Combating the Novel Coronavirus (COVID-19): Week of Nov. 15

MHA Covid-19 update

MHA Covid-19 updateMichigan is once again among the states with the highest numbers of COVID-19 cases in the nation, with the New York Times reporting that Michigan and Minnesota lead the country in cases per capita. On Nov. 19, there were 3,424 adults hospitalized with confirmed cases of COVID-19, in addition to 50 children. Meanwhile, 60.3% of Michiganders aged 5 and older had been fully vaccinated as of Nov. 19.

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.

FDA Amends EUA to Allow Booster Shots to Fully Vaccinated People Aged 18 and Up

The Food and Drug Administration (FDA) amended the COVID-19 vaccine emergency use authorizations (EUAs) Nov. 19 to allow all individuals 18 years of age and older to receive booster shots of both the Pfizer and Moderna vaccines. The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) was scheduled to meet later that day to discuss additional clinical recommendations.

In its news release, the FDA said the expanded authorization for the booster doses is based on its analysis of immune response data that supported use in the previously authorized populations for boosters. Groups previously included in the EUAs were fully vaccinated individuals who are 65 years of age and older and who are 18 through 64 years of age at high risk of severe COVID-19 and/or experience frequent exposure to the coronavirus through living situations or workplaces.

Prior to the FDA announcement, Gov. Gretchen Whitmer encouraged residents to plan to get the booster doses as soon as they are authorized. The governor noted that more than a million booster doses have been administered within the state and urged everyone to get vaccinated and receive the booster shot.

Booster doses should be administered at least six months after the second dose of either the Pfizer or Moderna vaccine and at least two months following the single-dose Johnson & Johnson vaccine. Updated information for both the Pfizer and Moderna vaccines are available on the FDA website that provide details on the booster shots.

Members with questions on vaccines may contact Ruthanne Sudderth at the MHA.

MDHHS Announces Face Mask Advisory for Holiday Season

As both COVID-19 and influenza cases rise throughout the state, the Michigan Department of Health and Human Services (MDHHS) will issue a face mask advisory and offer guidance to prevent the spread of respiratory diseases during the holidays.

The department’s news release indicates it recommends everyone over the age of 2 wear a face mask at indoor gatherings regardless of their vaccination status. Establishments are also urged to implement policies to ensure that customers, employees and visitors wear masks. The advisory will remain in effect until further notice.

During a Nov. 19 news conference, MDHHS Director Elizabeth Hertel, Chief Medical Executive Natasha Bagdasarian, MD, and others also urged Michigan residents to get vaccinated against COVID-19 and the flu as soon as possible. The two vaccines can be administered simultaneously. Darryl Elmouchi, MD, MBA, president of Spectrum Health West Michigan, shared information about the unprecedented numbers of patients hospitals are seeing. He said Spectrum Health has 370 patients hospitalized with COVID-19, 86% of whom are unvaccinated against the disease.

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

Combating the Novel Coronavirus (COVID-19): Week of June 21

MHA Covid-19 update

The COVID-19 vaccines appear to be effective in protecting against serious illness from the more contagious delta variant of the virus. However, the variant continues to infect many in regions throughout the world, with news reports of renewed lockdowns in Australia and New Zeeland and increasing numbers of cases in U.S. states including Missouri, California, Florida and Texas, where fewer residents are vaccinated. Meanwhile, Michigan’s vaccine dashboard shows more than 61% of residents ages 16 and older have received at least one dose of a COVID-19 vaccine, with nearly 9 million doses administered.

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.

Emergency Orders Rescinded Effective June 22

Several emergency public health orders that have been in place for much of the last 15 months are rescinded as of 12:01 a.m. June 22. The orders rescinded and the dates on which they took effect are:

  1. Gatherings and Face Mask Order (June 1, 2021)
  2. Temporary Restrictions for Entry into Congregate Care and Juvenile Justice Facilities (Oct. 29, 2020)
  3. Mandatory Testing for Michigan Department of Health and Human Services' Juvenile Justice Facility Staff (Sept. 18, 2020)
  4. Mandatory Testing for Michigan Department of Health and Human Services Hospitals and Centers Staff (Sept. 14, 2020)
  5. Exceptions to Temporary Restrictions on Entry into Congregate Care and Juvenile Justice Facilities (June 29, 2020)
  6. Exceptions to Temporary Restrictions on Entry into Certain Facilities (June 3, 2020)
  7. Safe Housing for Housing Unstable Individuals (May 12, 2020)
  8. Handling of Bodily Remains (May 4, 2020)
  9. Safe Housing for Michigan Homeless (April 28, 2020)

While the rescission of the facemask and hospital visitor restrictions would seemingly allow hospitals to stop screening visitors and make their own determinations about masking, the Michigan Occupational Safety and Health Administration (MIOSHA) announced new rules June 22 that essentially defer to the OSHA at the federal level. The OSHA rules currently in place still require healthcare facilities to screen visitors and require masks for employees. However, some exceptions are outlined by the OSHA for well-defined areas where employees are fully vaccinated; a flowchart on the OSHA website provides details. The OSHA also refers healthcare facilities to Centers for Disease Control and Prevention recommendations that continue to urge mask requirements for visitors. The MHA is reviewing the OSHA complete set of rules.

Because the MIOSHA adopted the OSHA rules by reference, the OSHA effective and compliance dates apply. The OSHA COVID-19 Emergency Temporary Standard (ETS) is effective June 21, 2021. The compliance date for the ETS is July 6, 2021, with a few exceptions. Compliance with paragraphs (i) Physical Barriers, (k) Ventilation, and (n) Training is required by July 21, 2021.

As an interim final rule, the new OSHA standard is open for comment. The MHA will submit comments on behalf of its members after a more thorough review of the rule, and members are encouraged to share content for the MHA comment letter with Laura Appel. The MHA will continue to advocate with the MIOSHA for consistency in state and federal rules for healthcare settings and keep members apprised of any developments on this issue. Members with questions may contact Adam Carlson 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 Michigan Department of Health and Human Services Community Health Emergency Coordination Center (CHECC).

Combating the Novel Coronavirus (COVID-19): Week of June 14

MHA Covid-19 update

MHA COVID-19 UpdateNearly 61 percent of Michiganders ages 16 and over had received a COVID-19 vaccine as of June 17, supporting the state’s decision to rescind public health orders related to slowing the spread of the disease (see below). Experts continue to urge the public to use caution, especially when around those who have not been vaccinated.

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.

COVID-19 Public Health Orders Ending June 22

Gov. Gretchen Whitmer announced June 17 that COVID-19 public health orders originally established to prevent the spread of COVID-19 will be rescinded June 22. The recission of emergency orders issued by the Michigan Department of Health and Human Services (MDHHS) includes the statewide mask mandate, limitations on gathering capacities, hospital visitor requirements and mandated hospital testing protocols for staff. However, hospitals continue to have the ability to enforce infection control practices within their facilities that require such items as screening upon entry, visitor limitations and mask requirements. In addition, the mask requirement for healthcare employees remains in effect under existing rules of the Michigan Occupational Safety and Health Administration. Hospitals may want to refer to existing CDC guidance on masking in healthcare facilities when reviewing or developing visitor policies.

The MHA issued a statement supporting the announcement, stressing the important role that the COVID-19 vaccine has played in reducing transmission and illness. In addition, the statement specifies that hospitals will continue protocols in their facilities to prevent the spread of infectious disease.

Members with questions may contact Adam Carlson at the MHA.

U.S. Supreme Court Upholds the Affordable Care Act

The U.S. Supreme Court issued a ruling June 17 on California v. Texas that upholds the Affordable Care Act (ACA). In response to the opinion, the MHA issued a statement to media statewide that describes the ruling as a “victory for all who believe in expanding access to healthcare.” The value of the ACA to Michigan is shown in the increase in enrollment for the Healthy Michigan Plan, which has grown over the past year by more than 250,000 beneficiaries who would otherwise have been uninsured at some time during the pandemic.

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).

Combating the Novel Coronavirus (COVID-19): Week of May 10

MHA Covid-19 update

MHA COVID-19 UpdateAs the spring surge of COVID-19 cases continues to recede in Michigan, the state has surpassed the 55% mark in adults ages 16 and older receiving at least one dose of the vaccine to prevent the disease. In addition, the Michigan Department of Health and Human Services (MDHHS) has launched its “Vacc to Normal” tracker that reports both state and federal data on vaccination rates, providing markers for reopening the state’s economy.

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.

Press Conference Urges Youth Vaccinations

The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) voted late May 12 to recommend use of the Pfizer COVID-19 vaccine in children ages 12 to 15. The MDHHS and the Protect Michigan Commission, with assistance from the MHA, held a press conference May 13 promoting this expansion of eligibility and urging parents to get their kids vaccinated as quickly as possible.

Because research has shown that children are more likely to get vaccinated if their parents are vaccinated, the MHA encourages members to begin their outreach on the vaccine eligibility of this age group with adults already vaccinated by their hospitals/health systems.

Pfizer’s studies have proved its vaccine is safe and effective for 12- to 15-year-olds, for whom it is 100% effective in preventing COVID-19. In addition, the CDC announced that COVID-19 vaccines may now be given in conjunction with other vaccines. It was previously recommended that two weeks pass between getting a COVID-19 vaccine and any other inoculation. With this change, providers are encouraged to offer other recommended immunizations when administering COVID-19 vaccine to young teens to help offset the decreased rate of childhood vaccinations during the pandemic.

The MDHHS is also urging all primary care physicians (PCPs), especially pediatricians, to enroll as COVID-19 vaccine program participants to ensure all families with a PCP can access the vaccine. Hospitals that wish to transfer vaccine to any primary care office settings must verify the office setting is enrolled and has a redistribution agreement in place to ensure the vaccine supply is tracked appropriately.

The state’s Vacc to Normal economic reopening plan will not include the numbers of vaccinated 12- to 15-year-olds toward easing public health measures and gathering capacity limits, as the plan ties vaccination rates of adults 16 and older to those events. The newly eligible age group, which comprises approximately 498,000 kids in Michigan, will be included in the regular data tracking on the state’s vaccine dashboard. On May 10, Michigan reached the milestone of 55% of adults having at least initiated vaccination, which will allow office workers to return to their places of employment May 24.

Vaccine Now to Be Ordered via Michigan Care Improvement Registry

The MDHHS has announced a change in the way COVID-19 vaccines are allocated. Providers must now electronically request their desired doses through the Michigan Care Improvement Registry (MCIR), including both first and second doses. Orders will not be automatically approved; local health departments (LHDs) will review requests and approve allocations accordingly. Providers should ensure they are following LHD guidance prior to placing an order in MCIR.

Providers should plan operationally to order second doses within the MDHHS MCIR order timing recommendations to ensure they arrive before patients’ second dose appointments. The MDHHS has provided a tip sheet on how to place orders; a recording and slides from a May 11 webinar detailing the process; and additional ordering information and resources on its website. It will add other materials as they are created throughout the transition.

The state has also received an allocation of the Moderna vaccine in the new 14-dose (maximum 15-dose) vials. Both the 10- and 14-dose vials may be ordered via MCIR.

Comprehensive resources for COVID-19 vaccination efforts are available on the MDHHS COVID-19 Vaccine Provider Guidance webpage. Members with vaccine questions may contact Ruthanne Sudderth at the MHA.

CDC Updates Guidance, Michigan Lifts Mask Requirement for Fully Vaccinated Individuals

CDC Director Rochelle Walensky, MD, announced May 13 revised guidance allowing fully vaccinated individuals to participate in any indoor or outdoor activity without masks. Walensky cited several factors that influenced the decision, including published literature on the safety of the COVID-19 vaccine and its effectiveness on the original virus and its variants circulating in the United States; the low risk of transmission from vaccinated individuals; and universal access to vaccines. The recommendations specifically apply to individuals in nonhealthcare settings. The CDC stated that healthcare settings can continue infectious disease practices that require masks within their facilities.

The following day, Gov. Gretchen Whitmer announced the MDHHS would update its Gathering and Mask Order to align with the updated CDC guidance, effective May 15. Under the updated order, Michiganders who are outdoors will no longer need to wear a mask regardless of vaccination status. Residents who have not completed their vaccinations must continue to wear a mask or face covering indoors to protect themselves and others. After July 1, the broad indoor mask mandate will expire.

While the MDHHS order has been updated, the Michigan Occupational Safety and Health Administration (MIOSHA) emergency rules for workplace safety remain in effect. Among other things, the rules stipulate screening and tracking of visitors and employees, mask wearing and other social distancing measures. The MHA has been in contact with the MIOSHA and expects the emergency rules to be significantly revised in the coming days (see below).

Process to Approve MIOSHA Permanent COVID-19 Workplace Rules Continues

The MIOSHA continues to pursue permanent workplace COVID-19 rules, even though Michigan is making progress vaccinating eligible residents. Because the state recently reached the 55% vaccination benchmark in the governor’s MI Vacc to Normal plan, in-person work will no longer be prohibited where it is feasible for the employee to work remotely, beginning May 24. All other workplace regulations that govern the use of personal protective equipment, physical distancing, contact tracing and other pandemic-related modifications would be required under the rules.

The MHA submitted comments to the MIOSHA expressing disagreement with the proposed permanent COVID-19 rules as written, because they fail to address concerns on cementing rules into the administrative code that do not reflect the rapidly changing environment related to the pandemic. The MHA recommended the rules be updated to address, at a minimum, two main concerns:

  1. Any new standard should be promulgated in a manner that would allow future updates, based on current CDC guidance, to be made automatically.
  2. A sunset clause for the rules to expire after the MDHHS declaration of emergency has ended.

The MIOSHA will host a public hearing at 9 a.m. May 26.

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).

Combating the Novel Coronavirus (COVID-19): Week of July 20

MHA Covid-19 update

coronavirus updateAs the threat posed by COVID-19 rises across the country, the MHA continues to keep members apprised of developments affecting Michigan hospitals during the pandemic through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Tools Available to Advocate for Next COVID-19 Relief Package

The MHA participated in a Virtual Advocacy Day that the American Hospital Association (AHA) hosted July 20, featuring presentations from AHA President and CEO Rick Pollack and AHA Executive Vice President Tom Nickels. An update was shared on efforts to include provisions to support hospitals in the next COVID-19 relief package, which includes additional dollars for the emergency relief fund, forgiveness for accelerated payments, and liability protections for front-line medical providers and facilities.

Since Senate negotiations on the bill reportedly stalled July 23, it remains important for healthcare providers to advocate for these provisions. The AHA has issued an Advocacy Alert (password required) asking that members contact their senators to stress their importance. While Michigan’s U.S. Sens. Debbie Stabenow and Gary Peters are healthcare champions, there is value in them hearing from their constituents on the importance of this funding. To aid in these efforts, the AHA has developed resources and a digital toolkit to help members engage with lawmakers virtually. Members with questions on federal advocacy topics may contact Laura Appel at the MHA.

HHS Extends Public Health Emergency

On July 23, the U.S. Department of Health and Human Services (HHS) extended the COVID-19 public health emergency for another 90 days. The renewal, officially signed by HHS Secretary Alex Azar, ensures that waivers received from the HHS and the Centers for Medicare & Medicaid Services will continue. Policies extended include the 20% Medicare inpatient add-on payment for COVID-19 patients, relaxed telehealth restrictions and other Section 1135 waivers. Members with questions should contact Laura Appel at the MHA.

HHS Announces Targeted CARES Act Funding, Clarifies Required Reporting

The HHS recently announced $10 billion in additional “targeted” hospital funding from federal Coronavirus Aid, Relief, and Economic Security (CARES) Act provider relief funds to assist hospitals with COVID-19 response efforts. The HHS asked hospitals to submit data on their COVID-19-positive inpatient admissions for the period Jan. 1 through June 10, 2020. Payments will be issued to hospitals with more than 161 COVID-19 admissions during this period, with a portion of Michigan hospitals set to receive additional funding from the allocation.

The HHS also shared details on reporting requirements for recipients of CARES Act provider relief funds. Recipients that received one or more payments exceeding $10,000 in the aggregate from the Provider Relief Fund, including the newly announced payments, are required to submit reports to the HHS on how the funds have been expended, using a portal that the HHS will open Oct. 1. Detailed instructions regarding these reports will be released by Aug. 17, and the Health Resources and Services Administration will host educational sessions for providers.

The MHA will continue to monitor hospital distributions from the CARES Act Provider Relief Fund and update members as information becomes available. Members with questions about this funding are encouraged to contact Jason Jorkasky at the MHA.

Guidance Released on Wage Increase for Direct Care Worker Grants

The Michigan Department of Health and Human Services released further information and guidance regarding the $2 per hour wage increase for direct care workers via state grants that was signed into law through Senate Bill (SB) 690 July 1. The department’s frequently asked questions document contains information regarding eligibility of individuals and facilities, as well as the logistics for providing the increased funding at skilled nursing facilities.

In SB 690, the Legislature appropriated $120 million to increase the wages of direct care workers. The language of the bill provided that the increases are above the rates paid March 1 and apply to the period from July 1 through Sept. 30, 2020. Only “direct care workers” at skilled nursing facilities are eligible for the grants. These workers include registered nurse, licensed practical nurse, competency-evaluated nursing assistant or respiratory therapist. The MHA will continue to share additional information about the grants as it becomes available. Members with questions on this issue may contact Adam Carlson at the MHA.

State FY 2020 Budget Protects Healthcare Priorities

During the week of July 20, negotiations ended on the state fiscal year (FY) 2020 budget as the Legislature approved a plan addressing a deficit of nearly $2.2 billion caused by economic losses surrounding the COVID-19 pandemic (see related article). The MHA actively worked with lawmakers to ensure that the association’s budget priorities were held harmless from reductions, including the rural access pool and obstetrical stabilization fund, Medicaid rates and provider tax funded pools. In the coming months, the Legislature and administration will work on the state budget for FY 2021, which begins Oct. 1, and the MHA will continue to stress the importance of fully funding healthcare during those negotiations. Members with questions may contact Adam Carlson at the MHA.

State Senate Approves Liability Protection Bill

Legislation to limit legal liability for healthcare facilities during the COVID-19 pandemic passed the Senate July 23 after receiving approval from the full House late July 22. Senate Bill (SB) 899 would protect facilities from lawsuits related to pandemic response. Specifically, the legislation protects from lawsuits related to the provision of care to COVID-19 patients, rescheduling patient care because of governmental orders or shortages of supplies.

Sen. Michael MacDonald (R-Macomb Township) introduced SB 899, and it passed the Senate May 7. The final version of the legislation as approved July 23 reflects the House substitute that was adopted in committee July 22. The legislation requires Gov. Gretchen Whitmer’s signature before becoming law. The MHA will continue to monitor and keep members informed on the issue. Members with questions should contact Adam Carlson at the MHA.

National COVID-19 Testing Implementation Forum and Testing Supply Registry Announced

The HHS announced July 21 a new program to capture feedback between federal officials and the private sector on COVID-19 testing. The National Testing Implementation Forum will bring together representatives from key stakeholder groups to share information and provide input to federal leaders about SARS-CoV-2 testing and diagnostics. A key aim of the forum is to share perspectives on how the HHS can best address end-to-end testing supply chain issues across commercial, public health, academic and other sectors and define optimal testing in various settings (diagnostic, screening, surveillance, others). The group will also aim to increase public health laboratory capacity, implement a national surveillance strategy, seek new techniques such as sample pooling and identify barriers to a streamlined national laboratory testing reporting system.

The same day, the Advanced Medical Technology Association (AdvaMed) announced the creation of a comprehensive, national COVID-19 diagnostic supply registry to help state and federal governments in their pandemic responses. As outlined in AdvaMed’s news release, the national registry is being launched in partnership with 13 commercial diagnostics manufacturers, nearly all of which produce supplies used in Michigan. The new registry will streamline communications and data sharing between diagnostic firms and the government, facilitate collaboration with public health stakeholders to optimize access to COVID-19 testing, and standardize reporting. Questions related to COVID-19 testing can be directed to Brittany Bogan at the MHA.

Grace Period Granted for Remote Pharmacy Supervision Step Down

The governor issued Executive Order (EO) 2020-152 July 14, removing some of the flexibility related to remote supervision of pharmacy technicians and staff that existed in EO 2020-124, which has since been rescinded. The Department of Licensing and Regulatory Affairs (LARA) has issued a memo discussing the topic and a timeline to fully transition from remote to on-site supervision. LARA will give pharmacies until 11:59 p.m. Sept. 30, 2020, before enforcing supervision and other requirements. Members with questions about EO 2020-124, EO 2020-152 or the memo from LARA may contact Paige Fults at the MHA.

Multilingual Mask-up Materials Available

The state of Michigan has available for download No Mask, No Entry posters in various languages, including English, Spanish, Arabic, Traditional Chinese, Simplified Chinese, Korean, Burmese, French, American Sign Language, Swahili and Bangla. Questions on available resources can be sent to the MHA Communications department.

U.S.-Canadian Border Remains Closed, Healthcare Employees Exempted

Acting Homeland Security Secretary Chad Wolf recently announced that the United States and Canada have extended the mutual ban on nonessential travel between the two countries until Aug. 20; that ban had been set to expire July 21. Essential travel, including that of healthcare workers, may continue uninterrupted. The MHA will continue to monitor and work with state and federal governments to keep the border open for essential healthcare employees. Members with questions on this issue may contact Adam Carlson 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: