Combating the Novel Coronavirus (COVID-19): Weeks of Nov. 22 and 29

MHA Covid-19 update

MHA Covid-19 updateThe state’s coronavirus webpage indicates there were an average of 9,222 new COVID-19 cases per day Dec. 2 and 3, bleakly demonstrating the current surge of the disease in Michigan. However, 55.6% of Michiganders ages 5 and older were fully vaccinated as of Dec. 3, and more than 1.6 million residents had received booster shots as of that date.

The MHA continues to keep members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Collaborative Efforts Urge Public to Take Precautions, Get Vaccinated

As the omicron variant, the latest version of the evolving coronavirus, begins to appear in the United States, the MHA, its members and public health agencies are urging the public to be particularly mindful of precautions they can take to guard against infection. At this time, there is no evidence to indicate omicron is present in Michigan. However, the MHA will remain in close contact with the State Department of Laboratories as it sequences samples and will keep members apprised of any developments.

The Michigan Department of Health and Human Services (MDHHS) and the MHA issued a joint press release Dec. 2 using a new set of infographics developed by the association. These images show the percentages of vaccinated versus unvaccinated COVID-19 hospitalizations, those in ICUs and those on ventilators. The release urged the public to get vaccinated to not only protect their own health, but the health of healthcare workers and to avoid additional strain on the state’s healthcare systems.

MHA-member health systems provided the data for this effort. The release included the following messages:

  • Three out of four COVID-19 patients are unvaccinated (76%).
  • 87% of COVID-19 ICU patients are unvaccinated.
  • 88% of COVID-19 ventilator patients are unvaccinated.

Members are encouraged to share these figures along with their organizations’ local data to maintain the public’s awareness. Members with questions may contact Ruthanne Sudderth at the MHA.

In addition, the MHA published a consensus statement Nov. 22 to statewide media on behalf of the chief medical officers of its member hospitals urging the public to take action to help slow COVID-19 growth throughout the state and educate them about the serious nature of the current surge and hospital capacity issues. MHA members are encouraged to use this statement locally or use it as a template for an organization-specific update to their communities. This message has been widely broadcast throughout the state (see related article).

Members with questions about vaccines and COVID-19 precautions may contact Ruthanne Sudderth at the MHA.

CMS Delays Enforcement of Healthcare Worker Vaccine Mandate as Courts Issue Injunctions

Although Michigan was not impacted by the Nov. 29 preliminary injunction against enforcement of the Centers for Medicare & Medicaid Services (CMS) healthcare worker vaccine mandate in 10 states, a separate preliminary injunction issued Nov. 30 does affect Michigan by placing a hold on the mandate in all other states. The federal government has appealed each order to the U.S. Court of Appeals in their respective circuits and asked the appellate courts to set aside the district courts’ preliminary injunction pending appeal.

Subsequently, the CMS issued a memorandum Dec. 2 confirming that it will not enforce its vaccine mandate while the court orders are in effect. The memo states that the CMS has “suspended activities related to the implementation and enforcement of this rule pending future developments in the litigation.” It also states that “while these preliminary injunctions are in effect, surveyors must not survey providers for compliance with the requirements of the” mandate.

The document does not state what the CMS would do when and if the preliminary injunctions are removed, such as setting new compliance dates.

The federal mandates do not impact hospitals’ ability to implement their own organization-based staff vaccine requirements if they choose to adopt such a policy.

MHA members are encouraged to follow the American Hospital Association (AHA) blog authored by Sean Marotta, a partner at Hogan Lovells and outside counsel for the AHA. The blog will be updated regularly as new developments occur. The MHA will also keep members apprised of developments. Members with questions may contact Amy Barkholz at the MHA.

Medicaid Coverage Expands to Cover Authorized In-home COVID Test Kits

The MDHHS recently released concurrent proposed and final policies to expand Medicaid coverage of COVID-19 testing to include home testing kits authorized by the U.S. Food and Drug Administration when administered consistent with recommendations by the Centers for Disease Control and Prevention. The expanded coverage for dates of service on and after Aug. 30, 2021, is contingent upon approval by the CMS. Approved testing kits must be prescribed or ordered by a Medicaid-enrolled participating pharmacy. Coverage will continue through 15 months following the end of the federal public health emergency. Comments should be submitted by Jan. 4. Questions may be directed to Vickie Kunz at the MHA.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpageQuestions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC).

Combating the Novel Coronavirus (COVID-19): Weeks of Nov. 23 and Nov. 30

MHA Covid-19 update

04COVID-19 patients continued to fill Michigan hospitals throughout the Thanksgiving holiday and into December, while drug companies Pfizer and Moderna applied for emergency authorization of their respective COVID-19 vaccines from the Food and Drug Administration (see related article). The MHA keeps members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Nursing Home Application Deadline Extended; CRC Bulletin Issued

The state announced Nov. 30 that it is extending the deadline from Dec. 1 to Dec. 15 for long-term care (LTC) facilities to become care and recovery centers (CRCs) and COVID relief (CR) facilities. The MHA has advocated for this extension to ensure LTCs do not transfer residents to hospitals without medical indication simply to avoid being out of compliance with new law requirements. While this is a positive step, the MHA will continue to advocate for more permanent solutions to transfer issues and the number of LTCs approved as CRCs and CR facilities.

The MDHHS also issued a bulletin for hospital-based CRCs. Bulletin Number MSA 20-78 supplements Bulletin Number MSA 20-73, which established operational requirements for nursing facilities to operate as CRCs during times of a public health emergency and provides a pathway for Michigan hospitals to establish hospital-based CRCs to support the safe care and isolation of COVID-19-positive individuals. Details about requirements for hospitals seeking designation as a CRC, how to apply and more are available in the bulletin.

Quarantine Duration Requirements Addressed

The MHA hosted its weekly call of hospital/health system chief medical officers Dec. 4, which was joined by representatives of the MDHHS. Among the topics discussed was quarantine requirements and the new guidance from the Centers for Disease Control and Prevention (CDC) advising the public that shorter quarantine periods of 7-10 days may be acceptable, depending on their access to testing and their symptoms or lack thereof.

According to Public Act 238 of 2020, healthcare workers who are exposed to COVID-19 but test negative and are not symptomatic are still able to report to work. Employees’ quarantine needs apply to how they spend time outside of work. There remains in state statute a 14-day quarantine provision for employees who test positive for COVID-19. The MHA is working with state officials and legislators to amend Public Act 238 of 2020 to bring quarantine times for employees who test positive in line with the CDC guidance. Additional information on the statute and administration rules is available from the Michigan Occupational Safety and Health Administration (MIOSHA), as discussed below.

Healthcare facilities and professionals may get questions from patients/community members on this change in quarantine guidance. The state announced its recommendation that the public continue to use the 14-day quarantine as a best practice, but if that is not feasible, the 10-day recommendation should be followed. The state did not endorse a seven-day quarantine with a negative test as a safe alternative.

MIOSHA Emergency Rules Clarified

The MHA hosted a call Dec. 1 with representatives from MIOSHA regarding its emergency rules that, among other items, emphasize the use of a remote workforce and proper use of personal protective equipment.

MIOSHA provided an overview of the rule set and answered questions, emphasizing the agency’s reliance on CDC guidelines in developing the rules and the availability of the free MI Symptoms app to assist employers. Questions or requests for the meeting materials should be directed to Adam Carlson at the MHA.

New Uses of Surge Capacity Beds May Require Certificate of Need Approval

Temporarily licensed surge capacity beds that have already been approved by the Bureau of Community and Health Systems (BCHS) may continue to be used if the following criteria are met:

  • An originally required emergency certificate of need (CON) approved by the MDHHS remains in effect.
  • The facility has maintained the BCHS-approved surge capacity so that it can be used within 48 hours if needed.
  • The facility has not notified the BCHS since the original approval that it has voluntarily surrendered the surge capacity.

If facilities with existing BCHS-approved surge capacity beds want to operate these beds in a different location, manner or use than originally requested, they must contact the MDHHS CON program, as applicable, and the Michigan Department of Licensing and Regulatory Affairs (LARA) State Licensing Section to determine whether new approval is required. Such requests must include a detailed narrative description of the proposed new use, space and floor plans of the area showing the new bed locations. If the proposed space deviates from current BCHS physical plant regulatory requirements, such as minimum square footage, hand sink locations or number of patients/residents to a room, the facility must include a narrative description of how those issues will be addressed to ensure patient/resident safety and care needs.

If the state has questions or concerns on a proposal as submitted, the Health Facilities Engineering Section engineer assigned to the facility will follow up as needed to address those concerns.

All applications not previously approved must apply to both the MDHHS and LARA as applicable and required. Both BCHS-HFD and Appendix E forms are required when applying. Members with questions may contact Paige Fults at the MHA.

BCBSM Provides Update on Coverage for COVID-19 Care and Testing

Blue Cross Blue Shield of Michigan (BCBSM) recently announced that it will continue to waive cost-sharing for its members diagnosed and treated for COVID-19 through March 31, 2021. This extension of a temporary benefit, originally set to expire Dec. 31, means members will not pay out-of-pocket costs — copays, deductibles or coinsurance — for the medical care and pharmacy costs associated with COVID-19. Members with feedback or questions are encouraged to contact Jason Jorkasky at the MHA.

Judge Denies Injunction for Bars, Restaurants Ordered Closed by MDHHS

A federal judge Dec. 2 denied a motion for preliminary injunction seeking to end the temporary MDHHS-ordered closure of bars and restaurants intended to prevent further spread of COVID-19. The MHA submitted an amicus or “friend of the court” brief in support of the temporary emergency measures enacted by the MDHHS. The MHA also issued a media statement supporting the order, which is effective from Nov. 18 through Dec. 8.

The ruling on Michigan Restaurant and Lodging Association v. Gordon was issued by Judge Paul Maloney of the U.S. District Court for the Western District of Michigan. It states that the motion was not granted to plaintiffs because it found the MDHHS’ reasoning for the order convincing and that groups tend to linger more in those settings than transitional environments like a food court or airport dining area.

Maloney further stated that, because the Michigan courts have not yet had an opportunity to evaluate the state issues and these challenges must be adjudicated before the federal claims can be considered, he scheduled a Dec. 17 certification hearing and will accept briefs from the parties to determine which legal questions to pass on to the state courts for further consideration. The MHA’s brief in support of the MDHHS provided medical evidence of the effectiveness of face covering and social distancing in curbing the spread of infection and reducing strain on the healthcare system. There are several other legal challenges in federal and state court against state and local public health orders requiring face coverings, social distancing measures and cooperation with contact tracing. Members with questions about the ruling may contact Amy Barkholz at the MHA.

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: