The number of Michiganders hospitalized with COVID-19 has continued to rise, with 1,811 adults and 35 children confirmed as inpatients Oct. 8. An additional 119 adults and six children were hospitalized with illnesses suspected to be COVID-19. Of that number, 485 adults were in intensive care units and 250 were ventilated.
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.
Pfizer Requests Emergency Use Authorization of COVID-19 Vaccine for Children Ages 5-11
Pfizer and BioNTech announced Oct. 7 that they have submitted a request to the U.S. Food and Drug Administration (FDA) for emergency use authorization in children ages 5-11. The FDA will review the evidence to determine whether the shots are safe and effective for this age group, and an independent expert panel will publicly debate the evidence Oct. 26. From that point, advisers to the Centers for Disease Control and Prevention (CDC) will make their recommendation, and the CDC will make a final decision. If regulators agree, shots could be available to the 5-11 age group within a matter of weeks.
The MHA will keep members informed as new details emerge. Those with vaccine questions may contact Ruthanne Sudderth at the MHA.
Nursing Care and Recovery Center Applications Re-opened
The Michigan Department of Health and Human Services (MDHHS) recently released a new policy bulletin to update regulations from November 2020 that allow COVID Relief Facilities and eligible nursing facilities to retain COVID-19-positive residents. Public Act (PA) 231 of 2020 established criteria under which nursing facilities could care for COVID-19-positive residents, with the statute put into effect through MSA Bulletins 20-73 and 20-78. Facilities designated as Care and Recovery Centers or COVID Relief Facilities will need to apply for that designation on a yearly basis.
Nursing facilities that had not applied for either designation before the Dec. 1, 2020, deadline may now apply if they wish to seek accreditation. Like the previous policy, nursing facilities that have applied for COVID Relief Facility designation but have not yet received approval/denial for participation may continue to care for individuals who have tested positive for COVID-19. Members with questions may contact Adam Carlson at the MHA.
Funding Available for Nursing Home Patients Awaiting Transfer
The MDHHS released a template in June to collect information from hospitals about the number of COVID-19-positive nursing facility patients who were retained by hospitals and had less than 72 hours remaining in their isolation period. The MDHHS will provide additional payment to hospitals for qualifying inpatient stays between Jan. 1 and Sept. 30, 2021.
The additional funding was a result of the MHA’s 2020 year-end advocacy efforts that totaled $3.3 million in gross funding for hospitals through Public Act 231 of 2020. The MDHHS will pay hospitals for each qualifying day until the funds are spent and will notify hospitals if the allotted funds for the additional payment are spent prior to the expected eligibility end date. The MHA encourages hospitals to complete and submit the template through the MDHHS File Transfer portal per the department’s instructions to receive the enhanced payment. Although the application period has been open for several months, a significant portion of funding remains available. Members that need a copy of the template may contact Jason Jorkasky at the MHA.
The MHA, in collaboration with Michigan Department of Health and Human Services (MDHHS), will host a webinar via Zoom from 9 to 10 a.m. EDT May 13 to discuss Medicaid cost report completion, submission, acceptance and settlement under the new Community Health Automated Medicaid Processing System Facility Settlement subsystem. This session will provide hospital staff an opportunity to meet the MDHHS cost report staff and leadership team, learn how to address potential issues presented by the changes, and engage in a question-and-answer session to improve the cost report life cycle under the new system.
Hospitals are encouraged to participate in this webinar, which is targeted to hospital staff who complete and submit the cost report and consulting or accounting firms hospitals use to assist with cost reports. The webinar is offered free of charge and no registration is required.
To enhance the value of the session, the MHA is seeking input by May 11 from member hospital staff regarding topics they would like the webinar to cover, including questions on the completion, submission and acceptance process for the cost report. The MHA will share this information with the MDHHS in advance so the identified issues can be addressed during the event. Members with questions should contact Jason Jorkasky at the MHA.
A leadership change in the Michigan Department of Health and Human Services ( MDHHS) took place Jan. 22 when Robert Gordon announced his resignation and Elizabeth Hertel was appointed to replace him as director of the department. The MHA has a longstanding relationship with Hertel, who has served at both the MDHHS and Trinity Health, and issued a statement of support in response to the announcement. Hertel begins her tenure as director as COVID-19 continues to evolve and affect every Michigander’s life. The MHA keeps members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.
President Biden Releases Vaccine Operational Plans
The Biden administration announced Jan. 26 new details of its plans to increase vaccine supply and distribution to states in the coming weeks and months. The state of Michigan has issued updated operational plans that will coordinate with these federal efforts and resources. These plans will continue to be modified going forward. Highlights of the Biden vaccine plan are:
Supply Forecasting: The Biden administration plans to provide states with a three-week planning forecast of vaccine supply, which will allow states to communicate advanced information about allocations to providers and improve their planning capabilities.
More Vaccine Overall: The federal government is working to purchase 200 million additional doses of Pfizer and Moderna vaccine (100 million of each). The president also increased the national vaccination goal to 1.5 million people per day rather than 1 million.
More Vaccine to States: The president stated that starting next week, states would receive approximately 17% more vaccine each week than they have previously.
Syringe Supply: Biden is using federal actions to increase production of critical vaccine-related supplies, especially the syringes needed to extract the sixth dose from Pfizer vials.
As the state of Michigan continues to hone its plan to coordinate with federal efforts, the MHA is providing feedback to the MDHHS on ensuring the allocation formulas are fair and equitable for hospitals and health systems of all sizes and geographies. The association advised the state to incorporate data on both inpatient and outpatient measures into its allocation calculations. Additional information will be shared as it becomes available. Members with questions may contact Ruthanne Sudderth at the MHA.
State Announces Protect Michigan Commission to Promote, Improve Vaccine Acceptance
Gov. Gretchen Whitmer Jan. 25 appointed the bipartisan Protect Michigan Commission, which represents a diverse array of industries, professions, and backgrounds. Housed within the MDHHS, the commission will help raise awareness of the safety and effectiveness of an approved COVID-19 vaccine, educate state residents and help protect their health and safety. The governor has named Spectrum Health President and CEO and MHA Executive Committee Member Tina Freese Decker as a co-chair of the commission, and MHA Senior Vice President of Public Affairs & Communications Ruthanne Sudderth as a commission member.
The Protect Michigan Commission, first announced in December, serves in an advisory capacity to Whitmer and the MDHHS. It is tasked with providing public leadership to elevate and reinforce the importance of an approved COVID-19 vaccine, identifying barriers that may impede Michigan residents’ acceptance of an approved COVID-19 vaccine — including identifying areas or groups that are likely to experience vaccine hesitancy — and develop an outreach action plan designed to overcome these barriers. The commission must complete its work and submit a brief final report to the governor by Dec. 31, and appointees will serve until the group’s dissolution. The MHA will keep members apprised of the commission’s work.
New Reporting Guidelines Issued for Provider Relief Fund Disbursements
The U.S. Department of Health and Human Services (HHS) recently announced that it is modifying the reporting timeline and reporting requirements for the Provider Relief Fund (PRF). The modifications delay the reporting deadlines in response to the year-end passage of the Coronavirus Response and Relief Supplemental Appropriations Act.
The HHS indicated that providers that received at least $10,000 in PRF funds may now register for the PRF Reporting Portal. This will allow them to eventually submit information to comply with HHS reporting requirements, though data reporting is not yet required. The registration process is expected to take 20 minutes and must be completed in a single session.
The HHS released new reporting guidance that supersedes previously issued guidance. The new guidance maintains the two general reporting categories — unreimbursed COVID-19 expenses and lost patient revenue — but is more flexible in what is allowed. Under the new guidance, providers may use “the difference between 2020 budgeted and 2020 actual patient care revenue.” Health systems are now also able to transfer funds received from targeted PRF distributions to other hospitals within the system.
The MHA will notify members of any substantive developments in PRF reporting requirements. Members with questions should contact Jason Jorkasky at the MHA.
AHA Partner Offers PPE Donation for Hospitals
Through a partnership between the American Hospital Association (AHA) and the web application HealthEquip, hospitals in need of personal protective equipment (PPE) may receive donations of surgical masks, face shields and other PPE for a small processing fee and shipping costs. Participating hospitals will be matched based on their need and limited available quantities of donated equipment.
Hospitals may sign up to HealthEquip’s DonorExchange to enter PPE requests; the HealthEquip team will match hospitals with the donated PPE and arrange shipment. HealthEquip also offers the ability to purchase specific PPE though its Marketplace. Members with questions about supply chain issues may contact Adam Carlson or Rob Wood at the MHA.
COVID-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.
The MHA is hosting a virtual health finance forum for MHA members from 3 to 5 p.m. Dec. 17. Participants will hear about:
MHA strategic action plan.
Provider relief funds reporting requirements.
Virtual care policies implemented by payers during the COVID-19 pandemic.
There is no cost to participate, but participants must register to receive the information necessary to access the virtual meeting.
This forum is sponsored by MHA endorsed business partner MCAG, an expert in recovering money due its clients from class action settlement funds. Participants are encouraged to review the MCAG website to understand the services it offers and how they may benefit health systems. Questions should be directed to Jason Jorkasky at the MHA.
As the Thanksgiving holiday approaches, the number of hospitalizations due to COVID-19 continues to rise. The MHA keeps members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.
Vaccine Studies Show 95% Effectiveness
Moderna announced Nov. 16 that the latest trials and studies of its COVID-19 vaccine show 95% effectiveness, and Pfizer updated its findings Nov. 18, announcing its vaccine also shows 95% effectiveness. Moderna’s results stem from its Phase 3 clinical trial of 30,000 individuals, and Pfizer’s efficacy rate resulted from a final analysis of its trial with more than 41,000 volunteers. Both vaccines use messenger RNA (mRNA) technology to cause the effective immune response. A key difference between the vaccines is that Moderna’s vaccine can be safely stored in freezers at about 25 degrees Fahrenheit (minus 4 degrees Celsius), a temperature easily reached by a normal freezer. The Pfizer vaccine requires ultracold storage only achieved by specialized freezers or dry ice.
Pfizer applied with the Food and Drug Administration for emergency use authorization of its vaccine Nov. 20, and Moderna expects to soon apply for the authorization. Although distribution dates are not yet certain, the Michigan Department of Health and Human Services (MDHHS) has advised that providers should be prepared to accept vaccine by early December to ensure expedient distribution and administration when shipments begin. Members with questions may contact Ruthanne Sudderth at the MHA.
Provider Relief Fund Further Clarified
The U.S. Department of Health and Human Services (HHS) has issued two important clarifications related to Provider Relief Fund (PRF) reporting.
The HHS had previously stated that providers could claim only the value of depreciation for COVID-19-related capital purchases with useful lives of more than 12 months. However, after urging from the American Hospital Association and the MHA, the agency stated that expenses for capital equipment, facilities projects and inventory may be fully expensed in cases where the purchase was directly related to the prevention, preparation for and response to COVID-19. Examples of such purchases include:
Upgrading heating, ventilation and air conditioning systems to support negative pressure units.
Retrofitting COVID-19 units.
Enhancing or reconfiguring intensive care unit capabilities.
Leasing or purchasing temporary structures to screen and/or treat patients.
Leasing permanent facilities to increase hospital capacity.
The HHS also clarified that providers’ reporting of net patient revenue should NOT include payments received from or made to third parties that relate to care not provided in 2019 or 2020.
COVID-19 ICU Best Practices Follow-Up Webinar Offered Nov. 24
A Nov. 11 COVID-19 webinar titled “ICU Management & Treatment of COVID-19 Patients” was hosted under the MI-COVID19 registry continuous quality improvement initiative and provided meaningful discussion for participants. As a result, a follow-up webinar has been scheduled for noon to 1 p.m. EST Nov. 24. Objectives include:
Summarizing the latest COVID-19 intensive care unit (ICU) guidelines and recommendations.
Discussing best practices for management of critically ill COVID-19 patients.
Identifying resources and creating a network for ICU leaders in Michigan to advance the care of critically ill COVID-19 patients.
CDC Offers Education on Telehealth and Health Equity Dec. 8
The Centers for Disease Control and Prevention (CDC), through its Clinician Outreach and Communication Activity division, will host an educational event via Zoom from 2 to 3 p.m. EST Dec. 8 that will focus on telehealth and health equity. Details and access information for the event are available online. Presenters from Kaiser Permanente and the Veterans Health Administration will discuss how telehealth has affected health equity in their patient populations before and during the COVID-19 pandemic.
Topics will also include challenges and opportunities related to telehealth implementation. Presenters will share strategies to expand access that can reduce disparities and improve culturally responsive care to help achieve health equity within each organization. In addition, presenters from the CDC will share telehealth strategies that incorporate the CDC’s frameworks for Addressing Health Equity in Public Health Practice.
In associated news, the MHA recently released its Pledge to Address Racism and Health Inequities that was approved by the MHA Board of Trustees at its Nov. 4 meeting (see related article).
COVID-19 Relief Facility Application Now Open
The state has released the application for being designated a COVID-19 Relief (CR) Facility, which are designed to allow eligible Nursing Facilities to retain COVID-19-positive residents. These facilities will meet criteria established in Senate Bill 1094 to care for COVID-19-positive residents who become ill and do not require hospital-level care. The purpose of the CR Facilities is to provide care in place with enhanced infection control measures for individuals with confirmed COVID-19 who have not met the criteria for discontinuation of Transmission-Based Precautions and have limited access to the state’s Care and Recovery Centers. All approved CR Facilities may retain, or readmit after acute care, their own COVID-19-positive residents.
Facilities must meet certain criteria to qualify for CR Facility designation or admission of new COVID-19-positive residents, as detailed in Bulletin Number MSA 20-73 from the Medical Services Administration. The bulletin also provides a list of documents and details applicants should have prepared before applying.
Completed applications should be submitted by 5 p.m. Dec. 1. The MDHHS, in partnership with the Michigan Department of Licensing and Regulatory Affairs, will review applications as they are received. Notification of application status will be contingent upon the volume of applications received. However, it is estimated that facilities seeking CR Facility designation may expect to be notified about the determination within one to two weeks of application submission. Questions about CR Facilities may be submitted to the MDHHS via email.
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.
Opportunity Set for Hospitals to Discuss Vaccine Distribution with State
The MHA continues to interface with the Michigan Department of Health and Human Services (MDHHS) on both COVID-19 and flu vaccine planning.
The MDHHS Immunizations Division and Michigan Chief Medical Executive Joneigh Khaldun, MD, have invited hospitals to discuss COVID-19 vaccine distribution. MHA members are encouraged to identify a chief medical officer, COVID-19 vaccine director and/or other staff member within their organization to participate in this conversation from 8 to 9 a.m. Nov. 13 via Zoom. The MHA will also provide hospitals with a summary and next steps following the meeting. For instructions to join the meeting, contact the MHA by Nov. 12.
The state is finalizing its COVID-19 stakeholder work group, and the MHA has worked to ensure that the association, a small/midsize hospital and a large health system are represented.
Provider Relief Fund Reporting Requirements Clarified
The U.S. Department of Health and Human Services (HHS) recently issued a clarification to its Oct. 22 reporting requirements for providers that received Provider Relief Fund payments. Specifically, the Oct. 22 guidance stated that recipients must report their use of PRF payments by submitting the following information:
Healthcare-related expenses attributable to COVID-19 that another source has not reimbursed and is not obligated to reimburse, which may include General and Administrative or healthcare-related operating expenses.
PRF payment amounts not fully expended on healthcare-related expenses attributable to COVID-19 are then applied to patient care lost revenues, net of the healthcare-related expenses attributable to COVID-19 calculated under Step 1. Recipients may apply PRF payments toward lost revenue, up to the amount of the difference between their 2019 and 2020 actual patient care revenue.
As urged by the MHA and the American Hospital Association, the HHS now states that healthcare-related expenses will not be netted against patient care lost revenue in Step 2.
Members with questions on the reporting requirements may contact Jason Jorkasky at the MHA.
Progress Made on COVID-19-related Legislation
Gov. Gretchen Whitmer signed House Bill (HB) 6293 Nov. 5, allowing nonclinicians to order COVID-19 tests. The legislation largely codifies Executive Order 2020-104, which was invalidated by the Michigan Supreme Court ruling in October. The legislation extends the flexibility on ordering COVID-19 tests through June 30, 2021. To request a list of Executive Orders that have been codified in law or otherwise re-authorized by the administration, contact Sean Sorenson-Abbott at the MHA.
The Michigan Senate passed Senate Bill (SB) 1185, also known as the “pandemic health care immunity act,” Nov. 5. The governor signed identical language into law Oct. 28 (HB 6159), but Sen. Curt VanderWall (R-Ludington) introduced SB 1185 to potentially expand the liability time period beyond March 9 through July 15, should additional protections be necessary. The MHA supports the legislation and will continue to monitor SB 1185.
Nov. 11 Webinar to Discuss COVID-19 ICU Best Practices
A webinar will be held from noon to 1 p.m. EST Nov. 11 to discuss best practices of the treatment and management of COVID-19 patients in preparation for a resurgence of the disease through the fall and winter. Hosted by the Mi-COVID19 registry continuous quality improvement initiative, the webinar will feature panelists from Henry Ford Health System, Michigan Medicine, MidMichigan Health and Spectrum Health. Online registration is required to participate.
The number of COVID-19 cases is climbing, and Michigan hospitals are again experiencing an influx of patients battling the disease. 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.
Hospitals, Businesses Call for Collective Action to Avert More COVID-19 Deaths
The MHA released a joint statement to statewide media Oct. 22 that was signed by physician leaders of hospitals and healthcare systems throughout Michigan. The letter includes 28 signatures that represent 110 of Michigan’s 137 hospitals plus MHA Chief Medical Officer Gary Roth, DO. The goal of the statement is to make clear that, regardless of state law, executive orders or local public health directives, hospitals and healthcare systems across the state are standing as a united front in policies and interventions that will help fight the spread of COVID-19. It also emphasizes that the recent jump in COVID-19 cases across Michigan puts the state’s entire healthcare system at risk of another capacity crisis and asks the public to take the necessary steps to prevent the spread of this deadly disease.
Several media outlets across the state have reported on the letter and healthcare providers’ united stance to stave off COVID-19. Members that were not included on the statement and would like the signature of their facility’s physician leader added to the MHA website copy should contact Lucy Ciaramitaro at the MHA.
In addition, members of the Michigan Economic Recovery Council (MERC) sent a letter Oct.. 21 to Gov. Gretchen Whitmer, Senate Majority Leader Mike Shirkey and House Speaker Lee Chatfield, urging collective action to prevent additional deaths from COVID-19. As a member of the MERC, MHA CEO Brian Peters joined leaders from the healthcare, labor, higher education and business communities in stressing the need for clearly defined, mandatory standards that govern mask usage, workplace practices, public gathering and certain social activities that can be deployed with discipline. The letter indicates that success in suppressing spread of COVID-19 will maintain the health of Michigan’s economy and support the education of the state’s children.
HHS Revises Provider Relief Fund Usage and Reporting Requirements
The U.S. Department of Health and Human Services (HHS) issued Oct. 22 revised federal Provider Relief Fund (PRF) usage and reporting requirements. These new requirements come on the heels of problematic requirements the HHS issued Sept. 16 that would have resulted in many hospitals being required to return PRF payments to the federal government. The HHS indicated in its announcement that it modified the PRF usage and reporting requirements in response to advocacy efforts by stakeholders, which included efforts by the MHA, the American Hospital Association and others.
The HHS also notes in its reporting document that, if recipients do not expend PRF payments in full by the end of calendar year 2020, they will have an additional six months in which to use remaining amounts toward expenses attributable to COVID-19, but not reimbursed by other sources, or to apply toward lost revenues in an amount not to exceed the difference between 2019 and 2021 actual revenue.
Finally, the HHS revised the definition of “Reporting Entity,” as delineated on Page 2 of the usage and reporting requirements document.
Questions on revised PRF reporting requirements should be directed to Jason Jorkasky at the MHA.
House Republicans Unveil COVID-19 Plan
Michigan House Republicans announced their “Comeback Roadmap” Oct. 20, providing a proposed structure that would govern public health response activities in Michigan. The plan would provide for state level public health orders when COVID-19 cases are high, then delegate those decisions to counties that see lower COVID-19 cases, hospitalizations and positivity rates, among other metrics. The Republicans are expected to introduce legislation to codify this plan in the coming weeks and committee hearings could occur on the proposal thereafter. The MHA will monitor this proposal as additional action is taken. Members with questions may contact Adam Carlson at the MHA.
MDHHS Vaccine Plan Published
The Michigan Department of Health & Human Services (MDHHS) recently submitted its interim draft COVID-19 Vaccination Plan to the federal government.
The plan identifies gaps and lessons learned from the implementation of other vaccines and uses those experiences to improve preparedness for the COVID-19 vaccine. The state will use the 2020-2021 seasonal flu campaign as a full-scale exercise for the COVID-19 vaccine effort.
Under the interim draft, the initial distribution of COVID-19 vaccine will go to critical populations. This includes all people working in a healthcare setting, and hospitals will be among the first to receive vaccine distributions. Vaccine allocation is covered in Section 7 of the plan, which begins on page 32. Section 8 addresses COVID-19 Vaccine Storage and Handling and begins on page 36. Members with questions or comments on the interim draft should contact Laura Appel at the MHA.
Bills Signed to Codify Executive Orders on Liability and Nursing Homes
The governor signed legislation Oct. 22 to codify protections that were originally established in previous executive orders (EOs). House Bill (HB) 6159 is specific to healthcare providers and provides broad liability protections from March 29 through July 14 for healthcare entities and professionals working to respond to the pandemic. The language in this bill closely mirrors the language in subsection 8 from the now-rescinded EO 2020-61. In addition, the governor signed the MHA-supported package of bills (HBs 6030, 6031,6032, 6101) providing broad liability protection to employers that includes further protections to healthcare providers and reinstates many of the provisions in previous EOs, such as language providing quarantine exceptions for healthcare workers.
The governor also signed Senate Bill (SB) 1094 to provide additional guidelines on establishing regional nursing home “hubs” (now referred to as Care and Recovery Centers) and prohibit nursing homes from admitting COVID-19-positive patients without verification of their ability to handle those patients. This bill codifies EO 2020-169, which reflected the recommendations and work of the Nursing Home Task Force. Members with questions on either piece of legislation may contact Adam Carlson at the MHA.
Eligible Facilities May Apply for Designation as Care and Recovery Centers
The MDHHS has moved to a rolling deadline for eligible nursing facilities to apply for the Care and Recovery Center (CRC) designation. Recognizing the limitations that SB 1094 imposes on a hospital’s ability to discharge nursing home residents, hospitals with affiliated nursing homes or networks that include eligible nursing facilities may want to consider applying for the CRC designation.
The purpose of CRCs is to provide care for individuals with confirmed COVID-19 who have not met criteria for discontinuation of Transmission-based Precautions. CRCs operate when hospitals need to discharge residents to manage bed availability and provide an alternative for nursing facilities that do not have the capacity to safely care for residents. Facilities that wish to operate a CRC must have the capacity to designate a distinct area for COVID-19 isolation, be able to dedicate staff to the CRC, and meet other established standards. Specific criteria and other details are available in MSA Policy 20-66 and the CRC operational guidance and protocols. Members with questions on the CRC designation may contact Brittany Bogan at the MHA.
MDHHS Issues EO Updating Nursing Home Visitation Requirements
MDHHS Director Robert Gordon issued an Emergency Order Oct. 21 that updates and further expands requirements for residential care facilities, while also permitting indoor visitation in these facilities in certain circumstances.
Under the order, visitation rules are linked to the risk level of the county and the occurrence of positive COVID-19 cases involving residents or staff within the prior 14 days. Local health departments also can determine that indoor visitation may be unsafe. A health evaluation must be conducted, and some visitors will be required to receive COVID-19 testing prior to entry, while facemasks will always be required. Lastly, visits will be allowed by appointment only and visitors per scheduled visit will be limited to two people or fewer. Members with questions may contact Brittany Bogan at the MHA.
Legislation Advances to Allow Nonclinicians to Order COVID-19 Tests
The Michigan Legislature recently finalized House Bill 6293, which would allow nonclinicians to order COVID-19 tests until June 30, 2021. The legislation codifies the governor’s EO 2020-14, which was in question due to the Oct. 2 Michigan Supreme Court ruling on emergency executive power. The bill now goes to the governor, who is expected to approve it. The MHA supports this important legislation that ensures healthcare providers can quickly and effectively order needed COVID-19 tests and will keep members informed when it becomes law. Members with questions may contact Adam Carlson at the MHA.
Exemption of Michigan Licensure during Time of Disaster
There have been many questions raised about out-of-state healthcare providers since the Supreme Court nullified Gov. Gretchen Whitmer’s extended State of Emergency. Therefore, the MHA worked with the Bureau of Professional Licensing (BPL) within the Michigan Department of Licensing and Regulatory Affairs (LARA) to update the document BPL Clarification: Exemption of Michigan Licensure Time of Disaster, which was originally released March 16.
Per MCL 333.16171 of the Public Health Code, LARA still has the authority to allow out-of-state, Canadian and health providers who have been retired within the last five years to continue to assist during a time of disaster. While the state of emergency has been rescinded, LARA strongly believes COVID-19 qualifies as a disaster and developed updated guidance.
Health systems must keep complete documentation of these individuals, as it must be made available in the event the department receives an official complaint about an individual provider. The MHA has also updated its compliance memo on the topic with the recommendations related to proper tracking. Members with questions should contact Paige Fults at the MHA.
With the Oct. 2 Michigan Supreme Court ruling that the legal basis for Gov. Gretchen Whitmer’s COVID-19-related executive orders is unconstitutional, a greater degree of uncertainty surrounds the ways Michigan hospitals, businesses and residents are responding to the challenges of the continuing pandemic. The MHA is keeping members apprised of this and other pandemic-related developments affecting Michigan hospitals through email updates and the MHA Coronavirus webpage. The Supreme Court ruling and additional important updates are outlined below.
MHA Evaluating Impact of Supreme Court Striking Down Governor’s State of Emergency Powers
The Michigan Supreme Court’s ruling declaring the legal basis for the governor’s COVID-19-related executive orders unconstitutional was in response to a request from the U.S. District Court for the Western District of Michigan. The lower court asked for a review of the constitutionality of two Michigan statutes Whitmer relied on in issuing her executive orders, the Emergency Management Act (EMA) of 1976 and the Emergency Powers of the Governor Act (EPGA) of 1945. The Michigan Supreme Court unanimously ruled the governor lacked authority to issue or renew executive orders under the EMA after April 30, 2020, without concurrence by the Legislature. By a 4-3 margin, the court ruled the EPGA also violated the Michigan Constitution.
The current executive orders (EOs) remain in effect until at least Oct. 23 because, under Michigan Court Rules, orders of the Michigan Supreme Court are not effective sooner than 21 days, allowing the opportunity for a party to request a rehearing. However, this was not a routine appeal from the Michigan Court of Appeals or through the Michigan state courts. Because this was a certified question from the federal court, the U.S. District Court will now need to issue an opinion in the federal case that prompted the Supreme Court’s ruling, Midwest Institute of Health v. Governor. The timing for this decision is unknown.
The MHA posted a statement on the ruling on its website, encouraging all Michiganders to continue to be extremely vigilant about following COVID-19 prevention guidance, including masking, physical distancing, washing hands frequently and receiving flu vaccines.
It is anticipated that many of the healthcare-related orders will be implemented through state regulatory agencies and local/county government agencies. Michigan Department of Health and Human Services (MDHHS) Director Robert Gordon issued an Emergency Order Oct. 5 that mandates masks in public places and limits gathering sizes. The MHA is reviewing the order and will alert members if its effects are expected to be different than those experienced under the governor’s orders. The association will also apprise members of any additional state-level announcements as they become available.
An updated list of the governor’s EOs that impact members is available on the MHA website to ensure hospitals are aware of potential items the healthcare community may need have addressed; all EOs and MDHHS orders are available on the state's COVID-19 webpage.
CMS Revises Reporting Requirements
The Centers for Medicare & Medicaid Services (CMS) issued new guidance on COVID-19 reporting requirements and a workflow process that outlines how the CMS will enforce hospital compliance. Hospitals are encouraged to read the revised guidance and note the following changes from previous requirements:
Mandatory supply-related data reports are now required once per week.
Psychiatric (except those that are distinct-part psychiatric hospitals) and rehabilitation hospitals will be required to report only once per week.
Beginning Nov. 1, remdesivir and staffing-related data will be optional.
Additional reporting requirements will begin Nov. 1 for certain data on influenza patients.
Hospitals are also required to provide data into the state’s COVID-19 data portal, EMResource. Hospitals may choose to allow the state to enter data into the U.S. Department of Health and Human Services’ TeleTracking COVID-19 portal on their behalf. Members with questions about this process or the CMS guidelines may contact Jim Lee at the MHA.
Medicare Advance Payment Repayment Update
WPS, the Medicare Administrative Contractor (MAC) for most of Michigan, recently released information regarding the CMS’ instructions to MACs to implement the provision of the Continuing Appropriations Act of 2021 delaying the Medicare advance payment repayment timeline. Changes to the repayment terms are as follows:
The repayment period has been extended, and the automatic recoupment will begin one year after the date the accelerated or advance payment was issued.
During the first 11 months after repayment begins, repayment will occur through an automatic recoupment of 25% of the provider/supplier Medicare payments.
At the end of the 11-month period, the recoupment rate will increase from 25% to 50%. The automatic recovery at the 50% recoupment rate will continue for six months.
If the total amount of the accelerated/advance payment is not recovered within 29 months from the date the payment was made, a demand letter for the outstanding balance will be issued. The demanded amount will be subject to a 4% interest rate.
The MHA will continue to work with the Michigan congressional delegation and the American Hospital Association to further improve these processes. Members with questions may contact Jason Jorkasky at the MHA.
Governor Announces Broadband Internet Grants
The governor announced Oct. 8 during the North American International Cyber Summit that $12.7 million in funding is available to increase broadband internet access across Michigan. As telehealth and remote work have gained popularity during the COVID-19 pandemic, this effort to improve internet access is welcomed by members – especially those in rural areas.
According to the announcement, more than 1,243,000 Michigan households do not have a permanent, fixed broadband connection at home, resulting in $1.8 billion to $2.7 billion in potential economic benefit left unrealized among disconnected households.
The new broadband projects were selected through the Connecting Michigan Communities (CMIC) grant program and are expected to extend access to more than 10,900 households, businesses and community anchor institutions in Michigan. A list of counties/areas impacted by these awards is available on the CMIC Broadband Grant webpage. Recommendations for the second round of CMIC grant awards totaling $5.3 million will be announced soon, and the governor recently signed a state budget that includes an additional $14.3 million in grant funding for a third round of projects in 2021.
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.
State Budget Deficit Deal Contains no Healthcare Cuts
Gov. Gretchen Whitmer and legislative leaders announced June 29 they reached an agreement to resolve the fiscal year (FY) 2019-2020 budget deficit. The deal uses a combination of funding from the state Budget Stabilization Fund, federal Coronavirus Relief Funds (CRF) and cuts to the state budget. No cuts to healthcare were announced in the information provided.
In a joint release, Senate Majority Leader Mike Shirkey (R-Clarklake), House Speaker Lee Chatfield (R-Levering) and the governor spelled out approximately $900 million in spending from the federal funds for schools, hazard pay for teachers, replacement funds for colleges and universities, and new funds for local governments. Together with what was appropriated earlier in June, the state will have allocated $3 billion of its existing CRF. The budget also recognizes the benefit of the enhanced federal Medicaid matching funds, which brings $340 million to the state for the current fiscal year.
The budget agreement includes $490 million in savings to state government. This includes state layoffs, furlough days and budget cuts. The MHA does not believe rural hospitals or labor and delivery funding for small and rural hospitals is at risk. The association will continue its efforts to ensure the appropriations for hospital Medicaid funding remain in place and continue into FY 2021. For more information about the FY 2020 budget agreement, contact Adam Carlson at the MHA.
Additional Allocation and Guidance Announced for Remdesivir
The U.S. Department of Health and Human Services (HHS) announced June 29 an agreement with drug maker Gilead Sciences to allow U.S. hospitals to purchase, through September, up to 500,000 treatment courses of remdesivir, the antiviral drug that has shown encouraging results in treating COVID-19 patients. As with the 120,000 treatment courses donated earlier by the drug maker, the HHS and state health departments will allocate them based on hospitalization data.
Under the agreement, hospitals will pay no more than the wholesale acquisition price for the drug, up to $3,200 per five-day treatment course. To make future allocations of remdesivir, the HHS will be asking hospitals and health systems to submit data every two weeks.
The state of Michigan recently updated guidance for the use of remdesivir, which is available through the June 30 COVID-19 update that was emailed to members. The state is also asking for the completion of a two-part survey during treatment. Part 1 of the survey identifies the patient’s profile and demographics and is due within 24 hours of starting the medication. Part 2 is a patient follow-up survey that captures outcome data. Members with questions may contact Laura Appel at the MHA.
One COVID-19 Data Submission Can Now Fulfill EMResource and NHSN Requirements
The state of Michigan has started the process of uploading COVID-19 data from EMResource into the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN) COVID-19 Module. This process will allow hospitals to enter data in the EMResource system with no duplicate data entry into the NHSN COVID-19 Module.
To facilitate this, hospitals must enter the NHSN ID associated with each facility in EMResource, ensure the mandatory baseline data elements have been entered, and update within 24 hours any EMResource data elements that correspond to the NHSN COVID-19 Module data elements. The upload process will occur daily for data entered by 5 p.m. Hospitals should log into the NHSN system the following day to verify the data was uploaded correctly. Members with questions on the process should contact Jim Lee at the MHA.
AHA Releases New COVID-19 Financial Impact Report
The American Hospital Association (AHA) released a financial impact report June 30 that estimates at least an additional $120.5 billion in financial losses for the nation’s hospitals from July 2020 through December 2020, due in large part to lower patient volumes. These estimates are in addition to the $202.6 billion in losses the AHA estimated between March 2020 and June 2020 in a report released in May. This brings total losses for the nation’s hospitals and health systems to at least $323.1 billion in 2020. The MHA is regularly collecting data from members on the financial impact the pandemic is having on Michigan hospitals. For more information, contact Jason Jorkasky at the MHA.
Delays in Unemployment Insurance Benefits
Some people who filed unemployment claims due to the COVID-19 pandemic have not received their unemployment benefits or are receiving them sporadically. The Michigan Unemployment Insurance Agency (UIA) is experiencing a backlog due to the extraordinary volume of claims received, the surge of fraudulent identity theft claims that recently occurred, and the limitations of work volume that can be completed by the UIA’s adjudication staff. The UIA has announced that it is working to resolve the backlog of claims and has indicated that all claimants who are eligible for benefits will receive them. Members with questions related to unemployment claims may contact Neil MacVicar at the MHA.