Combating the Novel Coronavirus (COVID-19): Week of March 1

MHA Covid-19 update

MHA Coronavirus UpdateState data through March 4 indicated that Michigan has received more than 3 million doses of COVID-19 vaccine and administered more than 2.5 million vaccinations, marking a significant improvement in protection against the coronavirus in the state. However, nearly 1,300 new cases and 56 deaths were recorded March 6. 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.

Johnson & Johnson Vaccine Authorized for Emergency Use, Provider Materials Available

The Johnson & Johnson (Janssen) single-dose COVID-19 vaccine has received emergency use authorization from the U.S. Food & Drug Administration (FDA) and the Centers for Disease Control & Prevention (CDC) Advisory Committee on Immunization Practices for people aged 18 and older. The MHA issued a media statement on the official launch of a third safe and effective COVID-19 vaccine into circulation in the U.S. Johnson & Johnson (J&J) told the media it intends to deliver 20 million doses of the vaccine to Americans during March and 100 million doses by June.

Michigan received 82,700 doses of the single dose vaccine upon its approval. J&J immediately shipped all available doses and now needs to resume manufacturing; therefore, no new J&J vaccine will be available until the week of March 22. Updates on allocations will be available as that date approaches. A limited number of hospitals received J&J doses and have been advised to use them to pilot an effort to vaccinate patients being discharged from an inpatient or emergency department setting.

The Michigan Department of Health and Human Services (MDHHS) has posted new materials for providers that will be administering the J&J/Janssen vaccine on its Provider Education and Resources webpage, which includes important information on all three currently authorized vaccines. The MHA has also updated its vaccine toolkit, including communications tools, to reflect the addition of the J&J vaccine.

The MHA is aware of ongoing misinformation regarding both the effectiveness of this vaccine and how it was developed (as it relates to use of fetal tissue). Members are encouraged to join the MHA in countering misleading information on their communication channels whenever possible, using appropriate background information and talking points.

Members with vaccine questions may contact Ruthanne Sudderth at the MHA.

State Expands Eligibility for Vaccination to 50 and Older, Other Special Populations

The MDHHS announced March 3 that new groups would soon be eligible for the COVID-19 vaccine. Adults age 50 and older with underlying medical conditions or disabilities, as well as anyone 16 and older who cares for a child with special health needs, will be eligible starting March 8. Any adult age 50 and older will be eligible, regardless of health status, starting March 22. The MHA issued a media statement in support of the expanded eligibility.

Providers or regions that are not yet prepared to open eligibility to these groups are not required to do so, as many vaccination sites still have waiting lists of adults 65 and older. The expanded eligibility simply allows those who see declining numbers of previously eligible individuals to maintain their vaccination rates. The announcement follows the state’s long-held strategy to implement eligibility groups in overlapping waves to ensure vaccination rates remain as high as possible.

The state’s COVID-19 vaccine prioritization guidance has been updated to reflect the expansion. It outlines the eligible groups and timeframes, as well as the state’s goals in following this strategy.

Members with questions on vaccine eligibility should contact Ruthanne Sudderth at the MHA.

COVID-19 Relief Packages Pass U.S. House and Senate

The U.S. House of Representatives voted Feb. 27, largely along party lines, to approve a modified version of the American Rescue Plan Act of 2021, legislation to provide for a roughly $1.9 trillion COVID-19 relief package that includes a number of provisions that affect hospitals and health systems. The House bill included expanded subsidies for certain forms of healthcare coverage and provisions to bolster the nation’s COVID-19 healthcare response with additional resources for vaccines, treatment, personal protective equipment, testing, contact tracing and workforce development. Other healthcare-related provisions would provide funding to the Department of Labor for worker protection activities.

The Senate took up the legislation March 5 and passed, on a party-line vote, its own COVID-19 reconciliation bill the next day. The Senate retained the House’s provisions that affect healthcare, added $8.5 billion for rural health, and enhanced Medicaid funding and financial support for state and local government that will assist Michigan, including its efforts to protect against healthcare cuts. However, the Senate did not incorporate continued suspension of the sequester reduction to hospital Medicare payments or funding for loan forgiveness for Medicare accelerated payments to hospitals. Major changes in the Senate legislation affected an increase to the federal minimum wage, the income level cap for those receiving the $1,400 stimulus checks, and details surrounding expanded unemployment benefits.

The Senate version of the legislation will now return to the House for further deliberation and a vote. The House is expected to pass the bill and send it to President Joe Biden for signature before the expanded unemployment benefits that are currently in place expire March 14.

The MHA will soon contact members with more detail on this legislation and what it means for Michigan providers. Members with questions may contact Laura Appel at the MHA.

State Legislature Approves Federal COVID-19 Funds

The Michigan Legislature March 3 approved a supplemental spending bill that included $2.3 billion for COVID-19-related response activities. The bulk of healthcare-related funding reflects federal money that was sent to the state in December but had not yet been approved by the state Legislature.

The legislation includes $207 million for COVID-19 epidemiology and laboratories, $110 million for immunizations, and $150 million to increase direct care worker wages by $2.25 per hour through September 2021. It has been sent to Gov. Gretchen Whitmer for final approval.

An additional $347 million for COVID-19 epidemiology and laboratories was also included in the bill but is specifically tied to provisions that would eliminate the authority of the MDHHS director to issue pandemic-related orders and is expected to be vetoed. Members with questions may contact Adam Carlson at the MHA.

Remdesivir Add-on Payment to Hospitals Established

The MDHHS released a policy March 4 to establish an add-on payment to reimburse hospitals for remdesivir treatment costs for Medicaid COVID-19 patients discharged between Jan. 1 and Sept. 30, 2021. The MDHHS will reimburse hospitals up to $3,100 per five-day treatment.

The MDHHS will make these payments on a quarterly basis for both Medicaid fee-for-service and managed care patients. Implementation of this policy is pending approval by the Centers for Medicare & Medicaid Services. Members with questions may contact Vickie Kunz at the MHA.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions 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): Weeks of Aug. 31 and Sept. 7

MHA Covid-19 update

Deborah Birx, MD, response coordinator of the White House Coronavirus Task Force, met with hospital representatives in Michigan Sept. 2. Shown (left to right) are Rob Casalou, president and CEO, Trinity Health Michigan Region; Birx; MHA CEO Brian Peters; and Rosalie Tocco-Bradley, MD, chief clinical officer, Saint Joseph Mercy Health System.The MHA continues to keep members apprised of developments affecting Michigan hospitals during the pandemic through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Requirements Clarified on Quarantines for Ill Employees

Executive Order (EO) 2020-166, which mandated a 10-day home quarantine period for an individual who exhibited any COVID-19 symptoms, was recently rescinded and replaced with EO 2020-172.

The previous order had provided no exception for a subsequent negative COVID-19 test or an alternative medical explanation for the symptoms. EO 2020-172 clarifies the symptoms of COVID-19, stipulates that two or more symptoms must be present to require quarantine, and allows an employee to avoid quarantine if their symptoms can be explained by another medical or physical condition. In addition, healthcare professionals and workers at specifically defined healthcare facilities are exempted from a requirement to stay at home for 14 days following close contact with someone who is COVID-19 positive.

Although the new EO does not address all the MHA’s concerns, it provides beneficial clarity. Members with questions should contact Amy Barkholz at the MHA.

Dr. Birx Meets with Governor, Healthcare Leaders in Michigan

A small group of healthcare leaders were invited to meet Sept. 2 with Deborah Birx, MD, the response coordinator of the White House Coronavirus Task Force. Birx came to Michigan to meet with the governor in Lansing and with healthcare leaders at St. Mary Mercy Livonia about Michigan’s efforts to fight COVID-19 and the continuing challenges that could be aided by additional federal action.

Part of the conversation with the healthcare group focused on growing concerns over inadequate lab and testing supplies for diagnosing both COVID-19 and other conditions. The MHA expressed several concerns related to lab supplies and other issues that were also outlined in a letter to Birx.

Birx provided input on a range of issues, including urging hospitals to be “efficient” in their use of lab supplies for COVID-19 testing, offering praise for how Michigan and Detroit, specifically, have managed COVID-19 outbreaks and the public health response, and more.

The MHA will keep members apprised of any additional communication from the White House Coronavirus Task Force in follow-up to this meeting.

Visitor Restrictions for Residential Care Facilities Updated

The Michigan Department of Health and Human Services (MDHHS) issued an order Sept. 10 that will allow outdoor visits at residential facilities while continuing to require precautions to protect against COVID-19. Residential facilities are not required to allow visitors under this order, which takes effect Sept. 15; it simply allows the visits if they meet the requirements and wish to allow guests.

The order is based in part on recommendations from the governor’s Nursing Home Preparedness Task Force and creates exceptions to the governor’s order that temporarily restricts visits at healthcare, residential, congregate care and juvenile justice facilities. The MDHHS also considered the flattening of the COVID-19 curve and the impact of the visitor restrictions on residents of these care facilities in issuing the order. Residential facilities are required to ensure that outdoor visitation areas allow for at least 6 feet of separation between all people and provide adequate protection from weather elements. Someone trained in infection control must also be within sight range for compliance reasons.

Facilities must meet certain criteria, including having had no new COVID-19 cases originate at the facility within the previous 14 days. Additional requirements and a description of the facilities the order affects can be found in the emergency order.

Authorized Use of Remdesivir Expanded

The Food and Drug Administration recently expanded the authorized use of remdesivir for treating COVID-19 patients. Remdesivir can now be used for all hospitalized COVID-19 patients, confirmed or suspected, whether the patient is on oxygen, off oxygen or intubated. This is a departure from the previous policy that restricted such treatment to those who required oxygen. For additional details, members can review the complete authorization letter issued Aug. 28.

Webinar Recording to Focus on PPE Strategies and Trends

The Department of Health and Human Services (HHS) Assistant Secretary for Preparedness and Response will hold a webinar Sept. 24 on personal protective equipment (PPE) preservation strategies, trends and lessons learned. Although the HHS webinar appears to be at maximum capacity, recordings of the event will be available upon request. The COVID-19: Optimizing Healthcare Protective Equipment and Supplies webinar will include public and private sector presenters on optimizing supplies of respirators and PPE, including crisis capacity strategies, respirator and mask testing programs, disinfection and decontamination procedures, and acquisition and distribution policies. An online flyer provides more information on the topics to be covered and how to receive the recording.

CMS Releases Guidance for Reporting Requirements for Labs and Long-term Care Facilities

The Centers for Medicare & Medicaid Services (CMS) released COVID-19 reporting requirements Sept. 8 for laboratories and long-term care facilities. The new guidance complements a Sept. 2 interim final rule. Laboratories are expected to comply with the new requirements by Sept. 23. Those not in compliance will be subject to civil monetary penalties. The CMS also released new enforcement information for long-term care facility reporting requirements.

The MHA continues to work with both the MDHHS and the HHS to streamline the reporting process. Members with questions on data reporting should contact Jim Lee at the MHA.

Recording COVID-19 Federal Payments on the Medicare Cost Report

A recently updated CMS COVID-19 FAQs clarifies that COVID-19 Provider Relief Fund payments and Paycheck Protection Program loan forgiveness funds from the Small Business Administration should not be recorded as offsets to expenses on the Medicare cost report. This information is particularly important for critical access hospitals’ and other hospitals’ cost-based Medicare reimbursements, which would have been reduced if COVID-19 funding were to offset costs. The answers specific to Cost Reporting begin on page 98 of the document. Members with questions should contact Laura Appel.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC). Members with MHA-specific questions should contact the following MHA staff members:

Combating the Novel Coronavirus (COVID-19): Week of June 29

MHA Covid-19 update

The MHA continues to keep members apprised of developments during the pandemic through email updates and the MHA Coronavirus webpage. Important updates on how the pandemic is affecting Michigan hospitals are outlined below.

State Budget Deficit Deal Contains no Healthcare Cuts

Gov. Gretchen Whitmer and legislative leaders announced June 29 they reached an agreement to resolve the fiscal year (FY) 2019-2020 budget deficit. The deal uses a combination of funding from the state Budget Stabilization Fund, federal Coronavirus Relief Funds (CRF) and cuts to the state budget. No cuts to healthcare were announced in the information provided.

In a joint release, Senate Majority Leader Mike Shirkey (R-Clarklake), House Speaker Lee Chatfield (R-Levering) and the governor spelled out approximately $900 million in spending from the federal funds for schools, hazard pay for teachers, replacement funds for colleges and universities, and new funds for local governments. Together with what was appropriated earlier in June, the state will have allocated $3 billion of its existing CRF. The budget also recognizes the benefit of the enhanced federal Medicaid matching funds, which brings $340 million to the state for the current fiscal year.

The budget agreement includes $490 million in savings to state government. This includes state layoffs, furlough days and budget cuts. The MHA does not believe rural hospitals or labor and delivery funding for small and rural hospitals is at risk. The association will continue its efforts to ensure the appropriations for hospital Medicaid funding remain in place and continue into FY 2021. For more information about the FY 2020 budget agreement, contact Adam Carlson at the MHA.

Additional Allocation and Guidance Announced for Remdesivir

The U.S. Department of Health and Human Services (HHS) announced June 29 an agreement with drug maker Gilead Sciences to allow U.S. hospitals to purchase, through September, up to 500,000 treatment courses of remdesivir, the antiviral drug that has shown encouraging results in treating COVID-19 patients. As with the 120,000 treatment courses donated earlier by the drug maker, the HHS and state health departments will allocate them based on hospitalization data.

Under the agreement, hospitals will pay no more than the wholesale acquisition price for the drug, up to $3,200 per five-day treatment course. To make future allocations of remdesivir, the HHS will be asking hospitals and health systems to submit data every two weeks.

The state of Michigan recently updated guidance for the use of remdesivir, which is available through the June 30 COVID-19 update that was emailed to members. The state is also asking for the completion of a two-part survey during treatment. Part 1 of the survey identifies the patient’s profile and demographics and is due within 24 hours of starting the medication. Part 2 is a patient follow-up survey that captures outcome data. Members with questions may contact Laura Appel at the MHA.

One COVID-19 Data Submission Can Now Fulfill EMResource and NHSN Requirements

The state of Michigan has started the process of uploading COVID-19 data from EMResource into the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN) COVID-19 Module. This process will allow hospitals to enter data in the EMResource system with no duplicate data entry into the NHSN COVID-19 Module.

To facilitate this, hospitals must enter the NHSN ID associated with each facility in EMResource, ensure the mandatory baseline data elements have been entered, and update within 24 hours any EMResource data elements that correspond to the NHSN COVID-19 Module data elements. The upload process will occur daily for data entered by 5 p.m. Hospitals should log into the NHSN system the following day to verify the data was uploaded correctly. Members with questions on the process should contact Jim Lee at the MHA.

AHA Releases New COVID-19 Financial Impact Report

The American Hospital Association (AHA) released a financial impact report June 30 that estimates at least an additional $120.5 billion in financial losses for the nation’s hospitals from July 2020 through December 2020, due in large part to lower patient volumes. These estimates are in addition to the $202.6 billion in losses the AHA estimated between March 2020 and June 2020 in a report released in May. This brings total losses for the nation’s hospitals and health systems to at least $323.1 billion in 2020. The MHA is regularly collecting data from members on the financial impact the pandemic is having on Michigan hospitals. For more information, contact Jason Jorkasky at the MHA.

Delays in Unemployment Insurance Benefits

Some people who filed unemployment claims due to the COVID-19 pandemic have not received their unemployment benefits or are receiving them sporadically. The Michigan Unemployment Insurance Agency (UIA) is experiencing a backlog due to the extraordinary volume of claims received, the surge of fraudulent identity theft claims that recently occurred, and the limitations of work volume that can be completed by the UIA’s adjudication staff. The UIA has announced that it is working to resolve the backlog of claims and has indicated that all claimants who are eligible for benefits will receive them. Members with questions related to unemployment claims may 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 webpage. Questions 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). Members with MHA-specific questions should contact the following MHA staff members: