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

MHA Covid-19 update

MHA Covid-19 updateThe state of Michigan held a press conference Jan. 11 to discuss the rapid rise in case numbers, hospitalizations (especially pediatric hospitalizations) and positivity rates. Speakers urged all residents who are eligible to be both vaccinated and boosted as quickly as possible. Representatives from Children’s Hospital of Michigan joined the event to discuss the concerning rise in childhood case rates and hospitalizations.

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.

SCOTUS Upholds CMS Vaccine Mandate, Enforcement Proceeds

The U.S. Supreme Court issued decisions Jan. 13 on the Centers for Medicare & Medicaid Services (CMS) and Occupational Safety and Health Administration (OSHA) vaccine mandates. As expected, the court blocked the Biden administration from enforcing the vaccine or test mandate issued under OSHA, but upheld the ability of the CMS to enforce the healthcare worker vaccine mandate.

The Supreme Court has repeatedly upheld the constitutionality of state vaccine mandates in a variety of settings, as well as mandates by private employers. These challenges were different because they presented the question of whether Congress had authorized the executive branch to institute the requirements through the agencies of OSHA and the CMS/Department of Health and Human Services.

Michigan was not one of the 26 states covered by the court injunction to the CMS mandate, and Michigan has no other state-issued prohibitions on enforcing federal or private vaccine mandates. Hence, the mandate and enforcement move forward. The currently posted deadline for completing the first required vaccine dose is Jan. 27, and the second dose is required by Feb. 28. Boosters are currently not part of the mandate.

The MHA responded to a number of media inquiries following the Supreme Court announcement, including from The Detroit News, Detroit Free Press and MiBiz. The association reiterated its long-standing position that mandates of this kind should be left up to local healthcare decision-makers and that hospitals and the MHA have always urged every resident who is eligible to get vaccinated to protect themselves and others. The MHA also stressed that, while the small number of hospital workers who have already ended their employment due to an organization’s mandate did not necessarily worsen the existing staffing shortages, the timing of a nationwide mandate amid this omicron surge could not be worse, as the shortages are more serious than ever. The association assured reporters that hospitals will proceed with compliance and that the MHA and its members will continue to strenuously advocate for staffing assistance from federal and state partners.

Members with questions about deadlines, enforcement or other elements of the mandate are encouraged to review the posted CMS guidance to ensure their organizations are prepared to comply.

MIOSHA: Hospitals May Currently Use CDC Quarantine Guidance Without Penalty

The MHA has continued to work with state regulators on securing updated guidance for hospitals and health systems as it relates to worker quarantine periods. Federal Occupational Safety and Health Administration (OSHA) rules have not yet been fully rescinded to allow for healthcare settings to confidently follow new, less restrictive Centers for Disease Control and Prevention (CDC) quarantine guidance.

However, the Michigan Occupational Safety and Health Administration (MIOSHA) has stated it was told OSHA is in the process of withdrawing the relevant rules and the state agency is preparing to update its rules to align with the revised federal rules. MIOSHA also indicated that, until updates are made at the federal and state levels, it will not issue citations specifically regarding quarantine and isolation requirements if an employer were following the Dec. 23, 2021, updated CDC guidance for healthcare personnel.

An existing OSHA provision recognizes the CDC’s ‘‘Strategies to Mitigate Healthcare Personnel Staffing Shortages.’’ This guidance allows elimination of quarantine for certain healthcare workers as a last resort if the workers’ absence would mean there are no longer enough staff to provide safe patient care, specific other amelioration strategies have already been tried, patients have been notified, and workers are using additional personal protective equipment at all times.

The MHA will continue to keep members apprised of developments on this issue. Members with questions may contact Laura Appel at the MHA.

Long-term Care Facility Capacity for COVID Care Increases

Michigan now has 50 Tier-2 COVID-19 Relief Facilities (CRFs) able to take COVID-19 patients from hospitals at discharge if their normal nursing facility isn’t able to accommodate them. This is an increase from just 27 CRFs late in 2021 and includes an Upper Peninsula facility in Hancock.

In addition, Michigan now has nine facilities designated as Care and Recovery Centers (CRC)s, including one in Escanaba in the Upper Peninsula.

The CRC and the CRF programs were established under Michigan Public Act 231 of 2020. These programs were designed to ensure Michigan’s nursing homes were prepared to provide care to individuals who have tested positive for coronavirus under transmission-based precautions within the guidelines and best practices from the Centers for Disease Control and Prevention. Michigan’s nursing homes must be reviewed by the Michigan Department of Health and Human Services (MDHHS) to ensure they meet the minimum criteria outlined within the legislation and associated MDHHS policies. Members with questions may contact Paige Fults at the MHA.

Red Cross Declares First Ever National Blood Supply Crisis

The American Red Cross declared a national blood supply shortage and operational crisis Jan. 10. This is the first time such a crisis has been declared, and it could impact hospitals’ ability to provide certain types of care or transfusions in the coming days and weeks. This is a result of the current COVID-19 surge causing canceled donation appointments, Red Cross staffing shortages and more.

The Red Cross chief medical officer sent a notification directly to hospital transfusion leaders outlining these operational challenges and how to plan for expected shortages. The Red Cross also urged the public to donate blood as soon as possible.

The MHA will be amplifying to the public the need for blood donors through its social and traditional media channels.

Michigan Sees Surge in Unemployment Fraud

Michigan has seen a recent surge in unemployment fraud claims, according to the MHA Unemployment Compensation Program (MHA UCP). The increase in unemployment fraud is related to identity theft that occurs when the state Unemployment Insurance Agency (UIA) system is penetrated. Over the past several weeks, the MHA UCP has seen fraud in about 15 to 20% of all new claims for its clients.

The MHA UCP has worked closely with the UIA on this issue and has mitigated the impact for clients, who have not been assessed charges on these claims. To learn more about the services available through the MHA UCP, contact Neil MacVicar at the MHA.

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 Dec. 13

MHA Covid-19 update

MHA Covid-19 updateA full year after COVID-19 vaccines were made available in the U.S., the coronavirus continues to sicken and kill people, with nationwide deaths from the illness surpassing 800,000. As demonstrated in a collection of headlines, Michigan’s hospitals are being stretched to treat COVID-19 patients across the state.

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.

Legislation Signed to Delay Sequestration Cuts

President Joe Biden signed legislation Dec. 10 to stop Medicare cuts to hospitals, physicians and other providers from going into effect early next year. As urged by the MHA and the AHA, both the U.S. Senate and House recently voted to pass the legislation.

Specifically, the bill would extend the moratorium on the 2% Medicare sequester cuts until April 1, 2022, and reduce the cuts from 2% to 1% from April 1 through June 30, 2022. The package also would stop the 4% statutory Pay-As-You-Go sequester from taking effect early next year. Other provisions in the package would mitigate a separate Medicare payment cut to physicians; delay payment cuts and private payer data reporting requirements for certain hospital laboratories; and more (see related article). Members with questions may contact Laura Appel at the MHA.

Licensing Flexibility Passes Legislature, Awaits Governor’s Signature

The state Legislature completed work Dec. 14 on Senate Bill 759, which allows healthcare workers licensed in another state to work in Michigan during times of great need (see related article). The MHA issued a media statement both thanking legislators for their support of licensing flexibility and encouraging Gov. Gretchen Whitmer to sign the bill into law as soon as it’s enrolled.

Members with questions may contact Adam Carlson at the MHA.

State Approves Additional Tier-2 COVID Relief Facilities

Fifteen additional Tier-2 COVID Relief Facilities (CRFs) were recently approved by the state at a time when post-acute placements are critically needed.

Tier-2 CRFs can keep their own COVID-19-positive residents and are able to admit new residents who test positive only if additional capacity is needed and the nearest COVID Recovery Center (CRC) is more than 25 miles away or at maximum capacity with patients positive for the disease.

With the additional facilities, there are currently 27 CRFs in the state. While this is a positive development, the number is significantly lower than the more than 100 CRFs the state had approved before starting its annual renewal process in October. That process took nearly a month to approve the additional facilities. The MHA continues to advocate that the state not use an annual application process for approving CRFs due to the time involved and the delays it causes for hospital transfer.

In addition, Michigan currently has no Tier-2 CRFs north of Grayling. Therefore, the MHA is urging the state to work with facilities in the northern Lower Peninsula and Upper Peninsula to quickly approve them as CRFs. Members with questions may contact Paige Fults at the MHA.

Changes Continue with Legal Action on Vaccine Mandates

The U.S. Court of Appeals for the Fifth Circuit issued a ruling Dec. 15 ordering the Centers for Medicare & Medicaid Services (CMS) vaccine mandate rule to resume in about half of the country while saying 24 states are not subject to the mandate. This means that the mandate is back in place for Michigan, requiring healthcare workers to be fully vaccinated. However, the suspension of enforcement of the mandate continues.

The Fifth Circuit upheld the Louisiana district court’s preliminary injunction as applied to facilities in the 14 states that are plaintiffs in the case. An additional 10 states that are plaintiffs in a Missouri case do not need to comply with the mandate while the injunction stands. Michigan is not a plaintiff in either lawsuit.

The American Hospital Association (AHA) provides a blog with the latest details of the CMS vaccine mandate cases, as well as an update on an appeals court ruling challenging the Occupational Safety and Health Administration vaccine mandate.

The recent court actions are additional steps toward the suits eventually being appealed to the U.S. Supreme Court. These legal actions do not impact individual organizations’ vaccine policies. Members with questions should 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 webpageQuestions 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)

Out-of-state Licensure Provider Exemption to Expire Jan. 11

This article was updated Nov. 17 to reflect an extension of the expiration date from Dec. 12 to Jan. 11, 2022. 

The Michigan Department of Licensing and Regulatory Affairs (LARA) has provided a 30-day notice that the out-of-state licensure provider exemption will no longer be in effect as of Jan. 11, 2022. The MHA worked with the state to develop this provision effective March 16, 2020, and to keep it in effect since then. This decision means healthcare providers should not rely on MCL 333.16171(c) to respond to the COVID-19 pandemic beyond 11:59 p.m. Jan. 11. The clarification document from LARA reflects the Jan. 11 expiration date.

Providers working in Michigan with out-of-state licenses will not be grandfathered into compliance. To continue to support healthcare systems, LARA has agreed to assist in expediting complete license applications for individuals who have been using this provision in response to COVID-19. The department has clarified that this provision cannot be used for labor disputes in the days leading up to its expiration.

Members needing assistance with expediting complete license applications should contact Paige Fults at the MHA.

Input Needed on Allocation of Opioid Settlement Funding

The MHA and its member hospitals have been heavily committed to addressing the misuse of prescription drugs, which has increased during the COVID-19 pandemic. While the MHA continues to work with stakeholders on passing current legislation to expand treatment access related to opioid use disorders, it also supports gathering ideas on best ways to assist and increase care options for this patient population.

Therefore, the MHA has responded to the Michigan Department of Health & Human Services (MDHHS) survey asking healthcare stakeholders for input on the allocation of settlement dollars from several lawsuits against manufacturers and distributers of opioids. The results will shape the administration’s proposals to the Legislature for establishing a fund that directs settlement dollars to support substance use services and abate harm created by opioids.

Members are encouraged to complete the survey to provide the administration with hospital input on how these funds could support the best patient outcomes and sustained recovery. The survey will take approximately 20 minutes to complete. Members may also share the survey with other community stakeholders they believe can provide valuable input on how the settlement funds can best assist in treating and preventing OUD. Questions can be emailed to the MDHHS Opioids Task Force or Paige Fults at the MHA.

Nursing Home On-site Survey Waiver Request for Eligible Facilities

The Department of Licensing and Regulatory Affairs Bureau of Community and Health Systems (BCHS) is required to make at least one visit to each licensed nursing home every three years for an evaluation of licensure. The department may waive this required visit if the licensed provider is eligible, requests a waiver and submits evidence that the facility is fully accredited from an acceptable accrediting body by Aug. 27. Eligibility can be looked up on the department’s website. If a facility is not listed, it either means they are not scheduled for a state licensing survey in the coming year or they are a licensed-only program that is not eligible for the waiver.

 Instead of performing an unannounced on-site state licensing survey, the department will perform a desk review of documentation submitted through the waiver request. The licensed provider will be contacted by the State Licensing Section with its decision by Sept. 24. The process for nursing homes to submit a request for a state licensing survey waiver must be done online.

Members with questions about the procedure should reach out to the BCHS State Licensing Section at (517) 241-1970, or Paige Fults at the MHA.

Nurse Licensure Compact Bill Reintroduced in 2021-2022 Session

Rep. Mary Whiteford (R-Casco Township) recently reintroduced legislation that would allow Michigan to join the Nurse Licensure Compact (NLC). House Bill 4046 was sent to the House Health Policy Committee for consideration in the 2021-2022 legislative session. A similar bill, House Bill 4042, passed both chambers of the Michigan Legislature during the last session and was sent to the governor, who vetoed the bill Dec. 30. The veto letter discusses her opposition to signing the NLC. The MHA continues to support the NLC to ensure healthcare access for all patients in Michigan. Members with questions should contact Adam Carlson at the MHA.

MHA Members Provide Committee Testimony on CRNA Legislation

james north

James North, MD, CPE, director of medical operations, ProMedica Physicians Group.Health policy committees in both the state House and Senate addressed legislation relevant to hospitals during the week of March 1. The House took testimony on several bills from the recently introduced reform package, while the Senate heard testimony on a bill to allow pharmacies to fill noncontrolled substance prescriptions written by licensed, out-of-state physician assistants (PAs) and advanced practice registered nurses (APRNs).

Steve Barnett, president and CEO, McKenzie Health; Sid Martin, orthopedic surgeon, Hurley Medical Center; David Jahn, president and CEO, War Memorial Hospital; and Toni Schmittling, CRNA, Michigan Association of Nurse Anesthetists, provided testimony March 3 to the House Health Policy Committee in support of House Bill (HB) 4359, which would modernize the scope of practice for certified registered nurse anesthetists (CRNAs). “Certified registered nurse anesthetists are the main anesthesia provider in facilities across Michigan, every day. The same is true in virtually every other state in our nation,” said Barnett.

The MHA supports HB 4359, sponsored by Rep. Mary Whiteford (R-Casco Township), which would also bring Michigan in line with 42 other states and the U.S. military, all of which provide flexibility regarding a physician supervision requirement. Currently in the state of Michigan, a licensed physician of any specialty must supervise a CRNA to deliver anesthesia care.

HB 4359 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. This change would eliminate a costly regulation while maintaining patient safety. It is a policy that has been allowed and proven effective during the COVID-19 pandemic.

In the Senate Health Policy and Human Services Committee, the MHA submitted written testimony supporting Senate Bill (SB) 166, introduced by Sen. Curt VanderWall (R-Ludington), which would allow pharmacies to fill noncontrolled substance prescriptions written by licensed, out-of-state PAs and APRNs.

Testifying on behalf of the bill was James North, MD, CPE, director of medical operations, ProMedica Physicians Group. “Currently, Michigan pharmacies are unable to fill prescriptions written by physician assistants and advance practice registered nurses who are not Michigan licensed. This means the routine use of maintenance medication is often disrupted which, in some scenarios, leads to adverse patient events,” said North.

For additional information on these bills, contact Adam Carlson at the MHA.

Implicit Bias Training Draft Rules Released and Hearing Date Set

The Michigan Department of Licensing and Regulatory Affairs (LARA) is seeking public input on draft rules regarding implicit bias training that were ordered in Executive Directive 2020-07. Aimed at reducing racial disparities in the delivery of healthcare services, the directive instructed LARA to establish implicit bias training standards as part of the knowledge and skills necessary for health professionals’ licenses and registrations in Michigan.

During the fall of 2020, the MHA and several member hospitals were among nearly 100 stakeholders that participated in the Implicit Bias Training Rules Advisory Work Group to help develop the draft rules. Members are asked to review the rule set and submit any feedback to Paige Fults at the MHA by March 3 in preparation for an upcoming virtual public hearing scheduled for 1 p.m. March 9. A notice of public hearing and a copy of the draft rule language can be downloaded from the LARA Administrative Rulemaking System webpage.

The MHA supports implicit bias training for all healthcare personnel, and ensuring equitable access and care for all patients is an MHA strategic priority. Those wishing to track the rulemaking process can do so by subscribing to receive administrative rules email notices. For more information, contact Paige Fults at the MHA.

Clarification for Out-of-State Provider License Exemptions during COVID-19

Health professionals who are licensed in another state and are in good standing in that state can practice in Michigan without a separate Michigan license during the current COVID-19 pandemic.

The Bureau of Professional Licensing within the Michigan Department of Licensing and Regulatory Affairs (LARA) has issued a guidance document clarifying when exemptions of Michigan licensure apply to health professionals. LARA is applying the use of a Public Health Code provision (as referenced in the document) that allows providers who have the education, training and experience to meet the requirements for Michigan licensure to provide medical care in a time of disaster, such as the COVID-19 crisis, without applying for licensure within the state. This flexibility is greatly appreciated while the medical community continues to work together in providing the necessary personnel resources to treat patients affected by COVID-19 and to respond appropriately to the urgent needs and issues related to the pandemic. The guidance also indicates that providers who had a Michigan license but retired within the last five years and certain students in their last year of an accredited program can assist in care for those affected by COVID-19 without applying for a license.

Health systems must keep complete documentation of these individuals and make it available in the event LARA receives an official complaint about an individual provider. The MHA recommends hospitals continue to follow the compliance memo they received in October related to proper tracking for all individuals who are eligible for the license exemption. Members needing a copy of the memo should contact Paige Fults at the MHA.

Recapping 2020 Election Results

MI Vote Matters

MI Vote MattersWhile the 2020 general election is complete, vote counting continues in Michigan and across the country, driven by both record voter turnout and a record number of absentee ballots cast. Michigan, like many states, does not allow absentee ballots to be counted before the opening of the statewide polls, which contributes to the delay in voting results. The MHA is just beginning to evaluate the impact of the results and how it will affect healthcare in Michigan. The association is, however, certain that Election 2020 will bring significant change to Lansing and Washington, DC. Below is a snapshot of the key election results:

  • News outlets across the country called the presidential race in favor of former Vice President Joe Biden on Nov. 7. While ballots in Alaska, Georgia and North Carolina continue to be counted, President-elect Biden has surpassed the necessary threshold of 270 electoral college votes to win the presidency. President-elect Biden and Vice President-elect Kamala Harris delivered their victory speech on the evening of Nov. 7. President Donald Trump has yet to officially concede the race.
  • Media outlets project incumbent U.S. Sen. Gary Peters as the winner of Michigan’s U.S. Senate race, but Republican U.S. Senate candidate John James has also refused to concede, alleging unsubstantiated issues with the vote counting process. Current projections predict the Republicans will maintain control of the U.S. Senate.
  • All of Michigan’s 14 U.S. House seats were up for election Tuesday. Michigan’s congressional delegation will remain split, with equal representation from both parties. Two new members of Congress were elected to fill open seats: Republican Peter Meijer in District 3 and Republican Lisa McClain in District 10. The Democrats are projected to retain control of the U.S. House.
  • The Republicans maintained a 58-52 majority in the Michigan House. House Democrats were able to flip Republican-held open seats with the election of Kelly Breen in District 38 and Christine Morse in District 61. Republicans were able to protect the party’s vulnerable seats while upsetting Democratic incumbents Sheryl Kennedy (District 48) and Brian Elder (District 96).
  • In the Michigan Supreme Court, Chief Justice Bridget Mary McCormack was reelected and the open seat was filled by Democrat-nominated Elizabeth Welch, giving Democrats a majority on the court.  
  • Both ballot proposals passed. The proposals will amend the state Constitution to provide more flexibility in how revenue from oil, gas and mineral state-land lease royalties is allocated and require a search warrant to access a person's electronic data or electronic communications.

Visit the MHA Elections website for links to all election results, ballot proposals and more. Members with questions should contact Paige Fults at the MHA.