Healthcare Bills Highlight Lame-duck Session

capitol building

The Michigan Legislature completed most of its lame-duck agenda during the week of Dec. 14, addressing a wide range of issues impacting hospitals. The most notable legislation included a supplemental appropriations bill for COVID-19 relief, an extension of unemployment insurance benefits, and several Certificate of Need (CON) bills. The House is expected to meet during the week of Dec. 21 to concur on substitute bills passed by the Senate, but no further voting is expected in the Senate in 2020.

The supplemental spending bill passed by the Senate totaled $465 million and included several line items to directly assist hospitals. Senate Bill (SB) 748 provides $10 million as grants to hospitals for staffing assistance, $17.8 million for remdesivir Medicaid reimbursement, $48 million for additional vaccine and testing capacity, $100 million to continue the direct hazard pay adjustment for direct care workers and first responders, and $15 million to replenish the state stockpile of personal protective and other emergency equipment. The appropriations provide significant relief for MHA members to close out the legislative year, and the association supported the bill. SB 748 also allocated $220 million to extend unemployment insurance (UI) benefits through March 31 to assist unemployed Michiganders. MHA-supported SB 604 would extend UI benefits from 20 to 26 weeks, continue to not charge employers’ individual accounts for COVID-19-related claims, allow employees to use UI for COVID-19-related absences, and continue to expand the UI Workshare Program until April.

Final changes were made to several CON bills and sent to the governor’s desk. SBs 669, 671, 672 and 673 would add two members to the CON commission representing the public (SB 671), increase the threshold for covered capital expenditures to $10 million (SB 669), remove psychiatric beds as a covered service in counties with fewer than 40,000 residents (SBs 672 and 673) and remove air ambulance as a covered service starting June 1, 2021 (SB 672). Language was removed from SB 672 that would have automatically expanded the number of counties exempted from psychiatric bed CON requirements in future years. The MHA continues to support SBs 669 and 671 and remains neutral on SBs 672 and 673. The Legislature also passed SB 1160, which would amend the CON statute related to swing beds by removing the existing requirement that hospitals provide evidence of difficulty placing patients in skilled nursing home beds during the 12 months prior to the swing bed application. The MHA did not take a position on SB 1160.

COVID-19-related legislation also included SB 1185, which would provide an additional period of liability immunity for healthcare providers and facilities. The extension would last from Oct. 29, 2020, to Feb. 14, 2021, and was supported by the MHA. SBs 879 and 920 would continue authorization for early prescription refills, pharmacy operational changes and the 60-day prescriptions that were addressed in Executive Order 2020-61. The MHA did not take a position on SBs 879 and 920.

The Legislature also passed SB 1253, which puts a 28-day time limit on emergency orders from state departments before requiring a vote by both chambers of the Legislature. The MHA opposed the bill, which now moves to the governor’s desk.

SB 1021 would allow the Michigan Department of Licensing and Regulatory Affairs to issue health professional licenses to individuals with similar experience from Canada and was sent to the governor’s desk for signature. The MHA supported SB 1021 in both chambers. HB 4042, which would enter Michigan into the nurse licensure compact, was also sent to the governor’s desk for signature. The MHA sent a memo to the administration encouraging the governor to sign HB 4042.

Several bills addressing behavioral health were sent to the governor’s desk. MHA-supported SB 758 would add Michigan to the interstate psychology licensure compact, which is intended to permit the practice of telepsychology across state lines without applying for another license. Two other behavioral health bills were passed to create new licensure options for facilities. HB 5832 would create a license for crisis stabilization units, and HB 5298 would establish licensure for psychiatric treatment facilities for Medicaid recipients under the age of 21. The MHA did not take a position on either bill. Both chambers also approved SB 813, which would require a report to the Legislature on psychiatric patient deaths that occur within 72 hours of treatment. SB 813 was amended to ensure that the Michigan Department of Health and Human Services would be responsible for reporting, and the MHA did not take a position.

Finally, the Legislature passed HBs 4186 and 4187, which would establish the data breach notification act. This package has been in progress for several years and maintains the exemption for hospitals that was previously negotiated. The MHA remained neutral on the bills.

Members with questions on legislative action should contact Adam Carlson at the MHA.

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

MHA Covid-19 update

MHA Coronavirus UpdateThe 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.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC). Members with MHA-specific questions should contact the following MHA staff members:

Combating the Novel Coronavirus (COVID-19): Week of May 18

MHA Covid-19 update

MHA COVID-19 UpdateThe MHA has continued to keep members apprised of developments during the COVID-19 pandemic through regular email updates and the MHA Coronavirus webpage. Important updates on how the pandemic is affecting Michigan hospitals are outlined below.

Executive Order 2020-17 Rescinded, Other Restrictions Eased

Gov. Gretchen Whitmer announced May 21 that she is rescinding Executive Order (EO) 2020-17 effective May 29. This EO was issued in March and banned “nonessential” medical procedures in hospitals, ambulatory surgery centers and dentists’ offices. The MHA issued a media statement in support of her action and will continue to run statewide television and social media ads urging people not to delay care and assuring that hospitals are safe places to receive services.

The governor also announced during a May 21 news conference that auto dealerships, retailers and veterinarians can open to the public, by appointment only, effective May 29, and that, effective immediately, groups of 10 or fewer people may gather outside of their homes. Whitmer announced May 18 that the Upper Peninsula (Region 8) and 17 counties in northern lower Michigan (Region 6) will be permitted to partially reopen their economies May 22, in accordance with the “Safe Start” recommendations developed by the Michigan Economic Recovery Council.

Liability Protections for Healthcare Workers, Facilities

The MHA testified May 19 via videoconference before the state House Judiciary Committee to advocate for Senate Bill (SB) 899, which offers strong and broad liability protections for healthcare workers and facilities treating COVID-19 patients. The MHA and members have identified this as an important element to operating within pandemic and emergency situations. A variety of other healthcare groups submitted cards of support for the bill, including the Michigan State Medical Society and the Healthcare Association of Michigan, which represents long-term care facilities.

SB 899 originally passed the Senate May 7. The MHA will continue to work with members of the House of Representatives as the legislation progresses to support healthcare personnel responding to the COVID-19 pandemic. Members with questions may contact Adam Carlson at the MHA.

Laboratories and Testing

The Michigan Department of Health & Human Services (MDHHS) announced May 18 that the Laboratory Emergency Response Network (MiCLERN) hotline will be taken offline at 5 p.m. ET May 22. The announcement stated that this is due to “recent changes to COVID-19 prioritization criteria and stabilized testing capacity that no longer requires prior issuance of Person Under Investigation (PUI) identifiers for MDHHS Bureau of Laboratory (BOL) testing of COVID-19 specimens.” The state clarified that COVID-19 specimens that are sent to the state laboratory no longer require a PUI form, but should still include the State of Michigan Test Requisition form (DCH-0583) and two unique identifiers.

Hospitals in need of swabs and transport media for testing are reminded to report their needs to the BOL by sending an email to MDHHSLab@michigan.gov using the subject line “EM COVID-19 Supplies,” per recent guidance shared with members in the May 6 email update. Members with questions should contact Brittany Bogan at the MHA.

MVC Offers Resources for Resuming Non-COVID Procedures

The Michigan Value Collaborative (MVC) represents a partnership among 87 Michigan hospitals and 40 physician organizations that aims to improve the health of Michigan through sustainable high-value healthcare. Supported by Blue Cross Blue Shield of Michigan, the MVC helps its members better understand their performance using robust multipayer data, customized analytics and at-the-elbow support.

To assist hospital systems with prioritizing the restart of surgical services with the least impact on caring for remaining COVID-19 patients, the MVC has designed reports that display resource utilization metrics at a statewide and member hospital level for 17 elective surgical procedures. More information is available by contacting the MHA Keystone Center.

Pharmacy Refill Order Extended

The governor signed EO 2020-93 May 19, extending a previous order giving pharmacists increased operational capacity. It also expands access to prescriptions for patients. The order allows pharmacists to dispense emergency refills of prescriptions for up to a 60-day supply and requires insurers to cover early refills for up to a 90-day supply during the pandemic. It also allows pharmacists to dispense COVID-19 treatments according to government-approved protocols. EO 2020-93 took immediate effect and will expire at 11:59 p.m. June 16, 2020. Members with questions may contact Paige Fults at the MHA.

EMResource Now Tracking Psychiatric Facility Data

The state of Michigan recently launched a new module in EMResource targeted toward freestanding psychiatric facilities. The data collected in this new module requests data on beds, COVID-19 patients, staffing and personal protective equipment availability. Psychiatric facilities are required to report this information weekly by 11:59 p.m. ET every Friday. The MHA is seeking clarification from the state on whether this data will also be posted to its COVID-19 data website alongside existing health system/hospital data on related measures, or on any other public website. Members with questions may contact Jim Lee at the MHA.

Multisystem Inflammatory Syndrome in Children

A Clinician Outreach and Communication Activity webinar on the clinical characteristics of Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 is now available online. The Centers for Disease Control & Prevention (CDC) hosted the webinar May 19. The MDHHS reported that, since April 1, there have been 28 identified cases in Michigan, and treatment with intravenous immunoglobulin and steroids is proving to be effective. The CDC issued a Health Advisory May 14 and recommends healthcare providers report any patient who meets the case definition to local and state health departments to enhance knowledge of risk factors, clinical course, and treatment of this syndrome.

Healthcare Workers Still Permitted to Cross Closed Canadian Borders

The U.S. Department of Homeland Security May 19 reissued its order closing the United States – Canadian ground border through 11:59 p.m. ET June 22. Healthcare workers will continue to be permitted to cross to report to work.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. If staff members at MHA-member facilities are not receiving necessary information from the MHA, they are asked to check the spam/junk mail folders in their email systems or ask their information technology departments to ensure MHA messages are not being blocked.

Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC). Members with MHA-specific questions should contact the following MHA staff members: