Carlos Jackson, federal lobbyist, Cornerstone Government Affairs.
The MHA Legislative Policy Panel convened March 15 to develop recommendations for the MHA Board of Trustees on legislative initiatives impacting Michigan hospitals.
The meeting was highlighted by a presentation on Medicaid redetermination from Brian Keisling, director, Bureau of Medicaid Policy, Operations and Actuarial Services. The state is starting the renewal process this month for nearly three million Medicaid beneficiaries. Keisling discussed the approach they’re taking to review beneficiaries as part of the redetermination process and planned communications with beneficiaries whose eligibility will expire or renew.
Moving to action items, the panel recommended the MHA advocate for incentives that would support birthing hospital participation in Levels of Maternal Care.
In addition, the panel discussed issues around telehealth and the potential discrimination against living organ donors.
The panel received updates on other issues including a federal update from federal lobbyist Carlos Jackson with Cornerstone Government Affairs, hospital workforce funding, state budget negotiations and MHA efforts related to behavioral health.
For more information on the MHA Legislative Policy Panel, contact Adam Carlson at the MHA.
Governor Gretchen Whitmer signed a supplemental appropriation bill on March 8 that includes $75 million for hospital recruitment, retention and training of healthcare workers. The funding was included as a part of House Bill 4016 …
The MHA Keystone Center presented Laura Smith, RN at MyMichigan Medical Center Alpena, with the quarterly MHA Keystone Center Speak-up! Award, which celebrates individuals or teams in Michigan hospitals demonstrating a commitment to the prevention …
The Department of Health and Human Services COVID-19 public health emergency expires May 11, 2023, which may significantly decrease the flexibility providers have become accustomed to. The MHA will host The End of the …
Candida auris cases have been reported in multiple healthcare facilities in Michigan, including acute care hospitals, long-term acute care hospitals and skilled nursing facilities. Auris is a yeast pathogen that can cause serious …
The MHA released another episode of the MiCare Champion Cast, which features interviews with healthcare policy experts in Michigan on key issues that impact healthcare and the health of communities. On episode 27, Adam Novak, …
The Michigan Department of Health and Human Services recently released a final policy bulletin informing providers that Medicaid eligibility redeterminations will resume in June 2023 for the first time since early 2020, with some …
The MHA Excellence in Governance Fellowship is now available to healthcare board members looking for innovative, effective ways to lead their organizations as hospitals and health systems navigate financial strain and labor challenges. Applications are …
Every board member must have a common understanding of critical issues, the implications for the hospital or health system and how to share the impact with government and community leaders. Without support, it is difficult …
The deadline to be featured as a sponsor of the MHA Annual Membership Meeting brochure, which is shared with hospital and health system CEOs, is March 17. The MHA’s sponsors are vital to helping conference …
The MHA received media coverage the week of March 6 regarding Gov. Whitmer signing House Bill 4016, which will appropriate $75 million for the recruitment, retention and training of hospitals workers. Below is a collection …
The Michigan Department of Health and Human Services (MDHHS) recently released a final policy bulletin informing providers that Medicaid eligibility redeterminations will resume in June 2023 for the first time since early 2020, with some enrollees who no longer meet program eligibility criteria losing coverage as early as July.
The Medicaid program has grown to nearly 3.2 million Michiganders, an increase of more than 700,000 when compared to pre-pandemic levels. The MDHHS will complete eligibility redeterminations for all Medicaid enrollees over a 12-month period. Hospitals are encouraged to discuss the importance of updating Medicaid patient contact information in the state’s MI Bridges system and how to maintain Medicaid coverage or find new coverage on the federal marketplace. Hospitals are invited to join the MHA, the Michigan Primary Care Association, the Michigan Association of Health Plans and other stakeholders for a members-only webinar March 20. This will cover the redetermination processes, timelines and provider roles.
The MDHHS also announced that it has started unwinding many of the changes that were made to the Michigan Medicaid program in order to ease rules and provide flexibilities to providers as a result of the COVID-19 public health emergency (PHE). Michigan will continue to unwind the pandemic-related program changes before the authority for these policies expires on May 11, 2023. The MHA will host an additional webinar on March 30 to cover details of the PHE ending and what hospitals need to know.
The MDHHS developed a website with information important to providers that will be updated as new information becomes available. The Centers for Medicare & Medicaid Services also recently released a fact sheet related to the PHE expiration’s impact on:
COVID-19 vaccines, testing, and treatments.
Telehealth services.
Healthcare access and continuing flexibilities for healthcare professionals.
Inpatient hospital care at home.
Members with questions are encouraged to contact Jason Jorkasky at the MHA.
“The country is lyric, the town dramatic. When mingled, they make the perfect musical drama” — Henry Wadsworth Longfellow
Having just returned from the annual American Hospital Association (AHA) Rural Health Care Leadership Conference, where I was joined by a strong contingent of MHA members and staff, the future of our rural hospitals has been top of mind.
When I was in graduate school at the University of Michigan many years ago, I recall clearly our discussions related to rural health. In short, we were taught that rural America was statistically older, poorer and sicker than the rest of the country – and this demographic and socioeconomic reality led to all kinds of challenges for those responsible for the health of rural populations and the viability of rural hospitals.
Fast forward to the most recent (2020) census and this dynamic remains true. In addition, we discovered that between 2010 and 2020, rural America actually lost population for the first time in history. Here in Michigan, the latest projections indicate that while the total state population will grow moderately over the next 20 years, the population in rural Michigan will remain flat or even decrease.
The operating environment has never been more difficult for healthcare organizations, for reasons we have documented at length in prior CEO Reports. This statement is particularly true for rural hospitals – 100 of which from across the country have actually closed since 2005. Many more have had to make the difficult decision to terminate service lines or otherwise scale back their operations to keep their doors open. What is driving these challenges? A few items come immediately to mind:
An older and poorer population translates into a higher percentage of government payors (Medicare and Medicaid), which traditionally do not fully cover the true cost of care.
The traditional volume-based reimbursement model that has been one of the cornerstones of American healthcare does not serve rural providers – which often lack sufficient volume – particularly well. The pitfalls of the volume-based model were on full display during the worst days of the COVID-19 pandemic, particularly when non-emergent procedures were suspended.
Recruiting physicians today most often involves recruiting a spouse as well; in other words, there must be a good job match for both parties to spur a relocation. Physician recruitment is more difficult in rural communities for the simple fact that there are fewer potential jobs for that spouse. In addition, the on-call coverage demands can be particularly significant in rural areas, because the number of available rotating on-call clinicians is simply fewer. I would be remiss if I didn’t mention the Merritt Hawkins firm, which is one of our original MHA Service Corporation Endorsed Business Partners, and is dedicated to working with our members to create solutions to some of the most vexing challenges of the day.
Lastly, it is no secret the country is in the middle of a behavioral health crisis, with a lack of available placements leading to behavioral health patients boarding in emergency departments throughout the state, awaiting placement in a more appropriate setting. Hospitals are experiencing higher costs caring for these patients, increasing security to protect other patients and staff, while receiving little to no reimbursement since these patients have yet to be admitted to an inpatient psychiatric unit. This lack of access is even worse in rural areas. For example, the Upper Peninsula only has one licensed child psychiatrist for the entire region.
The reality is that when we think about rural Michigan and the more densely populated areas of the state, we are all inextricably linked. There is no “us and them.” People from the big city travel every day to rural communities for conferences and events, meetings, sales calls, deliveries, vacations and visits with friends and family (and people from rural communities come to the big city for the same reasons). While we want to ensure the vibrancy of a hospital in a rural community so that the residents have access to quality healthcare, we should all want the same thing, because we never know when we might be on one of those sales calls or vacations and need that same access. This is not just theoretical, as I have countless stories about this phenomenon playing out in real life, and I suspect you do as well.
Moreover, hospitals are one of the largest – if not the largest – employers in many rural Michigan communities, playing a crucial role in the economic vibrancy of the state. Healthcare careers provide stable, good paying jobs and positively impact lives every day. Not only are hospitals important for access to care, but also as economic drivers. 121,000 total workers are associated with the healthcare sector in rural Michigan, including 81,000 direct jobs. These direct healthcare workers received $7.6 billion in total wages, salaries and benefits and contributed $1.4 billion in local, state and federal taxes. In addition, the existence of a hospital nearby is one very important item for businesses of all kinds when considering investment in a new factory, office or headquarters.
So, the vibrancy of our rural hospitals should be a priority. What is the MHA doing about it? As it turns out, we have done a lot. Beyond our advocacy on the traditional Medicaid and Medicare budgets, certificate of need, medical liability, workforce funding and many, many other public policy issues that affect all our members, here are just a few of our rural advocacy highlights:
We fought hard to secure passage of the Healthy Michigan Plan (our Medicaid expansion program) and have advocated for full funding in every budget cycle since. For the reasons cited above, this is particularly impactful for our rural hospitals.
We worked to pass, implement and protect the Critical Access Hospital program, which has created an important lifeline for 37 Michigan hospitals. And the MHA was successful in changing existing statue at the end of 2022 to make adoption of the new Rural Emergency Hospital designation possible for our members.
We have worked very hard to protect the 340B drug pricing program, which is vital to many rural hospitals and their ability to provide access to care to all in their communities. Our work includes advocacy with both the state legislature and Congress, and even in the federal courts, where the MHA has filed amicus curiae briefs related to recent 340B cases.
The MHA successfully advocated for two new supplemental Medicaid payment pools that specifically benefit our rural members with implementation of the rural access pool in fiscal year (FY) 2012 and the obstetrical stabilization fund in FY 2015. Our advocacy efforts were also successful in securing Medicaid outpatient rate increases in FY 2020, the first increase in two decades, followed by an additional increase in FY 2021. These increases resulted in a 63% increase for critical access hospitals and a 21% increase for all other hospitals compared to Jan. 1, 2020, rates.
We successfully advocated for an extension of both the Medicare-dependent Hospital and Low-volume Adjustment programs during the 2022 Congressional lame-duck session, which provide critical support to many rural hospitals.
Finally, we have successfully advocated for passage and implementation of state legislation that modernizes the scope of practice for certified registered nurse anesthetists and allows flexibility for each hospital to choose the anesthesia care model that best fits its location, staffing and resources to offer safe and effective patient care.
Our advocacy is also focused on ensuring our members can tell their story and connect with lawmakers, both at the state and federal levels. The MHA hosted its first ever Rural Advocacy Day last September in Lansing to facilitate conversation between rural hospital leaders and members of the Michigan Legislature. The MHA also accompanied members in February for the National Rural Health Association’s Rural Health Policy Institute event. MHA members met with Michigan’s congressional delegation and staff during the trip to discuss rural health issues facing Michigan hospitals. And if you haven’t yet had the opportunity to listen to the Rural Health Rising podcasts, I encourage you to tune in to our friend JJ Hodshire, the CEO of Hillsdale Hospital and an MHA Board member, as he does a fantastic job shining a light on a wide range of rural health issues – with an impressive set of special guests – in real time.
Successful advocacy and storytelling require teamwork. As mentioned above, for years we have partnered closely with the AHA and the National Rural Health Association. We have also enjoyed a close partnership with the Michigan Center for Rural Health (MCRH), and I am pleased to share Hunter Nostrant, CEO of Helen Newberry Joy Hospital, is a member of both the MHA Board of Trustees as well as the MCRH Board.
The mission of the MHA is to advance the health of individuals and communities, and in that context, we have always strived to represent all our members and communities. Each hospital is vital to the health of our great state. While the path forward may be difficult, I’m encouraged by the many rural hospital leaders – some of the nicest, and most talented people that I have met – that have developed innovative and strategic ways to address these challenges and position themselves to be able to care for their communities for years to come.
The MHA continues to utilize public healthcare ambassadors, referred to as MiCare Champions, to advocate for public policy needs for Michigan hospitals and health systems. The MiCareMatters campaign originally launched in 2017 with the aim …
Applications for the 2023 Michigan State Loan Repayment Program (MSLRP) will be accepted from March 6-31 through the File Transfer Application System. Providers are strongly encouraged to create an account in the system before starting the application period. The MSLRP assists employers in the recruitment …
Myers and Stauffer LC, Michigan’s contractor for the federally mandated Medicaid disproportionate share hospital (DSH) audits, encourages hospital staff to participate in the upcoming virtual training at 10 a.m. Feb. 28. Hospital staff are also …
The Michigan Department of Health and Human Services will reimburse for doula services provided to individuals covered by Medicaid beginning Jan. 1, 2023. Doula providers are required to be registered and approved on the …
“Last Wednesday, North Carolina Treasurer Dale Folwell released a report alleging 9 prominent North Carolina health systems overpaid their CEOs more than $1.75 billion from 2010 to 2021. …
The issue of CEO compensation is tricky for hospitals because the public’s unaware of how hospitals operate—7/24 serving all comers. In North Carolina, hospitals directly impact 8% of the state’s economy. Understandably, they pay attention to Exec Comp! The Treasurers Report should prompt discussion about the role of hospitals in the state and their future. It’s an incomplete picture. “
The Michigan Department of Health and Human Services (MDHHS) will reimburse for doula services provided to individuals covered by Medicaid beginning Jan. 1, 2023. Doula providers are required to be registered and approved on the MDHHS Doula Registry and enrolled in the Community Health Automated Medicaid Processing System (CHAMPS) as a Medicaid provider. Doulas should contact the Medicaid health plan (MHP) prior to providing services to MHP enrollees, as doulas must be contracted with the MHP or receive approval to provide out-of-network services.
Doulas must be at least 18 years old and possess a high school diploma or equivalent credentials. The MDHHS will certify doulas who have completed training provided by an MDHHS-approved training program or organization.
Myers and Stauffer LC, Michigan’s contractor for the federally mandated Medicaid disproportionate share hospital (DSH) audits, encourages hospital staff to participate in the upcoming virtual training at 10 a.m. Feb. 28. Hospital staff are also encouraged to view a pre-recorded general DSH training prior to the webinar. The pre-recorded training covers general DSH survey instructions and updates, while the Feb. 28 training will cover Michigan-specific requirements, followed by a question-and-answer session.
The following information may be used to join the Michigan-specific webinar:
Join from the meeting link.
Meeting password: 9ovN4X.
Join by phone: 929-352-2629.
Meeting number (access code): 959 209 351#.
Myers and Stauffer also plan to distribute the initial data request for the fiscal year 2020 audits to hospitals Feb. 10 and hospitals will have until March 13 to return the completed survey.
Members with questions should contact Katie Jaskolski at the MHA.
Gov. Whitmer released her executive budget recommendation Feb. 8 for fiscal year 2024. The proposed budget fully protects traditional hospital line items for Medicaid and the Healthy Michigan program, continues targeted rate increases from recent budget cycles and includes new investments in workforce training and development. None of the line items important to MHA members were recommended for reductions in the recommendation.
The MHA will share additional information on the new initiatives in the coming weeks, but below are a few key pieces for MHA members.
New or expanded funding items:
Healthy Moms and Healthy Babies – $62 million.
Implementing recommendations from the Racial Disparities Task Force – $58 million.
Increased rates for laboratory services, traumatic brain injury services and other related professional services – $120 million.
Expanding eligibility for the Michigan Reconnect scholarship program – $140 million.
Building capacity for insulin production in Michigan – $150 million.
Discretionary mental health supports for K-12 students – $300 million.
Items receiving continued, full funding:
The Healthy Michigan Plan (Medicaid expansion).
Hospital Quality Assurance Assessment Program.
Rural and obstetrical stabilization pools.
Hospital outpatient rate increase.
Critical access hospital rate increase.
MHA CEO Brian Peters released a statement in support of the executive budget recommendation, thanking Gov. Whitmer for her continued commitment to protecting hospitals and supporting healthcare workers.
Members with questions about the budget or any other state legislation impacting hospitals should contact the MHA advocacy team.
The following statement can be attributed to Brian Peters, CEO of the Michigan Health & Hospital Association.
Gov. Whitmer and her administration demonstrated their commitment to protecting hospitals and supporting healthcare workers with the release today of the 2024 executive budget recommendation. Not only does it continue to protect vital funding pools in the state budget, but also provides health equity resources and includes significant workforce investments that should help grow the healthcare talent pipeline.
Important items included in the state budget include support for rural and critical access hospitals, obstetrical services, graduate medical education, the Healthy Michigan Plan and Michigan’s Medicaid population. The investments to expand the Healthy Moms, Healthy Babies program and to implement recommendations from the Racial Disparities Task Force should help improve health outcomes and reduce disparities in care. The announced workforce development investments such as lowering the eligibility age for Michigan Reconnect are long-term strategies that should help fill the incoming talent pipeline as staffing challenges continue to impact hospitals and their overall patient capacity.
Actions like today show Gov. Whitmer is a healthcare champion and on behalf of Michigan’s hospitals, we thank her for helping Michigan advance the health and wellness of individuals and communities. The MHA is committed to working with lawmakers throughout the budget process to identify funding solutions that expand access to care, protect the viability of hospitals and assist healthcare workers.
Myers and Stauffer LC, Michigan’s contractor for the federally mandated Medicaid disproportionate share hospital (DSH) audits, encourages hospital staff to participate in the upcoming virtual training at 10 a.m. Feb. 28. Hospital staff are also encouraged to view a pre-recorded general DSH training prior to the webinar. The pre-recorded training covers general DSH survey instructions and updates, while the Feb. 28 training will cover Michigan-specific requirements, followed by a question-and-answer session.
The following information may be used to join the Michigan-specific webinar:
Join from the meeting link.
Meeting password: 9ovN4X.
Join by phone: 929-352-2629.
Meeting number (access code): 959 209 351#.
Myers and Stauffer also plan to distribute the initial data request for the fiscal year 2020 audits to hospitals Feb. 10 and hospitals will have until March 13 to return the completed survey.
Members with questions should contact Katie Jaskolski at the MHA.