The legislation needed for hospitals to begin converting to Rural Emergency Hospitals (REH) in Michigan was sent to the Governor’s desk Dec. 6 for final approval. Due to limited session days left, the language to allow for REH licensure in Michigan was officially included in Senate Bill (SB) 183. After the REH amendments were adopted, SB 183 passed with overwhelming support in both the State House and Senate.
The MHA has been actively working with the Michigan Department of Health and Human Services, the Michigan Department of Licensing and Regulatory Affairs (LARA) and the Whitmer administration’s legal team on REH licensure during the legislative process and have received positive indications of the administration’s support for SB 183.
Member hospitals considering conversion to an REH are encouraged to review the final rules by the Centers for Medicare and Medicaid Services (CMS). Some key changes outlined in the final rule include:
Clarification that REHs can operate provider-based rural health clinics (RHCs) and that REHs are considered hospitals with less than 50 beds for purposes of the payment limit exception. Provider-based RHCs will maintain their excepted status upon a hospital’s REH conversion.
A roughly $4,000 per month increase in monthly facility payments due to a misstep in the methodology that the National Rural Health Association (NRHA) highlighted in the MHA comment on the proposed rule.
The CMS agreed with the NRHA that one-lane federal highways should be excluded from the definition of primary roads. Primary roads are now defined as state or federal highways with two or more lanes in either direction.
Additionally, the CMS has released initial information on the application process. There will also be an application process at the state level through LARA. This application is still in development.
Members considering converting to the REH designation should contact Lauren LaPine at the MHA for support in navigating this process.
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.
The U.S. House of Representatives passed July 27 the Advancing Telehealth Beyond COVID–19 Act to expand telehealth services by extending several telehealth flexibilities under Medicare that were initially authorized during the public health emergency relating to the COVID-19 pandemic.
Specifically, the bill allows federally qualified health centers and rural health clinics to serve as the distant site (i.e., the location of the healthcare practitioner); allows beneficiaries to receive telehealth services at any site, regardless of type or location; allows any type of practitioner to furnish telehealth services, subject to approval by the Centers for Medicare & Medicaid Services; and allows audio-only evaluation and management, and behavioral health services.
The legislation passed the House in a 416-12 vote. The entire Michigan delegation to the U.S. House voted in favor of the bill. The bill now moves to the U.S. Senate, where it likely has adequate support for passage.
For more information about the Advancing Telehealth Beyond COVID-19 Act, contact Lauren LaPine at the MHA.
The Centers for Medicare and Medicaid Services (CMS) recently released a proposed rule to obtain comment on potential Conditions of Participation (CoPs) for critical access hospitals (CAHs) and certain rural hospitals seeking to convert from their current status to be designated as a Rural Emergency Hospital (REH). REHs are a new provider type authorized by the Consolidated Appropriations Act passed Dec. 27, 2020, to address concern regarding the closure of rural hospitals across the country. This new designation provides an opportunity for CAHs and rural hospitals with 50 or fewer beds to continue providing essential services in their communities effective Jan. 1, 2023. REHs would be required to:
Discontinue providing acute care inpatient services.
Provide 24-hour emergency services, observation care and can choose to offer additional outpatient services.
Have an annual per patient average stay of 24 hours or less.
Have a transfer agreement with a Level I or II trauma center but not precluded from having agreements with Level III or IV trauma centers.
The CMS recently included payment policies related to the new REH in the 2023 Medicare outpatient prospective payment system (OPPS) proposed rule. Medicare outpatient services provided by a REH will be paid 105% of the Medicare OPPS rate with the REH also receiving a monthly facility payment. The CMS proposes a monthly payment of $268,294 for each REH in 2023, with this amount increased annually based on the hospital market basket change.
The CMS proposes that REHs may provide outpatient services that are not paid under the OPPS such as laboratory services paid under the Clinical Lab Fee Schedule (CLFS), which would be paid at the CLFS rate. REHs can also provide distinct part skilled nursing facility (SNF) services which would be paid based on the SNF prospective payment system. Services paid outside of the OPPS such as lab and SNF would not receive the additional 5% payment. The CMS also seeks input on quality measures recommended by the National Advisory Committee on Rural Health and Human Services, and additional suggested measures for the REH quality reporting program. The CMS is seeking additional comments on behavioral and mental health, rural virtual care and maternal health services.
Comments on the proposed CoP rule are due Aug. 29, while comments regarding payment provisions included in the OPPS proposed rule are due Sept. 13. The CMS is expected to release a final OPPS rule around Nov. 1. Members with questions should contact Lauren LaPine at the MHA.
Registration is currently open for Rural Advocacy Day as the MHA facilitates connections between rural hospital leaders throughout Michigan with legislators to discuss the vital role these hospitals and organizations play in their communities. The event is scheduled from 9 a.m. to 2 p.m. Sept. 21 at the MHA Capitol Advocacy Center located in downtown Lansing.
Small or rural members will have the opportunity to have one-on-one meetings with lawmakers, engage with legislative leadership, learn how to host lawmakers for hospital tours and more.
Registration is available online and required by Friday, Sept. 16. Questions about the event and further details may be directed to Lauren LaPine at the MHA; contact Meghan Protz-Sanders at the MHA for assistance with registration.
The Centers for Medicare & Medicaid Services (CMS) released a proposed rule June 30 that would establish conditions of participation (CoPs) that Rural Emergency Hospitals (REHs) must meet to participate in the Medicare and Medicaid programs. This proposed rule also includes changes to the Critical Access Hospital CoPs. Proposed payment and enrollment policies, quality measure specifications and quality reporting requirements for REHs will be included in future rulemaking. The CMS also modifies the provider agreement regulations to include REHs. The public comment period will end Aug. 29.
The MHA has been working closely with the Michigan Department of Health and Human Services (MDHHS) and the Michigan Department of Licensing and Regulatory Affairs (LARA) over the past few months to develop the licensure criteria and conversion process for eligible facilities in Michigan to convert to an REH after Jan. 1, 2023. The MHA will develop a comment letter in response to the proposed rule and share a draft with small/rural members prior to submission. To include input from Michigan hospitals eligible to convert to an REH in its comments,the MHA has created a brief survey to collect critical feedbackthat should be submitted by Aug. 1. Members with questions or concerns are encouraged to contact Lauren LaPine at the MHA.
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The MHA has submitted comments regarding the proposed rule to update the fiscal year 2023 Medicare fee-for-service inpatient prospective payment system.
The MHA has submitted comments regarding the proposed rule to update the fiscal year 2023 Medicare fee-for-service inpatient prospective payment system. The association will provide updated information following release of the final rule, which is expected to occur around Aug. 1 for the Oct. 1 effective date. Members with questions should contact Vickie Kunz at the MHA.
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The MHA is developing an advocacy day specially designed for small or rural hospital members. Rural Advocacy Day will be held Sept. 21 at the MHA Capitol Advocacy Center in downtown Lansing.
MHA CEO Brian Peters expressed the MHA’s support for the Michigan Department of Licensing and Regulatory Affair’s new implicit bias training requirement for all professions licensed or registered under the Public Health Code in a story by Michigan Capitol Confidential.
The MHA is developing an advocacy day specially designed for small or rural hospital members. Rural Advocacy Day will be held Sept. 21 at the MHA Capitol Advocacy Center in downtown Lansing. Members at small or rural hospitals will have the opportunity to hold one-on-one meetings with lawmakers, engage with legislative leadership, learn how to host lawmakers for hospital tours and more. Additional details will be sent in July. Due to the interactive nature of this event, there will be no virtual option. Members with questions should contact Lauren LaPine at the MHA.
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. 
