The Michigan Legislature addressed several bills impacting hospitals during the week of April 26. Some of the bills that saw action deal with making changes to prior authorization for healthcare services, expanding scope of practice for certain mental health providers and allowing Michigan pharmacies to fill prescriptions from additional licensed, out-of-state, health professionals.
The prior authorization legislation, Senate Bill (SB) 247, was unanimously supported in a Senate floor vote. The bill was introduced by Sen. Curt VanderWall (R-Ludington) and would make changes to the prior authorization process for commercial insurers. Most notably,SB 247 would shorten the timeline for insurer approvals to five business days and require online publication of prior authorization policies and notices of any changes to those policies. The MHA has supported the legislation, which has now been referred to the House Health Policy Committee.
The full Senate also unanimously supported SB 191, which would expand the mental health code to allow for more services to be delivered by physician assistants, certified nurse practitioners and certified clinical nurse specialists. The bill has been referred to the House Health Policy Committee. SB 191 was also introduced by VanderWall and supported by the MHA.
The Senate Health and Human Services Committee took testimony on SB 246, which would expand the Essential Health Provider Loan Repayment Program. Also introduced by VanderWall, this bill would raise the maximum allowable loan forgiveness for health professionals who agree to work additional years in a health resource shortage area and is supported by the MHA.
Testimony was also taken in Senate Health and Human Services Committee on House Bills (HBs) 4043 and 4044, which would provide Michigan’s mental health crisis hotline with access to the state’s electronic inpatient bed registry. The bills were introduced by Rep. Mary Whiteford (R-Casco Twp.) and would ensure that hospitals are not held liable if the bed registry data is incorrect. MHA has not taken a position on HBs 4043 and 4044.
The House Health Policy Committee took testimony on SB 18 and SB 166, both supported by the MHA. SB 18 was introduced by Sen. Dale Zorn (R-Ida) and would add Michigan to the Physical Therapist Licensure Compact (PTLC). Joining the PTLC would grant certified physical therapists the ability to have one multistate license, allowing them to practice in their home state and other PTLC states. Introduced by VanderWall, SB 166 would allow Michigan pharmacies to fill noncontrolled substance prescriptions written by out-of-state physician assistants (PAs) and advance practice registered nurses (APRNs). Current statute allows out-of-state prescriptions from only physicians, dentists or veterinarians.
James L. North, MD, CPE, director of medical operations, ProMedica, testified before the committee on SB 166, explaining the problems the state law currently poses for patients who visit hospitals located just beyond Michigan’s borders, college students and Michigan residents who spend the winter months outside of the state. Because Michigan pharmacies cannot fill prescriptions written by PAs and APRNs who do not have Michigan licenses, patients’ medication can be dangerously delayed.
Contact Adam Carlson at the MHA for more information on state legislation.
As of March 18, the state’s COVID-19 Vaccine Dashboard indicated just over 27% of Michigan’s nearly 8.1 million residents ages 16 and above had received at least one dose of a vaccine. 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.
Medicare Payments Rates for COVID-19 Vaccinations Increased
Medicare payments to healthcare providers administering COVID-19 vaccines nearly doubled March 15 when the Biden administration updated the rates with immediate effect. The change is designed to increase the number of providers administering the shots nationwide.
Rates have increased to $40 per dose administered for all three of the currently available vaccines, up from approximately $23 per shot for two-dose vaccines and $28 for the single-dose vaccine.
The White House also announced that the administration will fully cover all Medicaid and Children’s Health Insurance Program beneficiaries’ COVID-19 shots, as mandated by the $1.9 trillion relief package President Joe Biden signed into law March 11.
There are currently more than 2,500 providers enrolled to administer vaccines in Michigan, but most have not been receiving vaccines due to limited supply. The state of Michigan may activate more of those providers to expand the vaccinations to additional populations as more vaccine becomes available.
Member Communication Tools Updated as Data Suggests Spring Surge of COVID-19
The MHA is concerned that data shows the start of a spring COVID-19 surge, with rising levels of case numbers over the first two weeks of March after weeks of plateau, in concert with hospitalizations that have again risen above 1,000. With these data trends in mind, the MHA is emphasizing the need for all Michigan residents to remain cautious, continue to practice proven preventive measures and be vaccinated as soon as a vaccine is available to them. Wearing masks, physically distancing and hand washing continue to be important following vaccination, since the vaccine’s protection doesn’t take full effect for up to a month after the final dose, and it will be several months before the majority of people can be vaccinated.
Members are encouraged to use the association’s updated COVID-19 communication toolkit and their trusted clinicians and healthcare professionals to amplify these messages to their communities. Additional information and talking points may be requested from Ruthanne Sudderth at the MHA.
Vaccine Allocations to Increase, Eligible Groups and Vaccination Sites Expand
The Michigan Department of Health and Human Services (MDHHS) has continued to urge the federal government to provide additional doses of the Johnson & Johnson one-dose vaccine. A small allocation of the vaccine is expected to arrive during the week of March 22, and hospitals that receive it are asked to use it for individuals in the inpatient or emergency department settings prior to discharge.
The state has expanded vaccine eligibility to include anyone 16 or older with an underlying medical condition effective March 22. Two weeks later, April 5, anyone 16 and older will become eligible. The complete MDHHS Prioritization Guidance is available on the state's coronavirus webpage.
In addition, several new retail pharmacy settings have joined the federal retail pharmacy vaccination program, including CVS, Walgreen’s, Walmart, Meijer, Rite-Aid, Snyder Drugs, Kroger and many more in Michigan. The federal mass vaccination clinic at Ford Field in Detroit will start vaccinating people March 24. The vaccine doses sent to the federal retail partners and Ford Field are in addition to Michigan’s state allocation of vaccines and are shipped directly to the federal retail partners and Ford Field. These shipments do not affect the supply of doses being sent to hospitals and health departments.
The Ford Field site will vaccinate approximately 6,000 individuals per day at the building and through a mobile clinic. Any Michigander may register for an appointment at the clinic by visiting the online portal, texting “EndCOVID” to 75049 or calling the state’s COVID-19 hotline at (888) 535-06136 and pressing 1. The hotline should be used only by those without internet access and could be the slowest option.
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.
As of Feb. 10, the state’s COVID-19 Vaccine Dashboard indicated nearly 1.5 million doses of vaccine have been administered in Michigan to protect residents from the disease. While the virus continues its assault across the globe, the MHA keeps members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.
The Executive Budget Recommendation presented to the Michigan Legislature Feb. 11 fully protects hospital and healthcare priorities and includes new funding for pandemic-related needs including testing, vaccine operations and more (see related article).
Vaccination Supply Shortages Discussed
The MHA continues to host monthly calls with the Michigan Department of Health and Human Services (MDHHS) and supply chain leaders at member hospitals. During the Feb. 8 call, the groups discussed a shortage of some types of vaccination supplies and efforts at the state level to address them. The MDHHS reminded hospital leaders that it has a limited supply of syringes available to assist with administering the sixth dose of the Pfizer vaccine that is sometimes available in a vial. A shortage of sharps containers is expected to continue for a few months. Hospitals that need additional vaccination supplies are encouraged to contact their local healthcare coalitions.
The group also discussed an alert from 3M about counterfeit N95 masks that have been found in several states. Members are encouraged to check their inventory and contact 3M at (800) 426-8688 if they have the counterfeit masks. Facilities that face a significant N95 shortage due to this fraud should contact their healthcare coalition to help fill emergency supply gaps. Members with questions may contact Adam Carlson at the MHA.
Federal Pharmacy Vaccine Program Adds Doses to State Supply
Through a federal program announced Feb. 2, COVID-19 vaccine is being sent directly to Meijer and other pharmacies to administer doses to priority populations. The doses being sent to these pharmacies are in addition to states’ existing allocation sent to hospitals and health departments. The additional doses are being sent to community pharmacies as an additional access point and are separate from the pharmacy program responsible for vaccinating long-term care facility residents/staff. The federal government has also announced it will begin sending some doses directly to federally qualified health centers.
The MHA has communicated with the state about the need to ensure any pharmacy receiving vaccine directly from the federal government is following state prioritization guidelines. State officials will work with their federal partners to communicate these priority group requirements to any pharmacy receiving vaccine directly from the federal government.
All vaccine providers in Michigan are expected to follow current priority groups for vaccinations. The vaccines should currently be administered to the following population groups:
Phase 1A (healthcare workers and long-term care residents).
Phase 1B groups A and B (first responders, pre-K through grade 12 educators, childcare workers, corrections workers and workers in other congregate care settings).
Phase 1C group A (residents age 65 years and older).
The state is also working to vaccinate veterans. Providers should not yet begin to vaccinate those under 65 with underlying conditions (phase 1C group B). The state’s vaccine prioritization document provides complete details about these categories. The priority groups follow federal guidance closely and are unlikely to be changed.
Vaccination Data Required
It continues to be important for providers to enter and update data on employee and patient COVID-19 vaccinations in the state EMResource portal each Wednesday. In addition, members should report race and ethnicity data on those receiving vaccinations in the Michigan Care Improvement Registry, as a primary goal for the state is to ensure there is no disparity in vaccination rates across races and ethnicities. Members facing challenges in collecting this data or with other data-related questions should contact Jim Lee at the MHA.
The MHA has continued to keep members apprised of developments during the COVID-19 pandemic through regular email updates and the MHA Coronavirus webpage. Important updates on how the pandemic is affecting Michigan hospitals are outlined below.
Executive Order 2020-17 Rescinded, Other Restrictions Eased
Gov. Gretchen Whitmer announced May 21 that she is rescinding Executive Order (EO) 2020-17 effective May 29. This EO was issued in March and banned “nonessential” medical procedures in hospitals, ambulatory surgery centers and dentists’ offices. The MHA issued a media statement in support of her action and will continue to run statewide television and social media ads urging people not to delay care and assuring that hospitals are safe places to receive services.
The governor also announced during a May 21 news conference that auto dealerships, retailers and veterinarians can open to the public, by appointment only, effective May 29, and that, effective immediately, groups of 10 or fewer people may gather outside of their homes. Whitmer announced May 18 that the Upper Peninsula (Region 8) and 17 counties in northern lower Michigan (Region 6) will be permitted to partially reopen their economies May 22, in accordance with the “Safe Start” recommendations developed by the Michigan Economic Recovery Council.
Liability Protections for Healthcare Workers, Facilities
The MHA testified May 19 via videoconference before the state House Judiciary Committee to advocate for Senate Bill (SB) 899, which offers strong and broad liability protections for healthcare workers and facilities treating COVID-19 patients. The MHA and members have identified this as an important element to operating within pandemic and emergency situations. A variety of other healthcare groups submitted cards of support for the bill, including the Michigan State Medical Society and the Healthcare Association of Michigan, which represents long-term care facilities.
SB 899 originally passed the Senate May 7. The MHA will continue to work with members of the House of Representatives as the legislation progresses to support healthcare personnel responding to the COVID-19 pandemic. Members with questions may contact Adam Carlson at the MHA.
Laboratories and Testing
The Michigan Department of Health & Human Services (MDHHS) announced May 18 that the Laboratory Emergency Response Network (MiCLERN) hotline will be taken offline at 5 p.m. ET May 22. The announcement stated that this is due to “recent changes to COVID-19 prioritization criteria and stabilized testing capacity that no longer requires prior issuance of Person Under Investigation (PUI) identifiers for MDHHS Bureau of Laboratory (BOL) testing of COVID-19 specimens.” The state clarified that COVID-19 specimens that are sent to the state laboratory no longer require a PUI form, but should still include the State of Michigan Test Requisition form (DCH-0583) and two unique identifiers.
Hospitals in need of swabs and transport media for testing are reminded to report their needs to the BOL by sending an email to MDHHSLab@michigan.gov using the subject line “EM COVID-19 Supplies,” per recent guidance shared with members in the May 6 email update. Members with questions should contact Brittany Bogan at the MHA.
MVC Offers Resources for Resuming Non-COVID Procedures
The Michigan Value Collaborative (MVC) represents a partnership among 87 Michigan hospitals and 40 physician organizations that aims to improve the health of Michigan through sustainable high-value healthcare. Supported by Blue Cross Blue Shield of Michigan, the MVC helps its members better understand their performance using robust multipayer data, customized analytics and at-the-elbow support.
To assist hospital systems with prioritizing the restart of surgical services with the least impact on caring for remaining COVID-19 patients, the MVC has designed reports that display resource utilization metrics at a statewide and member hospital level for 17 elective surgical procedures. More information is available by contacting the MHA Keystone Center.
Pharmacy Refill Order Extended
The governor signed EO 2020-93 May 19, extending a previous order giving pharmacists increased operational capacity. It also expands access to prescriptions for patients. The order allows pharmacists to dispense emergency refills of prescriptions for up to a 60-day supply and requires insurers to cover early refills for up to a 90-day supply during the pandemic. It also allows pharmacists to dispense COVID-19 treatments according to government-approved protocols. EO 2020-93 took immediate effect and will expire at 11:59 p.m. June 16, 2020. Members with questions may contact Paige Fults at the MHA.
EMResource Now Tracking Psychiatric Facility Data
The state of Michigan recently launched a new module in EMResource targeted toward freestanding psychiatric facilities. The data collected in this new module requests data on beds, COVID-19 patients, staffing and personal protective equipment availability. Psychiatric facilities are required to report this information weekly by 11:59 p.m. ET every Friday. The MHA is seeking clarification from the state on whether this data will also be posted to its COVID-19 data website alongside existing health system/hospital data on related measures, or on any other public website. Members with questions may contact Jim Lee at the MHA.
Multisystem Inflammatory Syndrome in Children
A Clinician Outreach and Communication Activity webinar on the clinical characteristics of Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 is now available online. The Centers for Disease Control & Prevention (CDC) hosted the webinar May 19. The MDHHS reported that, since April 1, there have been 28 identified cases in Michigan, and treatment with intravenous immunoglobulin and steroids is proving to be effective. The CDC issued a Health Advisory May 14 and recommends healthcare providers report any patient who meets the case definition to local and state health departments to enhance knowledge of risk factors, clinical course, and treatment of this syndrome.
Healthcare Workers Still Permitted to Cross Closed Canadian Borders
The U.S. Department of Homeland Security May 19 reissued its order closing the United States – Canadian ground border through 11:59 p.m. ET June 22. Healthcare workers will continue to be permitted to cross to report to work.
Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. If staff members at MHA-member facilities are not receiving necessary information from the MHA, they are asked to check the spam/junk mail folders in their email systems or ask their information technology departments to ensure MHA messages are not being blocked.