COVID-19 hospitalizations in Michigan have been rising in recent weeks, with 875 adults hospitalized with confirmed or suspected cases on May 11; 77 of that number were in intensive care units. In addition, 36 children were in the hospital with confirmed or suspected cases on that date. A daily average of over 2,700 cases were confirmed from May 5 through 11.
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.
MDHHS Shares Updated FDA Guidelines for Johnson & Johnson COVID-19 Vaccine
The Michigan Department of Health and Human Services (MDHHS) has reminded providers of updated guidelines from the Food and Drug Administration (FDA) for use of the Johnson & Johnson/Janssen COVID-19 vaccine. The new guidelines essentially limit use to individuals 18 and older who cannot or will not take one of the other approved vaccines. The risk of thrombosis with thrombocytopenia syndrome (TTS) warrants limiting the authorized use of the vaccine. TTS is a syndrome of rare and potentially life-threatening blood clots in combination with low levels of blood platelets. Members are encouraged to review the provider guidelines. For more information regarding vaccines, contact Ruthanne Sudderth at the MHA.
The number of confirmed and suspected cases of COVID-19 in Michigan went up April 7-13 from the previous week, rising from an average of 750 per day to 1,104 per day. Out of the 7,725 confirmed and suspected cases that week, 81 Michiganders died. On April 13, 482 adults and 14 children were hospitalized in Michigan with confirmed and suspected COVID-19, with 104 in intensive care units and 40 using ventilators to breathe. The state is currently reporting this information once a week. Nationwide, the daily average case rate was 29,401 as of April 13, with 452 deaths per day attributed to COVID-19. Federal officials have warned of an uptick as the BA.2 variant spreads and many locations drop mask requirements and social distancing measures.
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.
Health Secretary Extends Public Health Emergency
U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra announced April 12 that the HHS is extending the COVID-19 public health emergency (PHE) another 90 days effective April 16, pushing the new expiration to mid-July.
The extension will continue the relaxation of several healthcare-related regulations, including:
Continued coverage of expanded telehealth services for government and private payer beneficiaries.
Continuous enrollment in Medicaid and the Medicaid federal match rate:
The 90-day extension of the PHE will extend the enhanced federal match rate through Sept. 30, reducing the provider taxes hospitals pay to support certain Medicaid supplemental payment pools as well as reducing the state’s general fund contribution to the overall Medicaid program.
The PHE extension also extends the Medicaid enrollment maintenance of effort (MOE) by 90 days, which means the state will generally not remove individuals from the Medicaid program for another quarter. Michigan Medicaid enrollment is now more than 3 million people due to the current PHE-related MOE.
The continuation of permissible use of COVID-19 tests, vaccines and therapeutics still operating under emergency use authorization.
Liability protection for certain provider types administering COVID-19 vaccines.
Swing bed flexibility.
Certain requirements for critical access and rural hospitals.
CRNA supervision waived.
Other regulations.
MHA members are encouraged to review an overview from the Centers for Medicare & Medicaid Services outlining all federal requirements for healthcare providers that are modified while the PHE remains in place.
The HHS intends to provide states with at least 60 days’ notice prior to any possible termination or expiration of the PHE in the future.
The American Hospital Association and Children’s Hospital Association, with the MHA’s support, have urged the HHS to better define long COVID-19 treatment and coverage plans before ending the emergency. The MHA will keep members apprised of any developments on these topics.
The Michigan Department of Health and Human Services (MDHHS) reported there were an average of 752 new confirmed and suspected COVID-19 cases per day from April 2 through April 6. As of April 6, 453 adults and 17 children were hospitalized with confirmed and suspected cases; 96 adults were in intensive care units, 39 of them on ventilators. The MDHHS is now reporting this data once a week.
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 Revokes Sotrovimab Authorization
The Food and Drug Administration (FDA) has revoked emergency use authorization (EUA) for sotrovimab, a monoclonal antibody treatment for COVID-19 patients at risk of developing severe disease. This occurred due to the treatment’s ineffectiveness as a remedy for the omicron subvariant BA.2, which is now responsible for more than half of all U.S. infections.
The FDA authorized a new monoclonal antibody, Eli Lilly’s bebtelovimab, Feb. 11 that remains effective against omicron variants; the bebtelovimab EUA is still in place. The MHA will continue to work with the Michigan MDHHS leadership on therapeutics recommendations and availability in Michigan. Members with questions may contact Laura Appel at the MHA.
President Biden Announces Long COVID-19 Care Planning
President Joe Biden announced April 5 that the U.S. Department of Health and Human Services (HHS) will assemble a cross-government plan to manage “long COVID.” However, it is largely dependent on being funded by Congress.
The plan’s goals are broadening research, detection and treatment access to fight lingering or late-emerging effects of COVID-19 that are estimated to impact between seven million and 23 million Americans. The symptoms include shortness of breath, heart irregularities, kidney problems and more.
The American Hospital Association (AHA) and other federal advocacy groups sent a letter to HHS Secretary Xavier Becerra in March stating that there is “a need for further clinical guidance regarding the symptoms of and best course of treatment for long Covid-19 patients.” According to news reports, the Biden administration needs at least $25 million in the 2023 federal budget to build on tracking and surveillance progress, in addition to the $50 million the Centers for Disease Control and Prevention is already spending.
The long COVID-19 plan further includes establishing a Center of Excellence to treat long COVID-19 patients through in-person, multispecialty and telehealth services. The administration reportedly wants to establish long COVID-19 clinics around the country modeled after a Veterans Affairs clinic setup.
The MHA will continue to work closely with the AHA about the viability of this plan, both operationally and politically, and will keep members apprised of progress or plans that may impact hospitals, health systems and their patients. Members with questions may contact Laura Appel at the MHA.
With the number of new cases trending downward, Michigan hospitals continued to have patients with severe cases of COVID-19 in their intensive care units (ICUs). As of March 25, 100 Michiganders with confirmed or suspected COVID-19 were in ICUs, 44 of them on ventilators. They were among the 516 adults and 22 children hospitalized with confirmed or suspected cases that day.
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.
Legislative Action Will Assist Hospitals in Providing High-quality Care
The Legislature has sent Senate Bill (SB) 247 to Gov. Gretchen Whitmer to be signed into law, making significant changes to prior authorization in the state of Michigan. The MHA-supported bill would shorten the timelines for approval of authorization requests, ensure that emergency care can be provided without prior approval, and require insurers to post their prior authorization policies on their website and accept electronic requests, among other improvements to the process.
Whitmer signed SBs 246 and 435, increasing forgivable loan amounts for health professionals who work in medically underserved communities as part of the Michigan Essential Health Provider Program and expanding the physician specializations that qualify for the program to include behavioral health professionals. The new law also extends the sunset on the interstate Physician Licensure Compact, ensuring that physicians coming to Michigan from another compact state can quickly become licensed to practice in the state.
More information on these bills and other legislation affecting hospitals is available in a related article.
Vaccination Progress Among Michiganders Highlights Racial Disparities
More than 60% of all Michigan residents aged 5 and older are fully vaccinated against COVID-19. However, only slightly more than 40% of Black residents are among those fully vaccinated. Nearly 28% of Michigan children aged 5 through 11 years have received their first dose of the vaccine, but fewer than 17% of Black Michigan children in that age range have received their first dose. Providers should continue efforts to reach families with young children and nonwhite patients to reduce the disparities in the impact of COVID-19 on different populations. For information on vaccines, contact Ruthanne Sudderth at the MHA.
The MHA recently developed a tracking tooloutlining state and federal COVID-19 protocols for healthcare personnel. The document is updated as agencies revise their guidelines or mandates and includes vaccination, masking and COVID-19 testing guidelines from both the Centers for Disease Control and Prevention and the Michigan Department of Health and Human Services (MDHHS). The downloadable tool can also be found on the MHA website on the COVID-19 Resources page under Resources for Healthcare Professionals. Members with questions may contact Lucy Ciaramitaro at the MHA.
As Michigan begins the third year of living with COVID-19, new cases, hospitalizations and deaths are trending downward and hopes are high that a new variant will not emerge to cause another surge of disease. The state reported there were 2,770 cases recorded for March 17 and 18 (including about 825 cases attributable to older lab results), 648 adults and children were hospitalized with confirmed and suspected cases, and 50 deaths caused by the disease were recorded over the two-day period. These numbers are fractions of what was seen in December and January, when Michigan hospitals were at or near inpatient capacity.
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.
MIOSHA Will Not Increase COVID-19 Inspections of Healthcare Facilities
Barton Pickelman, director of the Michigan Occupational Safety and Health Administration (MIOSHA) within the Department of Labor and Economic Opportunity, has confirmed that MIOSHA will not be conducting additional, focused, COVID-19 compliance inspections of healthcare facilities in Michigan. Although a March 2 memo issued by the federal Occupational Safety and Health Administration (OSHA) announced a 90-day COVID-19-focused inspection initiative for hospitals and skilled nursing care facilities, Pickelman noted that MIOSHA and other state plans are not required to adopt the federal OSHA initiative. Because MIOSHA has already conducted state emphasis programs for healthcare over the past two years, it is not adopting the federal inspection initiative.
Separate from the OSHA inspections, surveyors from the Michigan Department of Licensing and Regulatory Affairs (LARA) will continue to check for compliance with requirements of the Centers for Medicare & Medicaid Services and state licensing agencies during regular survey visits or in response to specific complaints. LARA will confirm that facilities have written policies and protocols in place surrounding COVID-19 screening processes, are following their policies as written, and that these policies and protocols can allow either active or passive screening procedures, consistent with guidance from the Centers for Disease Control and Prevention (CDC).
MHA Creates State/Federal COVID-19 Guidelines Tracker for Providers
To help hospitals and health systems keep track of COVID-19 guidelines, the MHA has developed a document outlining state and federal COVID-19 protocols for healthcare personnel, including vaccination, masking and COVID-19 testing guidelines from both the CDC and the Michigan Department of Health & Human Services (MDHHS). The downloadable tool can be found on the MHA’s website on the COVID-19 webpage under Resources for Healthcare Professionals. Those with questions may contact Lucy Ciaramitaro at the MHA.
The state of Michigan reported that 1,842 new cases of COVID-19 were confirmed statewide March 3 and 4, with an average of 921 cases per day. Out of 68 recorded COVID-19-related deaths for the two days, 54 were identified during a Vital Records review. Adults in the hospital March 4 with confirmed cases of COVID-19 numbered 865, along with 27 children. This is a significant drop from early January, when more than 4,000 Michiganders were hospitalized with the disease.
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.
Webinar Recap: Navigating Paxlovid and Drug-Drug Interactions
The MHA recently hosted a webinar in partnership with the Michigan Department of Health and Human Services (MDHHS) and Michigan Medicine to provide information regarding Pfizer’s Paxlovid (nirmatrelvir tablets and ritonavir tablets, co-packaged for oral use) and drug-drug interactions. Paxlovid has been authorized by the Food and Drug Administration for emergency use for the treatment of mild to moderate COVID-19 in adults and children (12 years of age and older, weighing at least 88 pounds). Paxlovid is available by prescription only and should be initiated as soon as possible after diagnosis of COVID-19 and within five days of symptom onset. A Paxlovid drug-drug interaction summary will be updated by Michigan Medicine as more information becomes available.
The MDHHS confirmed Paxlovid is available at all Meijer pharmacies and encouraged providers to prescribe Paxlovid to eligible patients as soon as possible. Meijer pharmacies were selected due to market coverage and the ability to conduct home deliveries for patients unable to travel. As relative supply of oral antivirals increases and demand remains low, the MDHHS anticipates expanding to additional dispensing sites soon. Facilities interested in making this available through outpatient pharmacies should check with the MDHHS. Members with questions regarding Paxlovid drug-drug interactions should contact Nicholas Dillman, PharmD, at Michigan Medicine. Other questions can be directed to Renée Smiddy at the MHA.
The current surge of hospitalizations due to COVID-19 has continued its downward trend. The seven-day average of hospitalizations in the U.S. as of Feb. 13 was 80,185, down from 136,534 Jan. 20. Michigan hospitalizations for confirmed and suspected cases of COVID-19 included 1,896 adults and 71 children as of Feb. 16, down from the Jan. 20 totals of 4,554 adults and 130 children.
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.
Governor Signs Supplemental Budget Dedicating $300 Million to Healthcare Workforce
Gov. Gretchen Whitmer Feb. 16 signed House Bill 5523, a $1.2 billion supplemental funding bill that includes$300 million for healthcare providers for recruitment, retention and training purposes, $225 million of which will be specifically for acute-care and behavioral health hospitals. MHA Board Chair and BHSH System President & CEO Tina Freese Decker provided comments of appreciation for the governor signing the bill in the official announcement. (See related article.)
MDHHS Rescinds Indoor Mask Advisory with Exceptions
The statewide indoor masking advisory that the Michigan Department of Health and Human Services (MDHHS) issued earlier in the omicron surge was rescinded Feb. 16. However, the state continues to recommend masking in healthcare settings and some other high-risk indoor locations.
While hospitalizations have improved significantly recently, the MHA continues to encourage people to voluntarily wear high-quality masks when in indoor public spaces, especially if they are immunocompromised or haven’t yet been fully vaccinated.
The state also announced that it will monitor and act on COVID-19 cycles in the following three key phases:
Response — Local and state public health implement rapid response to a surge. The public may be advised to increase masking, testing and social distancing.
Recovery — Post-surge. No immediate resurgence predicted. Local and state public health will monitor conditions that could lead to future surges.
Readiness — A surge in cases is expected, with implications for severity of illness and hospital capacity. Increased communication to the public regarding possible new risks.
More Data Sought on Pfizer Vaccine for Children 6 Months through 4 Years
The MHA continues to monitor Pfizer’s actions to seek approval for a vaccine for kids aged 6 months through 4 years. Pfizer recently sought federal approval of the vaccine for this age group, but paused its request days later due to efficacy questions related to dosage. It is now awaiting further data about three doses for this age group before renewing its request for approval under emergency use authorization. The association will keep members apprised of any developments on this or related issues. Members with vaccine questions may contact Ruthanne Sudderth at the MHA.
The number of hospitalizations in Michigan due to confirmed and suspected cases of COVID-19 was the lowest since early November during the week of Jan. 31. However, with 2,882 adults and 70 children hospitalized Feb. 4 with confirmed and suspected COVID-19, some facilities in the state continue to be filled to or near capacity.
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.
Application for Long-term Care Facilities to Care for COVID-19 Patients Extended
As a result of MHA advocacy, the state recently issued new guidance extending the application period for long-term care facilities to care for COVID-19 patients through Feb. 28. The guidance will ease the process of discharging COVID-19 patients from hospitals to nursing facilities. Additionally, in a change from previous policy, long-term care facilities that applied last year and remain in good standing are authorized to retain their status through the new application deadline.
The COVID Recovery Center and the COVID Relief Facility (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 COVID-19 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.
Michigan now has 54 Tier-2 CRFs able to take COVID-19 patients from hospitals at discharge if their normal nursing facility isn’t able to accommodate the patient, up from just 27 CRFs in late 2021. Members with questions may contact Adam Carlson.
As the number of new cases and hospitalizations due to COVID-19 begin to diminish in Michigan, both Pfizer and Moderna have launched trials for vaccines targeting the omicron variant of the coronavirus. The variant is estimated to make up 99% of the current cases in the United States.
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.
CMS Vaccine Requirement for Healthcare Workers Began Jan. 27
The Centers for Medicare & Medicaid Services (CMS) requirement that healthcare workers be vaccinated against COVID-19 took effect Jan. 27. Employees are required to have received a first dose by that date and a second dose — if getting a two-dose vaccine — by Feb. 28.
The Michigan Department of Health and Human Services (MDHHS) issued a letter to all providers detailing the requirements of the CMS rule and provided implementation tools for providers to execute the policy internally. These include FAQs, education materials and more. MHA members are encouraged to use these tools as necessary to comply with the mandate.
The 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.
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.
COVID-19 hospitalizations in Michigan have been rising in recent weeks, with 875 adults hospitalized with confirmed or suspected cases on May 11; 77 of that number were in intensive care units. In addition, 36 children were in the hospital with confirmed or suspected cases on that date. A daily average of over 2,700 cases were confirmed from May 5 through 11.