MHA Monday Report Nov. 14, 2022

MHA Monday Report

MI Vote Matters logoRecapping 2022 Election Results

Midterm election results are in, bringing new leadership to the Michigan Legislature and a returning administration at the top of the ticket. Election 2022 will bring significant change to Lansing, as Democrats will now control the Governor’s office and both chambers of the state legislature for the first time since 1984 …


capitol buildingLegislature Returns for Lame Duck Session

The legislature returned during the week of Nov. 7 to vote on legislative leadership and kickoff the 2022 lame-duck session. Only a handful of MHA-tracked bills saw action, including legislation to implement the new federal Rural Emergency Hospital (REH) designation …


CMS Finalizes Rate Cuts in 2023 Medicare Physician Fee Schedule

The Centers for Medicare & Medicaid Services (CMS) recently released the 2023 Medicare Physician Fee Schedule (PFS) final rule, effective Jan. 1, 2023. The rule reduces the PFS conversion factor by $1.55 (4.7%) to $33.06 in a calendar year (CY) 2023 from $34.61 in CY 2022 …


October MA Enrollment Increases by 17,000 Beneficiaries

Medicare Advantage (MA) enrollment in Michigan totaled approximately 1.22 million in October, an increase of 17,000 beneficiaries since July. The October enrollment is spread across 48 MA plans that are currently operating in the state …


The MHA Keystone Center Offers Ongoing Workforce Well-Being Courses

Through a partnership with the Duke Center for Healthcare Safety and Quality, the MHA Keystone Center is pleased to offer the second iteration of its WELL-B webinar series geared to support healthcare workers experiencing burnout …


The Keckley Report 

Paul KeckleyThe Physician Pay Rule in Context: Profession “Heal Thyself”

“Last Tuesday, the Center for Medicare and Medicaid Services (CMS) published its 2023 payment schedule for physicians along with changes in the Medicare shared savings program, outpatient, behavioral and home health services…

Healthcare is at a crossroad. Physicians are caught in the crossfire of policies to lower health costs and capital necessary to transform the system from specialty care and volume-based incentives to value and wellbeing.”

Paul Keckley, Nov. 7, 2022


Laura AppelMHA in the News

The MHA received media coverage on the continued surge of RSV cases across Michigan’s pediatric hospitals that is stressing hospital capacity during the week of Nov. 6. Laura Appel, executive vice president …

Legislature Returns for Lame Duck Session

capitol building

capitol buildingThe legislature returned during the week of Nov. 7 to vote on legislative leadership and kickoff the 2022 lame-duck session. Only a handful of MHA-tracked bills saw action, including legislation to implement the new federal Rural Emergency Hospital (REH) designation.

During the House Health Policy Committee, Senate Bill (SB) 450 received another hearing and was reported to the full House of Representatives. SB 450, introduced by Sen. Jim Stamas (R-Midland), would ensure visitors of cognitively impaired patients are permitted in healthcare facilities. The bill would prohibit the directors of the Michigan Department of Health and Human Services (MDHHS) or a local health officer from issuing an order that prohibits a patient representative from visiting a cognitively impaired individual in a healthcare facility. As written, the legislation does not prevent a healthcare facility from implementing reasonable safety measures for visitors and will still allow for facilities to limit the number of representatives per patient. The MHA is neutral on the bill and will continue to monitor any action taken.

MHA staff was also in attendance to support House Bill (HB) 6380. Introduced by Rep. Andrew Fink (R-Hillsdale), HB 6380 would make the necessary changes to state law to allow for Michigan hospitals to pursue a new federal designation of REH status. An REH designation comes with significant requirements such as limiting total beds to 50, maintaining an average length of stay of 24 hours or less and a required transfer agreement with a level I or II trauma center. Hospitals that choose to convert to an REH will receive enhanced federal reimbursement to provide critical emergency and outpatient services, especially in geographic areas. The MHA provided testimony on the bill in September and will continue to advocate for its passage before the end of the year.

On the Senate side, the Health and Human Services Committee took action on SB 1172, introduced by Sen. Stephanie Chang (D-Detroit). SB 1172 would amend the Mental Health Code to allow for conservation officers to transport behavioral health patients to the proper care setting. Currently, conservation officers and Michigan’s state parks and public venues are required to contact another form of law enforcement if they encounter someone experiencing a mental health crisis. The MHA is supportive of SB 1172, which will help shorten patient wait times for these particular cases.

If members have questions about these issues or any others impacting healthcare, please contact Adam Carlson at the MHA.

Legislature Returns to Continue Healthcare-related Work

The Legislature returned the week of Sept.19 to continue work on several pieces of legislation that the MHA is currently monitoring. Committees met in both the House and Senate, taking up legislation that included several new bills supported by the MHA in the areas of behavioral health, rural emergency hospitals, speech-language pathologist licensure and telemedicine.

In the House Health Policy Committee, initial testimony was taken on new legislation to make changes to the preadmission screening process for behavioral health patients. House Bill (HB 6355), introduced by Rep. Graham Filler (R-St. Johns) and supported by the MHA, would memorialize the requirement for preadmission screening units operated by the Community Mental Health (CMH) services program to provide a mental health assessment within three hours of being notified by a hospital of the patient’s need. If a preadmission screening unit is unable to perform the assessment within the three-hour time frame, HB 6355 would also allow for a clinically qualified individual at a hospital who is available to perform the required assessment.

Kathy Dollard, Psychologist and Director of behavioral health for MyMichigan Health, joined the committee to testify in support of HB 6355.

Kathy Dollard, psychologist and director of behavioral health for MyMichigan Health, joined the committee to testify in support of HB 6355. “Strengthening our behavioral health system includes strengthening our behavioral health workforce and that can start with creative solutions like providing clinically qualified hospital personnel the ability to conduct pre-admission screenings,” said Dollard. No votes were held on HB 6355 at this initial hearing.

MHA staff also provided testimony during committee on HB 6380. Introduced by Rep. Andrew Fink (R-Hillsdale), HB 6380 would make the necessary changes to state law to allow for Michigan hospitals to pursue a new federal designation of “Rural Emergency Hospital” (REH) status. A REH designation comes with significant requirements such as limiting total beds to 50, maintaining an average length of stay of 24 hours or less and a required transfer agreement with a level I or II trauma center. Hospitals that choose to convert to a REH will receive enhanced federal reimbursement to provide critical emergency and outpatient services, especially in geographic areas.

Lauren LaPine and Elizabeth Kutter of the MHA testified in support of HB 6380.

Lauren LaPine, director of small and rural hospital programs, MHA, and Elizabeth Kutter, senior director of advocacy, MHA, testified in support of the legislation. “HB 6380 provides rural hospitals in our state with the ability to continue providing care in our most rural communities,” said LaPine. No votes were taken on HB 6380.

Initial testimony on two bills that were previously reviewed by MHA’s Legislative Policy Panel also occurred during committee. Senate Bill (SB) 811, introduced by Sen. Curt VanderWall (R-Ludington), would extend the length of time for an individual to complete a temporary Speech-Language Pathologist license and extend the length of time those temporary licenses are valid. The MHA is supportive of SB 811, which did not see any votes this week.

House committee members also took initial testimony on SB 450, which would ensure that visitors of cognitively impaired patients are permitted in healthcare facilities. Introduced by Sen. Jim Stamas (R-Midland), the bill would prohibit the director of the Michigan Department of Health and Human Services (MDHHS) or a local health officer from issuing an order that prohibits a patient representative from visiting a cognitively impaired individual in a healthcare facility. As written, the legislation does not prevent a healthcare facility from implementing reasonable safety measures for visitors and will still allow for facilities to limit the number of representatives per patient. The MHA is neutral on the bill and will continue to monitor any action taken.

The Senate Health and Human Services Committee took initial testimony on SB 1135, which was introduced by Sen. Mike MacDonald (R-Macomb Township). SB 1135 would specify that previous expansions to Medicaid telemedicine coverage also apply to the Healthy Michigan Program and Michigan’s medical assistance program. Most notably, the legislation would require continued coverage for audio-only telemedicine services. The MHA is supportive of SB 1135, which would continue virtual care policies that have proved to be effective and safe during the COVID-19 pandemic.

In the Senate’s Regulatory Reform Committee, testimony was taken on another MHA-supported bill to regulate the sale of kratom in Michigan. Kratom is a substance of concern with opiate-like effects that has no approved medical use in the United States. HB 5477, introduced by Rep. Lori Stone (D-Warren), would create a license for kratom sales and manufacturing, require testing of products and require new safety warnings on kratom substances sold in Michigan. While the MHA prefers a federal Schedule I ban of the drug, the association is supportive of HB 5477, which will help limit adolescent addiction and prevent adulterated products from being on the market.

Members with questions on these bills or any other state legislation should contact Adam Carlson at the MHA.

Behavioral Health Legislation Introduced in State House

capitol building

capitol buildingNew legislation to make changes to the screening process for potential admission to inpatient psychiatric care for behavioral and mental health patients was introduced Aug. 17 in the Michigan House of Representatives.

Rep. Graham Filler (R-St. Johns) introduced House Bill (HB) 6355 to amend the Mental Health Code and make the preadmission screening process more efficient. Under the bill, preadmission screening units, whether operated by the Michigan Department of Health and Human Services or Community Mental Health services programs, must provide a mental health assessment within three hours of being notified by a hospital of the patient’s need. If a preadmission screening unit is unable to perform the assessment in a timely manner, HB 6355 would also allow for a clinically qualified individual at the acute care hospital to perform the required assessment. The bill provides for reimbursement to the hospital if hospital staff provide the preadmission screening.

The MHA supports HB 6355 because it addresses the ongoing issue of long wait times for emergency department behavioral and mental health patients. This legislation should help shorten the difficult wait times between the evaluation and beginning services.

HB 6355 was referred to the House Health Policy Committee. Members with questions regarding HB 6355 should contact Adam Carlson at the MHA.

Behavioral Health Supplemental Budget, Policy Bills Advance

capitol building

capitol buildingThe Michigan Legislature advanced several hospital-related bills during the week of June 13. Most notably, the Senate advanced a $590 million supplemental appropriations bill related to behavioral health. Several other policy bills the MHA is watching also received committee action in the House and Senate.

The supplemental funding bill that includes the MHA’s request to support behavioral health was approved by the state Senate. Senate Bill (SB) 714, introduced by Senate Majority Leader Mike Shirkey (R-Jackson), would appropriate $590 million and includes several MHA-supported one-time line items for behavioral health. Included in the supplemental bill is $100 million in infrastructure grants for pediatric inpatient psychiatric services, $20 million in infrastructure grants for hospital behavioral health intake enhancements, $25 million to prepare for the expansion of the essential health provider loan repayment program, and $30 million to expand the state’s apprenticeship program for new behavioral health staff. The legislation now moves to the House for its consideration as the Legislature continues its work on the fiscal year 2023 state budget.

The House Health Policy Committee took testimony on a package of Certificate of Need (CON) bills that were reintroduced from the 2019-2020 session. Senate Bills (SBs) 181182183 and 190 would remove psychiatric bed capacity from CON oversight, increase the threshold for capital expenditures, increase the number of members on the CON Commission and remove air ambulance services from CON. The bills were introduced by Sens. Curt VanderWall (R-Ludington), Lana Theis (R-Brighton) and Michael MacDonald (R-Macomb Township). The MHA opposes the tie-barred package of bills and provided written testimony to the committee in support of Michigan’s current CON program. No votes were held on the bills.

The House Health Policy Committee also heard testimony on bills to change lead testing requirements for children. House Bills (HBs) 4678 and 4679, introduced by Reps. John Cherry (D-Flint) and Helena Scott (D-Detroit), would require minors to be screened for lead poisoning between the ages of 9 and 12 months and the ages of 2 and 3 years old and would include this information as part of the child’s immunization record. Providers would also be expected to identify high risk factors such as the age of the child’s residence, but it is unclear how penalties would be assessed for the new requirements. The MHA has not yet taken a position on the bills but will continue to monitor any action taken.

In the Senate Health Policy and Human Services Committee, bills to allow Michigan to join the Psychology Interjurisdictional Compact were taken up again. This compact is a legal agreement among states that creates an expedited pathway to licensure for psychologists who wish to practice telepsychiatry across state lines. HBs 5488 and 5489 were introduced by Reps. Bronna Kahle (R-Adrian) and Felicia Brabec (D-Pittsfield Township), respectively, and are supported by the MHA. The bills now go to the Senate floor for a final vote and, if approved, will be sent to the governor desk for final consideration.

The Senate Health Policy and Human Services Committee also took up HB 5163, which was introduced by Rep. Angela Witwer (D-Delta Township) and would create an opt-out grant program for hospitals to establish medication-assisted treatment (MAT) for substance use disorders in their emergency departments. Hospitals provided MAT programs prior to introduction of the bill, and the MHA has already partnered with the Michigan Department of Health and Human Services to implement the first round of grants provided under this legislation. No hospitals would be required to participate in the program. HB 5163 was advanced to the Senate floor for further action.

For more information on these and other state bills related to healthcare, contact Adam Carlson at the MHA.

Legislature Advances Prior Authorization, Workplace Safety Bills

capitol building

capitol buildingDuring the week of March 14, the Michigan Legislature acted on a bill to make changes to the prior authorization process for commercial insurers and a bill to increase penalties for assaulting healthcare employees and volunteers.

The House Health Policy Committee reported Senate Bill (SB) 247, which would make changes to decrease wait times for commercial insurance prior authorization requests. Introduced by Sen. Curt VanderWall (R-Ludington), the legislation would shorten the timeline for approval to seven calendar days, or 72 hours for urgent requests, as well as ensure that emergency care can be provided without prior approval. The MHA supports the bill and provided written testimony to the committee earlier in the year. SB 247 now heads to the House floor for a full vote.

The full House of Representatives March 16 voted in support of legislation to increase penalties for assaulting healthcare employees and volunteers. House Bill (HB) 5682, introduced by Rep. Mike Mueller (R-Linden), went through several changes in committee, and the language now doubles the fines for assaulting a healthcare employee or volunteer in any care setting. HB 5682 would also require the posting of signage in hospital emergency rooms to deter potential assaults. Michigan hospitals may obtain example signs from the MHA free of charge. The MHA supports the bill, which will now go to the Senate for further consideration.

For more information on these bills or other state legislation related to healthcare, contact Adam Carlson at the MHA.

MHA and Members Testify in Support of Licensure Exemption Bill

Sean Gehle (left) and Adam Carlson (right) testify in support of SB 759.

The House Health Policy Committee, chaired by Rep. Bronna Kahle (R-Adrian), reported the MHA-supported Senate Bill (SB) 759 to the full House Dec. 9. Before the bill was reported, Adam Carlson, senior vice president of advocacy, MHA, and Sean Gehle, regional vice president, advocacy and government relations, Trinity Health, provided testimony urging support for SB 759 and discussing its importance in continuing care for patients during the pandemic.  

SB 759 codifies into law a flexibility granted by the Department of Licensing and Regulatory Affairs (LARA) Bureau of Professional Licensing that has been imperative in fighting the workforce shortage. In March 2020, due to the COVID-19 pandemic, LARA activated its statutory authority given in the Public Health Code that allows it to grant licensure exemptions “in a time of disaster” such as a pandemic. This permits out-of-state providers who are in good standing and trained, educated and experienced to render medical care in Michigan without a Michigan license.

The LARA provision is set to expire Jan. 11. The MHA has worked collaboratively with the administration to continue to allow hospitals and health systems the ability to quickly and efficiently recruit out-of-state workers during this public health emergency. SB 759 is now awaiting a vote in the full House. Members with questions should contact Adam Carlson at the MHA.

House Health Policy Committee Advances MHA-supported Bills

capitol building

Michigan Capitol BuildingThe House Health Policy Committee met Nov. 4 to take up several bills that the MHA has indicated support for.

The committee advanced a bill to allow Michigan pharmacies to fill noncontrolled substance prescriptions written by out-of-state advance practice prescribers, which was introduced by Sen. Curt VanderWall (R-Ludington) as Senate Bill (SB) 166. House Bill (HB) 5261, introduced by Rep. Abdullah Hammoud (D-Dearborn) and supported by the MHA, was also reported to the House floor. HB 5261 would create specific exemptions for providers to administer opioids to a patient who has an active non-opioid directive form if they are provided during a surgical operation or if the provider deems the opioids medically necessary.

The House Health Policy Committee also took initial testimony on a pair of bills to allow Michigan to join the Psychology Interjurisdictional Compact (PSYPACT). This compact is a legal agreement among states that creates an expedited pathway to licensure for psychologists who wish to practice telepsychiatry across state lines. HBs 5488 and 5489 were introduced by Reps. Bronna Kahle (R-Adrian) and Felicia Brabec (D-Pittsfield Township), respectively, and are supported by the MHA. The association will continue to keep members apprised of any action taken on this legislation.

Any members with questions can reach out to Adam Carlson at the MHA.

Legislative Action Continued During the Week of Oct. 11

capitol building

Several pieces of legislation impacting hospitals were acted upon during the week of Oct.11. In the Senate, votes were taken on legislation to establish a grant program for emergency department-based medication assisted treatment (MAT). In the House, an MHA-supported bill on pharmacy wholesale distributors was reported from committee, and testimony was taken on an MHA-supported bill on background checks and a new package of Certificate of Need (CON) bills.

Senate Bill (SB) 579, which would establish an opt-out grant program for hospitals to establish emergency department-based MAT programs, was reported from committee and passed unanimously by the full Senate. SB 579 was introduced by Sen. Curt VanderWall (R-Ludington) and is supported by the MHA. The Senate Health Policy and Human Services Committee also approved several mental health jail diversion and transportation bills.

In the House Health Policy Committee, members voted to report the pharmacy wholesale distributors bill to the House floor. House Bill (HB) 5072 was introduced by Rep. Ryan Berman (R-Commerce Township) and is a state-level effort to exempt hospitals and other healthcare entities that are under common control from a medication distribution threshold that currently requires registration as wholesalers. The MHA supports the bill, as it would remove the requirement for additional paperwork for hospital pharmacies..

The House Health Policy Committee also took testimony on a new package of CON bills that make no substantive changes to covered services. HBs 507450755076 and 5077 would require CON Commission reports and minutes to be posted online in a timely fashion. The package would also require the Legislature’s Joint Legislative Committee that oversees CON activities to meet annually and review the report. The MHA has confirmed that the Michigan Department of Health and Human Services does not expect the bills to hinder the success of the program.

Another MHA-supported bill was discussed in the House Judiciary Committee. HB 5358, introduced by Rep. Graham Filler (R-Dewitt), would ensure employers have access to general information for background checks. Information like birthdates is important to ensure the identity of people in certain court-related documents and maintain efficient turnaround times for necessary background checks

Members with questions on state healthcare legislation may contact Adam Carlson at the MHA.