Hospital Funding Approved, CRNA Legislation Signed into Law

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Michigan Capitol BuildingSenate Bill (SB) 27, a supplemental budget bill containing funding for $160 million of COVID-19 relief for Michigan hospitals which accounts for the cost of treating COVID-19 patients, was passed in the Senate and is being sent to the governor for signature. The MHA will work with the Michigan Department of Health and Human Services on the distribution of the funding. The association will keep members apprised of further action on this bill or other supplemental appropriations that impact hospitals.

In addition, Gov. Gretchen Whitmer signed into law July 13 MHA-supported legislation modernizing the scope of practice for Certified Registered Nurse Anesthetists (CRNAs) as Public Act 53 of 2021. Introduced as House Bill 4359 by Rep. Mary Whiteford (R-Casco Township), the new law will allow flexibility for each hospital to choose the anesthesia care model that best fits its location, staffing and resources to offer safe and effective patient care by eliminating the state requirement that a CRNA must work under direct physician supervision.

This change has long been an MHA priority and will eliminate a costly regulation for hospitals while maintaining patient safety. The MHA worked diligently with other stakeholders representing provider groups as the bill was negotiated. The Michigan State Medical Society was neutral on the final version of the legislation signed by the governor, which includes a provision maintaining physician input on patient care and patient-centered care teams.

The MHA testified in support of the legislation in both the House and Senate and applauds the work of both chambers and the governor in passing the law.

The new law, which is set to take effect Oct. 11, brings Michigan in line with 42 other states and the U.S. military. To fully implement the law, the governor must submit a letter to the Centers for Medicare & Medicaid Services to formally exercise the exemption from the federal supervision requirement for CRNAs once the federal declaration of emergency related to the COVID-19 pandemic ends. The MHA will urge the governor to perform this final action when appropriate.

Questions on the budget or the new rules for CRNAs in Michigan can be directed to Adam Carlson at the MHA.

Healthcare Bills Progress Prior to State Legislative Summer Break

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Michigan CapitolThe Michigan Legislature continued work on bills impacting Michigan hospitals as it goes into the final week before its summer break. Action was taken during the week of June 21 on issues regarding certified registered nurse anesthetists (CRNAs), the fiscal year (FY) 2022 budget, pharmacy benefit managers (PBMs), requirements for Canadian health professionals in Michigan and allowing certain health professionals to train nurse aides. In addition, the Michigan Department of Health and Human Services held a news conference on legislation related to treatment for opioid use disorder (OUD), and the governor signed legislation related to the Certificate of Need (CON) program.

Both the House and Senate took action on House Bill (HB) 4359, voting to support the important legislation that would modernize the scope of practice for CRNAs. The bill was introduced by Rep. Mary Whiteford (R-Casco Township) and will now go to the governor’s desk for signature. The legislation would bring Michigan in line with 42 other states and the U.S. military, all of which provide flexibility regarding physician supervision of CRNAs delivering anesthesia care. The MHA has supported HB 4359 with testimony in both chambers and will continue to advocate for the bill to be signed into law.

Representatives in the House approved House Bill (HB) 4410, which would provide for all funding for the FY 2022 budget year, aside from community colleges and higher education. HB 4410 would protect key hospital priorities, including graduate medical education, disproportionate share hospital funding, rural and obstetrics stabilization pools, critical access hospital funding and Medicaid rate increases. The bill includes new provisions that would make changes to streamline prior authorization timeframes for Medicaid health plans and boilerplate that would prohibit the use of any funds for vaccinations under a mandatory vaccination program. Due to concerns that the vaccine mandate provision could hinder state vaccination efforts, the MHA will work closely with the administration to address potential issues. HB 4410 will now be sent to the Senate for consideration.

The House Health Policy Committee reported Senate Bill (SB) 416 to the floor. The bill was introduced by Sen. Wayne Schmidt (R-Traverse City) and would ensure that Canadian health professionals who have previously taken relevant medical exams could apply for Michigan licensure. SB 416 clarifies legislation supported by the MHA during the last session that provided licensure reciprocity to Canadian health professionals who want to work in Michigan. It will now be sent to the full House for a vote.

The House Health Policy Committee also took testimony on HB 5089, which was introduced by Rep. Ann Bollin (R-Brighton Township) and would allow a registered professional nurse to train nurse aides without a permit for up to four months after the end of the COVID-19 declared state of emergency. The MHA has not taken a position on HB 5089 and no vote was held.

In the Senate Health Policy and Human Services Committee, further testimony was held on HB 4348, which would regulate and establish licensure for PBMs in Michigan. The legislation was introduced by Rep. Julie Calley (R-Portland) and is supported by the MHA to help slow the rising cost of prescription medications. No vote was held in committee on HB 4348.

Dr. Daniel Roper participated in the June 23 event that announced legislation to increase access to lifesaving treatment for opioid use disorder.A news conference was held June 23 to announce the introduction of a bill that would provide funding for a grant program for hospitals to increase access to medication assisted treatment for OUD in the emergency department (ED). The MHA Legislative Policy Panel supports the bill, which is intended to increase access to lifesaving treatment for OUD. Daniel Roper, MD, chief of emergency services and medical director of the ED at Mercy Health Saint Mary's in Grand Rapids, represented one of 19 Michigan hospitals currently providing medications for OUD in EDs during the event, noting that the proposed bill would remove barriers for other providers to offer the treatment. The bill is expected to be introduced before the legislative summer break, and the MHA will keep members apprised of its movement.

Lastly, the governor signed SB 440 into law June 24 as Public Act 35 of 2021. SB 440 was introduced by Sen. Winnie Brinks (D-Grand Rapids) and would remove full-body PET scanner services from CON oversight.

Members with questions on these or other state legislative issues should contact Adam Carlson at the MHA.

MDHHS Director Hertel Addresses MHA Legislative Policy Panel

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MDHHS Director Elizabeth Hertel provides a state update on the COVID-19 pandemic.The MHA Legislative Policy Panel convened March 24 to develop recommendations for the MHA Board of Trustees on legislative initiatives impacting Michigan hospitals.

The meeting was highlighted by a presentation from Michigan Department of Health & Human Services (MDHHS) Director Elizabeth Hertel, who provided a statewide update related to the pandemic, including increasing COVID-19 infection rates and hospitalizations, as well as vaccine distribution. Hertel also discussed future MDHHS funding objectives and targets, which includes an increased focus on behavioral health.

Moving to action items, due to significant concerns regarding patient safety and regulatory structure, the panel recommended that the MHA oppose planned legislation that would create a Recovery Care Center license for a healthcare facility. With the new license, ambulatory surgery centers would be able to provide more invasive procedures by adding overnight rooms.

The panel also recommended that the MHA oppose House Bill 4355 as introduced, which would expand telehealth services by allowing out-of-state providers to deliver telehealth treatments to Michigan residents.

The panel received updates on issues at both the state and federal level. State level updates were provided on COVID-19 vaccination efforts, the Department of Insurance and Financial Services auto no-fault insurance fee schedule rules open comment period, state budget negotiations and House Bill 4359 that would modernize the scope of practice for certified registered nurse anesthetists. Federal updates focused on suspending the Medicare sequester and the recently enacted COVID-19 relief legislation known as the American Rescue Plan.

For more information on the MHA Legislative Policy Panel, contact Adam Carlson at the MHA.