Fiscal Year 2023 State Budget Signed

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capitol buildingGov. Whitmer signed July 20 the fiscal year 2023 state budget. Included in the 2023 budget agreement is $625 million in new investments for behavioral health funding and the healthcare workforce. This includes:

  • $50 million to expand pediatric inpatient mental and behavioral health capacity throughout the state.
  • $30 million to establish crisis stabilization units for mental and behavioral healthcare.
  • $10 million to fund the essential health provider loan repayment program to cover behavioral and mental health professionals.
  • New and ongoing funding of $3.5 million to support the statewide trauma system.
  • $56 million to increase Medicaid reimbursement rates for primary care clinician services.
  • $56 million to fund the Michigan Associate Degree in Nursing to Bachelor of Science in Nursing program at community colleges across the state.

Additionally, the state budget provides the resources necessary for hospitals and health systems to continue advancing the health of individuals and communities throughout Michigan. Specifically, the budget reflects the protection or enhancement of many MHA priorities, including:

  • Maintains funding for the Healthy Michigan Plan.
  • Protects funding for the graduate medical education of physician residents.
  • Supports disproportionate share hospitals.
  • Continues funding for the rural access pool and obstetrical stabilization fund.

Each of these funding sources are instrumental to keeping hospitals financially secure, particularly those serving vulnerable and underserved populations. MHA CEO Brian Peters released a statement July 1 applauding the healthcare focus of this budget and highlighting significant investments toward rural and behavioral health. These new appropriations will allow hospitals to continue and expand upon service lines that are in increased demand due to the pandemic.

The governor also made several line-item vetoes that do not directly impact hospital priorities when signing the budget, including vetoes of funding the administration argues is anti-abortion.

Members with questions may contact Adam Carlson.

State Budget Advances to Governor’s Desk

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capitol buildingThe fiscal year (FY) 2023 state budget bills were approved by the Michigan Legislature July 1. House Bill (HB) 5783 and Senate Bill (SB) 845, which provide for the FY 2023 budget, now go to the governor’s desk for final review and signature into law.

In a statement released July 1, MHA CEO Brian Peters said, “The fiscal year 2023 state budget approved by the Michigan Legislature provides necessary resources to assist hospitals and health systems in advancing the health of individuals and communities throughout our state. We appreciate the work and consideration placed by lawmakers that continues to protect hospital priorities.”

These priorities include maintaining funding for the Healthy Michigan Plan, graduate medical education of physician residents, disproportionate share hospitals that treat the highest numbers of uninsured and underinsured patients, the rural access pool and obstetrical stabilization fund, and critical access hospital reimbursement rates, all of which support access to healthcare services in rural areas. Each of these areas are instrumental in keeping hospitals financially secure, particularly in areas serving vulnerable and underserved populations.

The budget also supports MHA and hospital priorities with new funding to improve and enhance state behavioral health facility capacity and address the healthcare workforce. Michigan lacks adequate capacity to treat patients with behavioral and mental illness, and this new funding is an important and necessary step to address the shortage. The investment of state funds to expand access to Bachelor of Science in nursing degree programs at the state’s community colleges is a significant movement toward replenishing Michigan’s healthcare talent pipeline.

In other action, the House of Representatives supported legislation to create an opt-out grant program for hospitals to establish medication-assisted treatment (MAT) for substance use disorders in their emergency departments. SB 579, introduced by Sen. Curt VanderWall (R-Ludington), now returns to the Senate for a final concurrence vote before it is sent for the governor’s signature. Hospitals provided MAT programs prior to introduction of the bill, and the MHA has already partnered with the Michigan Department of Health and Human Services (MDHHS) to implement the first round of grants provided under this legislation. No hospitals would be required to participate in the program.

The full Senate advanced to the House of Representatives a bill to register certain medical laboratories in Michigan. SB 812, also introduced by VanderWall, would create a registry for interventional pain management, kidney access and vascular laboratories. As currently written, SB 812 would not provide any form of oversight or clinical requirements for the registered labs, and the MDHHS would not have authority to deny or remove registered labs from the list. The MHA has not taken a position on the bill but is closely monitoring any changes.

Finally, a bill related to telemedicine was introduced in the Senate. SB 1135, introduced by Sen. Mike MacDonald (R-Macomb Township), would amend the state’s Social Welfare Act to ensure that recent expansions in telehealth visit coverage also apply to the Medicaid Medical Assistance Program and Healthy Michigan Program. The bill would specify that recipients are covered equally for telehealth visits, expand the “distant site” definition, and ensure that providers are reimbursed at an equal rate to in-person services. The MHA is reviewing the legislation and has not yet taken a position on the bill. The association will keep members apprised of future action.

Members with questions on state legislation related to healthcare should contact Adam Carlson at the MHA.

Fiscal Year 2023 State Budget Advances Health of Individuals and Communities

Brian Peters

The following statement can be attributed to Brian Peters, CEO of the Michigan Health & Hospital Association. *The budget has since been signed by Gov. Whitmer on July 20, 2022.

Brian PetersThe fiscal year 2023 state budget approved by the Michigan Legislature provides necessary resources to assist hospitals and health systems in advancing the health of individuals and communities throughout our state. We appreciate the work and consideration placed by lawmakers that continues to protect hospital priorities.

These priorities include maintaining funding for the Healthy Michigan Plan, graduate medical education of physician residents, disproportionate share hospitals which treat the highest numbers of uninsured and underinsured patients, the rural access pool and obstetrical stabilization fund, and critical access hospital reimbursement rates which all support access to healthcare services in rural areas. Each of these areas are instrumental to keeping hospitals financially secure, particularly in areas serving vulnerable and underserved populations.

We are also extremely happy to see new funding to improve and enhance state behavioral health facility capacity and to address the healthcare workforce. Michigan lacks adequate capacity to treat patients with behavioral and mental illness and this new funding is an important and necessary step to address the shortage. The investment of state funds to expand access to bachelor of science in nursing degree programs at the state’s community colleges is a significant movement towards replenishing Michigan’s healthcare talent pipeline.

We look forward to a signed budget that provides the resources necessary for hospitals and health systems to care for all Michiganders.

Governor’s Budget Recommendation Supports Healthcare Workers, Protects Hospitals

State Budget Director Chris Harkins presents the FY 2023 executive budget.

The fiscal year (FY) 2023 executive budget recommendation was presented to the Legislature Feb. 9 by State Budget Director Chris Harkins.

The governor’s budget for the upcoming fiscal year protects key hospital priorities and includes the significant increase to outpatient Medicaid rates that took effect in October 2020. Key elements in the proposals for FY 2023 are:

  • The continuation of enhanced outpatient Medicaid rates. For FY 2022, the increase in rates is projected to result in the continuation of funding that translates to $250 million in net revenue for hospitals.
  • The executive budget recommendation protects critical access hospital funding, the rural access pool and the obstetrics stabilization fund from reductions.
  • Disproportionate share hospital payments and graduate medical education funding are also protected from reductions, continuing to reflect the MHA’s 2016 budget agreement.
  • The state’s obligation for the Healthy Michigan Plan is fully funded, and the executive recommendation continues funding for extended postpartum coverage of 12 months for new mothers who rely on Medicaid.

The executive budget recommendation also calls for additional investments in workers, education, and licensing that include:

  • $500 million of “Hero Pay” for essential workers, which includes those who were on the front lines during the pandemic.
  • $230 million for transformational educational infrastructure to improve and promote collaboration in higher education for health science and medical education.
  • $1.1 million to establish a task force and implement its recommendations dedicated to expediting and breaking down barriers to licensure for non-U.S. medical professionals

The executive budget recommendation is in addition to the $300 million for healthcare workforce recruitment, retention and training that the Legislature approved Feb. 9 (see related article). The MHA will work with lawmakers and keep members apprised as budget negotiations continue with the Legislature in the spring. As outlined in a media statement from MHA CEO Brian Peters, this was an important first step to preserve access to care in all hospitals across the state. Members with questions may contact Adam Carlson at the MHA.

Headline Roundup: Workforce Funding, Executive Budget and More

The MHA responded to several media requests the week of Feb. 7 on topics including passage Feb. 9 of House Bill 5523 that provides $300 million in healthcare workforce funding, Gov. Gretchen Whitmer’s Feb. 10 executive state budget recommendation and COVID-19 hospitalizations.

The MHA published statements on behalf of MHA CEO Brian Peters in reaction to the Michigan Legislature passing HB 5523 and the executive budget recommendation.

Below is a collection of headlines from around the state that reference the statements or include quotes from MHA representatives.

Thursday, Feb. 10

Wednesday, Feb. 9

Tuesday, Feb. 8

Members with any questions regarding media requests should be directed to John Karasinski at the MHA.

Healthcare Priorities Protected, Workforce Sustainability Addressed in Executive Budget

MHA CEO Brian Peters

MHA CEO Brian PetersThe following statement can be attributed to Brian Peters, CEO of the Michigan Health & Hospital Association.

Crucial healthcare funding sources remain protected in the fiscal year 2023 executive budget recommendation. We’d like to express our gratitude toward Gov. Gretchen Whitmer and her administration for their commitment supporting rural and critical access hospitals, graduate medical education, the Healthy Michigan Plan and Michigan’s Medicaid population.

Our hospitals are also experiencing a staffing crisis that requires multiple solutions. We are thrilled to see programs that would improve retention and recruitment of healthcare workers. The proposed Hero Pay recognizes the tremendous dedication and sacrifice of healthcare workers throughout the pandemic, while the talent pipeline will be expanded through additional investments in medical education and reviewing potential licensing flexibility for foreign-trained medical professionals.

Michigan’s behavioral health system is also stressed to its limits, and we’re encouraged to see a greater focus and financial resources toward providing potentially transformational improvements to the state’s behavioral health system that can address many of the challenges patients and families currently face.

We’d be remiss if we did not thank all lawmakers and state officials who have worked tirelessly over the past two years to provide relief and support to hospitals and health systems over the course of the pandemic. As we enter another budget cycle, we look forward to continuing to engage with the Michigan Legislature to advance the health of Michigan individuals and communities.

Senate Introduces Behavioral Health Funding, Including MHA Priorities

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State legislative action continued during the week of Oct. 25, including committee votes on bills impacting behavioral health and certificate of need.

The state Senate introduced a $350 million supplemental spending request related to behavioral health. The bill includes the MHA priority of providing $100 million to fund additional inpatient psychiatric beds and $20 million to improve behavioral health services in hospital emergency departments. The proposal also includes additional funds to attract behavioral health providers and add funding to the Essential Health Provider Loan Repayment Program that would allow psychiatrists to be added to the list of professionals eligible for loan forgiveness. The supplemental was referred to the Appropriations Committee, and the MHA encourages the Legislature to quickly pass this important funding to improve behavioral healthcare in Michigan.

On a related note, the state Senate Government Operations Committee reported Senate Bills 597 and 598 that would create new specialty integrated plans to replace the current prepaid inpatient health plans and contract with each community mental health services program to deliver physical and behavioral health services to Michigan’s Medicaid population. The MHA-supported bills were amended in committee to slow the timeline for the transition from the current system, which could now take up to eight years in the committee-approved legislation. 

The House Health Policy Committee approved four Certificate of Need (CON) bills that make no substantive changes to covered services. House Bills (HBs) 507450755076 and 5077 would require CON Commission reports and minutes to be posted online pursuant to certain deadlines and would require annual meetings of the Legislature’s Joint Legislative Committee, which oversees CON.  The committee did not make changes to the legislation from the introduced version, and the MHA has confirmed that the Michigan Department of Health and Human Services does not expect the bills to hinder the success of the program. The bills will next be considered on the House floor.

The House Health Policy Committee also took testimony on HBs 526152625263 and 5264, which are related to improving the availability of an MHA-supported non-opioid directive form. The package is currently being amended based on stakeholder input and will be discussed again in future committee meetings.

Members with questions on the state budget or healthcare legislation may contact Adam Carlson at the MHA.

State Budget Signed, Healthcare Policy Bills Advanced

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capitol buildingThe week of Sept. 27 was highlighted by the governor signing the fiscal year (FY) 2022 state budget, legislative passage of a funding bill for the statewide trauma system, and policy bills in both the House and Senate. In the House Health Policy Committee, the MHA supported a bill to create a grant program for medication assisted treatment (MAT) in emergency departments and a pharmacy wholesalers bill. In the Senate, further testimony was taken on the behavioral health package and several policy bills

The governor Sept. 29 signed the FY 2022 budget, which fully protects traditional hospital funding including the Healthy Michigan Plan, the rural access pool, the obstetrical stabilization fund and maintaining rate increases for Medicaid and critical access hospitals. In addition, the MHA successfully advocated for extending postpartum coverage to a full year for mothers who are beneficiaries of the Healthy Michigan Plan and an additional $3 million in trauma funding to establish systems of care for stroke and heart attack emergencies. The MHA released a media statement thanking the governor and Legislature for passing a budget on time that maintains access to care throughout Michigan.

The Senate also passed House Bill (HB) 5094, legislation to fund the statewide trauma system. The MHA supports the bill and applauds the Legislature’s quick work to pass the bill over the past few weeks. HB 5094, introduced by Rep. Mary Whiteford (R-Casco Township), will now be sent to the governor’s desk and is expected to be signed.

The MHA supported two bills in the House Health Policy Committee the week of Sept. 27. HB 5163, introduced by Rep. Angela Witwer (D-Delta Township), would create an opt-out grant program for MAT in emergency departments. That bill is identical to an MHA-supported version being considered by the Senate. HB 5072, introduced by Rep. Ryan Berman (R-West Bloomfield Township), is a state-level effort to exempt hospitals or other healthcare entities that are under common control from a medication distribution threshold that currently requires registration as wholesalers. It would also exempt from the threshold the distribution of minimal quantities of medications by a licensed retail pharmacy to a licensed practitioner for office use.

In the Senate, further testimony was taken on Senate Bills (SBs) 597 and 598, which would create new specialty integrated plans to replace the current prepaid inpatient health plans and contract with each community mental health services program to deliver physical and behavioral health services to Michigan’s Medicaid population. The MHA-supported bills were introduced by Sens. Mike Shirkey (R-Clark Lake) and John Bizon (R-Battle Creek). Testimony was also heard in the Senate Health Policy Committee regarding several bills on which no votes were held. Those bills included legislation to create licensure for mental health transport organizations and a bill to allow HIV-positive patients to donate organs to other HIV-positive patients.

For more information on state healthcare legislation, contact Adam Carlson at the MHA.

Week of Sept. 27 Media Recap

The MHA responded to several media requests the week of Sept. 27 that focused on the signing of the fiscal year 2022 state budget by Gov. Whitmer and the healthcare workforce crisis.

The Center Square published Sept. 29 a story on the signing of the budget that included a portion of a media statement from MHA CEO Brian Peters.

“The COVID-19 pandemic has challenged hospitals throughout the state and, on behalf of our members, we commend Gov. Whitmer for signing today a state budget that continues vital funding sources for our hospitals, increases support for direct care workers and ambulance services, and maintains extended Medicaid coverage for mothers up to 12 months postpartum,” said Peters. “We extend equal appreciation to both the Legislature and Gov. Whitmer and her administration for passing a budget on time that maintains access to care throughout Michigan.”

The MHA contributed to a story published Sept. 27 by Bridge Michigan that looks at the potential of using overseas healthcare personnel to address the existing national healthcare workforce shortage.

Members with questions on COVID-19 efforts and resources should contact Ruthanne Sudderth, and any questions regarding media requests should be directed to John Karasinski at the MHA.

CEO Report — Our Commitment to Safety and Quality

MHA Rounds Report - Brian Peters, MHA CEO

If you can’t describe what you are doing as a process, you don’t know what you’re doing.” — W. Edwards Deming

MHA Rounds Report - Brian Peters, MHA CEOThe last week has been an eventful and successful one for the MHA. The Michigan Legislature and Gov. Gretchen Whitmer came to an agreement on the state budget for the new fiscal year, which fully preserves all our hospital and healthcare funding priorities — needed more than ever as our hospitals continue to combat COVID-19 and deal with extraordinary staffing challenges. We were officially honored by Modern Healthcare with the Best Places to Work in Healthcare distinction. And finally, we received great news when Blue Cross Blue Shield of Michigan (BCBSM) announced a $5 million commitment through 2024 to support the MHA Keystone Center’s expanded quality and safety improvement programs. I would like to personally thank BCBSM CEO Dan Loepp for his support of this continued partnership, which is the right thing to do for all Michiganders.

Since its inception in 2003, the MHA Keystone Center has provided leadership and facilitation that has directly resulted in improved patient care and quality outcomes — in other words, we have demonstrably saved lives and saved healthcare dollars. No wonder that the MHA Keystone Center has earned both national and international acclaim.

Our first flagship initiative involved central line associated bloodstream infections (CLABSI). Through that work, Michigan hospitals saw a 22% improvement in CLABSI rates. Initial BCBSM funding also supported work that saw a 31% improvement in catheter-associated urinary tract infections (CAUTI) and a 5.9% improvement in venous thromboembolism.

Following our initial successes, the Great Lakes Partners for Patients (GLPP) Hospital Improvement Innovation Network (HIIN) was created, allowing us to collaborate with our colleagues in Illinois and Wisconsin. Our HIIN efforts from Sept. 2016 to March 2020 produced a total cost savings of nearly $293 million, saved 3,350 lives and avoided 25,204 incidents of harm among hospitalized patients.

The MHA is now one of eight organizations participating in the Superior Health Quality Alliance, a Centers for Medicare & Medicaid Services (CMS)-contracted organization that seeks to improve the quality of health and healthcare through innovation, effectiveness and efficiency in designing and implementing CMS Network of Quality Improvement and Innovation Contractors initiatives that are person-centered and integrated across the continuum of care and services. This important work with federal contracts is yet another way we can improve quality in the acute care setting.

High reliability work has been a focal point for the MHA for several years, which was initiated with our members in 2015. This work ensures exceptional quality of care is consistently delivered for every patient, every time. In 2018, the MHA Keystone Center launched a Reliability Culture Implementation Guide in partnership with our fellow state hospital associations from Illinois, Minnesota and Wisconsin. This guide provides resources available for front-line staff, executive leaders and board members to help identify areas of opportunity.

Over the past year, CEOs representing all our community hospitals have signed the MHA Pledge to Address Racism and Health Inequities, demonstrating our members’ unified commitment to address disparities, dismantle institutional racism and achieve health equity. Recent examples of tangible steps taken to accomplish those goals include the publishing of the Eliminating Disparities to Advance Health Equity and Improve Quality guide and offering a virtual series to address four diversity, equity and inclusion concepts: equitable conversations, equitable messaging, partnership building and diversity pipeline development. The Health Equity guide is geared to assist organizations in addressing health disparities to achieve equitable care by providing key strategies, recommendations for action, implementation levels, and resources to support progress.

Thanks to funding from the Michigan Health Endowment Fund, the MHA Keystone Center recently launched its second Age-Friendly Health Systems Action Community free of charge to MHA members. The Action Community builds on existing practices of participating organizations and combines them to reliably implement the evidence-based framework of high-quality care with all older adults in the system. With Michigan’s aging population, this work is exceptionally important and timely.

One way to help instill a safety culture within a healthcare organization is empowering all members of a care team to speak up if they think something may be wrong. Our patient safety organization created the quarterly Speak-up! Award program five years ago to honor healthcare staff who spoke up to prevent harm, which has prevented nearly $12 million in avoidable costs.

We have also done our part to address the tragedy of opioid overdoses, which lead to more deaths in Michigan than automobile accidents. The GLPP HIIN recently created the Midwest Alternatives to Opioids (ALTO) program; participating hospitals collectively have seen an 11.32% decrease in opioid administration and a 13.38% increase in ALTO administration. Because the COVID-19 pandemic has only worsened the opioid epidemic, we are committed to expanding this important work.

The MHA advocacy and policy departments also assisted in the creation of Project Baby Deer, a rapid Whole Genome Sequencing project to improve pediatric intensive care units and outcomes in Michigan. Genetic disorders are a leading cause of morbidity and mortality in infants. Early diagnosis of genetic disease has the potential to change clinical management in many meaningful ways, including initiating lifesaving treatments, avoiding unnecessary tests and procedures, shortening hospital stays and empowering families with real-time diagnoses to help with their understanding and decision-making. In addition to improving outcomes, Project Baby Deer also can prevent avoidable healthcare costs.

As you can see, we have a rich history that we can be incredibly proud of. And without question, BCBSM has been an instrumental partner with us on this journey, providing some $16 million in direct funding support to date. This new BCBSM funding will help to ensure that our critical work in safety and quality continues into the future. Specifically, it will allow the MHA Keystone Center to increase hospital participation in the Michigan Alliance for Innovation on Maternal Health (MI AIM), increasing implementation of pre- and post-partum Obstetric Hemorrhagic Risk Assessment, increasing implementation of Quantitative Blood Loss Assessment, and increasing the percentage of women who receive timely treatment of severe hypertension. It will accelerate our work on the opioid epidemic by maximizing the use of medication-assisted therapy, and it will allow us to expand our efforts to address healthcare workplace injuries — thereby ensuring that hospitals are as safe as possible for our front-line caregivers.

In each example noted above, we have helped to establish a clear process that people can understand, trust and execute.

Lastly, I want to stress that all Michigan hospitals and their team members voluntarily participate in MHA Keystone Center initiatives to advance safety for patients and workers and quality of care. There is no mandate in place to require hospitals to participate in this work, but they each choose to do so because of their missions to care for the sick and vulnerable. The pandemic has shined a bright light on the unselfishness of our healthcare heroes and their participation in these efforts is another terrific example of the lengths they go to improve care for their patients. I want to thank both BCBSM and our member hospitals for believing in this vital work and taking the steps necessary to ensure evidence-based best practices are implemented to the point that they make a difference in patients’ lives. This is mission-driven work that all Michiganders can be proud of

As always, I welcome your thoughts.