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

MHA Covid-19 update

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.

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 Sept. 28

MHA Covid-19 update

COVID-19 UpdateGov. Gretchen Whitmer has extended Michigan’s state of emergency through Oct. 27 due to the ongoing effects of the COVID-19 pandemic. As the coronavirus continues to burden the globe, the MHA keeps members apprised of pandemic-related developments affecting Michigan hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Phase 3 Funding Available for Providers Starting Oct. 5

The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration, announced Oct. 1 that $20 billion in new funding is available for providers fighting COVID-19.

Under this Phase 3 General Distribution allocation, providers that have already received Provider Relief Fund payments are invited to apply for additional funding that considers financial losses and changes in operating expenses caused by the coronavirus. An expanded group of behavioral health providers will also be eligible for relief payments. Providers can apply for funds from Oct. 5 through Nov. 6 and are encouraged to apply early. Details on eligibility criteria and payment methodology are available in the HHS announcement.

The HHS plans to host webinars to assist providers with the application process, and the MHA will share updates with members as they become available. Updated information can also be obtained by contacting the HHS call center at (877) 696-6775​ and by monitoring the Provider Relief Fund website.

Long-term Care Requirements for COVID-19 Revised

The Michigan Department of Health and Human Services (MDHHS) issued Medicaid policy bulletin MSA 20-66 Sept. 30 announcing the Care and Recovery Centers (CRCs) policy for treating COVID-19 patients and residents who require nursing facility care. This policy was developed from the recommendations submitted to the state by the COVID-19 Preparedness Nursing Home Task Force and the Center for Health and Research Transformation (CHRT) following their work over the summer.

CRCs will be care units dedicated exclusively to caring for and isolating COVID-19-affected residents. The CRC policy temporarily grants some Medicaid-certified nursing facilities the flexibility to operate CRCs during times of a public health emergency, as approved by the MDHHS. Full details on the inclusion and exclusion criteria to operate as a CRC are outlined in the bulletin. The public comment portion of the policy promulgation process is being conducted concurrently with the implementation of the final bulletin; comments on this proposed policy are due Nov. 4.

In addition, the governor Sept. 30 signed Executive Order (EO) 2020-191, which maintains protections for residents and staff of long-term care facilities, taking into consideration the recommendations from the nursing home task force. EO 2020-191 adds to the CRC policy by requiring enhanced communication and transparency and expanding notification requirements for positive cases to include legal guardians, health proxies, and current and prospective residents and staff. Facilities must also contact their local health department to report confirmed COVID-19 cases among staff or residents. This order rescinds EO 2020-179, lifting the previous prohibition on communal dining and instead requiring both communal dining and group activities be conducted consistent with guidance from the Centers for Medicare & Medicaid Services and MDHHS.

Additional updates related to long-term care reporting requirements and infection control guidance are expected as the state continues reviewing the task force and CHRT recommendations. The MHA hosted a webinar Sept. 30 to review those recommendations, and members can access a recording and slide deck from the webinar online.

Planning for Distribution of COVID-19 Vaccine

The MDHHS is developing a COVID-19 vaccine distribution/partnership plan that will be submitted to the federal government by Oct. 16. The department has confirmed that the MHA and hospitals will be key partners in the vaccination effort and will send COVID-19 vaccine enrollment forms to hospitals prior to Oct. 16. Any facility that wishes to receive COVID-19 vaccines when they are available must complete the enrollment form. The MDHHS will continue to lead COVID-19 vaccine efforts and will coordinate with MHA and the state’s emergency preparedness regions and structures on disseminating information.

The MHA encourages hospitals to continue to prepare for distribution of the COVID-19 vaccine. In the event that healthcare workers are among the first to receive the vaccine, hospitals should prepare their processes and procedures to accomplish this. This preparation should consider the likelihood of national and possibly state requirements, potentially through the Michigan Care Improvement Registry, for how COVID-19 vaccines are documented technologically.

Hospitals should also consider whether they have the type of storage necessary to receive and protect COVID-19 vaccines. Some types of the vaccine in development require specific cold or ultra-cold storage (as low as -112 Fahrenheit) to preserve the vaccine. The MHA will discuss these needs in its regular calls with hospital supply chain managers as appropriate.

In addition, providers should have discussions with patients who are at high risk of having a severe case of COVID-19 due to comorbidities or other factors, urging them to get the vaccine when it is available.

For additional information on influenza and COVID-19 vaccines, contact Ruthanne Sudderth at the MHA.

Proposed Policy Limiting Out-of-State Licensed Health Professionals Open for Comment

The MDHHS is now soliciting comments on a proposed policy that would discontinue the option for out-of-state licensed health professionals and nursing students to practice in Michigan at Medicaid-enrolled hospice agencies. The proposed policy has an effective date that is backdated to July 13, 2020.

Although this is a narrow provision, the MHA is concerned this policy could later be expanded to other kinds of healthcare facilities. Out-of-state clinicians are instrumental in maintaining the number of staff needed to serve COVID-19 patients, and the association believes the existing flexibility should remain in effect for all healthcare facilities as organizations prepare for a possible second COVID-19 surge during the cold weather months. The MHA encourages members to submit comment letters to Michelle Tyus at the MDHHS by the Nov. 4 deadline.

Age-Friendly Health Systems Action Community Launches Second Cohort

Knowing that older adults are at higher risk for morbidity and mortality related to COVID-19, the MHA Keystone Center recently announced its plans to launch a second cohort of the Age-Friendly Health Systems Action Community in early spring 2021. MHA members that are interested in and have the capacity to join the next cohort are asked to complete a brief survey by Oct. 16.

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: