The MHA received media coverage the weeks of Nov. 6 and Nov. 13 regarding a committee hearing on proposed nurse staffing ratio legislation. Additional topics covered include hospital market activity, rural emergency hospitals, behavioral health, the state’s STEMI system and the latest Leapfrog Hospital Safety Grades.
The coverage includes quotes from MHA CEO Brian Peters, as well as MHA board member Beth Charlton, president and CEO, Covenant HealthCare; and Doug Dascenzo, DNP, RN, chief nursing officer, Trinity Health Michigan. MHA Executive Vice President Laura Appel also appears in an American Hospital Association podcast episode.
Below is a collection of headlines from around the state.
The MHA received media coverage the week of Oct. 9 on rural healthcare challenges and legislation proposing state mandated nurse-to-patient staffing ratios.
The Detroit Free Press published an article Oct. 12 on the closure of Kelsey Hospital. Included is a quote from MHA CEO Brian Peters and MHA data regarding critical access hospitals and rural emergency hospitals. The story describes the close relationship and important impact hospitals have within their communities.
“We have to provide new options … new opportunities,” said Peters. “I think all of us — as residents of this state — want to have access to care, whether we’re in the big city or whether we’re on vacation in northern Michigan, or we’re commuting from point A to point B. You never know when you’re going to need health care and we need to have that infrastructure protected into the future.”
Two op-eds opposing one-size-fits-all nurse staffing ratios were also published. The first appeared in Bridge Michigan from MHA CEO Brian Peters, explaining the MHA’s opposition and the dramatic impact the legislation would have on a patient’s ability to access healthcare services.
Then Sen. Curt VanderWall presents to the MHA Legislative Policy Panel in 2019.
Rep. Curt VanderWall (R-Ludington) also published op-eds in the Ludington Daily News and Cleburne Times-Review explaining his opposition and the need for nurse staffing solutions that grow the talent pipeline while maintaining the ability to make staffing decisions at the local level.
Members with any questions regarding media requests should contact John Karasinski at the MHA.
“Plans are only good intentions unless they immediately degenerate into hard work.”— Peter Drucker
The theme of the 2022-2023 MHA program year was telling our story. With focus and passion, we told the stories of our hospitals and health systems, the challenges and adversity they face, and how they still provide high quality and accessible healthcare to their communities. This theme was intended to ensure that we as healthcare leaders continue to help those who don’t live and breathe healthcare understand the ways we are working to meet the most pressing needs, but also the support we need from other sectors to continue to offer strong and daily access to care for all. Our theme served to frame the four distinct pillars of our association strategic action plan, which included the financial sustainability of hospitals, workforce restoration and well-being, the behavioral health crisis and continued efforts towards achieving health equity.
I’m pleased to share we made significant progress in telling our story and achieving tangible, impactful results under each of the four strategic pillars, which is summarized in the latest MHA Annual Report. This work evolved around the ending of the COVID-19 public health emergency, a pandemic that tried our member organizations, and especially their healthcare workers, like nothing has before in most of our lifetimes. A large part of our success in making this transition and achieving so many significant outcomes was due to the MHA Board of Trustees, who I want to thank for their strong leadership and commitment to advancing the health of individuals and communities. I particularly want to express my gratitude to our outgoing Chair, T. Anthony Denton, for his steadfast leadership throughout this year.
Key to our efforts to safeguard the financial viability of hospitals is our continued focus on the state budget. Not only were we successful in continuing existing supplemental payment pools such as for Disproportionate Share Hospitals, Graduate Medical Education, Rural Access and Obstetrical Stabilization, but we also secured a Medicaid outpatient hospital rate increase. Collectively, these victories generated hundreds of millions in funding for Michigan hospitals. Long a priority of our association, the MHA also successfully advocated to ensure the Healthy Michigan Plan (our Medicaid expansion program) is fully funded. Our advocacy team continues to be one of the most respected in Lansing, as we saw several MHA-supported bills signed into law while experiencing a 100% success rate in making sure none of the 10 bills we opposed became statute.
Our work on behavioral health continues, as there remains a need to expand the number of behavioral health professionals and facilities to provide better access to care. The MHA secured both $50 million in the fiscal year 2023 state budget for expanding pediatric inpatient capacity, while adding an additional $10 million to create Psychiatric Residential Treatment Facilities to alleviate state hospital capacity issues. Much of the feedback we have received is the need to add quantitative data to the conversation to demonstrate to lawmakers and stakeholders the degree of the crisis. For several months, our team has been collecting data weekly on the number of patients waiting for a behavioral health bed in Michigan hospitals. This demonstrates the degree to which patients are having difficulty finding care, while also showing how many patients are utilizing hospital resources while the facility receives no reimbursement due to not having an acute care diagnosis billing code.
Lastly, we will not rest as our members continue to address health disparities to ensure health equity. The MHA Keystone Center works closely with the Michigan Alliance for Innovation on Maternal Health (MI AIM) to help address disparities and reduce the risk of maternal death. This past program year, their efforts resulted in 77% of Michigan birthing hospitals participating in MI AIM, 94% of which are compliant with the pre-partum assessment and 89% are compliant with the post-partum assessment. Our work with the MHA Public Health Task Force also continues as they explore strategies for collaboration that can improve data collection and public health initiatives.
Of course, there are always other items that come up that require MHA attention and effort that are not always known during the development of the strategic action plan. Responding to the shortages of chemotherapy drugs cisplatin and carboplatin and working with Michigan’s Congressional delegation is just one example of the value of association membership and how quickly we can mobilize our relationships in a time of crisis. Other wildcards include our work on licensing Rural Emergency Hospitals, tracking and increasing awareness of candida auris infections and expanding hospital bed capacity.
As we concluded our program year during our Annual Meeting on Mackinac Island, we were able to honor a true healthcare champion with our Meritorious Service Award in U.S. Sen. Debbie Stabenow. She announced earlier this year she will not seek an additional term in office and this award is the highest honor our association can bestow on an individual for their years of work towards enabling the health and wellness of individuals and communities. We have worked closely with Sen. Stabenow from her time in elected office in the Michigan Legislature to Congress and she will leave an extraordinary legacy for which the MHA family will be eternally grateful. We also had an opportunity to honor a number of other outstanding individuals for their contributions to Michigan healthcare.
Above all else, I want to take this opportunity to thank all MHA staff for their many contributions which made it another successful program year. The challenges we confront in healthcare are daunting and constantly evolving, but my confidence in our team at the MHA has never wavered, as they continue to display their exceptional commitment to their work and embody the MHA culture of member service and value creation every single day.
Now as we formally begin our 2023-24 program year on July 1, I am excited for the leadership of our new Chair Shannon Striebich. We offer our congratulations to her and look forward to working closely together. A year from now, I am confident we will once again be able to report on the successful outcomes we were able to achieve through our unity, collaboration and plain old fashioned hard work.
The Michigan Department of Health and Human Services (MDHHS) recently released a proposed policy to establish Medicaid reimbursement methodology for hospitals that convert to the new rural emergency hospital (REH) provider type. Critical access hospitals and rural hospitals with 50 or fewer beds are eligible to apply for the Medicare REH designation effective Jan. 1, 2023.
Hospitals that convert to the REH designation are required to update their enrollment and subspeciality with the MDHHS and must end date their inpatient services. Providers must notify the MDHHS via the Community Health Automated Medicaid Processing System within 35 days of any change to their enrollment information.
The MDHHS will reimburse REHs using existing Outpatient Prospective Payment System (OPPS) methodology. Critical access hospitals that convert to the REH designation will continue being paid based on the higher OPPS payment factor while others will be paid based on their current payment factor. The MDHHS updates the outpatient payment factors annually effective Jan. 1 to maintain budget neutrality following the Medicare update.
Hospitals are encouraged to review existing supplemental payment program policy to evaluate the potential impact. While the proposed policy does not provide specifics, the MHA anticipates that REHs will continue to receive outpatient Medicaid Access to Care Initiative and Hospital Rate Adjustment payments. The MHA will ask the MDHHS to clarify how the REH conversion will impact supplemental payment programs in the final policy. Hospitals are encouraged to review the proposed policy and submit comments to the MDHHS by May 10.
Members that are evaluating REH conversion are encouraged to contact Lauren LaPine at the MHA and members with questions regarding the proposed reimbursement policy should contact Vickie Kunz at the MHA.
Rural hospital leaders at NRHA Rural Health Insitute event in Washington D.C.
The MHA and rural hospital leaders visited Capitol Hill in Washington D.C. Feb. 7-9 to advocate for specific rural healthcare policies as part of the National Rural Health Association’s (NRHA) Rural Health Policy Institute event.
During the trip, the MHA and members met with Michigan’s congressional delegation and staff to discuss rural health issues facing Michigan hospitals. Topics included protection of the 340B drug pricing program, the new Rural Emergency Hospital (REH) designation, rural workforce shortages and reimbursement issues. Also participating in the visit were representatives from the Michigan Center for Rural Health.
Members with questions should contact Lauren LaPine at the MHA.
The new session for the 102nd Michigan Legislature kicked off during the week of Jan. 9 with swearing in ceremonies in both the House and Senate. Michigan Democrats in the majority started the session by introducing legislation to repeal right …
Hospitals interested in learning more about the new Rural Emergency Hospital (REH) designation are encouraged to attend an upcoming webinar from 12:30 p.m. to 2 p.m. ET Jan. 18 hosted by Mathematica and the Rural Health Redesign Center (RHRC) for …
The Michigan Department of Health and Human Services (MDHHS) issued a bulletin Jan. 5 to expand the types of providers who can perform Medicaid-covered, non-physician outpatient behavioral health services. Effective Feb. 4, Medicaid will cover and reimburse outpatient behavioral health …
A recent United States District Court for the District of Columbia ruling allows the Department of Health and Human Services (HHS) to propose a remedy for hospital 340B drug underpayments for calendar years 2018 to 2021. …
Rev. Martin Luther King Jr. once said, “Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.” As we honor Dr. King today and the legacy he created striving for racial equality, the MHA and …
“Blistering attacks on hospitals were a staple in media coverage in 2022. Comparatively, health insurers escaped unscathed. …
The near-term tension between hospitals and insurers will continue as affordability and transparency concerns mount. In tandem, government efforts to shift incentives to value-based payment models will expand as large employers and national plans implement more aggressive risk sharing agreements. The roles of the two sectors will converge in response to market demand. In anticipation, Deloitte, among others, merged its payer and provider practices to prepare its clients for the change. …”
Hospitals interested in learning more about the new Rural Emergency Hospital (REH) designation are encouraged to attend an upcoming webinar from 12:30 p.m. to 2 p.m. ETJan. 18 hosted by Mathematica and the Rural Health Redesign Center (RHRC) for an overview of the REH designation.
Participants will learn about REH requirements and the Centers for Medicare and Medicaid Services’ conditions for REH participation and payment. Presenters will also describe how the RHDC and its partners can assist entities through the REH conversion process and access ongoing transition support.
There is no cost to participate, but registration is required. Members with questions about the REH designation should contact Lauren LaPine.
Gov. Whitmer signed several bills into law Dec. 22 that were supported by the MHA and passed during the lame-duck session. Among these were expansions to the Michigan Reconnect Program, legislation to allow for a new rural emergency hospital licensure designation and interstate licensure opportunities for psychologists.
House Bills (HBs) 6129 and 6130 – legislation to expand the Michigan Reconnect program – were signed by the governor. The Michigan Reconnect program is a post-secondary scholarship program designed to provide funding to learners over the age of 25 interested in pursuing credentials or post-secondary degrees at community colleges or eligible training programs. Introduced by Reps. Ben Frederick (R-Owosso) and Sarah Anthony (D-Lansing), the package allows for several additional certifications to qualify for the scholarships including high-demand healthcare credentials. The MHA was supportive of the bills and will continue to advocate for future changes to lower the age of qualification for the program.
The legislation needed for hospitals to begin converting to Rural Emergency Hospitals (REHs) in Michigan was also signed into law. Due to limited session days left, the language to allow for REH licensure in Michigan was officially included in Senate Bill (SB) 183. REHs are a new federal designation that will require hospitals to give up inpatient services in exchange for improved federal outpatient reimbursement. Members with questions about the federal rules for REH designation can contact Lauren LaPine at the MHA for more information.
Legislation to allow Michigan to join the Psychology Interjurisdictional Compact (PSYPACT) was also approved by the governor. This will bring Michigan in line with 26 other states to create an expedited pathway to licensure for psychologists who wish to practice telepsychiatry across state lines. HBs 5488 and 5489 were introduced by Reps. Bronna Kahle (R-Adrian) and Felicia Brabec (D-Pittsfield Township) and supported by the MHA to help increase access to behavioral health services in Michigan.
Members with questions on these bills or any other lame duck action may reach out to Adam Carlson at the MHA.
The legislation needed for hospitals to begin converting to Rural Emergency Hospitals (REH) in Michigan was sent to the Governor’s desk Dec. 6 for final approval. Due to limited session days left, the language to allow for REH licensure in Michigan was officially included in Senate Bill (SB) 183. After the REH amendments were adopted, SB 183 passed with overwhelming support in both the State House and Senate.
The MHA has been actively working with the Michigan Department of Health and Human Services, the Michigan Department of Licensing and Regulatory Affairs (LARA) and the Whitmer administration’s legal team on REH licensure during the legislative process and have received positive indications of the administration’s support for SB 183.
Member hospitals considering conversion to an REH are encouraged to review the final rules by the Centers for Medicare and Medicaid Services (CMS). Some key changes outlined in the final rule include:
Clarification that REHs can operate provider-based rural health clinics (RHCs) and that REHs are considered hospitals with less than 50 beds for purposes of the payment limit exception. Provider-based RHCs will maintain their excepted status upon a hospital’s REH conversion.
A roughly $4,000 per month increase in monthly facility payments due to a misstep in the methodology that the National Rural Health Association (NRHA) highlighted in the MHA comment on the proposed rule.
The CMS agreed with the NRHA that one-lane federal highways should be excluded from the definition of primary roads. Primary roads are now defined as state or federal highways with two or more lanes in either direction.
Additionally, the CMS has released initial information on the application process. There will also be an application process at the state level through LARA. This application is still in development.
Members considering converting to the REH designation should contact Lauren LaPine at the MHA for support in navigating this process.
The Legislature returned the week of Sept.19 to continue work on several pieces of legislation that the MHA is currently monitoring. Committees met in both the House and Senate, taking up legislation that included several new bills supported by the MHA in the areas of behavioral health, rural emergency hospitals, speech-language pathologist licensure and telemedicine.
In the House Health Policy Committee, initial testimony was taken on new legislation to make changes to the preadmission screening process for behavioral health patients. House Bill (HB 6355), introduced by Rep. Graham Filler (R-St. Johns) and supported by the MHA, would memorialize the requirement for preadmission screening units operated by the Community Mental Health (CMH) services program to provide a mental health assessment within three hours of being notified by a hospital of the patient’s need. If a preadmission screening unit is unable to perform the assessment within the three-hour time frame, HB 6355 would also allow for a clinically qualified individual at a hospital who is available to perform the required assessment.
Kathy Dollard, Psychologist and Director of behavioral health for MyMichigan Health, joined the committee to testify in support of HB 6355.
Kathy Dollard, psychologist and director of behavioral health for MyMichigan Health, joined the committee to testify in support of HB 6355. “Strengthening our behavioral health system includes strengthening our behavioral health workforce and that can start with creative solutions like providing clinically qualified hospital personnel the ability to conduct pre-admission screenings,” said Dollard. No votes were held on HB 6355 at this initial hearing.
MHA staff also provided testimony during committee on HB 6380. Introduced by Rep. Andrew Fink (R-Hillsdale), HB 6380 would make the necessary changes to state law to allow for Michigan hospitals to pursue a new federal designation of “Rural Emergency Hospital” (REH) status. A REH designation comes with significant requirements such as limiting total beds to 50, maintaining an average length of stay of 24 hours or less and a required transfer agreement with a level I or II trauma center. Hospitals that choose to convert to a REH will receive enhanced federal reimbursement to provide critical emergency and outpatient services, especially in geographic areas.
Lauren LaPine and Elizabeth Kutter of the MHA testified in support of HB 6380.
Lauren LaPine, director of small and rural hospital programs, MHA, and Elizabeth Kutter, senior director of advocacy, MHA, testified in support of the legislation. “HB 6380 provides rural hospitals in our state with the ability to continue providing care in our most rural communities,” said LaPine. No votes were taken on HB 6380.
Initial testimony on two bills that were previously reviewed by MHA’s Legislative Policy Panel also occurred during committee. Senate Bill (SB) 811, introduced by Sen. Curt VanderWall (R-Ludington), would extend the length of time for an individual to complete a temporary Speech-Language Pathologist license and extend the length of time those temporary licenses are valid. The MHA is supportive of SB 811, which did not see any votes this week.
House committee members also took initial testimony on SB 450, which would ensure that visitors of cognitively impaired patients are permitted in healthcare facilities. Introduced by Sen. Jim Stamas (R-Midland), the bill would prohibit the director of the Michigan Department of Health and Human Services (MDHHS) or a local health officer from issuing an order that prohibits a patient representative from visiting a cognitively impaired individual in a healthcare facility. As written, the legislation does not prevent a healthcare facility from implementing reasonable safety measures for visitors and will still allow for facilities to limit the number of representatives per patient. The MHA is neutral on the bill and will continue to monitor any action taken.
The Senate Health and Human Services Committee took initial testimony on SB 1135, which was introduced by Sen. Mike MacDonald (R-Macomb Township). SB 1135 would specify that previous expansions to Medicaid telemedicine coverage also apply to the Healthy Michigan Program and Michigan’s medical assistance program. Most notably, the legislation would require continued coverage for audio-only telemedicine services. The MHA is supportive of SB 1135, which would continue virtual care policies that have proved to be effective and safe during the COVID-19 pandemic.
In the Senate’s Regulatory Reform Committee, testimony was taken on another MHA-supported bill to regulate the sale of kratom in Michigan. Kratom is a substance of concern with opiate-like effects that has no approved medical use in the United States. HB 5477, introduced by Rep. Lori Stone (D-Warren), would create a license for kratom sales and manufacturing, require testing of products and require new safety warnings on kratom substances sold in Michigan. While the MHA prefers a federal Schedule I ban of the drug, the association is supportive of HB 5477, which will help limit adolescent addiction and prevent adulterated products from being on the market.
Members with questions on these bills or any other state legislation should contact Adam Carlson at the MHA.
New State Legislative Session Begins
Hospitals Pursue Health Equity to Honor Martin Luther King Jr.
The Escalating, Ironic Tension Between Insurers and Hospitals
In the House Health Policy Committee, initial testimony was taken on new legislation to make changes to the preadmission screening process for behavioral health patients. 