FEMA Updates Interim Policy on Eligible Public Assistance Federal Cost Sharing

The Federal Emergency Management Agency (FEMA) has issued a new interim policy, Coronavirus (COVID-19) Pandemic: Safe Opening and Operation Work Eligible for Public Assistance. This interim policy supersedes version 1 that was published April 5, 2021.

This updated policy retroactively amends the applicable time period of eligibility to the beginning of the incident period of Jan. 20, 2020, and specifies that work conducted from the beginning of the incident period to Dec. 31, 2021, will be reimbursed at a federal cost share of 100 percent. Work conducted after Dec. 31, 2021, will be subject to the cost share established at that time.

This version of the interim policy maintains the same scope of work as Version 1, which includes COVID-19 diagnostic testing, purchase and distribution of face masks, cleaning and disinfection, screening and temperature scanning, and installation of temporary physical barriers and signage to support social distancing.

Member with questions on the interim policy may contact Renee Smiddy at the MHA.

FEMA Public Assistance Grant Agreements Updated, Applicant Trainings Planned

Hospitals and other organizations that have applied for Public Assistance (PA) from the Federal Emergency Management Agency (FEMA) will need to obtain updated grant agreements that reflect 100% federal reimbursement, updated from the previous agreements indicating 75% federal reimbursement and 25% local cost share. The Michigan State Police Emergency Management and Homeland Security Division is updating grant agreements for current grantees and will distribute final agreements as soon as possible. The division is currently experiencing a high volume of applicants due to the Wayne County floods and ongoing COVID-19 pandemic.

Any hospital that is seeking FEMA PA and has not attended a training is encouraged to join one of the upcoming trainings outlined on the state’s website. Any potential PA applicant must register at the FEMA Grants Portal and attend a virtual applicant training to be eligible for FEMA PA funds. The first round of PA applicant trainings was held in May 2020, and those who attended one of those sessions have satisfied their training requirement. However, some information may have been updated and hospitals may benefit from attending an upcoming training.

Members with questions should contact Renée Smiddy at the MHA.

FEMA Updates COVID-19 Interim Policy on Medical Care Eligible for Public Assistance

The Federal Emergency Management Agency (FEMA) has updated the COVID-19 Interim Policy on Medical Care Eligible for Public Assistance (PA). This interim policy is applicable only to eligible PA applicants and defines the requirements for determining eligibility of medical care work and costs under the PA program. This updated interim policy supersedes the May 9, 2020, policy. Highlights from the updated interim policy include:

  1. Federal Cost Share Increased to 100%, retroactive to Jan. 20, 2020, continuing through Sept. 30, 2021.
  2. FEMA requires PA funding to focus on the highest risk communities and underserved populations as determined by established social and economic disadvantage measures (e.g., the Centers for Disease Control and Prevention Social Vulnerability Index). Subrecipients must prioritize resources to ensure an equitable pandemic response and failure to comply may result in funding reductions. Prioritization of resources must be documented to ensure pandemic response and recovery efforts are conducted equitably.
  3. New eligibility of costs associated with COVID-19 vaccination. FEMA notes that, while the federal government provides the vaccine at no cost, there may be additional costs eligible for PA funding to support vaccine distribution and administration. COVID-19 vaccination eligible work and costs include:
    1. Community vaccination centers.
    2. Personal protective equipment, other equipment and supplies required for storing, handling, distributing/transporting and administrating COVID-19 vaccines.
    3. Facility support costs, including leases, utilities, maintenance and security.
    4. Additional staff, including medical and support staff not paid by another funding source.
    5. On-site infection control measures and emergency medical care for COVID-19 vaccination sites.
    6. Resources to support mobile COVID-19 vaccination in remote areas.
    7. Vaccine-related costs incurred by Federally Qualified Health Centers, Rural Health Clinics and Critical Access Hospitals that are not covered by another funding source.
    8. Communications to disseminate public information regarding vaccinations.
    9. Information technology equipment and systems for patient registration and tracking, vaccine-related inventory management, and/or analytics and reporting needs.
    10. Training and technical assistance on proper storage, handling, distribution and administration of COVID-19 vaccinations.
    11. Vaccination administration consistent with equitable pandemic response and recovery.

Members with questions should contact Renée Smiddy at the MHA

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

MHA Covid-19 update

MHA COVID-19 UpdateThe president signed the American Rescue Plan March 11, establishing as law the latest legislation to address the many areas of loss the country has suffered due to the COVID-19 pandemic. It includes $8.5 billion in funding for eligible rural healthcare providers to offset expenses and lost revenues attributable to the pandemic (see related article). 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.

Mass Vaccination Site to Open at Ford Field as Vaccination Eligibility Expands

In a March 11 address, President Joe Biden instructed states to open vaccine eligibility to all adults no later than May 1. The federal government expects a significant increase in vaccine doses in the coming weeks and will make a website available to help anyone find a vaccine appointment near them.

In response to the president’s directive, Gov. Gretchen Whitmer announced that Michigan will open eligibility to adults ages 16 through 49 with certain preexisting conditions March 22 and to any adults 16 and older April 5. This is in addition to all adults ages 50 through 64 becoming eligible March 22. This news is reflected in the state’s official Prioritization Guidance document posted on its vaccine webpage. Officials expect weekly allocations to continue to increase to help meet the increased demand. The MHA will keep members apprised of any additional information relating to the expanded eligibility.

Members are encouraged to prepare for increased calls and website traffic as vaccine eligibility broadens and to provide their communities with details on who they will be able to vaccinate and how to make appointments.

The governor also announced that a mass vaccination site will open March 24 at Ford Field in Detroit. It will have the capacity to administer 6,000 vaccine doses each day to serve residents in the broader southeast Michigan region. The Biden administration, in partnership with the Federal Emergency Management Agency (FEMA), selected southeast Michigan for this major new community vaccination site.

The site, which was selected according to the Centers for Disease Control and Prevention’s priority tool to help those hardest hit and most vulnerable, will operate from 8 a.m. to 8:30 p.m., seven days a week, for eight weeks under the federal government's vaccination pilot program. The facility will be managed by the state of Michigan with support from FEMA, Wayne County, the City of Detroit, Ford Field, Meijer, Henry Ford Health System and the Detroit Lions.

Federal efforts under development also include a Centers for Disease Control and Prevention (CDC) “equity index” that will rank states based on equity of access/administration of the vaccine in addition to the existing rankings that are based on doses given, speed, etc.

In addition, the CDC will be sending allocations directly to a list of federally qualified health centers across the nation, including those in the Michigan cities of Inkster, Pontiac, Brimley, Gladwin, Flint, Saginaw, Cassopolis, Kalamazoo, Centreville, Ann Arbor and Detroit.

CDC Issues COVID-19 Recommendations for Fully Vaccinated People

The CDC issued new recommendations March 8 for individuals who have been fully vaccinated against COVID-19. The agency considers people to be fully vaccinated two weeks after their second dose of the Pfizer and Moderna vaccines or two weeks after Johnson & Johnson’s Janssen single-dose vaccine.

The recommendations state that those meeting the full vaccination parameters may gather indoors with other fully vaccinated individuals without wearing a mask. In addition, they can gather indoors with unvaccinated people from one other household without masks, unless any of those people or anyone they live with has an increased risk for severe illness from COVID-19.

Fully vaccinated individuals who have been near someone who has the disease are no longer asked to avoid others or get tested unless they have symptoms. However, vaccinated people who live in a group setting and have been in contact with someone who has COVID-19 should quarantine for 14 days and get tested, even if they don’t have symptoms.

Because authorities do not yet know the extent to which vaccines mitigate the transmission of COVID-19, the CDC continues to recommend precautions that include wearing a mask, staying at least six feet apart from others, and avoiding crowds and poorly ventilated spaces. Anyone who has symptoms of COVID-19 should be tested and stay away from others.

The MHA will keep members apprised of any changes in these recommendations. Questions on the COVID-19 vaccine may be directed to Ruthanne Sudderth at the MHA.

COVID-19 Variants in Michigan More Transmissible than Original Virus

The Michigan Department of Health and Human Services (MDHHS) Bureau of Laboratories identified on March 8 the first Michigan case of the COVID-19 variant B.1.351 in a male child living in Jackson County. Case investigation is underway to determine close contacts and whether additional cases are associated with this case.

Cases caused by this variant, which originated in South Africa, were first reported in the United States at the end of January. It is believed to be more contagious, but there has been no indication that it affects the clinical outcomes or disease severity compared to the SARS-CoV-2 virus that has been circulating across the United States for the past year. Scientists are evaluating how well COVID-19 vaccines work against this newer variant, which has been identified in at least 20 other states and jurisdictions in the U.S.

The MDHHS has also provided information about the characteristics of the B.1.1.7 variant that was first discovered in the United Kingdom. This variant has now been identified in multiple Michigan communities after having first been detected in an isolate from a Washtenaw County case Jan. 16. It is approximately 50 percent more transmissible, leading to faster spread of the virus and potentially increasing numbers of cases, hospitalizations and deaths. Members should refer to the MHA’s COVID-19 alert sent Friday, March 12, for details and recommendations on managing variants.

The MHA and the MDHHS are closely monitoring case numbers, positivity rates and hospitalizations. The association will keep members apprised of any concerning data trends related to the variants. Members with data questions may contact Jim Lee at the MHA.

New Regulatory Flexibility Approved for Sharps Containers

The Department of Environment, Great Lakes, and Energy March 9 approved an MHA request to provide regulatory flexibility for hospitals facing a shortage of sharps disposal containers. State regulation currently requires hospitals to replace sharps containers every 90 days or when full, whichever is sooner. Through July 31, 2021, hospitals will now be exempt from the 90-day rule, meaning sharps containers will only be required to be replaced when full. The shortage is due to a production facility fire and increasing demand for the containers due to vaccinations; some MHA members had already received similar exemptions. The MHA will work with state government if additional flexibility is needed. Members with questions may contact Sean Sorenson-Abbott at the MHA.

State Provides Vaccine Communication and Administration Materials

A variety of vaccine materials are available for hospitals and other providers on the MDHHS Provider and Partner webpages for communication and administration purposes. These include toolkits for communicating with patients and communities regarding the safety and effectiveness of the vaccines, which are in the “COVID-19 Vaccine Communication Materials” section of the Partner page; Johnson & Johnson materials, including a Standing Order form for this vaccine; and more.

MDHHS Announces 22 Awardees in State’s Vaccine Pilot Program

The MDHHS and the Protect Michigan Commission have awarded 35,800 doses of COVID-19 vaccine to 22 pilot projects to help enhance the state's vaccine equity strategy. Three of the awards went to Henry Ford Health System, MidMichigan Health and Schoolcraft Memorial Hospital, and the remainder went to health departments, community-based clinics, agencies on aging and other vaccinators.

The pilot program is designed to help remove barriers to vaccine access for Michiganders ages 60 and older who live in communities with a high Social Vulnerability Index (SVI) and high COVID-19 mortality rates. Participating providers that have additional capacity in their projects may expand vaccination to include people ages 50-59 with disabilities or underlying conditions. The awardees were chosen from more than 70 applications. Additional details on the program are available in the MDHHS news release.

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 Aug. 10

MHA Covid-19 update

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.

Number of Michigan COVID-19 Cases Has Plateaued

Gov. Gretchen Whitmer announced during an Aug. 14 news conference that there have been 90,392 confirmed cases of COVID-19 in Michigan and 6,289 deaths. Currently, the state ranks 40th in the seven-day average of new COVID-19 cases per capita across the country and is 40th in the percentage of those testing positive on COVID-19 diagnostic tests. Although residents need to continue to follow recommended precautions, the number of Michigan’s new cases has plateaued, with the average infection rate reported as being half that of neighboring Midwest states. Testing continues to expand statewide, with 38,000 tests reported in one day and an average positive case rate of 3.2%.

MI Mask Aid Project to Provide 4 Million Free Masks to Needy Michiganders

The governor Aug. 14 announced the MI Mask Aid project, a partnership between the Federal Emergency Management Agency (FEMA) and Ford Motor Co. that will distribute 4 million free masks to those in need, including low-income students and minorities. FEMA has already sent 1.5 million masks to organizations that include local Community Action Agencies serving low-income residents, Michigan Department of Health and Human Services (MDHHS) offices, Area Agencies on Aging, homeless shelters and Native American tribes. Another 1 million face coverings from FEMA and 1.5 million from Ford will go to low-income schools, the City of Detroit, Federally Qualified Health Centers, some COVID-19 testing sites and to many of the organizations listed above to reach vulnerable populations — including minority residents who have been affected by the public health crisis due to racism. Mask distribution site information is available from the state COVID-19 hotline at (888) 535-6136 or through a Community Action Agency.

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 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:

Combating the 2019 Novel Coronavirus (COVID-19): Week of March 23

MHA Covid-19 update

Coronavirus update graphicAs of March 29, there have been more than 5,400 confirmed cases of COVID-19 in Michigan, and 132 of those infected have died. The MHA and Michigan hospitals continue the fight to flatten the curve and avoid overwhelming the healthcare system. MHA members can reference copies of the information they have received via email online, and updates and resources are available on the MHA COVID-19 webpage.

President Donald Trump signed the Coronavirus Aid, Relief, and Economic Security (CARES) Act March 27 to authorize nearly $2 trillion in expenditures to assist citizens and businesses impacted by the pandemic. More than $100 billion of that package will be disbursed to hospitals across the country (see related article).

The president declared March 27 that a major disaster exists in Michigan, responding to Gov. Gretchen Whitmer’s March 26 disaster declaration request. This major disaster declaration increases funding from the federal government and brings other federal assistance from the Federal Emergency Management Agency (FEMA). The MHA is working closely with the state to confirm what steps hospitals need to take with the approval of the disaster declaration. All hospitals should activate their command centers and submit emergency plans to the state, if not already completed. Hospital command centers should continue to work with their regional healthcare coalitions and emergency managers to submit daily resource needs to EMResource.

To assist hospitals in obtaining adequate personal protective equipment (PPE) as they care for patients with COVID-19, the state announced that companies wishing to donate PPE should contact the Michigan Community Service Commission at (517) 335-4295 rather than the regional healthcare coalitions. In addition, the MHA has posted a document providing information on how to donate supplies and funds to hospitals across the state to aid individuals in helping their local facilities. The MHA is hosting conference calls with hospital supply managers to assist with issues that arise.

The state has provided new forms and guidance regarding transfers to skilled nursing facilities (SNFs) and testing prioritization for persons under investigation (PUI). A new SNF transfer form was developed, with input from the MHA, the Health Care Association of Michigan and LeadingAge Michigan, that is in accordance with guidance from the Centers for Disease Control and Prevention. The MHA also worked with the state to streamline hospitals’ COVID-19 testing processes, and the new guidance for PUIs does so by broadening access to PUI authorization and making changes in testing prioritization. Additional details were provided in a message emailed to members March 25 and are available on the MHA Community site.

To ease bureaucratic delays as hospitals work through the pandemic, the MHA submitted an initial Section 1135 waiver request to the Centers for Medicare & Medicaid Services (CMS) March 23 for COVID-19-related and non-COVID-19-related care, and the CMS granted several of the waivers and modifications March 26, with more guidance expected in the coming days.  Additional information was emailed to members and is available on the MHA Community site. Questions on the waiver request should be directed to Amy Barkholz at the MHA.

In recognition of the demands placed on hospitals as the number of patients with COVID-19 increase, the Michigan Department of Health and Human Services (MDHHS) issued a memo March 23 describing the “COVID-19 Statewide Load Balancing plan.” The plan includes transfer of patients to “relief hospitals,” physician and facility communication, patient tracking, data and more. The memo identifies the Healthcare Coalition Regional Medical Coordination Centers (MCCs) as the state entities that will manage and facilitate the load balancing. Additional information is expected from the MDHHS on next steps for load balancing. The MHA recognizes the tremendous stress all hospitals are under to handle current and/or future COVID-19 patients, and the association will continue to convene members and the state to work through these constantly evolving challenges.

Updated information will continue to be published in Monday Report and members will receive emailed communication as often as necessary to ensure they are equipped to respond to cases of COVID-19 in their facilities and communities.

In addition to the resources provided on 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: