The MHA Board of Trustees met April 12 at the MHA Capitol Advocacy Center in downtown Lansing, joined by Michigan Senate Health Policy Chair Kevin Hertel (D-St. Clair Shores). Hertel acknowledged the state’s significant challenges in meeting behavioral healthcare and workforce needs and identified these areas as priorities for the Senate Health Policy Committee. Board members stressed the need for lawmakers to support policies that allow flexibility and foster innovation, such as continuing to expand telehealth options started during the pandemic and looking beyond staffing ratios toward more effective ways to meet patient care needs within a finite labor supply.
The board also heard from colleagues about a recent learning and technology exchange between Michigan health system leaders and their Israeli counterparts and had the opportunity to listen to the reflections of Shreya Desai, a neurobehavioral researcher and current government relations and health policy fellow with the MHA. Desai shared her experiences working with the MHA Advocacy Division and how it will influence her future medical career.
The board spent time providing input and direction on the key pillars of the association’s action plan, which is focused on supporting financial viability, promoting workforce sustainability, fostering health equity and addressing behavioral health needs. This strategic conversation included a review of recent state budget initiatives, including the MHA’s successful advocacy to secure $75 million for healthcare worker recruitment, retention and training for Michigan hospitals, which is the latest victory in a series of state budget appropriations that has resulted in $1.45 billion in new hospital funding since January 2020.
In addition, the board expressed support for ongoing efforts to work with the state to maximize the federal Medicaid match to increase overall Medicaid reimbursement rates and funding for targeted services such as obstetrics, outpatient, psychiatric and trauma care. In furtherance of workforce sustainability, the board supported the association’s social media campaign to promote and increase awareness of a broad range of healthcare careers. The board also engaged in a discussion of health equity and the association’s continued work to assist members in eliminating disparities in healthcare through the leadership of the MHA Health Equity Taskforce. Improving access and funding for behavioral health continues to be a key priority for the association and board members provided input to the MHA on data collection efforts to advance advocacy strategies to reduce emergency department wait times for patients seeking inpatient psychiatric care. Finally, the board approved Type 2B association membership for Southwest Michigan Behavioral Health.
For more information about the actions of the MHA Board of Trustees, contact Amy Barkholz at the MHA.
Michigan officially joined the Psychology Interjurisdictional Compact (PSYPACT) March 29, creating an expedited pathway to licensure for psychologists who wish to practice telemedicine services across state lines. To date, 36 states are authorized to join the PSYPACT.
The interstate compact license is voluntary for both the state and physicians and does not supersede or change Michigan’s medical practice standards. Participating states retain the authority to issue licenses, investigate complaints and discipline physicians practicing in their state. The compact applies to the delivery of psychological services through telecommunications technologies and only allows for temporary in-person telepsychology across state boundaries for 30 days in a calendar year.
The MHA testified in support of entering the PSYPACT. Michigan’s authorization to join the interstate compact became effective under Public Act 254 and 255 of 2022. The MHA support is based on an analysis that joining PSYPACT will increase the availability of telehealth services and give patients in rural and underserved communities more access to psychology services.
After the MHA’s recent visits to Capitol Hill to advocate for year-end member priorities, Congress has reached a major deal on a year-end omnibus legislative package. The package includes health policy measures related to Medicare and Medicaid provisions, telehealth and hospital-at-home programs.
Lawmakers are blocking the implementation of the Statutory Pay-As-You-Go (PAYGO) sequester which would have required a 4% cut to Medicare payments. In addition, both the Medicare Dependent Hospital and enhanced low-volume adjustment programs are extended for two years. The Medicare hospital-at-home program and pandemic-era telehealth flexibilities are also extended for two years. There is a one-year delay in lab payment changes stemming from the Protecting Access to Medicare Act of 2014.
Regarding Medicaid, the package separates the enhanced federal medical assistance percentage (FMAP) and the Medicaid eligibility maintenance of effort from the declaration of the Public Health Emergency. Beginning in April, states may remove those who no longer qualify for Medicaid, regardless of when the COVID-19 public health emergency ends. The enhanced FMAP, currently a 6.2% addition to state Medicaid matching rates, is gradually phased out through 2023. These changes help fund a year of continuous coverage provisions for children at risk of losing health insurance and standardizing 12 months of postpartum coverage.
Passage of the final legislation is likely to happen by midnight on Dec. 23, 2022. The bill text is public, giving high likelihood to the healthcare provisions outlined above. However, there is a possibility for last-minute changes.
For more information about the year-end omnibus legislation contact Laura Appel at the MHA.
MHA and Michigan hospital representatives pictured with Rep. John Moolenaar (R-Midland).
The MHA visited Capitol Hill in Washington DC last week to emphasize year-end priorities to Michigan’s congressional delegation.
The MHA and several hospital representatives met with House members and with U.S. Senator Debbie Stabenow to deliver the message that pending Medicare cuts are unsustainable and unacceptable. Memorial Healthcare CEO Brian Long joined the group to request prompt action to prevent the forthcoming 4% Statutory Pay-As-You-Go (PAYGO) sequester and extend or make permanent the low-volume adjustment and the Medicare-dependent hospital programs. Without an extension, these critical rural programs expire Dec. 16 and will reduce reimbursement to Michigan hospitals by more than $12 million annually. The MHA also pushed for making permanent the expansion of telehealth services and extending the hospital-at-home program. The members of the Michigan congressional delegation were receptive to these requests and generally expressed optimism that the pending Medicare reductions would be paused or even repealed.
The MHA also took part in both the American Hospital Association and Children’s Hospital Association advocacy briefings, which concurrently took place in DC. Both associations discussed their central priorities as the lame duck session nears its end and a new Congress prepares to enter Capitol Hill.
Members with questions about end of year priorities or future advocacy days on Capitol Hill may contact Laura Appel at the MHA.
“The world-altering powers that technology has delivered into our hands now require a degree of consideration and foresight that has never before been asked of us.” ― Carl Sagan
A long-held practice utilized by businesses of all stripes is the ubiquitous SWOT (strengths, weaknesses, opportunities and threats) analysis. For a hospital or health system in 2022, there is no shortage of candidates to fully stock the “threat” category. In this column, I want to draw attention to one that deserves increased attention because of its potential to cripple an organization in an instant: cybersecurity.
The wonders of technology have dramatically improved healthcare in Michigan and beyond. Advancements include imaging technology that identifies serious disease at a much earlier stage, robotic devices that permit surgical interventions that were previously considered too risky to attempt, remote patient monitoring and telehealth, and electronic medical records that facilitate better tracking and coordination for patients across various sites of care — the list is impressively long. And amid our current workforce shortage crisis, we often describe technology in healthcare as a “force multiplier” that can supplement and extend our limited staffing resources to help ensure adequate access to care.
Make no mistake, healthcare still has one foot on the proverbial dock and one foot in the proverbial boat. That is, many of our communications and services remain in the “analog” world, while a growing share have become electronic, digitized and inter-connected. This phenomenon — coupled with the fact that the personal health information we collect and store has more value on the black market than any other data — has painted a neon target on our back for a growing cadre of cybercriminals and adversarial nation states. It is no accident the FBI has identified healthcare as the number one target of these bad actors. And simply put, a cyberattack on a hospital is a “threat to life” crime. We must act accordingly.
The statistics on healthcare attacks are enough to keep any executive up at night. An attack on a midsize hospital creates an average shutdown time of 10 hours and costs on average $45,700 per hour, according to an Ipsos report. In the same report, 49% of the respondents said their annual compliance budget for cybersecurity wasn’t enough. According to IBM, a data breach at a healthcare organization costs more than any other sector at $10.1 million. And the threat continues to grow, as healthcare cyberattacks have increased by 84% from 2018 to 2021, according to Critical Insight. Michigan hospitals, health insurance companies, physician offices and others have been the victims of ransomware attacks and related cybercrime in recent years.
If this wasn’t bad enough, a spotlight was shone on cybersecurity this past spring during Russia’s invasion of Ukraine, when cyberattacks on the Ukrainian government and critical infrastructure organizations had the potential to ripple across multi-national organizations and infect U.S.-based operations, including healthcare. Experts believe this scenario will be part of every future global conflict. And unfortunately, for many hospitals and health systems who welcome patients from multiple foreign countries, and who have business partners outside the United States, the practice of “geo-fencing,” or blocking all incoming email traffic from outside the country, is not always a viable approach.
So where can hospitals and health systems turn for help? At the national level, the American Hospital Association anticipated this trend several years ago and employs John Riggi as the national advisor for cybersecurity and risk. John has been a resource for the MHA in the past and as a former leader within the FBI’s cybercrime division, he maintains close ties with all the relevant government agencies.
And here at the MHA, we are also very committed to strengthening our own cyber defenses, while doing the same for our members. We have appointed Mike Nowak to serve as our own Chief Information Security Officer. Several years ago, Mike and his team helped to launch, and have subsequently helped to operate, the Michigan Health Security Operations Center (Mi|HSOC) for hospitals and health systems. Created for healthcare providers by healthcare providers, this first of its kind entity has the proven ability to prevent, detect, analyze and respond to cybersecurity events. Operating 24/7/365, the Mi|HSOC has developed strong relationships and communication with law enforcement at various levels, including the Michigan State Police Cyber Division, FBI and Secret Service.
An organization that helped form the Mi|HSOC is CyberForce|Q, which is now an MHA Service Corporation Endorsed Business Partner. In addition to sharing tactical information on emerging threats with the members of the security operations center, CyberForce|Q offers a variety of additional cybersecurity services to our members and other healthcare clients.
The bottom line — the MHA and our partners have helped Michigan become a leader in this space. By mitigating potential risk, physicians, nurses and staff of our member hospitals have the best opportunity to provide exceptional patient care without any external interruptions. While the advocacy, policy and safety and quality areas of the association often receive public attention, our cybersecurity efforts are constantly at work, often without much notice, to protect healthcare in Michigan.
But we need your help. I am the farthest thing from an expert in this field, but one thing I have learned is that the “human factor” is the most critical element of our defenses — and therefore the most vulnerable. Think twice before opening a suspicious email or text message, safeguard your electronic devices and passwords and take the time to educate yourself on all of the best practices to follow in the midst of this new, online world. The health of your patients and communities may depend on it.
The Michigan Department of Health and Human Services (MDHHS) recently released a proposed policy to update Medicaid coverage of telemedicine services after the conclusion of the federal COVID-19 public health emergency (PHE). The policy outlines several updates, including:
Making permanent policies established during the PHE through bulletins MSA 20-09 (General Telemedicine Policy Changes) and MSA 21-24 (Asynchronous telemedicine services). MSA 20-09 requires either direct or indirect patient consent for all telemedicine services and defines originating and distant sites. MSA 21-24 clarifies Medicaid coverage for asynchronous telemedicine services, including store and forward services, remote patient monitoring and interprofessional consultations.
Not requiring prior authorization unless the equivalent in-person service requires prior authorization. Authorization requirements for Medicaid health plans may vary.
Establishing payment rates for allowable telemedicine services at the same level as in-person services. To effectuate this policy, the provider must report the place of service as they would if they were providing the service in-person, along with modifier 95 – Synchronous Telemedicine Service. *MDHHS varies from Medicare telehealth billing by not using place of service 02 or 10 but aligns in the use of modifier 95.
Allowing audio-only telemedicine services only for select situations where the beneficiary does not have access to audio/visual capabilities. These codes are currently represented as CPT codes 99441-99443 and 98966-98968.
Members are encouraged to submit commentsto the MDHHS by Sept. 20. Questions should be directed to Renée Smiddy at the MHA.
The U.S. House of Representatives passed July 27 the Advancing Telehealth Beyond COVID–19 Act to expand telehealth services by extending several telehealth flexibilities under Medicare that were initially authorized during the public health emergency relating to the COVID-19 pandemic.
Specifically, the bill allows federally qualified health centers and rural health clinics to serve as the distant site (i.e., the location of the healthcare practitioner); allows beneficiaries to receive telehealth services at any site, regardless of type or location; allows any type of practitioner to furnish telehealth services, subject to approval by the Centers for Medicare & Medicaid Services; and allows audio-only evaluation and management, and behavioral health services.
The legislation passed the House in a 416-12 vote. The entire Michigan delegation to the U.S. House voted in favor of the bill. The bill now moves to the U.S. Senate, where it likely has adequate support for passage.
For more information about the Advancing Telehealth Beyond COVID-19 Act, contact Lauren LaPine at the MHA.
