Why equity remains the missing element in achieving a more inclusive and diverse work environment.
Staff resistance that routinely surfaces and how to engage employees in every step of the DEI journey.
Equitable messaging to advertising, media and business-to-business partners that connects with the emotions of DEI.
Partnerships that enhance and increase DEI credibility and how to use the “win-when” partnership assessment framework.
The professional and personal member organizations that are based on racial affinity and can build on your DEI strategy, as well as the do's and do nots in developing a pipeline for inclusion.
An important orientation webinar will take place from 11 a.m. to noon June 30, followed by four webinars held from 11 a.m. through 12:15 p.m. Chief executive officers, medical, nursing and human resources executives, governing board members, and key DEI leaders are encouraged to participate. Pricing includes the entire series and is available for teams of five members and larger. Registration is due June 22.
To register, contact the MHA Field Engagement division indicating the intention to register for the DEI series and providing an email address and phone number. Registrants will be contacted for additional information to complete the process. Questions about the series should be directed to Erin Steward at the MHA.
The MHA is discussing with the state whether the information provided in the DEI virtual series will fulfill the new implicit bias training requirement for healthcare providers who apply for initial licensure or relicensure after May 31, 2022. For more information on the new rules, contact Paige Fults at the MHA. An additional opportunity to learn about DEI is available through a July 15 webinar offered by the MHA Keystone Center, which is not related to the new rules.
The Department of Licensing and Regulatory Affairs adopted new administrative rules that require implicit bias training as part of the knowledge and skills necessary for licensure or registration of healthcare professionals in Michigan, which were ordered in Executive Directive 2020-07. Adopted June 1, the new training requirement will take effect one year later, June 1, 2022.
During the fall of 2020, the MHA and several member hospitals were among nearly 80 stakeholders that participated in the Implicit Bias Training Rules Advisory Work Group to help develop the draft rules. The MHA also provided testimony in support of the rules during the public hearing held March 9 and expressed its support to the Joint Committee on Administrative Rules.
The MHA and its member hospitals support unconscious bias training for all healthcare personnel. Ensuring equitable access and care for all patients is an MHA strategic priority, and eliminating health disparities is crucial to the MHA mission of advancing the health of individuals and communities.
Even before Executive Directive 2020-07 was ordered, the MHA and the MHA Keystone Center were working to make strides in this area. Addressing health disparities is a foundational concept that shapes all the organizations’ quality improvement and safety efforts. There is ample evidence of the impact bias has on health, and healthcare systems have a moral obligation to equalize care, starting first by identifying and addressing any bias that may exist within their organization. The training helps individuals identify and acknowledge the biases they have, which often exist outside of their conscious awareness; this process helps providers deliver the best care possible. For more information, contact Paige Fults at the MHA.
Among the many actions President Joseph R. Biden took on his first day in office Jan. 20 was creating a White House COVID-19 response team to coordinate federal and state efforts to fight the pandemic. With this and other expected action by the new administration, the state of Michigan anticipates improvements in the production, distribution and operations for the COVID-19 vaccine. As the battle against the evolving virus continues, the MHA keeps members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.
Updates Provided as Vaccines Administration Continues
President Biden has indicated he will immediately be activating the federal Defense Production Act to significantly increase the supply of vaccine available to Americans. Gov. Gretchen Whitmer’s administration is working closely with the Biden team to increase Michigan’s weekly allocation of vaccine as soon as possible. The state is mapping details on how to support each of Biden’s points and how this plan can support Michigan’s plan to administer 50,000 or more shots per day.
The U.S. Department of Health and Human Services notified the Michigan Department of Health and Human Services (MDHHS) Jan. 20 that modified vaccine supply kits would begin being included that week with the shipments of the Pfizer vaccine to assist in administering the potential sixth dose of vaccine from vials originally labeled for five doses. In January, the Food and Drug Administration amended the emergency use authorization to reflect the additional dose, and McKesson increased the individual Pfizer ancillary kit contents from a kit that supported 975 doses to a kit supporting 1,170 doses. Members with vaccination supply chain questions can contact Adam Carlson or Rob Wood at the MHA.
The MDHHS is working toward using the Centers for Disease Control & Prevention (CDC) Social Vulnerability Index to identify areas and individuals in Michigan that may have less access to COVID-19 vaccine. The department will be encouraging vaccinating providers to use this data to find and vaccinate these individuals and communities. This work is in the early stages, and updates will be provided during the biweekly MDHHS calls with providers. The MHA will provide details on how to reach vulnerable individuals and communities as they become available.
The MHA will conduct a members-only event from 11 a.m. to noon Jan. 29 for an in-depth discussion on the status of COVID-19 vaccine distribution, coordination, coverage, communication and more. Members will receive participation information prior to the event.
In addition, the association (@MIHospitalAssoc) will host a Twitter chat from 1 to 2 p.m. Jan. 28 to inform Michiganders about the COVID-19 vaccine and promote to the public and media the excellent work of hospitals and health systems in leading this effort. The goal of the virtual conversation is to answer frequently asked questions and give hospitals an opportunity to share their experiences and resources related to the COVID-19 vaccine all in one place. Members may preview the chat questions, and those with Twitter accounts are encouraged to join the event to share about hospitals’ role in Michigan’s COVID-19 vaccine effort and be a source of trusted information about the vaccine itself. Members are asked to confirm their participation with Lucy Ciaramitaro at the MHA by Jan. 26.
Local health departments use an online registry to recruit volunteers for COVID-19 vaccine clinics. Vaccine volunteers do not necessarily need to be licensed health professionals, but do need to complete all training to ensure they can appropriately educate, administer, prepare, handle and report vaccine. Anyone interested in volunteering to assist in vaccine administration is encouraged to register. Training materials are available on both the MDHHS and CDC websites.
MDHHS Issues Updated List of COVID-19 Relief Facilities
The MDHHS issued an updated list of COVID Relief Facilities (CRFs), such as nursing homes and rehab facilities, approved to admit and accept transfers of individuals who remain subject to Transmission Based Precautions for COVID-19. The MDHHS will issue its next updated list the week of Feb. 1.
The CRF designation is defined as part of Public Act 231 of 2020. These facilities may care for COVID-19-positive residents of nursing facilities by retaining or admitting those residents. An appropriate CRF resident is a COVID-19-positive person who does not need the acute-care hospital level of services.
CRFs are designed to care for COVID-19-positive residents in-place with enhanced infection control measures for individuals who have not met criteria for discontinuing Transmission-Based Precautions and have limited access to the state’s Care and Recovery Centers. All CRFs may retain or readmit their own residents. Facilities that meet enhanced requirements may receive new admissions from other facilities or hospital discharges. Many other CRFs can retain their own residents even if they become COVID-19-positive. To request a copy of the list of CRFs accepting new admissions, contact Erin Emerson at the MDHHS. For more information on these facilities, contact Kelsey Ostergren at the MHA.
As the legislative lame-duck session continued during the week of Dec. 7, the Michigan Senate voted on several bills that would impact hospitals. The bills taken up included several COVID-19-related bills, as well as an extension of unemployment benefits and the nurse licensure compact legislation.
The Michigan Senate passed House Bill (HB) 4042, which would add Michigan to the interstate nurse licensure compact (NLC). The NLC allows registered nurses to have one multistate license with the privilege to practice in their home state and other NLC states. However, permanent relocation to another compact state requires obtaining licensure in the new state. HB 4042 was sponsored in 2019 by Rep. Mary Whiteford (R-Casco Township) and has been supported by the MHA. The bill now moves to Gov. Gretchen Whitmer’s desk for signature.
The COVID-19-related legislation most notable for hospitals was Senate Bill (SB) 1253, introduced by Sen. Lana Theis (R-Brighton Township), which would make changes to the ability of the director of the Michigan Department of Health and Human Services to issue emergency orders. Under the bill passed by the Senate, emergency orders would be valid for 28 days before needing to be approved by a vote of both legislative chambers. The MHA opposes the bill, which did not receive a Senate committee hearing and now moves to the House of Representatives for consideration.
The Senate also passed a pair of bills that would extend unemployment insurance (UI) benefits through March 31. SBs 604 and 749 would extend unemployment benefits from 20 to 26 weeks, continue to not charge employers’ individual accounts for COVID-19-related claims, allow employees to use UI for COVID-19-related absences, and continue to expand the UI Workshare Program until April. Additionally, SB 604 would create an exception for disqualification from UI benefits for individuals who can show that a documented case of domestic abuse led to their inability to work. The bills were introduced by Sens. Curtis Hertel (D-East Lansing) and Jim Stamas (R-Midland). The MHA supports both bills, which now await further consideration by the House.
Members with questions on HB 4042 should contact Paige Fults at the MHA. Other questions on legislative action can be directed to Adam Carlson at the MHA.
COVID-19 patients continued to fill Michigan hospitals throughout the Thanksgiving holiday and into December, while drug companies Pfizer and Moderna applied for emergency authorization of their respective COVID-19 vaccines from the Food and Drug Administration (see related article). The MHA keeps members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.
Nursing Home Application Deadline Extended; CRC Bulletin Issued
The state announced Nov. 30 that it is extending the deadline from Dec. 1 to Dec. 15 for long-term care (LTC) facilities to become care and recovery centers (CRCs) and COVID relief (CR) facilities. The MHA has advocated for this extension to ensure LTCs do not transfer residents to hospitals without medical indication simply to avoid being out of compliance with new law requirements. While this is a positive step, the MHA will continue to advocate for more permanent solutions to transfer issues and the number of LTCs approved as CRCs and CR facilities.
The MDHHS also issued a bulletin for hospital-based CRCs. Bulletin Number MSA 20-78 supplements Bulletin Number MSA 20-73, which established operational requirements for nursing facilities to operate as CRCs during times of a public health emergency and provides a pathway for Michigan hospitals to establish hospital-based CRCs to support the safe care and isolation of COVID-19-positive individuals. Details about requirements for hospitals seeking designation as a CRC, how to apply and more are available in the bulletin.
Quarantine Duration Requirements Addressed
The MHA hosted its weekly call of hospital/health system chief medical officers Dec. 4, which was joined by representatives of the MDHHS. Among the topics discussed was quarantine requirements and the new guidance from the Centers for Disease Control and Prevention (CDC) advising the public that shorter quarantine periods of 7-10 days may be acceptable, depending on their access to testing and their symptoms or lack thereof.
According to Public Act 238 of 2020, healthcare workers who are exposed to COVID-19 but test negative and are not symptomatic are still able to report to work. Employees’ quarantine needs apply to how they spend time outside of work. There remains in state statute a 14-day quarantine provision for employees who test positive for COVID-19. The MHA is working with state officials and legislators to amend Public Act 238 of 2020 to bring quarantine times for employees who test positive in line with the CDC guidance. Additional information on the statute and administration rules is available from the Michigan Occupational Safety and Health Administration (MIOSHA), as discussed below.
Healthcare facilities and professionals may get questions from patients/community members on this change in quarantine guidance. The state announced its recommendation that the public continue to use the 14-day quarantine as a best practice, but if that is not feasible, the 10-day recommendation should be followed. The state did not endorse a seven-day quarantine with a negative test as a safe alternative.
MIOSHA Emergency Rules Clarified
The MHA hosted a call Dec. 1 with representatives from MIOSHA regarding its emergency rules that, among other items, emphasize the use of a remote workforce and proper use of personal protective equipment.
MIOSHA provided an overview of the rule set and answered questions, emphasizing the agency’s reliance on CDC guidelines in developing the rules and the availability of the free MI Symptoms app to assist employers. Questions or requests for the meeting materials should be directed to Adam Carlson at the MHA.
New Uses of Surge Capacity Beds May Require Certificate of Need Approval
Temporarily licensed surge capacity beds that have already been approved by the Bureau of Community and Health Systems (BCHS) may continue to be used if the following criteria are met:
An originally required emergency certificate of need (CON) approved by the MDHHS remains in effect.
The facility has maintained the BCHS-approved surge capacity so that it can be used within 48 hours if needed.
The facility has not notified the BCHS since the original approval that it has voluntarily surrendered the surge capacity.
If facilities with existing BCHS-approved surge capacity beds want to operate these beds in a different location, manner or use than originally requested, they must contact the MDHHS CON program, as applicable, and the Michigan Department of Licensing and Regulatory Affairs (LARA) State Licensing Section to determine whether new approval is required. Such requests must include a detailed narrative description of the proposed new use, space and floor plans of the area showing the new bed locations. If the proposed space deviates from current BCHS physical plant regulatory requirements, such as minimum square footage, hand sink locations or number of patients/residents to a room, the facility must include a narrative description of how those issues will be addressed to ensure patient/resident safety and care needs.
If the state has questions or concerns on a proposal as submitted, the Health Facilities Engineering Section engineer assigned to the facility will follow up as needed to address those concerns.
All applications not previously approved must apply to both the MDHHS and LARA as applicable and required. Both BCHS-HFD and Appendix E forms are required when applying. Members with questions may contact Paige Fults at the MHA.
BCBSM Provides Update on Coverage for COVID-19 Care and Testing
Blue Cross Blue Shield of Michigan (BCBSM) recently announced that it will continue to waive cost-sharing for its members diagnosed and treated for COVID-19 through March 31, 2021. This extension of a temporary benefit, originally set to expire Dec. 31, means members will not pay out-of-pocket costs — copays, deductibles or coinsurance — for the medical care and pharmacy costs associated with COVID-19. Members with feedback or questions are encouraged to contact Jason Jorkasky at the MHA.
Judge Denies Injunction for Bars, Restaurants Ordered Closed by MDHHS
A federal judge Dec. 2 denied a motion for preliminary injunction seeking to end the temporary MDHHS-ordered closure of bars and restaurants intended to prevent further spread of COVID-19. The MHA submitted an amicus or “friend of the court” brief in support of the temporary emergency measures enacted by the MDHHS. The MHA also issued a media statement supporting the order, which is effective from Nov. 18 through Dec. 8.
The ruling on Michigan Restaurant and Lodging Association v. Gordon was issued by Judge Paul Maloney of the U.S. District Court for the Western District of Michigan. It states that the motion was not granted to plaintiffs because it found the MDHHS’ reasoning for the order convincing and that groups tend to linger more in those settings than transitional environments like a food court or airport dining area.
Maloney further stated that, because the Michigan courts have not yet had an opportunity to evaluate the state issues and these challenges must be adjudicated before the federal claims can be considered, he scheduled a Dec. 17 certification hearing and will accept briefs from the parties to determine which legal questions to pass on to the state courts for further consideration. The MHA’s brief in support of the MDHHS provided medical evidence of the effectiveness of face covering and social distancing in curbing the spread of infection and reducing strain on the healthcare system. There are several other legal challenges in federal and state court against state and local public health orders requiring face coverings, social distancing measures and cooperation with contact tracing. Members with questions about the ruling may contact Amy Barkholz at the MHA.
The Michigan Department of Health and Human Services (MDHHS) issued a new emergency order the evening of Nov. 15 limiting certain indoor gathering opportunities for three weeks in light of the exponentially increasing COVID-19 cases and hospitalization across the state. The MHA keeps members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.
MDHHS Issues Emergency Order Outlining Restrictions
The MDHHS issued a new emergency order Nov. 15 that attempts to curb community spread of COVID-19 by limiting indoor gathering opportunities at various venues for three weeks. These new restrictions do not place any limits on access to healthcare. The order takes effect at 12:01 a.m. Wednesday, Nov. 18.
Under this order, indoor residential gatherings are limited to two households at any one time. The order is aimed at limiting residential and nonresidential gatherings where COVID-19 spreads rapidly. Bars and restaurants will be open for outdoor dining, carry-out and delivery only. Gyms will remain open for individual exercise with strict safety measures in place. Casinos, movie theaters and group exercise classes will be closed. Professional and college sports meeting extraordinary standards for risk mitigation may continue without spectators; however, all other organized sports must stop. Colleges and high schools may proceed with remote learning, but must end in-person classes. The MDHHS has created an infographic explaining what is closed and what will remain open.
The MHA issued a media statement upon the MDHHS announcement, indicating appreciation for the strong and swift response to the current surge in COVID-19 cases that is stretching hospitals and healthcare personnel thin.
Public Cooperation Urged to Prevent Community Spread
The Michigan Economic Recovery Council held a virtual news conference Nov. 12 featuring its healthcare leader members to urge Michiganders to improve their preventive actions to help stop community spread of COVID-19. Participants included MHA CEO Brian Peters; Ed Ness, president & CEO, Munson Healthcare, and MHA Board Chair; Wright Lassiter, president & CEO, Henry Ford Health System; John Fox, president & CEO, Beaumont Health; and Tina Freese Decker, president & CEO, Spectrum Health. To add an Upper Peninsula perspective, Gar Atchison, market president, Upper Peninsula Health System, also took part in the conference. More than 20 news outlets from around the state joined the event (see related article).
Health system leaders shared the increasing challenges their facilities are having due to staff becoming sick in the community, tightening testing capacity, transfer difficulties as a result of widespread surge and more. When asked about state government action, the health leaders reminded Michigan residents that, if everyone does the right thing, there will be no need to return to the strict shutdowns experienced in the spring. Gov. Gretchen Whitmer held a news conference later that day, sharing updated case numbers and urging public compliance with preventive measures.
The MHA also issued a news release containing current data on hospitalizations. Members are encouraged to continue to engage their trustees and local business networks to emphasize that, by working together, the surge can be stopped. For more information, contact Ruthanne Sudderth at the MHA.
Distribution of Bamlanivimab Monoclonal Antibody
The MDHHS held a conference call with healthcare providers Nov. 12, outlining the process for distributing the newly approved COVID-19 antibody treatment bamlanivimab in Michigan. The state expects to receive 3,240 vials in the initial shipment and will release information on the treatment protocols. The MDHHS is still confirming the allocation strategy and expects to coordinate weekly distributions directly from Amerisource Bergen to hospitals based on the data reported for COVID-19 cases and hospitalizations. The MDHHS stated that it has been in direct contact with hospital pharmacy directors to discuss the distribution process, which will be adjusted weekly based on need. The MHA will provide an update as more information becomes available. Members with questions may contact Paige Fults at the MHA.
New COVID-19 Task Force Named; Pfizer States Vaccine 90% Effective
Though President Donald Trump’s campaign team continues to challenge election results, the Biden/Harris campaign has announced its COVID-19 task force and plan to handle the pandemic. The likely change in administrations is sure to bring change in pandemic response that will impact health systems and hospitals, as well many others. The MHA has begun to review the Biden/Harris plan and will inform members about what is expected to change or remain the same. Some of the key areas the association will watch include:
Supply chain strategy.
National consistency in preventive/containment measures.
In addition, Pfizer announced that its COVID-19 vaccine, long expected to be the first available, is currently showing 90% effectiveness against the virus. According to reports, Pfizer plans to ask the Food and Drug Administration for emergency authorization of the two-dose vaccine by the end of November, after it has collected the recommended two months of safety data. Pfizer also stated that it will have manufactured enough doses to immunize 15 million to 20 million people by the end of 2020.
COVID-19 Vaccine Distribution Plans Reviewed
The MHA held a call Nov. 13 for member hospitals and the MDHHS to discuss plans for distribution of the COVID-19 vaccines to health system and hospitals in the coming weeks. More than 170 individuals joined this important discussion.
The MHA will update and share with members a frequently asked questions document that will capture the lengthy question-and-answer session from the call. The discussion recapped expected shipment and storage requirements for vaccines A and B (expected to be Pfizer and Moderna vaccines), working with local health departments to ensure coordination in specific regions/communities, and much more. The MDHHS will send hospitals a follow-up survey to guide distribution, as well as a form for eventual redistribution among each organization’s locations. Members with questions may contact Ruthanne Sudderth at the MHA.
State Launches COVID-19 Contact Tracing Smart App
The state has officially launched MI COVID Alert, an app that lets users know if they have been in close physical proximity to someone who has tested positive for COVID-19. The app maintains broad privacy for users; it asks users to self-report positive COVID-19 tests and, using smartphone technology, knows what other users may have been exposed. It then alerts those users to a potential exposure. As hospital and health system employees are increasingly impacted by community spread, members are encouraged to have them consider using MI COVID Alert to help maintain maximum awareness of exposure risks. The app is free to download on both iPhone and Android devices via their respective app stores.
Members’ marketing and communications teams should also consider sharing this app on social media sites for communities to see and access. The state has created social media graphics so anyone can easily share information about the app on their social networks.
Given the ongoing challenges with Michiganders’ comfort level with standard contract tracing, this is another more confidential tool providers can urge the public to use to improve exposure awareness.
Operation Warp Speed Releases Playbook for COVID-19 Therapeutics
Operation Warp Speed, the federal government’s operation for planning COVID-19 vaccination and treatment, recently released an initial playbook to assist providers in planning. The playbook comes in anticipation of the likely issuance of emergency use authorizations for at least two monoclonal antibody therapeutic drugs developed to treat certain COVID-19-positive patients. The playbook lays out important information for hospitals and health systems to consider, including administration, details on the two drug options, who should receive the therapeutic and a site checklist. Members are encouraged to review the playbook for additional details.
Revised Clarification on License Exemptions
The Bureau of Professional Licensing within the Michigan Department of Licensing and Regulatory Affairs (LARA) has released a revised version of its guidance document clarifying when exemptions of Michigan licensure apply to health professionals. The most notable update includes flexibility to allow providers from other countries that are licensed and in good standing to practice in the state and permit students in their last year of an accredited program to assist in care for those affected by COVID-19. That flexibility had been lost with the rescission of Executive Order 2020-61.
Although LARA does not require documentation on these individuals, it must be made available in the event the department receives an official complaint about an individual provider. The MHA recommends hospitals continue to follow the updated compliance memo related to proper tracking for all individuals who are eligible for the license exemption. Members with questions should contact Paige Fults at the MHA.
MDHHS Announces New Reimbursement for SNF Care and Recovery Centers
The MDHHS rolled out a new application for skilled nursing facilities that are interested in becoming Care and Recovery Centers (CRCs). Included in that application is an updated reimbursement schedule for CRCs that, upon approval by the department, specialize in the care and treatment of nursing facility patients who have previously tested positive for COVID-19 and have not yet met criteria for discontinuation of Transmission-Based Precautions. The reimbursement schedule now provides payments based on number of beds with a $40,000 – $80,000 preparedness stipend, monthly deposit of $10,000 – $20,000, and a bed premium of $200 per COVID-19 day.
Job Fair for Southeast Michigan Healthcare Scheduled for Dec. 2
As members’ staffing challenges grow, the MHA continues to seek opportunities to assist. The association is a member of the Health Careers Alliance for Southeast Michigan, which is hosting a healthcare job fair from 9 a.m. to noon Dec. 2 and urges any employers in or near that region to participate. Hospitals and health systems can register online as employers; 20 employer slots were available as of Nov. 13. Members with specific questions about participation may contact Sarah Gregory, director of talent development, at the Workforce Intelligence Network.
The number of COVID-19 cases is climbing, and Michigan hospitals are again experiencing an influx of patients battling the disease. 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.
Hospitals, Businesses Call for Collective Action to Avert More COVID-19 Deaths
The MHA released a joint statement to statewide media Oct. 22 that was signed by physician leaders of hospitals and healthcare systems throughout Michigan. The letter includes 28 signatures that represent 110 of Michigan’s 137 hospitals plus MHA Chief Medical Officer Gary Roth, DO. The goal of the statement is to make clear that, regardless of state law, executive orders or local public health directives, hospitals and healthcare systems across the state are standing as a united front in policies and interventions that will help fight the spread of COVID-19. It also emphasizes that the recent jump in COVID-19 cases across Michigan puts the state’s entire healthcare system at risk of another capacity crisis and asks the public to take the necessary steps to prevent the spread of this deadly disease.
Several media outlets across the state have reported on the letter and healthcare providers’ united stance to stave off COVID-19. Members that were not included on the statement and would like the signature of their facility’s physician leader added to the MHA website copy should contact Lucy Ciaramitaro at the MHA.
In addition, members of the Michigan Economic Recovery Council (MERC) sent a letter Oct.. 21 to Gov. Gretchen Whitmer, Senate Majority Leader Mike Shirkey and House Speaker Lee Chatfield, urging collective action to prevent additional deaths from COVID-19. As a member of the MERC, MHA CEO Brian Peters joined leaders from the healthcare, labor, higher education and business communities in stressing the need for clearly defined, mandatory standards that govern mask usage, workplace practices, public gathering and certain social activities that can be deployed with discipline. The letter indicates that success in suppressing spread of COVID-19 will maintain the health of Michigan’s economy and support the education of the state’s children.
HHS Revises Provider Relief Fund Usage and Reporting Requirements
The U.S. Department of Health and Human Services (HHS) issued Oct. 22 revised federal Provider Relief Fund (PRF) usage and reporting requirements. These new requirements come on the heels of problematic requirements the HHS issued Sept. 16 that would have resulted in many hospitals being required to return PRF payments to the federal government. The HHS indicated in its announcement that it modified the PRF usage and reporting requirements in response to advocacy efforts by stakeholders, which included efforts by the MHA, the American Hospital Association and others.
The HHS also notes in its reporting document that, if recipients do not expend PRF payments in full by the end of calendar year 2020, they will have an additional six months in which to use remaining amounts toward expenses attributable to COVID-19, but not reimbursed by other sources, or to apply toward lost revenues in an amount not to exceed the difference between 2019 and 2021 actual revenue.
Finally, the HHS revised the definition of “Reporting Entity,” as delineated on Page 2 of the usage and reporting requirements document.
Questions on revised PRF reporting requirements should be directed to Jason Jorkasky at the MHA.
House Republicans Unveil COVID-19 Plan
Michigan House Republicans announced their “Comeback Roadmap” Oct. 20, providing a proposed structure that would govern public health response activities in Michigan. The plan would provide for state level public health orders when COVID-19 cases are high, then delegate those decisions to counties that see lower COVID-19 cases, hospitalizations and positivity rates, among other metrics. The Republicans are expected to introduce legislation to codify this plan in the coming weeks and committee hearings could occur on the proposal thereafter. The MHA will monitor this proposal as additional action is taken. Members with questions may contact Adam Carlson at the MHA.
MDHHS Vaccine Plan Published
The Michigan Department of Health & Human Services (MDHHS) recently submitted its interim draft COVID-19 Vaccination Plan to the federal government.
The plan identifies gaps and lessons learned from the implementation of other vaccines and uses those experiences to improve preparedness for the COVID-19 vaccine. The state will use the 2020-2021 seasonal flu campaign as a full-scale exercise for the COVID-19 vaccine effort.
Under the interim draft, the initial distribution of COVID-19 vaccine will go to critical populations. This includes all people working in a healthcare setting, and hospitals will be among the first to receive vaccine distributions. Vaccine allocation is covered in Section 7 of the plan, which begins on page 32. Section 8 addresses COVID-19 Vaccine Storage and Handling and begins on page 36. Members with questions or comments on the interim draft should contact Laura Appel at the MHA.
Bills Signed to Codify Executive Orders on Liability and Nursing Homes
The governor signed legislation Oct. 22 to codify protections that were originally established in previous executive orders (EOs). House Bill (HB) 6159 is specific to healthcare providers and provides broad liability protections from March 29 through July 14 for healthcare entities and professionals working to respond to the pandemic. The language in this bill closely mirrors the language in subsection 8 from the now-rescinded EO 2020-61. In addition, the governor signed the MHA-supported package of bills (HBs 6030, 6031,6032, 6101) providing broad liability protection to employers that includes further protections to healthcare providers and reinstates many of the provisions in previous EOs, such as language providing quarantine exceptions for healthcare workers.
The governor also signed Senate Bill (SB) 1094 to provide additional guidelines on establishing regional nursing home “hubs” (now referred to as Care and Recovery Centers) and prohibit nursing homes from admitting COVID-19-positive patients without verification of their ability to handle those patients. This bill codifies EO 2020-169, which reflected the recommendations and work of the Nursing Home Task Force. Members with questions on either piece of legislation may contact Adam Carlson at the MHA.
Eligible Facilities May Apply for Designation as Care and Recovery Centers
The MDHHS has moved to a rolling deadline for eligible nursing facilities to apply for the Care and Recovery Center (CRC) designation. Recognizing the limitations that SB 1094 imposes on a hospital’s ability to discharge nursing home residents, hospitals with affiliated nursing homes or networks that include eligible nursing facilities may want to consider applying for the CRC designation.
The purpose of CRCs is to provide care for individuals with confirmed COVID-19 who have not met criteria for discontinuation of Transmission-based Precautions. CRCs operate when hospitals need to discharge residents to manage bed availability and provide an alternative for nursing facilities that do not have the capacity to safely care for residents. Facilities that wish to operate a CRC must have the capacity to designate a distinct area for COVID-19 isolation, be able to dedicate staff to the CRC, and meet other established standards. Specific criteria and other details are available in MSA Policy 20-66 and the CRC operational guidance and protocols. Members with questions on the CRC designation may contact Brittany Bogan at the MHA.
MDHHS Issues EO Updating Nursing Home Visitation Requirements
MDHHS Director Robert Gordon issued an Emergency Order Oct. 21 that updates and further expands requirements for residential care facilities, while also permitting indoor visitation in these facilities in certain circumstances.
Under the order, visitation rules are linked to the risk level of the county and the occurrence of positive COVID-19 cases involving residents or staff within the prior 14 days. Local health departments also can determine that indoor visitation may be unsafe. A health evaluation must be conducted, and some visitors will be required to receive COVID-19 testing prior to entry, while facemasks will always be required. Lastly, visits will be allowed by appointment only and visitors per scheduled visit will be limited to two people or fewer. Members with questions may contact Brittany Bogan at the MHA.
Legislation Advances to Allow Nonclinicians to Order COVID-19 Tests
The Michigan Legislature recently finalized House Bill 6293, which would allow nonclinicians to order COVID-19 tests until June 30, 2021. The legislation codifies the governor’s EO 2020-14, which was in question due to the Oct. 2 Michigan Supreme Court ruling on emergency executive power. The bill now goes to the governor, who is expected to approve it. The MHA supports this important legislation that ensures healthcare providers can quickly and effectively order needed COVID-19 tests and will keep members informed when it becomes law. Members with questions may contact Adam Carlson at the MHA.
Exemption of Michigan Licensure during Time of Disaster
There have been many questions raised about out-of-state healthcare providers since the Supreme Court nullified Gov. Gretchen Whitmer’s extended State of Emergency. Therefore, the MHA worked with the Bureau of Professional Licensing (BPL) within the Michigan Department of Licensing and Regulatory Affairs (LARA) to update the document BPL Clarification: Exemption of Michigan Licensure Time of Disaster, which was originally released March 16.
Per MCL 333.16171 of the Public Health Code, LARA still has the authority to allow out-of-state, Canadian and health providers who have been retired within the last five years to continue to assist during a time of disaster. While the state of emergency has been rescinded, LARA strongly believes COVID-19 qualifies as a disaster and developed updated guidance.
Health systems must keep complete documentation of these individuals, as it must be made available in the event the department receives an official complaint about an individual provider. The MHA has also updated its compliance memo on the topic with the recommendations related to proper tracking. Members with questions should contact Paige Fults at the MHA.
The MHA is keeping members apprised of pandemic-related developments affecting Michigan hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.
Legislative Updates on Replacing Executive Orders
The state Legislature and Whitmer administration have been working to codify in statute, rule or other administrative order various COVID-19-related regulations in response to the Michigan Supreme Court Oct. 2 ruling that limited the governor’s authority to issue executive orders. As Gov. Gretchen Whitmer has been integrally involved in these negotiations, she is expected to approve various bills as the Legislature passes them (seerelated article). For assistance in identifying the executive orders that have been replaced, contact Adam Carlson at the MHA .
MHA, Public Health Officials Urge Residents to Intensify Prevention Efforts
At an Oct. 13 news conference, MHA CEO Brian Peters joined the Michigan Department of Health and Human Services (MDHHS) and the Michigan Association for Local Public Health to provide COVID-19 data updates and urge residents to strengthen their efforts to prevent both COVID-19 and the flu. Peters noted that COVID-19 hospitalizations have recently surged more than 80% and that, without the public’s help to stop the spread, Michigan’s healthcare system could be overwhelmed. (See related article.)
LARA Resident-related Infection Prevention and Control Scenarios
To help address inconsistencies in how state surveyors are assessing the use of personal protective equipment, particularly in nursing homes, the Michigan Department of Licensing and Regulatory Affairs Bureau of Community and Health Systems (BCHS) has created an internal guide titled “Resident-Related Infection Prevention and Control Scenarios.” The guide was developed in partnership with the MDHHS Epidemiology division and will act as a tool for BHCS staff to improve their consistency on Centers for Disease Control and Prevention (CDC) recommendations, as many nursing homes have adopted the CDC recommendations as part of their infection control programs. The guide will be continuously updated as changes to the recommendations occur. Members with questions may contact Paige Fults at the MHA.
COVID-19 Vaccine Distribution FAQs Developed
Following the MDHHS’s release of the COVID-19 vaccine provider agreements Oct. 9, the MHA received many questions on the form. Therefore, the association developed and the MDHHS approved a frequently asked questions (FAQ) document to assist members in completing the agreement, which were to be submitted to the MDHHS by Oct. 16. The MHA will update the FAQs as the vaccine distribution program progresses. Members with questions should contact Ruthanne Sudderth at the MHA.