Combating the Novel Coronavirus (COVID-19): Week of April 5

MHA Covid-19 update

MHA COVID-19 UpdateMichigan hospitals are quickly reaching inpatient capacity as coronavirus variants spread throughout the state and contribute to a severe surge in COVID-19. The MHA continues to keep members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Chief Medical Officers Urge Michiganders to Help Prevent COVID-19 Spread

The MHA released a media statement April 9 on behalf of Michigan’s hospital/health system chief medical officers urging people to protect those who cannot be vaccinated by taking the responsible, proven preventive measures. The statement provides context on the increased transmission and risks of the virus and associated complications for children.

In addition, Gov. Gretchen Whitmer held a news conference April 9, which also featured Tina Freese Decker, Spectrum Health president and CEO and MHA board chair-elect, outlining Michigan’s COVID-19 caseload and the need to stop the spread of the virus. The governor is urging federal agencies to redirect resources, including a large influx of vaccine, to Michigan as soon as possible. Her administration has indicated it is focused on getting more vaccine supply to providers/mass vaccination clinics where it can be administered most quickly to stop viral spread.

The Protect Michigan Commission is also planning regional press events, some of which will include hospital/health system participants, to promote the need for everyone eligible to get vaccinated as soon as possible. The MHA will keep members apprised and share any messaging or materials that hospitals can use on their own platforms to amplify the message.

Questions on COVID-19 vaccines should be directed to Ruthanne Sudderth at the MHA.

Testing and Vaccination Key to Curtailing Viral Spread

The Michigan Department of Health and Human Services (MDHHS) is offering free, on-site rapid COVID-19 testing in partnership with Michigan's intermediate school districts, local school districts and local health departments for residents returning from spring break travel. These fully staffed events are open to students, educators, district staff and community members, and will be scheduled prior to classes restarting. The current list of locations is available on the MDHHS website. Members with questions on testing sites should contact Laura Appel at the MHA.

As part of a virtual session with MHA staff April 5, U.S. Rep. Elissa Slotkin (D-Holly) outlined two strategies hospitals can follow to help address vaccine hesitancy in their communities. She encourages hospitals and health systems to use every patient interaction as an opportunity to discuss the COVID-19 vaccine, regardless of the reason for the visit. In addition, she suggested facilities provide vaccine educational opportunities in the form of webinars, town halls and other events that feature physicians and can reach vaccine-hesitant groups.

As the vaccine becomes more widely available, hospitals are encouraged to revisit offers to vaccinate employees who declined vaccines when first made available to them. Some may have wanted to wait for a single dose vaccine or a more convenient time, were reluctant to get the vaccine while pregnant, or faced other circumstances that may have since changed. In addition, as the state receives media requests, it is expected to begin sharing data on healthcare personnel vaccination rates. To ensure healthcare organizations are accurately represented in any data sharing that occurs, members are urged to confirm their employee vaccine data is up to date in the state’s EMResource portal.

MDHHS Reinstates 14-Day Quarantine, Reminds Providers to Use Michigan EUA Fact Sheets

Due to increasing case rates and variant spread in Michigan, the MDHHS is reinstating a 14-day quarantine for anyone who experiences close contact with a COVID-19-positive person, removing the option for a 10-day quarantine. The department’s COVID-19 public health frequently asked questions document has been updated to reflect the change.

The department also reminds vaccinators that they need to provide the Michigan versions of the emergency use authorization (EUA) fact sheets available on the MDHHS website. Each fact sheet has been updated and includes information on the Michigan Care Improvement Registry.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC).

Combating the Novel Coronavirus (COVID-19): Weeks of Aug. 31 and Sept. 7

MHA Covid-19 update

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

Requirements Clarified on Quarantines for Ill Employees

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

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

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

Dr. Birx Meets with Governor, Healthcare Leaders in Michigan

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

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

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

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

Visitor Restrictions for Residential Care Facilities Updated

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

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

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

Authorized Use of Remdesivir Expanded

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

Webinar Recording to Focus on PPE Strategies and Trends

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

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

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

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

Recording COVID-19 Federal Payments on the Medicare Cost Report

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

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

Combating the Novel Coronavirus (COVID-19): Week of July 20

MHA Covid-19 update

coronavirus updateAs the threat posed by COVID-19 rises across the country, the MHA continues to keep members apprised of developments affecting Michigan hospitals during the pandemic through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Tools Available to Advocate for Next COVID-19 Relief Package

The MHA participated in a Virtual Advocacy Day that the American Hospital Association (AHA) hosted July 20, featuring presentations from AHA President and CEO Rick Pollack and AHA Executive Vice President Tom Nickels. An update was shared on efforts to include provisions to support hospitals in the next COVID-19 relief package, which includes additional dollars for the emergency relief fund, forgiveness for accelerated payments, and liability protections for front-line medical providers and facilities.

Since Senate negotiations on the bill reportedly stalled July 23, it remains important for healthcare providers to advocate for these provisions. The AHA has issued an Advocacy Alert (password required) asking that members contact their senators to stress their importance. While Michigan’s U.S. Sens. Debbie Stabenow and Gary Peters are healthcare champions, there is value in them hearing from their constituents on the importance of this funding. To aid in these efforts, the AHA has developed resources and a digital toolkit to help members engage with lawmakers virtually. Members with questions on federal advocacy topics may contact Laura Appel at the MHA.

HHS Extends Public Health Emergency

On July 23, the U.S. Department of Health and Human Services (HHS) extended the COVID-19 public health emergency for another 90 days. The renewal, officially signed by HHS Secretary Alex Azar, ensures that waivers received from the HHS and the Centers for Medicare & Medicaid Services will continue. Policies extended include the 20% Medicare inpatient add-on payment for COVID-19 patients, relaxed telehealth restrictions and other Section 1135 waivers. Members with questions should contact Laura Appel at the MHA.

HHS Announces Targeted CARES Act Funding, Clarifies Required Reporting

The HHS recently announced $10 billion in additional “targeted” hospital funding from federal Coronavirus Aid, Relief, and Economic Security (CARES) Act provider relief funds to assist hospitals with COVID-19 response efforts. The HHS asked hospitals to submit data on their COVID-19-positive inpatient admissions for the period Jan. 1 through June 10, 2020. Payments will be issued to hospitals with more than 161 COVID-19 admissions during this period, with a portion of Michigan hospitals set to receive additional funding from the allocation.

The HHS also shared details on reporting requirements for recipients of CARES Act provider relief funds. Recipients that received one or more payments exceeding $10,000 in the aggregate from the Provider Relief Fund, including the newly announced payments, are required to submit reports to the HHS on how the funds have been expended, using a portal that the HHS will open Oct. 1. Detailed instructions regarding these reports will be released by Aug. 17, and the Health Resources and Services Administration will host educational sessions for providers.

The MHA will continue to monitor hospital distributions from the CARES Act Provider Relief Fund and update members as information becomes available. Members with questions about this funding are encouraged to contact Jason Jorkasky at the MHA.

Guidance Released on Wage Increase for Direct Care Worker Grants

The Michigan Department of Health and Human Services released further information and guidance regarding the $2 per hour wage increase for direct care workers via state grants that was signed into law through Senate Bill (SB) 690 July 1. The department’s frequently asked questions document contains information regarding eligibility of individuals and facilities, as well as the logistics for providing the increased funding at skilled nursing facilities.

In SB 690, the Legislature appropriated $120 million to increase the wages of direct care workers. The language of the bill provided that the increases are above the rates paid March 1 and apply to the period from July 1 through Sept. 30, 2020. Only “direct care workers” at skilled nursing facilities are eligible for the grants. These workers include registered nurse, licensed practical nurse, competency-evaluated nursing assistant or respiratory therapist. The MHA will continue to share additional information about the grants as it becomes available. Members with questions on this issue may contact Adam Carlson at the MHA.

State FY 2020 Budget Protects Healthcare Priorities

During the week of July 20, negotiations ended on the state fiscal year (FY) 2020 budget as the Legislature approved a plan addressing a deficit of nearly $2.2 billion caused by economic losses surrounding the COVID-19 pandemic (see related article). The MHA actively worked with lawmakers to ensure that the association’s budget priorities were held harmless from reductions, including the rural access pool and obstetrical stabilization fund, Medicaid rates and provider tax funded pools. In the coming months, the Legislature and administration will work on the state budget for FY 2021, which begins Oct. 1, and the MHA will continue to stress the importance of fully funding healthcare during those negotiations. Members with questions may contact Adam Carlson at the MHA.

State Senate Approves Liability Protection Bill

Legislation to limit legal liability for healthcare facilities during the COVID-19 pandemic passed the Senate July 23 after receiving approval from the full House late July 22. Senate Bill (SB) 899 would protect facilities from lawsuits related to pandemic response. Specifically, the legislation protects from lawsuits related to the provision of care to COVID-19 patients, rescheduling patient care because of governmental orders or shortages of supplies.

Sen. Michael MacDonald (R-Macomb Township) introduced SB 899, and it passed the Senate May 7. The final version of the legislation as approved July 23 reflects the House substitute that was adopted in committee July 22. The legislation requires Gov. Gretchen Whitmer’s signature before becoming law. The MHA will continue to monitor and keep members informed on the issue. Members with questions should contact Adam Carlson at the MHA.

National COVID-19 Testing Implementation Forum and Testing Supply Registry Announced

The HHS announced July 21 a new program to capture feedback between federal officials and the private sector on COVID-19 testing. The National Testing Implementation Forum will bring together representatives from key stakeholder groups to share information and provide input to federal leaders about SARS-CoV-2 testing and diagnostics. A key aim of the forum is to share perspectives on how the HHS can best address end-to-end testing supply chain issues across commercial, public health, academic and other sectors and define optimal testing in various settings (diagnostic, screening, surveillance, others). The group will also aim to increase public health laboratory capacity, implement a national surveillance strategy, seek new techniques such as sample pooling and identify barriers to a streamlined national laboratory testing reporting system.

The same day, the Advanced Medical Technology Association (AdvaMed) announced the creation of a comprehensive, national COVID-19 diagnostic supply registry to help state and federal governments in their pandemic responses. As outlined in AdvaMed’s news release, the national registry is being launched in partnership with 13 commercial diagnostics manufacturers, nearly all of which produce supplies used in Michigan. The new registry will streamline communications and data sharing between diagnostic firms and the government, facilitate collaboration with public health stakeholders to optimize access to COVID-19 testing, and standardize reporting. Questions related to COVID-19 testing can be directed to Brittany Bogan at the MHA.

Grace Period Granted for Remote Pharmacy Supervision Step Down

The governor issued Executive Order (EO) 2020-152 July 14, removing some of the flexibility related to remote supervision of pharmacy technicians and staff that existed in EO 2020-124, which has since been rescinded. The Department of Licensing and Regulatory Affairs (LARA) has issued a memo discussing the topic and a timeline to fully transition from remote to on-site supervision. LARA will give pharmacies until 11:59 p.m. Sept. 30, 2020, before enforcing supervision and other requirements. Members with questions about EO 2020-124, EO 2020-152 or the memo from LARA may contact Paige Fults at the MHA.

Multilingual Mask-up Materials Available

The state of Michigan has available for download No Mask, No Entry posters in various languages, including English, Spanish, Arabic, Traditional Chinese, Simplified Chinese, Korean, Burmese, French, American Sign Language, Swahili and Bangla. Questions on available resources can be sent to the MHA Communications department.

U.S.-Canadian Border Remains Closed, Healthcare Employees Exempted

Acting Homeland Security Secretary Chad Wolf recently announced that the United States and Canada have extended the mutual ban on nonessential travel between the two countries until Aug. 20; that ban had been set to expire July 21. Essential travel, including that of healthcare workers, may continue uninterrupted. The MHA will continue to monitor and work with state and federal governments to keep the border open for essential healthcare employees. Members with questions on this issue may contact Adam Carlson at the MHA.

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

Combating the Novel Coronavirus (COVID-19): Week of July 6

MHA Covid-19 update

During a July 9 news conference, the governor and her team commented on the rising numbers of COVID-19 cases in the state. Many Michigan residents have seemingly relaxed their attitudes toward physical distancing and wearing masks, both of which are critical to preventing the spread of the coronavirus.

The MHA issued a joint news release with the Michigan State Medical Society and Michigan Osteopathic Association (which make up the Partnership for Michigan’s Health) urging residents to remain vigilant about distancing and wearing masks to prevent a second large surge of COVID-19 in the state. In addition, the association July 10 provided member organizations with a variety of downloadable tools for educating their communities about the importance of wearing masks to guard against the disease. Questions about the news release and educational tools should be directed to Ruthanne Sudderth at the MHA.

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

Executive Directive Issued on Implicit Bias Training for Healthcare Workers

In an executive directive issued July 9, Gov. Gretchen Whitmer directed that all licensed healthcare workers receive implicit bias training in the future. The administration’s COVID-19 task force on racial disparities recommended the training as one way to improve equity of access and care going forward.

Under the directive, the Department of Licensing and Regulatory Affairs (LARA) will begin stakeholder outreach and rule development for implementation. It was noted during a July 9 news conference that it generally takes six to 12 months for requirements of this nature to take effect. Following the announcement, the MHA issued a statement of support for increased implicit bias training, noting that the MHA Keystone Center’s work in promoting health equity will continue.

The association encourages members’ continued participation in current efforts to improve health equity and will keep hospitals apprised of LARA’s next steps for stakeholder input on the new directive. For more information, contact Brittany Bogan at the MHA.

MIOSHA Plans to Inspect Hospitals’ Use of Personal Protective Equipment

The MHA is seeking clarity on a recent Michigan Occupational Safety & Health Administration (MIOSHA) announcement that it would be conducting inspections of hospitals for adequate personal protective equipment through the end of 2020. The MHA is seeking additional time and details about the timing and evaluation methods of these inspections to allow time for hospitals to have their plans/supplies voluntarily reviewed by the agency. The association will update members on any developments regarding this issue; those with questions may contact Laura Appel at the MHA.

Hospitals Should be Alert for Defective Testing Supplies, False Positive Tests

The MHA is aware of reports of Puritan HydraFlock Nasopharyngeal swabs breaking within patients’ nares during specimen collection. These swabs were part of Lot #7272 provided by the state lab in recent weeks. The Michigan Bureau of Laboratories is aware of these events and will be notifying sites that may have received swabs from that shipment. Hospitals that received these swabs are encouraged to consider pulling this inventory from use until more information is made available. Sites that experience issues with swabs of any brand or type should report the adverse event through the MedWatch Voluntary Reporting webpage provided through the U.S. Food and Drug Administration (FDA), as well as to any applicable Patient Safety Organization to which the site belongs.

In addition, the FDA released an alert July 6 about the increased risk of a false positive result with BD SARS-CoV-2 Reagents for the BD Max System test. Providers are encouraged to contact the FDA regarding suspected or actual adverse events connected with these tests.

The MHA and the Michigan Department of Health and Human Services (MDHHS) host weekly calls with lab directors to discuss COVID-1 testing issues. To learn more, contact Brittany Bogan at the MHA.

Medicare Quality Reporting Requirements Resumed July 1

July 1 was the expiration date of the blanket data reporting exceptions and extensions that were implemented in March across Medicare quality reporting and value-based payment programs. In response to COVID-19, the Centers for Medicare & Medicaid Services (CMS) made it optional to submit data from the fourth quarter of 2019 and the first two quarters of 2020 and announced it will not use claims data from Jan. 1 through June 30, 2020, to calculate performance in those programs. Due to the expiration of those provisions, the CMS expects hospitals to collect and report data for the third and fourth quarters of 2020 in accordance with regular program requirements. While the blanket reporting exception has ended, hospitals that are unable to meet third and/or fourth quarter 2020 data collection and reporting requirements due to events beyond their control may use the programs' existing policies to request an exception within 90 calendar days of the extraordinary circumstance. Members with questions should contact Brittany Bogan at the MHA.

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

Combating the Novel Coronavirus (COVID-19): Week of June 22

MHA Covid-19 update

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

Emergency CON Beds Extended to Aug. 31

When Gov. Gretchen Whitmer extended Michigan’s state of emergency through July 16, the emergency approval of hospital beds under the Certificate of Need (CON) process was extended through Aug. 31. Executive Order (EO) 2020-82 specifies those beds can remain online until the last day of the month following the end of the emergency declaration. The MHA will continue to seek clarification from the Department of Health and Human Services (MDHHS) and the Department of Licensing and Regulatory Affairs to determine whether this authorization can remain in place beyond Aug. 31. Members with questions may contact Adam Carlson at the MHA.

State Lab Limits Facilities from Which It Will Accept Testing Samples

The MDHHS released a new alert from the Bureau of Laboratories (BOL) June 22 stating that, due to a high volume of requests, the BOL is currently limiting the COVID-19 samples it is accepting. At this time, it will accept only samples from state-owned institutions of health and corrections, facilities facing active outbreaks, and small congregate care facilities (fewer than 100 screens) that have not established baseline/initial screens of residents and staff.

Organizations that do not meet this criteria and need immediate testing support should refer to the state-provided list of laboratories that have capacity to partner with new entities for COVID-19 testing. As noted in the guidance accompanying the MDHHS emergency order requiring nursing homes to increase testing, those nursing facilities that require state assistance for conducting the tests should email the department with the name and location of the facility and the number of residents and staff needing testing.

Governor Creates Nursing Home Task Force, Extends Visitor Restrictions

The governor signed EO 2020-135 June 26, creating the Michigan Nursing Homes COVID-19 Preparedness Task Force within the MDHHS. The task force will analyze data on COVID-19 in nursing facilities and make recommendations to the governor on improving data quality.

The task force is charged with recommending an action plan for preparing nursing homes for the potential of a future wave of COVID-19 cases by Aug. 31. The group will include individuals from state government, a representative of the Michigan Long Term Care Ombudsman Program, bipartisan representation from both houses of the Legislature, and 13 other members appointed by the governor, including individuals with a personal or professional interest in the health, safety and welfare of nursing home residents and workers. The MHA will keep members apprised of any opportunity for involvement with this task force.

The governor also issued EO 2020-136 to extend the existing restrictions on visitation to healthcare facilities, residential care facilities, congregate care facilities and juvenile justice facilities, but authorizes the MDHHS to gradually re-open visitation as circumstances permit. Hospitals are permitted by a June 3 MDHHS order to ease visitor restrictions if certain guidelines are followed. EO 2020-136 is effective immediately and continues through July 24.

Sen. Peters Reports on COVID-19 Funding for Hospitals, Urges Additional Funds be Distributed

U.S. Sen. Gary Peters released a report June 23 outlining findings of a study on COVID-19 relief funds from the CARES Act to hospitals. The report discloses that 41% of available hospital funding has not yet been distributed, despite hospitals’ financial distress.

The MHA worked closely with Sens. Peters and Debbie Stabenow and Michigan’s entire congressional delegation throughout the pandemic, and this report shows Peters’ tremendous commitment to healthcare in Michigan and beyond. The MHA will continue to advocate on the federal level for additional distribution of funding and for Medicare advance payment loans to be forgiven. Members with questions on federal advocacy may contact Laura Appel at the MHA.

State Updates Publicly Available COVID-19 Data

The state has recently added additional COVID-19 data to its public data website, which may be of interest to members:

Hospital and health system data continues to be publicly reported on Mondays and Thursdays on the state’s “Data About Places” webpage. Members with data questions may contact Jim Lee at the MHA.

Canadian Border Remains Closed to Nonessential Travelers, Open to Healthcare Workers

The U.S. Department of Homeland Security recently confirmed that the Canadian land border will remain closed to nonessential travelers through July 21; that ban had been set to expire June 23. Healthcare workers are deemed essential and continue to be permitted to cross the border for duty. Members with questions on this issue may contact Adam Carlson at the MHA.

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

Combating the Novel Coronavirus (COVID-19): Week of June 15

MHA Covid-19 update

Gov. Gretchen Whitmer issued Executive Order (EO) 2020-117 June 18 to extend Michigan’s state of emergency due to COVID-19 through July 16. The MHA continues to keep members apprised of developments during the pandemic through regular email updates and the MHA Coronavirus webpage. Important updates on how the pandemic is affecting Michigan hospitals are outlined below.

State Updates COVID-19 Testing Protocols in Nursing Homes

The Michigan Department of Health and Human Services (MDHHS) issued an order June 15 that changes testing, infection control and other requirements for nursing home settings to prevent COVID-19 in residents and staff. The order details specific testing timeframes and reporting requirements and was prompted by several sizeable COVID-19 outbreaks in nursing homes.

Other announcements from the MDHHS include making key healthcare staff available for up to 14 days to address staffing shortages and coordinating with Doctors Without Borders to help identify nursing facilities that need assistance with infection prevention and control. Doctors Without Borders is sending mobile teams to assess facility practices and provide tailored recommendation for improvement. The MHA will keep members apprised of the state’s testing sites/needs and how they may impact hospitals’ supplies and testing capacities.

Updates on Federal and State COVID-19 Funding

The Department of Health and Human Services (HHS) recently updated its FAQs on the Coronavirus Aid, Relief, and Economic Security (CARES) Act emergency relief fund, with specific attention to provider reporting. The updated document indicates providers that have received emergency relief payments do not need to submit a quarterly report to the HHS or the Pandemic Response Accountability Committee, as the HHS’s public release of the data meets the statutory reporting requirement for these funds. The HHS will also be posting each provider's total emergency relief fund payment amount on the USAspending.gov website, which satisfies the CARES Act reporting requirement.

However, providers must submit any reports requested by the HHS Secretary that are necessary to allow the HHS to ensure compliance with payment terms and conditions. The HHS will provide details of any such reports in the coming weeks. Members with questions may contact Laura Appel at the MHA.

The state Legislature approved $5.1 million for inpatient behavioral health providers to reimburse any additional costs they experienced during the pandemic. The legislation will now go to the governor for her signature. The MHA continues to advocate to protect providers from budget reductions and to bring additional funding to hospitals to offset costs of COVID-19 and lost revenue during the pandemic. Members with questions about behavioral health funding may contact Laura Appel, and those with state legislative questions may contact Adam Carlson at the MHA.

Pharmacy Executive Order Reissued

The executive order regarding pharmacies expired and was reissued June 16 as EO 2020-124 to extend its provisions through July 14. The MHA worked with the administration to ensure vulnerable patients could retain access to emergency prescription refills. Failure to refill the prescription might interrupt the patient’s ongoing care and have a significant adverse effect on their well-being. This EO also allows pharmacists to continue to supervise technicians and other pharmacy staff remotely.

Emergency Use Authorizations Revoked for Medications to Treat COVID-19

The Food and Drug Administration (FDA) revoked the emergency use authorization June 15 for hydroxychloroquine and chloroquine for treatment of COVID-19. The FDA cited clinical studies’ evidence that the drugs are not effective in treating the virus and may pose additional cardiac risks to patients taking the drugs.

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

Combating the Novel Coronavirus (COVID-19): Week of June 8

MHA Covid-19 update

COVID-19 UpdateThe MHA continues to keep members apprised of developments during the COVID-19 pandemic through regular email updates and the MHA Coronavirus webpage. Important updates on how the pandemic is affecting Michigan hospitals are outlined below.

Data Due June 15 to Potentially Qualify for Further COVID-19 Funding from HHS

The U.S. Department of Health and Human Services (HHS) has requested information from hospitals to determine the distribution of $10 billion to hospitals that have been particularly burdened with COVID-19 cases. Each healthcare facility with a Medicare Tax Identification Number is asked to submit the number of COVID-19-positive inpatients admitted from Jan. 1 through June 10.

Submission of this data by 9 p.m. ET June 15 is required to be eligible to receive the funding, but it is not a guarantee of eligibility. The HHS has posted a frequently asked questions document about funding through the Coronavirus Aid, Relief, and Economic Security (CARES) Act; information on this round of funding begins on page 26. The data must be submitted through the HHS’s TeleTracking system. More information on setting up an account and entering data is available on TeleTracking’s help webpage or by calling TeleTracking Technical Support at (877) 570-6903. Members with questions about federal funding may contact Laura Appel at the MHA.

Policy Updated on Decontaminating N95 Masks

The Food and Drug Administration (FDA) reissued emergency use authorizations related to respirator decontamination, noting that some respirators should not be decontaminated for reuse. The agency will no longer recommend decontamination for the reuse of respirators manufactured in China or those that have exhalation valves. Decontamination will be authorized only on non-cellulose-compatible N95 respirators. Healthcare personnel should use the decontamination process only when new, FDA-cleared N95 respirators, NIOSH-approved N95 respirators or other FDA-authorized respirators are unavailable.

State Issues Guidance on Testing Frequency and Available Capacity

To ensure available COVID-19 testing resources are being effectively used in high-risk populations and/or settings across the state, the Michigan Department of Health and Human Resources (MDHHS) issued recommendations June 10 on the ideal frequency of COVID-19 testing. The guidance assumes a scenario where sufficient testing supplies and capacity are available. To help meet the level of testing envisioned in these recommendations, the MDHHS has also published information regarding test sites that provide services at no cost to the patient and laboratories with available testing supplies and capacity to allow for new providers and congregate care facilities to send specimens. The June 10 recommendations and additional information on testing priorities and frequency by population is available in the June 10 update emailed to members.

Resources and Guidance Available for Lab Supplies and Reporting Results

The FDA’s web-based resource Testing Supply Substitution Strategies contains detailed information to support labs performing authorized COVID-19 tests, including validated supply alternatives for use when there is a supply issue with some components of a test. This PowerPoint presentation, which can be downloaded from the FDA website, does not alter emergency use authorizations that have already been issued nor specific FDA regulatory requirements. It is provided solely to address concerns about the availability of certain critical components of DOVID-19 diagnostic tests.

The U.S. Department of Health and Human Services (HHS) has provided guidance that specifies additional data that laboratories must report with their COVID-19 test results. The new data should be reported as soon as possible, but no later than Aug. 1. More information is available in the department’s news release.

Workplace Requirements for Outpatient Facilities

Executive Order 2020-114 stipulates accommodations for all workers required to return to the workplace during the pandemic. Section 9 of EO 2020-114 pertains specifically to outpatient healthcare facilities, including clinics and physician offices, and outlines requirements that do not apply to inpatient hospitals.

The requirement for checking patient temperatures for these facilities is different from the evaluation required for employees at inpatient or outpatient facilities. This section of EO 2020-114 does not change the requirements for employee health evaluations prior to entering healthcare facilities when reporting to work. Questions on the requirements should be directed to Amy Barkholz at the MHA.

The Joint Commission Offers Webinar as On-site Surveys Resume

The Joint Commission will host a webinar titled The Joint Commission – Plan for Resuming Surveys from 11 a.m. to noon June 18. Registration is required, and more information is available in the related article.

Blue Cross Cost Sharing Waiver Extended Through End of Year

Blue Cross Blue Shield of Michigan (BCBSM) announced it is extending cost sharing (copays, deductibles and coinsurance) waivers for COVID-19 testing and treatment through Dec. 31. These measures originally were set to expire June 30. The announcement says the cost share waivers “apply to members in fully insured commercial PPO and HMO plans, as well as individuals in fully insured Medicare Advantage plans. BCBSM will work with employer group customers that are self-insured to make decisions regarding their own benefits.” Members with questions on COVID-19 payer issues may contact Jason Jorkasky at the MHA.

“Don’t Delay Care” Campaign Update

The MHA “Hospitals are Safe – Don’t Delay Care” campaign began on social media and statewide television in mid-May and will end during the week of June 15. The campaign has focused on video views, building awareness for those who may be making decisions about seeking medical care during COVID-19. As of June 12, the video had been viewed on Facebook more than 577,000 times. Although the campaign is ending, the association will continue to share this message through its normal social media content. For more information on this or other public relations campaigns, contact Ruthanne Sudderth at the MHA.

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

Combating the Novel Coronavirus (COVID-19): Week of May 25

MHA Covid-19 update

The MHA has continued to keep members apprised of developments during the COVID-19 pandemic through regular email updates and the MHA Coronavirus webpage. Important updates on how the pandemic is affecting Michigan hospitals are outlined below.

Healthcare-related Executive Orders Issued/Replaced

Gov. Gretchen Whitmer issued Executive Order (EO) 2020-91 May 18, outlining a list of requirements for all Michigan businesses to follow in preparation for the eventual expiration of the stay-home order. It included requirements for employee training, sanitation, social distancing, submitting written plans to the state, and more. That order was rescinded May 21 and replaced with EO 2020-97, which adds specific requirements for outpatient healthcare settings.

Several state departments have collaborated to develop guidance to supplement EO 2020-97 and related orders and guidelines. Support was provided May 29 specifically for ambulatory care settings and for outpatient healthcare facilities in general. The MHA is reviewing the guidance, but has no reason to believe hospitals that have remained open throughout the pandemic are exempt from EO 2020-97. Until further clarification is available, the MHA recommends hospitals and health systems adhere to the order’s requirements for both office and outpatient care settings.

May 29 marked the expiration of EO 2020-17, which since March has restricted nonessential medical procedures done in hospitals, outpatient surgery centers and dentists’ offices. There are no restrictions accompanying the expiration of the order, but hospitals are urged to monitor personal protective equipment levels, testing capacity and more as additional elective procedures are made available. The MHA will continue to run its television and social media ad campaign through June, urging Michiganders to not delay care and assuring them hospitals are safe.

EO 2020-72, which limits visitors in health, nursing, congregate care and juvenile justice facilities, is set to expire at 11:59 p.m. ET May 31. It is likely that the governor will extend the order.

The governor signed EO 2020-104 May 26 to expand the types of medical personnel (such as nurses, pharmacists and physician assistants) who can order a COVID-19 test and to create a new category of community testing sites. These sites can offer testing to anyone who has reason to be tested without an advance provider order and without charging an out-of-pocket cost, thereby increasing access for Michigan communities. The order loosens restrictions on who is eligible for testing to those who:

  • Exhibit any symptom of COVID-19, including mild symptoms.
  • Has been exposed to a person with COVID-19.
  • Has been working outside their home for at least 10 days.
  • Resides in any congregate setting, such as a long-term care facility, prison or jail, homeless shelter or migrant camp.

The Michigan Department of Health and Human Services (MDHHS) also issued a memo officially expanding testing priorities, echoing some of the testing outlined in EO 2020-104. The memo was included in the MHA’s May 26 update emailed to members.

The governor issued EO 2020-95 May 20, extending protections and requirements for long-term care (LTC) residents and employees of LTC facilities. The order expands on protections provided in EOs 2020-50 and 2020-84 and provides clear procedures for facilities and hospitals to follow when residents test positive for or experience symptoms of COVID-19. The order took immediate effect and continues through June 17.

U.S. Senators Discuss COVID-19 with MHA Board Members

U.S. Sens. Debbie Stabenow (D-Lansing) and Gary Peters (D-Bloomfield Hills) joined a majority of the members of the MHA Board of Trustees via conference call May 28 for a conversation about a variety of COVID-19 issues facing hospitals. The MHA and board members told the senators about the need to support Medicare accelerated payment loan forgiveness, the continued challenges in obtaining testing supplies, the financial impact the pandemic has had on both urban and rural hospitals, and the need for COVID-19 funding mechanisms to include inpatient behavioral health providers.

The MHA reminds hospitals of the importance of sending detailed messages regarding their need for specific testing supplies to the MDHHS Bureau of Laboratories.

Hospitals Warned of Imposter Unemployment Claims

The Michigan Unemployment Insurance Agency (UIA) recently warned of attempts to file imposter unemployment claims by criminals who may pose as self-employed workers or independent contractors to illegally obtain benefits. The UIA has developed additional fraud protections, which may impact both new and existing claimants. Those impacted will receive instructions from the UIA on how to submit the necessary additional information to avoid or nullify “Stop Payment” notices.

As of May 27, Michigan was not listed as a state that has been targeted. Those who suspect an imposter claim has been filed in their name should contact the UIA immediately. Members with questions may contact Neil MacVicar at the MHA.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA Coronavirus webpage. If staff members at MHA-member facilities are not receiving necessary information from the MHA, they are asked to check the spam/junk mail folders in their email systems or ask their information technology departments to ensure MHA messages are not being blocked.

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

Combating the Novel Coronavirus (COVID-19): Week of May 18

MHA Covid-19 update

MHA COVID-19 UpdateThe MHA has continued to keep members apprised of developments during the COVID-19 pandemic through regular email updates and the MHA Coronavirus webpage. Important updates on how the pandemic is affecting Michigan hospitals are outlined below.

Executive Order 2020-17 Rescinded, Other Restrictions Eased

Gov. Gretchen Whitmer announced May 21 that she is rescinding Executive Order (EO) 2020-17 effective May 29. This EO was issued in March and banned “nonessential” medical procedures in hospitals, ambulatory surgery centers and dentists’ offices. The MHA issued a media statement in support of her action and will continue to run statewide television and social media ads urging people not to delay care and assuring that hospitals are safe places to receive services.

The governor also announced during a May 21 news conference that auto dealerships, retailers and veterinarians can open to the public, by appointment only, effective May 29, and that, effective immediately, groups of 10 or fewer people may gather outside of their homes. Whitmer announced May 18 that the Upper Peninsula (Region 8) and 17 counties in northern lower Michigan (Region 6) will be permitted to partially reopen their economies May 22, in accordance with the “Safe Start” recommendations developed by the Michigan Economic Recovery Council.

Liability Protections for Healthcare Workers, Facilities

The MHA testified May 19 via videoconference before the state House Judiciary Committee to advocate for Senate Bill (SB) 899, which offers strong and broad liability protections for healthcare workers and facilities treating COVID-19 patients. The MHA and members have identified this as an important element to operating within pandemic and emergency situations. A variety of other healthcare groups submitted cards of support for the bill, including the Michigan State Medical Society and the Healthcare Association of Michigan, which represents long-term care facilities.

SB 899 originally passed the Senate May 7. The MHA will continue to work with members of the House of Representatives as the legislation progresses to support healthcare personnel responding to the COVID-19 pandemic. Members with questions may contact Adam Carlson at the MHA.

Laboratories and Testing

The Michigan Department of Health & Human Services (MDHHS) announced May 18 that the Laboratory Emergency Response Network (MiCLERN) hotline will be taken offline at 5 p.m. ET May 22. The announcement stated that this is due to “recent changes to COVID-19 prioritization criteria and stabilized testing capacity that no longer requires prior issuance of Person Under Investigation (PUI) identifiers for MDHHS Bureau of Laboratory (BOL) testing of COVID-19 specimens.” The state clarified that COVID-19 specimens that are sent to the state laboratory no longer require a PUI form, but should still include the State of Michigan Test Requisition form (DCH-0583) and two unique identifiers.

Hospitals in need of swabs and transport media for testing are reminded to report their needs to the BOL by sending an email to MDHHSLab@michigan.gov using the subject line “EM COVID-19 Supplies,” per recent guidance shared with members in the May 6 email update. Members with questions should contact Brittany Bogan at the MHA.

MVC Offers Resources for Resuming Non-COVID Procedures

The Michigan Value Collaborative (MVC) represents a partnership among 87 Michigan hospitals and 40 physician organizations that aims to improve the health of Michigan through sustainable high-value healthcare. Supported by Blue Cross Blue Shield of Michigan, the MVC helps its members better understand their performance using robust multipayer data, customized analytics and at-the-elbow support.

To assist hospital systems with prioritizing the restart of surgical services with the least impact on caring for remaining COVID-19 patients, the MVC has designed reports that display resource utilization metrics at a statewide and member hospital level for 17 elective surgical procedures. More information is available by contacting the MHA Keystone Center.

Pharmacy Refill Order Extended

The governor signed EO 2020-93 May 19, extending a previous order giving pharmacists increased operational capacity. It also expands access to prescriptions for patients. The order allows pharmacists to dispense emergency refills of prescriptions for up to a 60-day supply and requires insurers to cover early refills for up to a 90-day supply during the pandemic. It also allows pharmacists to dispense COVID-19 treatments according to government-approved protocols. EO 2020-93 took immediate effect and will expire at 11:59 p.m. June 16, 2020. Members with questions may contact Paige Fults at the MHA.

EMResource Now Tracking Psychiatric Facility Data

The state of Michigan recently launched a new module in EMResource targeted toward freestanding psychiatric facilities. The data collected in this new module requests data on beds, COVID-19 patients, staffing and personal protective equipment availability. Psychiatric facilities are required to report this information weekly by 11:59 p.m. ET every Friday. The MHA is seeking clarification from the state on whether this data will also be posted to its COVID-19 data website alongside existing health system/hospital data on related measures, or on any other public website. Members with questions may contact Jim Lee at the MHA.

Multisystem Inflammatory Syndrome in Children

A Clinician Outreach and Communication Activity webinar on the clinical characteristics of Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 is now available online. The Centers for Disease Control & Prevention (CDC) hosted the webinar May 19. The MDHHS reported that, since April 1, there have been 28 identified cases in Michigan, and treatment with intravenous immunoglobulin and steroids is proving to be effective. The CDC issued a Health Advisory May 14 and recommends healthcare providers report any patient who meets the case definition to local and state health departments to enhance knowledge of risk factors, clinical course, and treatment of this syndrome.

Healthcare Workers Still Permitted to Cross Closed Canadian Borders

The U.S. Department of Homeland Security May 19 reissued its order closing the United States – Canadian ground border through 11:59 p.m. ET June 22. Healthcare workers will continue to be permitted to cross to report to work.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. If staff members at MHA-member facilities are not receiving necessary information from the MHA, they are asked to check the spam/junk mail folders in their email systems or ask their information technology departments to ensure MHA messages are not being blocked.

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

Combating the Novel Coronavirus (COVID-19): Week of May 11

MHA Covid-19 update

Despite slowing rates of infection, the state of Michigan surpassed 50,000 COVID-19 cases May 15. The MHA has continued to send regular updates to MHA members on matters related to the pandemic. Additional updates and resources are available on the MHA COVID-19 webpage. Following are highlights from the week of May 11.

Funding

The federal Family First Coronavirus Act provided a temporary 6.2 percentage point increase to the federal medical assistance percentage (FMAP) rate effective Jan. 1, 2020, through the end of the quarter in which the federal emergency expires, at least through June 30. Because of the increased FMAP rate, Michigan hospitals paid $29 million less tax to support supplemental Medicaid payments for the two most recent quarters. The MHA will provide additional information on the enhanced rate changes as it becomes available. Members with questions may contact Vickie Kunz at the MHA.

An extended increase in the FMAP rate is one aspect of the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act that the U.S. House of Representatives introduced May 12. Developed by House Democrats and passed by the full House late May 15, this COVID-19 response package includes several positive items for hospitals and health systems.

The act would increase the FMAP by 14 percentage points from July 1, 2020, through June 30, 2021, returning to 6.2 percentage points for the subsequent year. Some of the additional healthcare-related provisions include:

  • $100 billion for hospital and healthcare providers to be reimbursed for healthcare-related expenses or lost revenue directly attributable to the public health emergency.
  • $75 billion to bolster testing and contact tracing efforts.
  • Modified terms for the accelerated and advanced payments available through the Medicare program.
  • Elimination of cost-sharing for COVID-19 treatment in most forms of healthcare coverage.
  • Increased research of the impact of COVID-19 on behavioral health, including the impact on healthcare providers.
  • Nearly $1 trillion for states and local governments to respond to COVID-19.
  • Numerous changes to Medicare, Medicaid and other health programs.

The MHA will continue to express support for passage of this package with the Michigan congressional delegation. Members with questions may contact Laura Appel at the MHA.

Testing Updates

As the criteria for those eligible to receive a COVID-19 test has expanded, the state has focused on increased testing among four vulnerable populations: residents in long-term care facilities, residents in assisted living facilities, inmates in prisons and county jails, and the homeless/underserved. At the same time, the state is supporting the launch of several new drive-thru and community-based testing sites in targeted counties, cities and neighborhoods that have been most impacted by COVID-19. A Request for Proposals (RFP) was issued to set up these COVID-19 test sites around the state. The submission deadline for proposals is 11:50 a.m. May 18. A link to the RFP and additional information was sent to members in the May 14 email update. Members with questions may contact Brittany Bogan at the MHA.

Michigan Chief Medical Executive Joneigh Khaldun, MD, has clarified her April 20 memo regarding expanded criteria for COVID-19 testing eligibility. Although the memo allows for asymptomatic healthcare works and first responders, as well as critical infrastructure workers with or without COVID-19 symptoms, there is no requirement for healthcare providers to test any certain population. The expanded criteria are meant to allow for testing of these individuals if testing supplies are available.

Remdesivir Distribution

The Michigan Department of Health and Human Services (MDHHS) notified the MHA that the state received from the federal government 1,600 vials of the antiviral medication remdesivir May 9 and distributed them to 41 Michigan hospitals, in accordance with an “Interim Emergency Allocation Strategy” developed by the MDHHS. Remdesivir has been authorized for emergency use in the U.S. to potentially shorten the effects of COVID-19. The state received another supply of the drug May 14 and gathered data to determine the hospitals to distribute it to.

The U.S. Department of Health and Human Services (HHS) has set 11:59 p.m. ET May 18 as the next deadline for submitting data to inform the agency's distribution of its limited supply of remdesivir. Hospitals that already use the TeleTracking web portal for their daily reporting need to do nothing differently for this remdesivir data collection, except to ensure these data are submitted by the May 18 deadline. If hospitals encounter issues with accessing the TeleTracking portal or have questions about the data, they should contact TeleTracking Technical Support at (877) 570-6903.

The HHS will allocate all of the donated supply of remdesivir from Gilead in the coming weeks and anticipates that no more will be available in the U.S. until the fall or later. Thus, hospitals that receive an allocation should carefully consider decisions about how the drug is used. Members with questions may contact Laura Appel at the MHA.

Multisystem Inflammatory Syndrome in Children

The MDHHS issued a notice to healthcare providers May 15 regarding the symptoms of multisystem inflammatory syndrome in children (MIS-C), a condition related to COVID-19. Access to the notice was sent to members in the May 15 email update.

The Centers for Disease Control and Prevention (CDC) has provided additional background information on several cases of MIS-C and a case definition for this syndrome. The MIS-C case definition is as follows:

  • An individual under 21 years of age presenting with fever, laboratory evidence of inflammation, and evidence of clinically severe illness requiring hospitalization, with multisystem (>2) organ involvement (cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic or neurological); AND
  • No alternative plausible diagnoses; AND
  • Positive for current or recent SARS-CoV-2 infection by RT-PCR, serology, or antigen test; or COVID-19 exposure within the 4 weeks prior to the onset of symptoms

According to the state, “The CDC recommends healthcare providers report any patient who meets the case definition to local, state, and territorial health departments to enhance knowledge of risk factors, pathogenesis, clinical course, and treatment of this syndrome.” Although some individuals may have symptoms of Kawasaki disease, they should be reported if they meet the MIS-C case definition. The MIS-C diagnosis should also be considered in any pediatric death with evidence of SARS-CoV-2 infection.

Emergency CON Executive Order Extended to June 9

The governor issued Executive Order (EO) 2020-82 May 12, extending emergency Certificate of Need (CON) flexibility for healthcare providers to June 9. Initially, these CON measures were part of EO 2020-49, which was set to expire May 12. The EO relaxes regulatory requirements on hospitals and healthcare facilities that need to expand capacity to care for COVID-19 patients. The order also grants additional flexibility in the Department of Licensing and Regulatory Affairs’ decisions about licensing, registration and workflow requirements to help ensure adequate numbers of care providers. Members with questions may contact Adam Carlson at the MHA.

Telehealth Legislation

The Michigan House of Representatives acted on telehealth legislation May 13, passing bills that would expand access and improve reimbursement for telehealth services. The bipartisan package was introduced before the COVID-19 pandemic, but there is renewed urgency given the current necessity for telehealth services (see related article).

Reporting Deaths Due to COVID-19

The MDHHS recently provided guidance for healthcare providers on procedures to follow when someone dies of COVID-19 in their facility. The local health officer should be informed of the death between 8 a.m. and 5 p.m. the day the death occurs, seven days a week. Deaths occurring after 5 p.m. should be reported as soon as possible the following morning, but no more than 24 hours following the death. The MDHHS has provided more information online for reporting deaths from COVID-19.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. If staff members at MHA-member facilities are not receiving necessary information from the MHA, they are asked to check the spam/junk mail folders in their email systems or ask their information technology departments to ensure MHA messages are not being blocked.

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