Combating the Novel Coronavirus (COVID-19): Week of Jan. 10

MHA Covid-19 update

MHA Covid-19 updateThe state of Michigan held a press conference Jan. 11 to discuss the rapid rise in case numbers, hospitalizations (especially pediatric hospitalizations) and positivity rates. Speakers urged all residents who are eligible to be both vaccinated and boosted as quickly as possible. Representatives from Children’s Hospital of Michigan joined the event to discuss the concerning rise in childhood case rates and hospitalizations.

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.

SCOTUS Upholds CMS Vaccine Mandate, Enforcement Proceeds

The U.S. Supreme Court issued decisions Jan. 13 on the Centers for Medicare & Medicaid Services (CMS) and Occupational Safety and Health Administration (OSHA) vaccine mandates. As expected, the court blocked the Biden administration from enforcing the vaccine or test mandate issued under OSHA, but upheld the ability of the CMS to enforce the healthcare worker vaccine mandate.

The Supreme Court has repeatedly upheld the constitutionality of state vaccine mandates in a variety of settings, as well as mandates by private employers. These challenges were different because they presented the question of whether Congress had authorized the executive branch to institute the requirements through the agencies of OSHA and the CMS/Department of Health and Human Services.

Michigan was not one of the 26 states covered by the court injunction to the CMS mandate, and Michigan has no other state-issued prohibitions on enforcing federal or private vaccine mandates. Hence, the mandate and enforcement move forward. The currently posted deadline for completing the first required vaccine dose is Jan. 27, and the second dose is required by Feb. 28. Boosters are currently not part of the mandate.

The MHA responded to a number of media inquiries following the Supreme Court announcement, including from The Detroit News, Detroit Free Press and MiBiz. The association reiterated its long-standing position that mandates of this kind should be left up to local healthcare decision-makers and that hospitals and the MHA have always urged every resident who is eligible to get vaccinated to protect themselves and others. The MHA also stressed that, while the small number of hospital workers who have already ended their employment due to an organization’s mandate did not necessarily worsen the existing staffing shortages, the timing of a nationwide mandate amid this omicron surge could not be worse, as the shortages are more serious than ever. The association assured reporters that hospitals will proceed with compliance and that the MHA and its members will continue to strenuously advocate for staffing assistance from federal and state partners.

Members with questions about deadlines, enforcement or other elements of the mandate are encouraged to review the posted CMS guidance to ensure their organizations are prepared to comply.

MIOSHA: Hospitals May Currently Use CDC Quarantine Guidance Without Penalty

The MHA has continued to work with state regulators on securing updated guidance for hospitals and health systems as it relates to worker quarantine periods. Federal Occupational Safety and Health Administration (OSHA) rules have not yet been fully rescinded to allow for healthcare settings to confidently follow new, less restrictive Centers for Disease Control and Prevention (CDC) quarantine guidance.

However, the Michigan Occupational Safety and Health Administration (MIOSHA) has stated it was told OSHA is in the process of withdrawing the relevant rules and the state agency is preparing to update its rules to align with the revised federal rules. MIOSHA also indicated that, until updates are made at the federal and state levels, it will not issue citations specifically regarding quarantine and isolation requirements if an employer were following the Dec. 23, 2021, updated CDC guidance for healthcare personnel.

An existing OSHA provision recognizes the CDC’s ‘‘Strategies to Mitigate Healthcare Personnel Staffing Shortages.’’ This guidance allows elimination of quarantine for certain healthcare workers as a last resort if the workers’ absence would mean there are no longer enough staff to provide safe patient care, specific other amelioration strategies have already been tried, patients have been notified, and workers are using additional personal protective equipment at all times.

The MHA will continue to keep members apprised of developments on this issue. Members with questions may contact Laura Appel at the MHA.

Long-term Care Facility Capacity for COVID Care Increases

Michigan now has 50 Tier-2 COVID-19 Relief Facilities (CRFs) able to take COVID-19 patients from hospitals at discharge if their normal nursing facility isn’t able to accommodate them. This is an increase from just 27 CRFs late in 2021 and includes an Upper Peninsula facility in Hancock.

In addition, Michigan now has nine facilities designated as Care and Recovery Centers (CRC)s, including one in Escanaba in the Upper Peninsula.

The CRC and the CRF programs were established under Michigan Public Act 231 of 2020. These programs were designed to ensure Michigan’s nursing homes were prepared to provide care to individuals who have tested positive for coronavirus under transmission-based precautions within the guidelines and best practices from the Centers for Disease Control and Prevention. Michigan’s nursing homes must be reviewed by the Michigan Department of Health and Human Services (MDHHS) to ensure they meet the minimum criteria outlined within the legislation and associated MDHHS policies. Members with questions may contact Paige Fults at the MHA.

Red Cross Declares First Ever National Blood Supply Crisis

The American Red Cross declared a national blood supply shortage and operational crisis Jan. 10. This is the first time such a crisis has been declared, and it could impact hospitals’ ability to provide certain types of care or transfusions in the coming days and weeks. This is a result of the current COVID-19 surge causing canceled donation appointments, Red Cross staffing shortages and more.

The Red Cross chief medical officer sent a notification directly to hospital transfusion leaders outlining these operational challenges and how to plan for expected shortages. The Red Cross also urged the public to donate blood as soon as possible.

The MHA will be amplifying to the public the need for blood donors through its social and traditional media channels.

Michigan Sees Surge in Unemployment Fraud

Michigan has seen a recent surge in unemployment fraud claims, according to the MHA Unemployment Compensation Program (MHA UCP). The increase in unemployment fraud is related to identity theft that occurs when the state Unemployment Insurance Agency (UIA) system is penetrated. Over the past several weeks, the MHA UCP has seen fraud in about 15 to 20% of all new claims for its clients.

The MHA UCP has worked closely with the UIA on this issue and has mitigated the impact for clients, who have not been assessed charges on these claims. To learn more about the services available through the MHA UCP, 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 COVID-19 webpageQuestions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC).

Healthcare Bills Highlight Lame-duck Session

capitol building

The Michigan Legislature completed most of its lame-duck agenda during the week of Dec. 14, addressing a wide range of issues impacting hospitals. The most notable legislation included a supplemental appropriations bill for COVID-19 relief, an extension of unemployment insurance benefits, and several Certificate of Need (CON) bills. The House is expected to meet during the week of Dec. 21 to concur on substitute bills passed by the Senate, but no further voting is expected in the Senate in 2020.

The supplemental spending bill passed by the Senate totaled $465 million and included several line items to directly assist hospitals. Senate Bill (SB) 748 provides $10 million as grants to hospitals for staffing assistance, $17.8 million for remdesivir Medicaid reimbursement, $48 million for additional vaccine and testing capacity, $100 million to continue the direct hazard pay adjustment for direct care workers and first responders, and $15 million to replenish the state stockpile of personal protective and other emergency equipment. The appropriations provide significant relief for MHA members to close out the legislative year, and the association supported the bill. SB 748 also allocated $220 million to extend unemployment insurance (UI) benefits through March 31 to assist unemployed Michiganders. MHA-supported SB 604 would extend UI benefits from 20 to 26 weeks, continue to not charge employers’ individual accounts for COVID-19-related claims, allow employees to use UI for COVID-19-related absences, and continue to expand the UI Workshare Program until April.

Final changes were made to several CON bills and sent to the governor’s desk. SBs 669, 671, 672 and 673 would add two members to the CON commission representing the public (SB 671), increase the threshold for covered capital expenditures to $10 million (SB 669), remove psychiatric beds as a covered service in counties with fewer than 40,000 residents (SBs 672 and 673) and remove air ambulance as a covered service starting June 1, 2021 (SB 672). Language was removed from SB 672 that would have automatically expanded the number of counties exempted from psychiatric bed CON requirements in future years. The MHA continues to support SBs 669 and 671 and remains neutral on SBs 672 and 673. The Legislature also passed SB 1160, which would amend the CON statute related to swing beds by removing the existing requirement that hospitals provide evidence of difficulty placing patients in skilled nursing home beds during the 12 months prior to the swing bed application. The MHA did not take a position on SB 1160.

COVID-19-related legislation also included SB 1185, which would provide an additional period of liability immunity for healthcare providers and facilities. The extension would last from Oct. 29, 2020, to Feb. 14, 2021, and was supported by the MHA. SBs 879 and 920 would continue authorization for early prescription refills, pharmacy operational changes and the 60-day prescriptions that were addressed in Executive Order 2020-61. The MHA did not take a position on SBs 879 and 920.

The Legislature also passed SB 1253, which puts a 28-day time limit on emergency orders from state departments before requiring a vote by both chambers of the Legislature. The MHA opposed the bill, which now moves to the governor’s desk.

SB 1021 would allow the Michigan Department of Licensing and Regulatory Affairs to issue health professional licenses to individuals with similar experience from Canada and was sent to the governor’s desk for signature. The MHA supported SB 1021 in both chambers. HB 4042, which would enter Michigan into the nurse licensure compact, was also sent to the governor’s desk for signature. The MHA sent a memo to the administration encouraging the governor to sign HB 4042.

Several bills addressing behavioral health were sent to the governor’s desk. MHA-supported SB 758 would add Michigan to the interstate psychology licensure compact, which is intended to permit the practice of telepsychology across state lines without applying for another license. Two other behavioral health bills were passed to create new licensure options for facilities. HB 5832 would create a license for crisis stabilization units, and HB 5298 would establish licensure for psychiatric treatment facilities for Medicaid recipients under the age of 21. The MHA did not take a position on either bill. Both chambers also approved SB 813, which would require a report to the Legislature on psychiatric patient deaths that occur within 72 hours of treatment. SB 813 was amended to ensure that the Michigan Department of Health and Human Services would be responsible for reporting, and the MHA did not take a position.

Finally, the Legislature passed HBs 4186 and 4187, which would establish the data breach notification act. This package has been in progress for several years and maintains the exemption for hospitals that was previously negotiated. The MHA remained neutral on the bills.

Members with questions on legislative action should contact Adam Carlson at the MHA.

Michigan Senate Advances Healthcare Bills

capitol building

As the legislative lame-duck session continued during the week of Dec. 7, the Michigan Senate voted on several bills that would impact hospitals. The bills taken up included several COVID-19-related bills, as well as an extension of unemployment benefits and the nurse licensure compact legislation.

The Michigan Senate passed House Bill (HB) 4042, which would add Michigan to the interstate nurse licensure compact (NLC). The NLC allows registered nurses to have one multistate license with the privilege to practice in their home state and other NLC states. However, permanent relocation to another compact state requires obtaining licensure in the new state. HB 4042 was sponsored in 2019 by Rep. Mary Whiteford (R-Casco Township) and has been supported by the MHA. The bill now moves to Gov. Gretchen Whitmer’s desk for signature.

The COVID-19-related legislation most notable for hospitals was Senate Bill (SB) 1253, introduced by Sen. Lana Theis (R-Brighton Township), which would make changes to the ability of the director of the Michigan Department of Health and Human Services to issue emergency orders. Under the bill passed by the Senate, emergency orders would be valid for 28 days before needing to be approved by a vote of both legislative chambers. The MHA opposes the bill, which did not receive a Senate committee hearing and now moves to the House of Representatives for consideration.

The Senate also passed a pair of bills that would extend unemployment insurance (UI) benefits through March 31. SBs 604 and 749 would extend unemployment benefits from 20 to 26 weeks, continue to not charge employers’ individual accounts for COVID-19-related claims, allow employees to use UI for COVID-19-related absences, and continue to expand the UI Workshare Program until April. Additionally, SB 604 would create an exception for disqualification from UI benefits for individuals who can show that a documented case of domestic abuse led to their inability to work. The bills were introduced by Sens. Curtis Hertel (D-East Lansing) and Jim Stamas (R-Midland). The MHA supports both bills, which now await further consideration by the House.

Members with questions on HB 4042 should contact Paige Fults at the MHA. Other questions on legislative action can be directed to Adam Carlson at the MHA.

Combating the Novel Coronavirus (COVID-19): Week of June 29

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.

State Budget Deficit Deal Contains no Healthcare Cuts

Gov. Gretchen Whitmer and legislative leaders announced June 29 they reached an agreement to resolve the fiscal year (FY) 2019-2020 budget deficit. The deal uses a combination of funding from the state Budget Stabilization Fund, federal Coronavirus Relief Funds (CRF) and cuts to the state budget. No cuts to healthcare were announced in the information provided.

In a joint release, Senate Majority Leader Mike Shirkey (R-Clarklake), House Speaker Lee Chatfield (R-Levering) and the governor spelled out approximately $900 million in spending from the federal funds for schools, hazard pay for teachers, replacement funds for colleges and universities, and new funds for local governments. Together with what was appropriated earlier in June, the state will have allocated $3 billion of its existing CRF. The budget also recognizes the benefit of the enhanced federal Medicaid matching funds, which brings $340 million to the state for the current fiscal year.

The budget agreement includes $490 million in savings to state government. This includes state layoffs, furlough days and budget cuts. The MHA does not believe rural hospitals or labor and delivery funding for small and rural hospitals is at risk. The association will continue its efforts to ensure the appropriations for hospital Medicaid funding remain in place and continue into FY 2021. For more information about the FY 2020 budget agreement, contact Adam Carlson at the MHA.

Additional Allocation and Guidance Announced for Remdesivir

The U.S. Department of Health and Human Services (HHS) announced June 29 an agreement with drug maker Gilead Sciences to allow U.S. hospitals to purchase, through September, up to 500,000 treatment courses of remdesivir, the antiviral drug that has shown encouraging results in treating COVID-19 patients. As with the 120,000 treatment courses donated earlier by the drug maker, the HHS and state health departments will allocate them based on hospitalization data.

Under the agreement, hospitals will pay no more than the wholesale acquisition price for the drug, up to $3,200 per five-day treatment course. To make future allocations of remdesivir, the HHS will be asking hospitals and health systems to submit data every two weeks.

The state of Michigan recently updated guidance for the use of remdesivir, which is available through the June 30 COVID-19 update that was emailed to members. The state is also asking for the completion of a two-part survey during treatment. Part 1 of the survey identifies the patient’s profile and demographics and is due within 24 hours of starting the medication. Part 2 is a patient follow-up survey that captures outcome data. Members with questions may contact Laura Appel at the MHA.

One COVID-19 Data Submission Can Now Fulfill EMResource and NHSN Requirements

The state of Michigan has started the process of uploading COVID-19 data from EMResource into the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN) COVID-19 Module. This process will allow hospitals to enter data in the EMResource system with no duplicate data entry into the NHSN COVID-19 Module.

To facilitate this, hospitals must enter the NHSN ID associated with each facility in EMResource, ensure the mandatory baseline data elements have been entered, and update within 24 hours any EMResource data elements that correspond to the NHSN COVID-19 Module data elements. The upload process will occur daily for data entered by 5 p.m. Hospitals should log into the NHSN system the following day to verify the data was uploaded correctly. Members with questions on the process should contact Jim Lee at the MHA.

AHA Releases New COVID-19 Financial Impact Report

The American Hospital Association (AHA) released a financial impact report June 30 that estimates at least an additional $120.5 billion in financial losses for the nation’s hospitals from July 2020 through December 2020, due in large part to lower patient volumes. These estimates are in addition to the $202.6 billion in losses the AHA estimated between March 2020 and June 2020 in a report released in May. This brings total losses for the nation’s hospitals and health systems to at least $323.1 billion in 2020. The MHA is regularly collecting data from members on the financial impact the pandemic is having on Michigan hospitals. For more information, contact Jason Jorkasky at the MHA.

Delays in Unemployment Insurance Benefits

Some people who filed unemployment claims due to the COVID-19 pandemic have not received their unemployment benefits or are receiving them sporadically. The Michigan Unemployment Insurance Agency (UIA) is experiencing a backlog due to the extraordinary volume of claims received, the surge of fraudulent identity theft claims that recently occurred, and the limitations of work volume that can be completed by the UIA’s adjudication staff. The UIA has announced that it is working to resolve the backlog of claims and has indicated that all claimants who are eligible for benefits will receive them. Members with questions related to unemployment claims 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 COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the Michigan Department of Health and Human Services Community Health Emergency Coordination Center (CHECC). Members with MHA-specific questions should contact the following MHA staff members: