The Centers for Medicare and Medicaid Services (CMS) recently issued a proposed rule to modify the prior authorization process for certain payers. The proposal would require payers to:
Include a specific reason when denying a request.
Publicly report certain prior authorization metrics.
Make decisions within 72-hours for urgent requests.
Make decisions within seven days for standard, non-urgent requests, which is twice as fast as existing Medicare Advantage response timelines.
Enable improved data exchange.
The proposal generally applies to Medicare Advantage, Medicaid and Medicaid managed care and Children’s Health Insurance Program (CHIP) and CHIP managed care plans, as well as qualified health plans on the federally facilitated exchanges. Members are encouraged to review the proposal and submit comments to the CMS by the March 13, 2023 deadline.
“Medical education does not exist to provide students with a way of making a living, but to ensure the health of the community.” ― Rudolf Virchow
As we enter the final two months of the MHA program year, our “all-hands-on-deck” prioritization of the healthcare workforce continues, and I am pleased to share that we have made significant strides in this regard. Included in that progress is work with our partners in higher education, other Michigan healthcare associations, hospital clinical leaders and the Michigan Legislature.
One aspect of our workforce efforts is not new. For many years, the MHA has led a special Graduate Medical Education (GME) Advocacy Day, hosted at our MHA Capitol Advocacy Center (CAC) in downtown Lansing. At this event, medical students, residents from teaching hospitals and academic medical centers, and other key leaders converge on the Capitol and meet with legislators to discuss the vital importance of GME funding in the state budget process.
After a brief hiatus due to the pandemic, we are excited to play host once again for this important in-person event, as we will welcome our colleagues to the CAC on May 5.
When this event began, the primary focus was to express the importance of GME and the national prominence that Michigan has earned in medical education. We have more than 7,200 physician residents currently working in the state, which ranks fourth in the nation. In addition, Michigan is third in the country for student enrollment in public medical schools. The investment Michigan makes in GME is very valuable, as every $1 in GME generates $2.53 in federal funding in fiscal year 2022. While the current rate is enhanced due to the existing public health emergency, there is no question that GME funding for Michigan’s beginning physicians is a wise investment for the future healthcare workforce in our state. GME also improves access to care, as it allows physicians to further their medical education while delivering much-needed care to patients throughout Michigan in teaching hospitals, community clinics and laboratories.
The vital role of GME in filling the talent pipeline is more important today than ever, as Michigan hospitals (and the healthcare delivery system in general) struggle with workforce shortages that have been exacerbated by the COVID-19 pandemic. Those shortages across the state have caused Michigan to lose approximately 1,300 staffed hospital beds over the past 18 months. Nationally, the physician shortage is estimated to be between 37,800 and 124,000 by 2034, including primary care and nonprimary care specialties, as the Association of American Medical Colleges estimates two out of every five active physicians will be 65 or older within the next 10 years.
The participants in our GME Advocacy Day have experienced many of the challenges that we’ve shared with elected officials: stress, burnout, workplace violence, vaccine hesitancy and significant loss of life due to COVID-19 and a host of other medical issues. Their perspective is extremely valuable as we make the case for funding and public policy that ensures the viability of our healthcare infrastructure for years to come. In addition to full funding of the traditional GME pool, there are several related items on the radar screen here in Lansing, including:
Included in the state’s Higher Education budget proposal is House Bill 5785, which would provide funding to create a healthcare workforce collaborative between the MHA and Michigan’s public and private post-secondary educational institutions. This partnership would not only provide employers with a better understanding of statewide graduates in health professions, but further improve the knowledge of employment opportunities in healthcare for post-secondary education institutions throughout the state. Included in the collaborative would be the creation of a searchable and accessible repository that allows healthcare employers to understand current educational trends and provides prospective employees easy access to healthcare positions throughout the state.
The MHA also supports legislation designed to incentivize more medical school and advanced practice nursing program preceptors by providing new tax credits. Senate Bills 998 and 999 would create a new tax credit for individuals who agree to work as a preceptor for required clinical rotations. We believe this legislation could help increase the capacity for clinical rotations at hospitals across the state, which would also improve the talent pipeline.
As we advocate in support of GME and related issues, we of course greatly appreciate the collaboration of our friends from the Michigan State Medical Society (MSMS) and Michigan Osteopathic Association (MOA). Together, our three associations make up The Partnership for Michigan’s Health, which has a long history of working together on healthcare issues of common interest, including the achievement of major medical liability reforms in the early 1990s, which established the foundation for much of our advocacy work in the Legislature and the courts ever since.
Most recently, the collective voice of our three associations, along with associations representing various other areas of healthcare, led to successfully securing $300 million in state funding for the recruitment, retention and training of healthcare workers. Collectively, the Healthcare Workforce Sustainability Coalition was created to focus on workers already within the healthcare workforce. Gov. Whitmer also recently signed Senate Bill 247 that would decrease wait times for commercial insurance prior authorization requests, a priority for all three associations. We are also united in our opposition to Senate Bill 990 that would create a serious public health risk by licensing naturopathic practitioners and classifying them as physicians. As healthcare associations, the professional careers of our members are dedicated to serving their patients and protecting the health and safety of the public. This opposition is an example of our need to protect the public from a practice that lacks scientifically proven treatment methods and clinical training.
In addition, we have long collaborated with MSMS and MOA to produce The Economic Impact of Healthcare in Michigan Report, which provides a detailed look at the extensive roles hospitals and health systems play in their local economies. Work is underway on the next issue of the report. The MHA Keystone Center Board of Directors has also designated one seat each for the MSMS and the MOA since its inception to ensure physician representation as we strategize on safety and quality improvement issues. And finally, the MHA and the MOA literally got closer last year when the MOA relocated its offices to the MHA headquarters building in Okemos – an arrangement that is unique anywhere in the country.
I’d also be remiss if I didn’t mention the MHA’s new focus on engaging with our physician leaders. For the first time ever, the MHA will be hosting activities dedicated to our physician leaders during our MHA Annual Meeting, including several sessions that will include CME credits. MHA Chief Medical Officer Dr. Gary Roth is leading these efforts, which complement his work throughout the pandemic engaging with our health system chief medical officers to facilitate consistent and reliable dialogue that allowed the MHA to efficiently provide policy updates to our clinicians as well as real-time feedback to policymakers. We’re extremely fortunate to have Dr. Roth, as the MHA is one of just a few state hospital associations with a full-time CMO on its leadership team.
Lastly, in an effort to fully support our physician colleagues (and other caregivers), the MHA Keystone Center is offering the Well-being Essentials for Learning Life-Balance (WELL-B) webinar series to prevent healthcare burnout by delivering weekly webinars on evidence-based well-being topics, including prevalence and severity of burnout, relationship resilience and being present. It is encouraging to see that over 4,000 individuals have already signed up for this innovative program.
As you can see, there is no magic pill that can solve the healthcare staffing crisis overnight. It will take many years and a multitude of public and private solutions to protect access for all of Michigan’s communities. GME is one of those key solutions, and we call on our elected officials – and all Michiganders – to give it the support it deserves.
The Michigan Department of Health and Human Services 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 …
Legislation to decrease wait times for commercial insurance prior authorization requests was signed into law by Gov. Gretchen Whitmer April 7. Senate Bill 247, introduced by Sen. Curt VanderWall (R-Ludington), will shorten the timeline for approval to seven calendar days or 72 hours for urgent requests, as well as ensure that …
The Michigan Department of Health and Human Services recently released a proposed policy, effective July 1, 2022, allowing authorization for return transfers of stabilized infants from a neonatal intensive care unit back to the community hospital from which the patient was …
The Centers for Medicare & Medicaid Services recently released a proposed rule to update the Medicare fee-for-service prospective payment system for inpatient rehabilitation facilities for fiscal year 2023, which begins Oct. 1, 2022. Key highlights of the proposal include …
The Centers for Medicare & Medicaid Services recently released a proposed rule to update the Medicare fee-for-service prospective payment system for inpatient psychiatric facilities for fiscal year 2023, which begins Oct. 1, 2022. Key highlights of the proposal include …
Where is the line between governance and management? The truth is each board must set its own boundaries on governance versus management decisions, and boards must continuously revisit this line. The webinar You and Your Board: Creating a Synergistic Combination, offered from noon to 1 p.m. April 27 …
The MHA hosted a one-hour Twitter chat March 4 to discuss Emergency Department (ED) Medication for Opioid Use Disorder (MOUD).The chat allowed participants to engage with their peers and share information and resources related to ED MOUD, as many of these programs help address …
Healthcare workers across the country are experiencing a growing rate of incidents of violence against front-line caregivers, including workers in Michigan. In fact, healthcare workers are nearly four times more likely to experience violence than individuals in other industries, according to the …
“Last Monday, Medicare Trustees released the 56th edition of their National Health Expenditures (NHE) Forecast for 2021-2030 which is widely used by policymakers and operators to gauge what’s ahead for U.S. healthcare. Regrettably, it’s flawed.”
The Circle of Life Awards recognize innovative palliative or end-of-life care providers that measure and evaluate the impact of their work on patients, family and/or the community. Part 1 applications for the 2023 awards will be accepted through May 31.
Legislation to decrease wait times for commercial insurance prior authorization requests was signed into law by Gov. Gretchen Whitmer April 7. Senate Bill (SB) 247, introduced by Sen. Curt VanderWall (R-Ludington), will shorten the timeline for approval to seven calendar days or 72 hours for urgent requests, as well as ensure that emergency care can be provided without prior approval.
Shortening wait times for prior authorization requests has been an MHA priority for several legislative sessions. The MHA provided testimony in support of SB 247 in both chambers and shared a letter with the governor encouraging her to sign the bill. The legislation will take effect June 1, 2023.
Members with questions about SB 247 or other state legislation regarding healthcare should contact Adam Carlson at the MHA.
During the week of March 14, the Michigan Legislature acted on a bill to make changes to the prior authorization process for commercial insurers and a bill to increase penalties for assaulting healthcare employees and volunteers.
The House Health Policy Committee reported Senate Bill (SB) 247, which would make changes to decrease wait times for commercial insurance prior authorization requests. Introduced by Sen. Curt VanderWall (R-Ludington), the legislation would shorten the timeline for approval to seven calendar days, or 72 hours for urgent requests, as well as ensure that emergency care can be provided without prior approval. The MHA supports the bill and provided written testimony to the committee earlier in the year. SB 247 now heads to the House floor for a full vote.
The full House of Representatives March 16 voted in support of legislation to increase penalties for assaulting healthcare employees and volunteers. House Bill (HB) 5682, introduced by Rep. Mike Mueller (R-Linden), went through several changes in committee, and the language now doubles the fines for assaulting a healthcare employee or volunteer in any care setting. HB 5682 would also require the posting of signage in hospital emergency rooms to deter potential assaults. Michigan hospitals may obtain example signs from the MHA free of charge. The MHA supports the bill, which will now go to the Senate for further consideration.
For more information on these bills or other state legislation related to healthcare, contact Adam Carlson at the MHA.
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.