The Health Resources Services Administration (HRSA) recently opened an application process for $25.5 billion in federal COVID-19 funding for providers. The same application process is used for both Provider Relief Fund (PRF) Phase 4 and American Rescue Plan (ARP) Rural payments.
The PRF Phase 4 funding is open to a broad range of providers with changes in operating revenues and expenses due to the pandemic. ARP Rural funding is open to providers who serve rural beneficiaries of Medicare, Medicaid or the Children’s Health Insurance Program, known in Michigan as MIChild.
Additional information, including eligible provider types and application instructions, is available on the HRSA website. The agency must receive applications by Oct. 26, and members are encouraged to begin the process as soon as possible. Registration for webinars featuring guidance on using the application portal are also listed online. HRSA intends to start distributing the ARP funds by late November and the PRF funds by mid-December.
The Federal Communications Commission (FCC) announced that it voted March 30 to reopen the COVID-19 Telehealth Program, a $249.95 million federal initiative that builds on the $200 million program established as part of the CARES Act enacted in March 2020. The COVID-19 Telehealth Program is a reimbursement program that allows healthcare providers to receive compensation for telehealth-related expenses with appropriate invoices and documentation. The new application window for the second round of funding is expected to open within 30 days of the order, and the FCC will provide advance notification of that date.
The COVID-19 Telehealth Program was created to help healthcare providers provide connected care services to patients at their homes or mobile locations in response to the COVID-19 pandemic. With the relaunch of the program, the FCC announced that telehealth technology is a vital component of curbing inequities in access to healthcare services and that applications will be evaluated equitably to better ensure each state and territory can be approved for funding. Round 2 funding will prioritize low-income communities, tribal communities, areas with provider shortages and projects that were not approved during the Round 1 application. The second application process will differ from the first by having an application deadline meant to ensure all applications are reviewed, rather than applications being reviewed as submitted. The first round of funding for the program was depleted in July 2020 after issuing awards to 539 applicants. Members with questions should contact Renée Smiddy at the MHA.
As the threat posed by COVID-19 rises across the country, 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.
Tools Available to Advocate for Next COVID-19 Relief Package
The MHA participated in a Virtual Advocacy Day that the American Hospital Association (AHA) hosted July 20, featuring presentations from AHA President and CEO Rick Pollack and AHA Executive Vice President Tom Nickels. An update was shared on efforts to include provisions to support hospitals in the next COVID-19 relief package, which includes additional dollars for the emergency relief fund, forgiveness for accelerated payments, and liability protections for front-line medical providers and facilities.
Since Senate negotiations on the bill reportedly stalled July 23, it remains important for healthcare providers to advocate for these provisions. The AHA has issued an Advocacy Alert (password required) asking that members contact their senators to stress their importance. While Michigan’s U.S. Sens. Debbie Stabenow and Gary Peters are healthcare champions, there is value in them hearing from their constituents on the importance of this funding. To aid in these efforts, the AHA has developed resources and a digital toolkit to help members engage with lawmakers virtually. Members with questions on federal advocacy topics may contact Laura Appel at the MHA.
HHS Extends Public Health Emergency
On July 23, the U.S. Department of Health and Human Services (HHS) extended the COVID-19 public health emergency for another 90 days. The renewal, officially signed by HHS Secretary Alex Azar, ensures that waivers received from the HHS and the Centers for Medicare & Medicaid Services will continue. Policies extended include the 20% Medicare inpatient add-on payment for COVID-19 patients, relaxed telehealth restrictions and other Section 1135 waivers. Members with questions should contact Laura Appel at the MHA.
The HHS recently announced $10 billion in additional “targeted” hospital funding from federal Coronavirus Aid, Relief, and Economic Security (CARES) Act provider relief funds to assist hospitals with COVID-19 response efforts. The HHS asked hospitals to submit data on their COVID-19-positive inpatient admissions for the period Jan. 1 through June 10, 2020. Payments will be issued to hospitals with more than 161 COVID-19 admissions during this period, with a portion of Michigan hospitals set to receive additional funding from the allocation.
The HHS also shared details on reporting requirements for recipients of CARES Act provider relief funds. Recipients that received one or more payments exceeding $10,000 in the aggregate from the Provider Relief Fund, including the newly announced payments, are required to submit reports to the HHS on how the funds have been expended, using a portal that the HHS will open Oct. 1. Detailed instructions regarding these reports will be released by Aug. 17, and the Health Resources and Services Administration will host educational sessions for providers.
The MHA will continue to monitor hospital distributions from the CARES Act Provider Relief Fund and update members as information becomes available. Members with questions about this funding are encouraged to contact Jason Jorkasky at the MHA.
Guidance Released on Wage Increase for Direct Care Worker Grants
The Michigan Department of Health and Human Services released further information and guidance regarding the $2 per hour wage increase for direct care workers via state grants that was signed into law through Senate Bill (SB) 690 July 1. The department’s frequently asked questions document contains information regarding eligibility of individuals and facilities, as well as the logistics for providing the increased funding at skilled nursing facilities.
In SB 690, the Legislature appropriated $120 million to increase the wages of direct care workers. The language of the bill provided that the increases are above the rates paid March 1 and apply to the period from July 1 through Sept. 30, 2020. Only “direct care workers” at skilled nursing facilities are eligible for the grants. These workers include registered nurse, licensed practical nurse, competency-evaluated nursing assistant or respiratory therapist. The MHA will continue to share additional information about the grants as it becomes available. Members with questions on this issue may contact Adam Carlson at the MHA.
State FY 2020 Budget Protects Healthcare Priorities
During the week of July 20, negotiations ended on the state fiscal year (FY) 2020 budget as the Legislature approved a plan addressing a deficit of nearly $2.2 billion caused by economic losses surrounding the COVID-19 pandemic (see related article). The MHA actively worked with lawmakers to ensure that the association’s budget priorities were held harmless from reductions, including the rural access pool and obstetrical stabilization fund, Medicaid rates and provider tax funded pools. In the coming months, the Legislature and administration will work on the state budget for FY 2021, which begins Oct. 1, and the MHA will continue to stress the importance of fully funding healthcare during those negotiations. Members with questions may contact Adam Carlson at the MHA.
State Senate Approves Liability Protection Bill
Legislation to limit legal liability for healthcare facilities during the COVID-19 pandemic passed the Senate July 23 after receiving approval from the full House late July 22. Senate Bill (SB) 899 would protect facilities from lawsuits related to pandemic response. Specifically, the legislation protects from lawsuits related to the provision of care to COVID-19 patients, rescheduling patient care because of governmental orders or shortages of supplies.
Sen. Michael MacDonald (R-Macomb Township) introduced SB 899, and it passed the Senate May 7. The final version of the legislation as approved July 23 reflects the House substitute that was adopted in committee July 22. The legislation requires Gov. Gretchen Whitmer’s signature before becoming law. The MHA will continue to monitor and keep members informed on the issue. Members with questions should contact Adam Carlson at the MHA.
National COVID-19 Testing Implementation Forum and Testing Supply Registry Announced
The HHS announced July 21 a new program to capture feedback between federal officials and the private sector on COVID-19 testing. The National Testing Implementation Forum will bring together representatives from key stakeholder groups to share information and provide input to federal leaders about SARS-CoV-2 testing and diagnostics. A key aim of the forum is to share perspectives on how the HHS can best address end-to-end testing supply chain issues across commercial, public health, academic and other sectors and define optimal testing in various settings (diagnostic, screening, surveillance, others). The group will also aim to increase public health laboratory capacity, implement a national surveillance strategy, seek new techniques such as sample pooling and identify barriers to a streamlined national laboratory testing reporting system.
The same day, the Advanced Medical Technology Association (AdvaMed) announced the creation of a comprehensive, national COVID-19 diagnostic supply registry to help state and federal governments in their pandemic responses. As outlined in AdvaMed’s news release, the national registry is being launched in partnership with 13 commercial diagnostics manufacturers, nearly all of which produce supplies used in Michigan. The new registry will streamline communications and data sharing between diagnostic firms and the government, facilitate collaboration with public health stakeholders to optimize access to COVID-19 testing, and standardize reporting. Questions related to COVID-19 testing can be directed to Brittany Bogan at the MHA.
Grace Period Granted for Remote Pharmacy Supervision Step Down
The governor issued Executive Order (EO) 2020-152 July 14, removing some of the flexibility related to remote supervision of pharmacy technicians and staff that existed in EO 2020-124, which has since been rescinded. The Department of Licensing and Regulatory Affairs (LARA) has issued a memo discussing the topic and a timeline to fully transition from remote to on-site supervision. LARA will give pharmacies until 11:59 p.m. Sept. 30, 2020, before enforcing supervision and other requirements. Members with questions about EO 2020-124, EO 2020-152 or the memo from LARA may contact Paige Fults at the MHA.
Multilingual Mask-up Materials Available
The state of Michigan has available for download No Mask, No Entry posters in various languages, including English, Spanish, Arabic, Traditional Chinese, Simplified Chinese, Korean, Burmese, French, American Sign Language, Swahili and Bangla. Questions on available resources can be sent to the MHA Communications department.
Acting Homeland Security Secretary Chad Wolf recently announced that the United States and Canada have extended the mutual ban on nonessential travel between the two countries until Aug. 20; that ban had been set to expire July 21. Essential travel, including that of healthcare workers, may continue uninterrupted. The MHA will continue to monitor and work with state and federal governments to keep the border open for essential healthcare employees. Members with questions on this issue may contact Adam Carlson at the MHA.
As the state experiences a steady rise in the number of COVID-19 cases, Gov. Gretchen Whitmer has extended the official state of emergency in Michigan through Aug. 11. The MHA continues to keep members apprised of developments during the pandemic through email updates and the MHA Coronavirus webpage. Important updates on how the pandemic is affecting Michigan hospitals are outlined below.
HHS Announces Next Tranche of Funds for Hospitals with High COVID-19 Caseloads
The U.S. Department of Health and Human Services (HHS) announced July 17 that it will distribute $10 billion to hospitals with high numbers of COVID-19 patients, beginning the week of July 20. This is the second tranche of high-impact funds from the federal Coronavirus Aid, Relief, and Economic Security (CARES) Act.
Using data hospitals submitted on COVID-19-positive inpatient admissions for the period Jan. 1 to June 10, 2020, the HHS based this distribution on a formula for hospitals with over 161 COVID-19 admissions during that period, equating to one admission per day, or that experienced a disproportionate intensity of COVID-19 admissions (exceeding the average ratio of COVID-19 admissions/bed). The HHS also considered previous high-impact payments when determining each hospital’s payment in this distribution. Hospitals will be paid $50,000 per eligible admission.
The MHA and American Hospital Association have been advocating for additional hospital financial relief at every opportunity. This funding comes at a critical time, as cases of COVID-19 in Michigan are again rising. However, since not all hospitals will meet the threshold for receiving high-impact funds, securing additional funds for all hospitals and loan forgiveness for Medicare advance payments remain among the association’s top priorities.
Members with federal advocacy questions may contact Laura Appel at the MHA.
Changes Made in Federal Requirements for COVID-19 Reporting
The U.S. Department of Health and Human Services (HHS) announced July 13 it would discontinue the use of the National Healthcare and Safety Network COVID-19 Module for hospitals starting July 15. Instead, hospitals will be required to enter COVID-19 information daily into the HHS Teletracking portal. The department has updated its guidance and frequently asked questions (FAQs) to reflect the data fields that will be collected and their definitions, including new data elements.
The MHA is currently working with the state of Michigan to modify the state’s EMResource data collection system to allow the state to submit data on behalf of Michigan hospitals and to expedite the state and federal government approval process. Until the state of Michigan receives approval from the federal government, hospitals must enter COVID-19 information daily into both the HHS Teletracking portal and EMResource to be eligible to receive future distribution of resources, including pharmaceuticals and more.
The association will notify members when the state receives approval from the federal government to submit data on behalf of hospitals, which will allow providers to make daily entries into only the EMResource system. Members with questions may contact Jim Lee at the MHA.
State Works with MHA on Ending Relaxation of Scope of Practice, Immunity Provisions
The governor issued Executive Order (EO) 2020-150 to rescind EO 2020-61, which had allowed healthcare practitioners to temporarily practice beyond the scope of their license, with limitations. The governor referenced stable and manageable COVID-19 hospitalization rates and hospital resources as the reason for rescinding the expansion of scope, which also removed certain important immunity provisions that protected healthcare facilities and entities during the pandemic, effective July 13.
The MHA discussed the EO with the Michigan Department of Licensing and Regulatory Affairs (LARA), and the department issued a memo July 17 that outlines flexibility and license requirements that remain in place under EO 2020-150. The memo is available via the July 17 email update to members and also provides a timeline for returning to normal order for scope of practice. LARA is allowing providers an extended compliance deadline of 11:59 p.m. Aug. 31 before enforcing the updated supervision and other requirements. In addition, the EO extends the suspension of certain licensing and certification requirements for healthcare professionals, life support and first aid workers, and 911 operators.
Meanwhile, the MHA is working with the Legislature on Senate Bill 899, which would secure important immunity protections similar to those afforded in EO 2020-61. Members with questions on the memo from LARA may contact Paige Fults at the MHA.
MIOSHA Hospital State Emphasis Program and Requests for Voluntary Inspections
The Michigan Occupational Safety and Health Administration (MIOSHA) recently announced its Hospital State Emphasis Program, which focuses on inspecting hospital facilities for appropriate personal protective equipment and staff safety related to COVID-19.
Since the initial announcement, the MHA has shared a letter with leadership at the Department of Labor and Economic Opportunity suggesting opportunities for achieving good outcomes for patient care and worker safety. The MHA continues to work with MIOSHA to clarify areas of a FAQs document the agency is preparing.
While a limited number of MHA members are expected to be contacted for inspection under the State Emphasis Program, members may use MIOSHA in a consulting manner by request. Michigan employers may request a voluntary MIOSHA inspection of their workplace (full or partial) without the attachment of fines or penalties. These on-site consultations are conducted by occupational safety consultants or industrial hygienists through the Consultation Education and Training Division. Prior to the start of this type of inspection, employers must agree to correct all serious violations found during the voluntary inspection. For more information about the Hospital State Emphasis Program, contact Laura Appel at the MHA.
Governor Updates Mask Requirement
Gov. Gretchen Whitmer July 17 issued an updated executive order (EO 2020-153) requiring masks to be worn in public places and businesses and providing some clarification for how the requirement should be interpreted and enforced. Essentially, the new order provides clarity about law enforcement officers wearing masks, who is not required to wear a mask, and exceptions for removing a mask.
Healthcare settings are not mentioned specifically in the updated order; however, members continue to be advised to make their best effort to comply with the mask requirement enforcement for patients and visitors in their facilities, while prioritizing patients’ individual health and circumstances.
State Discusses Supply Chain Issues with MHA Members
The MHA continues to host calls for hospital supply chain contacts as needed. During a recent call, the state indicated it is working to increase the supply of key personal protective equipment, with a goal of having a 90-day supply on hand. Nitrile gloves will continue to be in short supply, and hospitals should follow conservation recommendations of the Centers for Disease Control and Prevention as much as possible.
MHA member HPS, a group purchasing organization, said that most of its vendors have an ample supply of personal protective equipment and related items available. The organization encourages groups that are not current HPS members to consider partnering with HPS as it adds additional contracts for personal protective equipment during the summer. Members with questions may contact Kevin Crampton at HPS.
Opportunities Available for Pooling Lab Tests for Asymptomatic Individuals
The MHA and the Michigan Department of Health and Human Services (MDHHS) host weekly calls with laboratory directors regarding COVID-19 testing capacity and the increasing demand for screening of asymptomatic populations. Those calls prompted a July 16 call for Michigan laboratories interested in pooled testing strategies for COVID-19, along with leaders from the state Bureau of Laboratories (BOL).
The statewide testing strategy has expanded to include more asymptomatic individuals to protect the safety of employees, students, patients and others. While this is a positive step, it has also placed further strain on an already limited supply of COVID-19 diagnostic tests. Pooling samples of asymptomatic individuals preserves limited testing resources but requires additional validation because the Food and Drug Administration (FDA) has approved the current diagnostic tests only for individuals suspected of having COVID-19.
To streamline additional studies, the FDA released in June template updates regarding the validation of diagnostic tests for developers that intend their analysis to be used for pooling patient samples or for screening asymptomatic individuals not suspected of having COVID-19. In addition, the FDA has made available new testing FAQs with information regarding the screening of asymptomatic individuals.
Labs that plan to begin their own validation studies are encouraged to share the information with the Michigan BOL. Members with questions, or those who wish to join the MHA calls with the laboratory directors, may contact Brittany Bogan at the MHA.
Healthcare Heroes Acknowledged via Social Media
From April through June, the MHA ran a social media campaign recognizing the heroic workers on the front lines of COVID-19 working throughout its member hospitals and health systems. The effort highlighted more than 250 healthcare professionals — nurses, physicians, environmental service workers and others — from communities across the state and thanked them for their dedication to fighting COVID-19 and caring for patients. Using information supplied by member hospitals, the campaign ran on the MHA’s Facebook, Twitter and Instagram accounts, and several video samples of the posts were included in related articles on the MHA Newsroom webpage. More than 431,000 people shared, liked and/or commented on the posts. Members with questions may contact Ruthanne Sudderth at the MHA.
The MHA continues to keep members apprised of developments during the COVID-19 pandemic through regular email updates and the MHA Coronavirus webpage. Important updates on how the pandemic is affecting Michigan hospitals are outlined below.
Data Due June 15 to Potentially Qualify for Further COVID-19 Funding from HHS
The U.S. Department of Health and Human Services (HHS) has requested information from hospitals to determine the distribution of $10 billion to hospitals that have been particularly burdened with COVID-19 cases. Each healthcare facility with a Medicare Tax Identification Number is asked to submit the number of COVID-19-positive inpatients admitted from Jan. 1 through June 10.
Submission of this data by 9 p.m. ET June 15 is required to be eligible to receive the funding, but it is not a guarantee of eligibility. The HHS has posted a frequently asked questions document about funding through the Coronavirus Aid, Relief, and Economic Security (CARES) Act; information on this round of funding begins on page 26. The data must be submitted through the HHS’s TeleTracking system. More information on setting up an account and entering data is available on TeleTracking’s help webpage or by calling TeleTracking Technical Support at (877) 570-6903. Members with questions about federal funding may contact Laura Appel at the MHA.
Policy Updated on Decontaminating N95 Masks
The Food and Drug Administration (FDA) reissued emergency use authorizations related to respirator decontamination, noting that some respirators should not be decontaminated for reuse. The agency will no longer recommend decontamination for the reuse of respirators manufactured in China or those that have exhalation valves. Decontamination will be authorized only on non-cellulose-compatible N95 respirators. Healthcare personnel should use the decontamination process only when new, FDA-cleared N95 respirators, NIOSH-approved N95 respirators or other FDA-authorized respirators are unavailable.
State Issues Guidance on Testing Frequency and Available Capacity
To ensure available COVID-19 testing resources are being effectively used in high-risk populations and/or settings across the state, the Michigan Department of Health and Human Resources (MDHHS) issued recommendations June 10 on the ideal frequency of COVID-19 testing. The guidance assumes a scenario where sufficient testing supplies and capacity are available. To help meet the level of testing envisioned in these recommendations, the MDHHS has also published information regarding test sites that provide services at no cost to the patient and laboratories with available testing supplies and capacity to allow for new providers and congregate care facilities to send specimens. The June 10 recommendations and additional information on testing priorities and frequency by population is available in the June 10 update emailed to members.
Resources and Guidance Available for Lab Supplies and Reporting Results
The FDA’s web-based resource Testing Supply Substitution Strategies contains detailed information to support labs performing authorized COVID-19 tests, including validated supply alternatives for use when there is a supply issue with some components of a test. This PowerPoint presentation, which can be downloaded from the FDA website, does not alter emergency use authorizations that have already been issued nor specific FDA regulatory requirements. It is provided solely to address concerns about the availability of certain critical components of DOVID-19 diagnostic tests.
The U.S. Department of Health and Human Services (HHS) has provided guidance that specifies additional data that laboratories must report with their COVID-19 test results. The new data should be reported as soon as possible, but no later than Aug. 1. More information is available in the department’s news release.
Workplace Requirements for Outpatient Facilities
Executive Order 2020-114 stipulates accommodations for all workers required to return to the workplace during the pandemic. Section 9 of EO 2020-114 pertains specifically to outpatient healthcare facilities, including clinics and physician offices, and outlines requirements that do not apply to inpatient hospitals.
The requirement for checking patient temperatures for these facilities is different from the evaluation required for employees at inpatient or outpatient facilities. This section of EO 2020-114 does not change the requirements for employee health evaluations prior to entering healthcare facilities when reporting to work. Questions on the requirements should be directed to Amy Barkholz at the MHA.
The Joint Commission Offers Webinar as On-site Surveys Resume
The Joint Commission will host a webinar titled The Joint Commission – Plan for Resuming Surveys from 11 a.m. to noon June 18. Registration is required, and more information is available in the related article.
Blue Cross Cost Sharing Waiver Extended Through End of Year
Blue Cross Blue Shield of Michigan (BCBSM) announced it is extending cost sharing (copays, deductibles and coinsurance) waivers for COVID-19 testing and treatment through Dec. 31. These measures originally were set to expire June 30. The announcement says the cost share waivers “apply to members in fully insured commercial PPO and HMO plans, as well as individuals in fully insured Medicare Advantage plans. BCBSM will work with employer group customers that are self-insured to make decisions regarding their own benefits.” Members with questions on COVID-19 payer issues may contact Jason Jorkasky at the MHA.
“Don’t Delay Care” Campaign Update
The MHA “Hospitals are Safe – Don’t Delay Care” campaign began on social media and statewide television in mid-May and will end during the week of June 15. The campaign has focused on video views, building awareness for those who may be making decisions about seeking medical care during COVID-19. As of June 12, the video had been viewed on Facebook more than 577,000 times. Although the campaign is ending, the association will continue to share this message through its normal social media content. For more information on this or other public relations campaigns, contact Ruthanne Sudderth at the MHA.