a new model to test innovative payment mechanisms to improve the financial stability of rural healthcare providers and to develop a strategy to improve physical communications infrastructure in rural areas to facilitate better healthcare services.
The president also signed Aug. 6 an EO to increase domestic production of medical supplies to avoid future shortages. This order aims to ensure the nation has ample medical supplies, medications and equipment to respond to pandemics and other crises and threats while combating the trafficking of counterfeit versions of these supplies via e-commerce. It also eases restrictions on domestic manufacturers, streamlines regulations and supports continuous and advanced manufacturers. In addition, it sets up measures for the HHS to identify vulnerabilities in the medical supply chain.
The MHA will keep members apprised of developments related to these EOs that will impact Michigan hospitals and health systems.
Michigan Continues Work to Increase PPE Stockpiles
In the most recent call the MHA hosted for hospital supply chain contacts, participants discussed procurement issues related to COVID-19, federal information on personal protective equipment (PPE) logistics, a program to procure Honeywell respirators and the state stockpile. The state shared that it is continuing to work to procure PPE to maintain a supply of 90 days of key PPE items on hand. The MHA will keep members informed of these efforts. Members with questions may contact Rob Wood at the MHA.
Governors Announce Bipartisan Interstate Compact for Antigen Tests
Gov. Gretchen Whitmer joined the governors of Maryland, Louisiana, Massachusetts, Ohio and Virginia Aug. 4 in announcing a major bipartisan interstate compact with the Rockefeller Foundation to expand the use of rapid point-of-care antigen tests to slow the spread of COVID-19 and continue safely reopening their respective states. Together, the states aim to show private manufacturers that there is significant demand to increase the production of tests that deliver results in 15-20 minutes. With the agreement, the states are in discussions with Becton Dickinson and Quidel — the U.S. manufacturers of antigen tests that have already been authorized by the Food and Drug Administration — to purchase 500,000 tests per state, for a total of 3 million tests. This purchasing agreement will provide a unique platform to purchase tests and supplies in a sustainable and cost-effective manner. In addition, the states will coordinate on policies and protocols regarding rapid antigen testing technology. The MHA will keep members apprised as this effort continues.
Cybersecurity Alert Fatigue Webinar Offered Aug. 27
COVID-19 has made many hospitals and health systems especially vulnerable to cybersecurity attacks as a constant flow of new information, vendors and other opportunities for infiltration come into their networks. The MHA and several of its members are active members of the Michigan Healthcare Security Operations Center, which is offering a 45-minute webinar at 11 a.m. Aug. 27 on cybersecurity alert fatigue. Members may register to participate in the webinar shortly before it begins.
In this webinar, the hosts will discuss how alert fatigue incorrectly results in normalizing danger across multiple industries and share lessons to combat it. They will also highlight how lessons from healthcare organizations can be imparted to improve internal cybersecurity teams. This webinar focuses on solutions that can be implemented by any organization – regardless of which tools or platforms are in place. Members with questions about this event or cybersecurity may contact Mike Nowak at the MHA.