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.

Fiscal Year 2022 State Budget Protects Healthcare

MHA CEO Brian Peters

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

MHA CEO Brian Peters

The 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. 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.

As our hospitals continue to face both a behavioral health and workforce crisis that is stressing hospitals to capacity, we look forward to continued discussions on how additional state and federal funding can be allocated through the supplemental budget process to secure support for transformational solutions

Legislature Passes State Budget That Protects Healthcare Funding

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Michigan CapitolThe Michigan Legislature approved Sept. 22 the fiscal year (FY) 2022 state budget. The governor has indicated support for the budget that goes into effect Oct. 1, and the agreement protects vital funding sources for patient care in Michigan hospitals and expands access to healthcare services. The MHA published a statement on the passage of the budget Sept. 22.

Specifically, the budget reflects the protection or enhancement of many MHA priorities:

  • Continues enhanced outpatient Medicaid rates. For FY 2022, the increase in rates is projected to result in the continuation of funding that translates to $270 million in net revenue for hospitals.
  • Protects funding for the rural access pool and obstetrical stabilization fund.
  • Continues to maintain funding for disproportionate share hospitals (DSH) and graduate medical education (GME), pursuant to the MHA board-supported multiyear budget agreement.
  • Fully funds the Healthy Michigan Plan.
  • Continues the additional $2.35 hourly wage increase for direct care workers at skilled nursing facilities and enhanced reimbursement for ground ambulance services to reimburse at 100% of the Medicare rate.
  • Continues expanded Medicaid coverage for women up to 12 months postpartum.
  • Adds $3 million in new funding to set up a statewide system of care for stroke and ST-elevated myocardial infarction (STEMI) emergencies within the existing statewide trauma system.

In addition, nearly $10 billion in state and federal funding is still available that will be allocated through a supplemental budget process. The MHA will advocate the state use portions of the funding to address the association’s behavioral health priorities and workforce issues.

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

MHA Values Work of Michigan Legislature on FY 2022 State Budget

MHA CEO Brian Peters

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

MHA CEO Brian PetersOn behalf of Michigan hospitals and health systems, we value the work of the Michigan Legislature to pass a budget that protect MHA priorities that include fully funding the Healthy Michigan plan, the rural access pool, the obstetrical stabilization fund, and maintaining rate increases for Medicaid and critical access hospitals. We also commend the legislature for expanding postpartum coverage to a full year for mothers on Healthy Michigan. However, more work remains, particularly to address the behavioral health crisis in Michigan. We look forward to working with the legislature through the supplemental appropriations process to secure transformational behavioral health solutions. 

MHA Board of Trustees Wraps up Unprecedented Program Year

The MHA Board of Trustees concluded the 2020-2021 program year by holding its first in-person meeting of the year at the MHA offices in Okemos for fully vaccinated attendees. As with every meeting since the onset of the COVID-19 crisis, the board reviewed the latest statewide COVID-19-related data and took a moment to reflect on the daunting toll the virus has taken in lives lost and strain placed on healthcare workers and all Michiganders. It was noted that, since the onset of the pandemic, Michigan hospitals have treated over 450,000 COVID-19 patients in emergency departments and admitted more than 120,000 for inpatient care, including 4,500 children. Despite these sobering statistics, the board celebrated the continued steep decline in COVID-19 hospitalizations and infections, as well as advancements in treatment since the onset of the pandemic; however, members expressed concern about slowing rates of vaccination as more infectious variants continue to spread nationally.

The board welcomed the staff of the Michigan Osteopathic Association (MOA), which represents osteopathic physicians statewide, as new tenants within the MHA headquarters building. MOA CEO and executive director, Kris Nicholoff, addressed the board and noted the longstanding and strong relationship between hospitals and the osteopathic community, which can be further strengthened through the new space-sharing arrangement.

The board also received a report on the status of healthcare funding priorities in the fiscal year 2022 state budget, which continue to be deliberated in the Legislature, as well as recent activities related to the statewide roll-out and provider concerns related to recent reforms to Michigan’s auto no-fault insurance law. Current Health PAC Chair and incoming MHA Board of Trustees Chair Tina Freese Decker provided an update on the status of the 2021 MHA Health PAC campaign, which has been extended through July 31. Freese Decker encouraged eligible individuals and organizations to meet their contribution goals. Information about the MHA Health PAC can be found online. The board also approved type 3 membership and Endorsed Business Partnership for NextJob, a nationwide reemployment solutions company.

The board concluded the meeting by acknowledging outgoing board members Edward Bruff, president & CEO, Covenant Healthcare, Saginaw; James (Chip) Falahee, senior vice president, Legal & Legislative Affairs, Bronson Healthcare Group, Kalamazoo; and David Jahn, president & CEO, War Memorial Hospital, Sault Ste. Marie. The board also recognized outgoing chair Ed Ness, president & CEO, Munson Healthcare, Traverse City, for his leadership during such a challenging program year and extended its best wishes to incoming chair Tina Freese Decker, president & CEO, Spectrum Health, Grand Rapids, for a successful year ahead. For more information about actions of the MHA Board of Trustees, contact Amy Barkholz at the MHA.

State of Reform: MHA Behavioral Health Priorities are Fully Funded in House Budget Proposal

Adam Carlson

State of Reform published an article May 19 on both chambers of the Michigan Legislature advancing budget proposals for both the current and upcoming fiscal year that fully fund hospital priorities, including a focus on behavioral health.

Adam Carlson, vice president, advocacy, MHAThe article quotes Adam Carlson, vice president, advocacy, MHA, on details of House Bill 4420. Included in the budget bill is $125 million to add more pediatric psychiatric patient beds in hospitals, improves behavioral health access in the Michigan emergency departments and adds more appropriate settings for inpatient behavioral health care.

“Given the anecdotal reports we are hearing about the increasing demand for behavioral health services and the increasing severity of these situations, we are hopeful that we can alleviate these pressures, fight back against them and provide better behavioral health care so people are getting the treatment they need,” said Carlson.

Read the article

State Budget Director Massaron Addresses MHA Legislative Policy Panel

Dave Massaron

Dave Massaron, State Budget DirectorThe MHA Legislative Policy Panel convened May 19 to develop recommendations for the MHA Board of Trustees on legislative initiatives impacting Michigan hospitals.

The meeting was highlighted by a presentation from State Budget Director Dave Massaron, who reviewed the fiscal year 2022 executive budget recommendation and provided an update on the recently passed legislative budget proposals. Massaron also discussed the American Rescue Plan and efforts to address deficiencies in state health infrastructure in the areas of public health, healthcare access, facilities and behavioral health.

Moving to action items, the panel recommended that the MHA support planned legislation around pharmacy concerns related to patient safety, as well as planned legislation that would provide licensure as a dietitian or nutritionist.

The panel also received updates on issues at the state level, including behavioral health, COVID-19 vaccinations and certificate of need.

For more information on the MHA Legislative Policy Panel, contact Adam Carlson at the MHA.