New legislation to make changes to the screening process for potential admission to inpatient psychiatric care for behavioral and mental health patients was introduced Aug. 17 in the Michigan House of Representatives.
Rep. Graham Filler (R-St. Johns) introduced House Bill (HB) 6355 to amend the Mental Health Code and make the preadmission screening process more efficient. Under the bill, preadmission screening units, whether operated by the Michigan Department of Health and Human Services or Community Mental Health services programs, must 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 in a timely manner, HB 6355 would also allow for a clinically qualified individual at the acute care hospital to perform the required assessment. The bill provides for reimbursement to the hospital if hospital staff provide the preadmission screening.
The MHA supports HB 6355 because it addresses the ongoing issue of long wait times for emergency department behavioral and mental health patients. This legislation should help shorten the difficult wait times between the evaluation and beginning services.
HB 6355 was referred to the House Health Policy Committee. Members with questions regarding HB 6355 should contact Adam Carlson at the MHA.
In preparation for the state’s anticipated grant program to implement an Emergency Department Medication for Opioid Use Disorder (ED MOUD) program, the MHA is asking all members to fill out a short survey by Sept. 23 to provide contact information for those within each member organization who support OUD work.
The Michigan Senate and House recently both passed Senate Bill 597, which requires all Michigan emergency departments who do not otherwise opt-out to implement an ED MOUD program. The governor has not yet signed the bill into law, but the MHA anticipates Gov. Whitmer will sign the bill in the coming months.
While ED MOUD programming currently exists and many Michigan hospitals are already implementing it, the bill will require the Michigan Department of Health and Human Services to create a grant program to provide financial support to emergency departments to implement ED MOUD programs. This funding will be available only to those with more than 50 overdose encounters a year. Hospitals will be required to either opt-out or complete an application for funding. As such, the MHA Keystone Center – which has been working closely with Michigan hospitals currently implementing the ED MOUD program – is preparing to support members once the bill is signed. Given the anticipated tight turnaround to complete paperwork, it is imperative for the MHA Keystone Center to have the appropriate contacts to aid in the registration or opt-out process.
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.
The Michigan Department of Health and Human Services (MDHHS) recently released a proposed policy for Medicaid coverage of doula services effective Oct. 1, 2022, contingent upon approval by the Centers for Medicare & Medicaid Services. The MHA supports this proposal and agrees with the MDHHS statement that the policy would improve birth outcomes, address social determinants of health, and decrease health and racial disparities for Medicaid beneficiaries.
A doula is a nonclinical person who typically provides physical, emotional and educational support services to pregnant women during the prenatal, labor and delivery, and postpartum periods. Doulas must have a current certification by a doula training program or organization approved by the MDHHS and provide it upon request. They must complete an online application in the Community Health Automated Processing System and enroll with an Individual National Provider Identifier as either a Rendering/Servicing-Only or Individual/Sole Provider to be a Medicaid-enrolled provider.
Under the proposed policy, Medicaid would cover various types of doula services, including community-based, prenatal, labor and delivery, and postpartum services when recommended by a licensed healthcare provider. Doula services are expected to be in-person, with prenatal and postpartum services available via telehealth when there is a barrier to in-person services. Covered services would include a maximum of six total visits during the prenatal and postpartum periods and one visit for labor and delivery. All prenatal and postpartum visits would need to be at least 20 minutes to be eligible for reimbursement. The proposed payment rate is $75 per visit for prenatal and postnatal visits and $350 for attendance at labor and delivery.
As MHA CEO Brian Peters outlines in his December CEO Report, the situation confronting Michigan hospitals is dire, with hospitalizations due to COVID-19 exceeding record highs and intensive care units full of patients — most of whom are unvaccinated. The MHA joins healthcare experts around the country in urging the public to get one of the available COVID-19 vaccines.
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.
Legislature Considers Bills to Assist in Treating COVID-19
The Michigan House Appropriations Committee voted Dec. 8 in support of House Bill 5523, a bill that would provide critical staffing resources to hospitals and other providers. The MHA urges hospitals and others to contact their legislators, urging them to support the bill (see related article).
In addition, the Michigan Senate unanimously voted Dec. 8 in support of Senate Bill (SB) 759, a bill that would allow healthcare workers licensed by another state to continue to practice in Michigan during COVID-19 (see related article).
Court Issues Temporary Stay of Vaccine Mandate Enforcement for Federal Contractors
A federal district judge in Georgia issued an injunction Dec. 7 that is applicable to all states and temporarily pauses enforcement of the Centers for Medicare & Medicaid Services (CMS) COVID-19 vaccine mandate for federal contractors.
This is a preliminary injunction; until there is a final decision from the highest appellate court on these challenges to the CMS rule, federal contractors should be prepared to comply if the requirement is upheld. Like previous injunctions, this does not impact a contractor’s ability to implement and enforce its own organization-based vaccine policy.
The MHA will apprise members of updates on legal challenges to President Joe Biden’s vaccine mandates as they become available. Those with questions may contact Amy Barkholz at the MHA.
“If you’re going through hell, keep going.” — Winston Churchill
Here are the facts, and they are not pretty: as we enter the final month of 2021, the situation confronting our Michigan hospitals is as dire as it has been since the start of the pandemic. A prolonged fourth surge has driven COVID-19 inpatient hospitalizations above 4,600 and ICU occupancy rates to nearly 90% — both metrics hovering near our all-time record highs. Michigan hospitals are also dealing with extraordinarily high volumes of non-COVID patients — likely the result of months of pent-up demand for healthcare from Michiganders who have delayed seeking treatment for a wide range of issues. Throughout the state, elective procedures are being deferred, emergency departments are placed on diversion, patients ready for discharge are stuck in hospital beds due to transportation shortages and wait times in emergency departments can often be measured in hours. As if this wasn’t enough, we are now beginning to see the first flu cases arrive in our hospitals, at the same time that the specter of yet another new COVID-19 variant looms on the horizon. In short, we’re going through hell.
Given this reality, it is no wonder that the significant workforce challenges that predated the pandemic have only gotten worse by the month (it doesn’t help that the rates of violence, either verbal or even physical, are increasing as patients and their families become impatient with longer wait times or visitor restrictions due to infection control protocols). Many of our caregivers have headed to jobs in other fields or retired altogether. The end result of this phenomenon: nationally, hospitals and health systems remain nearly 100,000 jobs below their pre-pandemic February 2020 peak. And here in Michigan we have approximately 800 fewer staffed hospital beds today than we did one year ago — in essence, this is the inpatient capacity equivalent of shuttering one of our largest hospitals. The workers who remain are facing unprecedented stress and fatigue. Already, three Department of Defense medical teams have been called in to provide staffing support to some of our hospitals. We welcome this support, but much more is needed.
However, Michigan’s healthcare community is coming together to advocate for solutions that address healthcare workforce sustainability in both the short and long term. Together with long-term care, medical transportation providers and higher education leaders, we are advocating for funding to support healthcare workforce staffing and growing the talent pipeline.
House Bill (HB) 5523 was introduced Dec. 8 and includes $300 million for healthcare workforce recruitment and retention payments. We are extremely appreciative of this appropriation and encourage lawmakers and the administration to quickly approve the funding for the healthcare workforce before the holiday break. Our communities depend on our hospitals both for life-saving treatment and as economic engines. An investment today will help set Michigan on a path forward to addressing this crisis.
In addition, first hearings were held Nov. 30 on HBs 5556 and 5557, which would allow community colleges to offer four-year bachelor of science in nursing degrees. The MHA supports this legislation that would improve the long-term nursing talent pipeline and would increase access to high-quality nurses in some areas served by Michigan’s small and rural hospitals where a four-year school does not currently exist.
At the MHA we have a mantra: “no data without stories, and no stories without data.” It takes both to move the needle on public opinion and, hence, public policy. We have heard countless stories about the current environment from nurses, doctors, hospital and health system leaders, patients and others. The stories range from insightful, to heartbreaking, to maddening. Now here is some compelling data, which points to what all Michiganders can do to help: 76% of COVID-19 hospital inpatients are unvaccinated, 87% in the ICU are unvaccinated and 88% on ventilators are unvaccinated. The data is clear; vaccines are safe and effective at preventing severe illness. It is quite literally the most powerful tool in our toolbox. While we recently surpassed 70% of the population age 16 and older receiving at least one dose of COVID-19 vaccine, we have a long way to go on this front. The vaccine uptake among eligible children ages 5-11 now stands at just 16.2%, with large disparities existing between suburban communities and their rural and urban counterparts.
What we need to do to get out of this current COVID-19 surge is simple, and the message from our hospitals is clear: get vaccinated, have your children vaccinated and receive your booster dose when eligible. Adhere to the Michigan Department of Health and Human Services mask advisory in large indoor gatherings. And if you do visit a healthcare facility, whether for a medical emergency or to accompany a loved one, please be patient and display some grace and empathy toward our healthcare workers. The pandemic is clearly not over, and they need your help and support now more than ever.
Applications for the 2022 Michigan State Loan Repayment Program (MSLRP) will be accepted from March 7-11 through the File Transfer Application System. Providers should create an account in the system as soon as possible, but should not upload their MSLRP application documents before March 7.
The MSLRP assists employers in the recruitment and retention of medical, dental and mental health primary care providers who continue to demonstrate their commitment to building long-term primary care practices in underserved communities designated as Health Professional Shortage Areas. Those selected will receive up to $200,000 in tax-free funds to repay their educational debt over a period of up to eight years of participation. Priority will be given to applications from inpatient pediatric psychiatrists, providers working at practice sites in Genesee County, and obstetric service providers working in northern Michigan.
The review process has been updated for this application period. Providers and employers are strongly encouraged to read more about the review process in the Selection Criteria, Application Review and Final Phase Process section of the MSLRP website. For more information, contact Brittany Brookshire at the Michigan Department of Health and Human Services.
Michigan hospitals have now given more than half a million COVID-19 vaccine doses, representing 55% of the total 909,038 doses provided in Michigan, according to data published Jan. 29 by the Michigan Department of Health and Human Services.
“Hospitals have played a vital role throughout this pandemic, and now they are leading the way delivering COVID-19 vaccine to our communities,” said MHA CEO Brian Peters. “While we still have a long way to go before all Michiganders are vaccinated, we celebrate today’s milestone as a sign of the progress we are making toward ending the pandemic. As vaccine supply increases, hospitals are at the ready to vaccinate more people every day.”
All vaccine received by hospitals is either administered or is scheduled to be provided as quickly as possible. Hospitals throughout the state are running vaccination clinics and scheduling appointments to help ensure vaccines are provided in a safe and orderly environment.
“Recipients of the over half a million vaccine doses include physicians, nurses, teachers, food service workers, security staff, patients and members of the community,” said MHA Chief Medical Officer Gary Roth, DO. “My colleagues in hospitals throughout Michigan are setting an example for the public: we believe in the safety and efficacy of the COVID-19 vaccine. Along with wearing a mask, practicing social distancing and washing hands regularly, receiving the vaccine, when it’s your turn, is something everyone can do to slow and ultimately stop the spread of COVID-19.”
Clinical studies have shown the two currently approved COVID-19 vaccines to be up to 95% effective in preventing the COVID-19 virus and safe for use in adults. These vaccines require two doses to get full protection, which are given over the course of either three or four weeks.
Healthcare workers, individuals aged 65 or older and some essential workers are currently eligible to receive the vaccine. Many hospitals are contacting their patients who have been or are currently under the care of their healthcare systems to inform them of vaccine availability. Other members of the public should contact their local health department, call 2-1-1 or visit the state’s COVID-19 website for information on scheduling a vaccine appointment. Individuals with questions about the vaccine, how it was developed and how it prevents COVID-19 are encouraged to talk with their healthcare provider or visit reputable sources of facts, such as the Michigan Department of Health and Human Services vaccine website.
The following statement can be attributed to Brian Peters, CEO of the Michigan Health & Hospital Association.
Michigan hospitals have been working around the clock to get more people vaccinated and keep our communities safe. Elizabeth Hertel is exactly the partner we need leading the state’s response to this virus, and we are eager to work closely with her moving forward.
The following statement is made on behalf of chief medical officers of Michigan hospitals and health systems
As the chief medical officers representing Michigan hospitals and healthcare systems, we want to tell the public that the recent Michigan Department of Health and Human Services three-week order is doing what we expected: it’s slowly stabilizing the spread of COVID-19 and leading to stabilized hospitalizations. To see meaningful change that truly alleviates stress on the healthcare system, we urge the state to extend protections through the holiday season. We still don’t know what impact Thanksgiving will have, but we do know that with the recent pause, we’re seeing some slight improvements. As a state, we must not let our guard down and reverse this progress.
Michigan was on the path to record COVID-19 case rates, deaths and hospitalizations when this order was adopted in November. Today, our hospitals continue to face critical healthcare worker staffing shortages and troubling bed capacity numbers. Our teams on the front lines are exhausted as this second surge continues; we never truly recovered from the first. Now, data is indicating slight declines in COVID-19 emergency department visits, daily admissions and total hospitalizations. As physicians, we’re telling you: these measures are working.
We urge Michiganders to continue taking preventive measures — stay home whenever possible, wear a mask, maintain at least six feet of distance from others, avoid crowds (especially indoor spaces where masks are removed), do not congregate with people other than those from your own household, get your flu shot and wash your hands frequently. Urge your friends, family and acquaintances to do the same.
Those of us working in hospitals are members of your community. We are your neighbors and friends. We have families and holiday traditions of our own that we’re missing, too. With vaccines now in sight, nobody wants to see the progress of the last three weeks go to waste.
All of us wish this holiday season could be normal. The reality is, this year is a time to focus on giving others, and yourself, the gift of health. That’s something we can all celebrate together in 2021.