Regulations Released to Implement No Surprises Act

Several federal agencies, including the Office of Personnel Management and the departments of Health and Human Services (HHS), Labor and Treasury, recently released “Part 1” of the regulations to implement the No Surprises Act via an interim final rule with comment period. The rule would implement many of the law’s requirements for group health plans, health insurance issuers, carriers under the Federal Employees Health Benefits program, healthcare providers and facilities, and air ambulance service providers. Most of the provisions would take effect Jan. 1, 2022, and would:

  • Prohibit out-of-network providers from billing patients more than their in-network cost-sharing amount for emergency services and when scheduled care is provided for many nonemergent services at an in-network facility.
  • Establish a formula to calculate the “qualifying payment amount” (QPA) for use in calculating patient cost-sharing unless billed charges are less than the QPA.
  • Permit patients to waive balance billing protections if the out-of-network provider gives notice and obtains the patient’s consent using a standard notice that will be issued by the HHS.
  • Implement a process through which the departments can receive complaints about potential violations for all consumer protection and balance billing requirements with a single process applied to health plans, providers, facilities and air ambulance providers.
  • Clarify the interaction between state and federal laws and address scenarios to help identify when state versus federal law would apply, such as when the health plan license and the provider are in different states.
  • Fail to address all provisions in the No Surprises Act, such as the independent dispute resolution process. Additional regulations would be issued on those provisions.   

The rule does not apply to individuals with coverage through Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care or TRICARE, since these programs already prohibit balance billing. The federal regulations also would establish requirements regarding initial payment or denial by health plans to providers, with health plans having 30 calendar days to make a payment or issue a denial notice after receiving a “clean claim.”

The MHA encourages American Hospital Association (AHA) members to register and participate in two upcoming webinars hosted by the AHA. A session to discuss the regulations will be held from 1 to 2 p.m. EDT July 21. A second webinar to discuss the association’s proposed input to the federal government will be held from 4 to 5 p.m. EDT Aug. 3.

The MHA also encourages members to review the proposed rule and contact Vickie Kunz at the MHA regarding any concerns by Aug. 27 and to submit comments on the interim final rule by Sept. 7.

CEO Report — Incorporating a Federal Advocacy Strategy

MHA Rounds Report - Brian Peters, MHA CEO

“You want a friend in Washington? Get a dog.” – Harry S. Truman

MHA CEO, Brian PetersI have a dog — a beautiful German Shepherd that joined our family in the midst of the pandemic.  I know that many of you have a family dog too, and they are indeed wonderful friends. But as it turns out, the MHA family is also fortunate to have friends in Washington, DC, and never before has that been more important. 

Hospitals and health systems play a key role in their local communities, both as healthcare providers and economic engines. While much of the funding, regulatory, and other public policy decision-making occurs at the local or state level, the truth is that federal politics has become increasingly important, as decisions made at the federal level can have profound impacts on the healthcare delivered in Michigan. The dramatic increase in enrollment for both Medicaid (a shared state/federal program) and Medicare (a strictly federal program) is just one of many reasons why. 

Over the years, the MHA’s engagement at the federal level has increased dramatically, to the point where we have now established meaningful relationships with the entire Michigan congressional delegation and their staffers. These relationships were on display early in the pandemic when we were able to convene conference calls with our delegation — both Republicans and Democrats together on the line at the same time — to listen to our insights and requests and target much-needed assistance to our members who were dealing with a true crisis. We have done all the blocking and tackling that is instrumental to federal advocacy, including routine in-person visits to our delegation members’ DC offices, developing congressional district-specific data and talking points on key issues, coordinating closely with the government relations officers of our member health systems (including those with multistate operations), organizing fundraising events and much more.   

We are fortunate to have a very close partner in this regard: the American Hospital Association.  I’m happy to share that more than 100 of our Michigan community hospitals are also AHA members, a penetration rate that puts Michigan in the very top tier nationally. As a result, our voice is heard clearly as many Michigan healthcare executives are actively involved in the policymaking process of the AHA, serving on various committee and task forces, including the AHA’s Regional Policy Boards. In this manner, we are able to identify needs unique to our region and provide direct input on public policy — and political strategy — to the AHA.  On that note, we are fortunate that Michigan’s own Wright Lassiter, president and CEO of Henry Ford Health System, is now the chair-elect of the AHA Board. 

In addition, the MHA’s political action committee, Health PAC, also has a formal working partnership with the AHAPAC, allowing us to support our members of Congress in this important way.

Recent examples of this partnership in action include our advocacy to protect the Affordable Care Act (ACA), as well as the 340B Drug Pricing Program, and our efforts to combat the COVID-19 pandemic. Several weeks ago, the United States Supreme Court released its opinion in the California v. Texas case that challenged the constitutionality of the ACA. The opinion reversed the Fifth Circuit’s judgement in the matter and upheld the constitutionality of the ACA. The MHA was formally involved in the case, as we joined a number of other state hospital associations in filing an amicus brief with the Supreme Court. We are very pleased with this outcome, which will help to preserve coverage for as many Michiganders as possible — a key MHA priority.

The MHA has also been involved in the federal legal strategy to support the 340B Drug Pricing Program, which is a federal program created by Congress to help provide relief from escalating drug prices to safety-net hospitals and other healthcare providers serving vulnerable patient populations. Over the past year, six drugmakers have stopped providing discount drug prices for pharmacies that contract with 340B providers. The MHA is working with the American Hospital Association Advocacy Alliance for the 340B Drug Program and the 340B Health coalition to protect this vital program. Last fall, the MHA organized a letter to the Michigan congressional delegation that was signed by representatives from 68 of the more than 80 Michigan 340B hospitals to share hospitals’ concern regarding drug manufacturers’ attempts to limit payment to contract pharmacies and other actions that are a significant detriment to 340B hospitals and the services they can provide to eligible patients because of the program. The MHA also joined other state hospital associations earlier this spring in submitting an amicus brief in support of the AHA’s petition to the U.S. Supreme Court for certiorari (a formal request to the court to take up the case) in its appeal of an appellate court decision unfavorable to hospitals on 340B.

Lastly, the MHA has been involved with various aspects of the COVID-19 response at the federal level, from advocating for provider relief funds to providing data and insights on the impact of the pandemic. In May, the MHA worked quickly to get a majority of Michigan’s U.S. House delegation to sign onto a letter urging Department of Health and Human Services (HHS) Secretary Xavier Becerra to extend the deadline for hospitals to use provider relief funds. This joint effort with the AHA and other groups ultimately led to the HHS announcing extended deadlines by which hospitals and other providers that received Provider Relief Fund (PRF) money may use their COVID-19 PRF payments. We also had several MHA members directly involved in submitting statements to Sen. Gary Peters on the impact of healthcare supply chain shortages during the pandemic, which were utilized by the Senate Homeland Security and Governmental Affairs Committee that Sen. Peters chairs.

The MHA is currently working on a comment letter for the recently released federal Occupational Safety and Health Administration (OSHA) Emergency Temporary Standards (ETS). Although the AHA achieved several improvements in the final proposed ETS, a number of issues remain. Because Michigan uses a state plan for OSHA regulation, MIOSHA adopted these rules June 22. The MHA is aware that the federal ETS is under regular review and amendments are possible. Filing comments brings attention to those parts of the rule that require further action.

Laura Appel, MHA senior vice president of health policy and innovation, has done an outstanding job as our point person on federal advocacy for many years now. I can tell you from firsthand experience that she knows her way around the federal policymaking process as well as she knows her way around the maze of offices on Capitol Hill. In addition, MHA Executive Vice President Chris Mitchell is serving as the chairman of the SAGRO (State Association Government Relations Officers) group, representing all the state hospital association advocacy leaders. MHA Chief Medical Officer Gary Roth, DO, is also serving as chairman of the SHAPE (State Hospital Association Physician Executives) group, leading his peers across the country. And for the past year I have had the privilege of serving as the chairman of the AHA State Issues Forum, which is the group of state hospital association CEOs focused on the strategic issues that we all share. Collectively, these engagements are just another indication of the stature and leadership of our association on the national level.

As you can see, our dedication to advocating for our members — and the pursuit of our mission to advance the health of individuals and communities — extends from Lansing to Capitol Hill. I am proud of the strong foundation that we have established in this regard and, given the increased focus on hospitals and healthcare in the national conscience as a result of the pandemic, I am convinced that our work at the federal level will continue to be critical. 

As always, I welcome your thoughts

Combating the Novel Coronavirus (COVID-19): Week of Sept. 21

MHA Covid-19 update

COVID-19 UpdateAs the coronavirus follows the world into yet another season, the MHA continues to keep members apprised of developments affecting Michigan hospitals during the COVID-19 pandemic through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Congress Extends Medicare Advance Payment Loan Repayment

U.S. House of Representatives leadership reached an agreement Sept. 22 on a Continuing Resolution to prevent the federal government from shutting down Oct. 1, which also includes two important provisions for hospitals. H.R. 8337, Continuing Appropriations Act, 2021 and Other Extensions Act of 2020, delays until Dec. 11, 2020, previously proposed Medicaid disproportionate share hospital (DSH) cuts. It also delays the deadline for loan repayment of COVID-19-related Medicare Advanced Payments to 12 months from the date an organization received its advanced payments. The language in the bill summary on these two issues states: 

  • Section 2303. Delay of DSH reductions. Section 2303 delays implementation of the allotment reductions for Medicaid disproportionate share hospitals through December 11, 2020.
  • Section 2501. Medicare Accelerated and Advance Payment Program Changes. Section 2501 extends both the period before repayment begins and the period before the balance must be repaid in full, reduces the recoupment percentage, and lowers the interest rate for payments made under the Medicare Accelerated and Advance Payment Programs and comparable programs between the date of enactment of the CARES Act and the end of the COVID-19 public health emergency.

While the MHA believes the steps taken in the H.R. 8377 are positive, the association will continue to work with the American Hospital Association to urge full forgiveness of the Medicare advanced payments, given the magnitude of the impact COVID-19 has had on hospitals and their patients. Members with questions may contact Laura Appel at the MHA.

HHS Issues Notice on Provider Relief Fund Reporting Requirements

The HHS released a notice Sept. 19 regarding reporting requirements for healthcare providers that received Provider Relief Fund (PRF) payments. This notice includes the categories of data elements that recipients must submit for calendar years 2019 and 2020. It is also a supporting document to its Aug. 14 post-payment notice of reporting requirements. The HHS stated that the reporting system will now be available in early 2021.

According to the guidelines, if recipients do not use all PRF funds by the end of calendar year 2020, they will have six additional months in which to use remaining funds. The funds may be used toward COVID-19 expenses that aren’t reimbursed by other sources or to apply toward lost revenues in an amount not to exceed the 2019 net gain.

The agency indicates these requirements will apply to any provider that received one or more payment totaling at least $10,000. The HHS will make an additional frequently asked questions document available prior to the reporting deadline. The MHA is working closely with the AHA on next steps and will keep members apprised.

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 July 13

MHA Covid-19 update

coronavirus updateAs 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.

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: