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State of Michigan Coronavirus Updates


LeadingAge Michigan is the convener for policy and advocacy discussions around critical senior issues for not-for-profit and mission based providers. We partner with a broad base of like-minded entities focused on policies that support member ability to serve Michigan seniors. This page is designed to provide a current set of resources that will assist in maintaining a safe and calm environment during the potential pandemic that is now developing.

 

 



Date


Resource

Description
8/31/2020




MDHHS CARES Act Funds for Nursing Homes




Last week, the Department issued guidance on a new program to assist with infection control resources for nursing homes which can be funded through the CARES Act. The application and information can be viewed here.


8/28/2020








MDHHS Releases PPE Funding for Front Line Workers







The department has finally released funding applications and guidance for use of CARES Act dollars dedicated by statute for PPE for front line workers. The grant funds can cover costs for up to 90 days of PPE for workers in long term care facilities, dialysis centers, outpatient centers, home health care, residential congregate facilities as well as other providers. More information is available. Applications will be accepted through Tuesday, September 8 and is available on the Michigan PPE Grant Program webpage.


8/28/2020
















MDHHS Updates Nursing Home Testing FAQs
















Today, the Department issued a brief update to Nursing Home testing Q/A – but note this does not reflect any of the federal changes in testing guidelines issued this week. However, there were two important new messages:

• The likelihood of false positives using any type of COVID diagnostic testing is very low. And the likelihood of false negatives is much higher. Because of that, it should never be assumed that a positive finding is truly false – especially if the support is based on a subsequent negative test. Since it is the negative test that is more likely inaccurate, all positive findings must be treated and addressed as any other positive even if there are concerns about the accuracy of the finding.
• Staff who work in multiple care settings and are tested positive must be reported by each care setting to all the appropriate authorities, since the persons may have had contact with each, and each must consider it an outbreak.
MDHHS SNF COVID19 Reporting FAQs V4 08.28.20.pdf – as of this afternoon the website has yet to be updated.


8/21/2020







Eye Protection Reminder







LeadingAge Michigan continues to receive questions about the PPE requirements for both transmission based precautions and standard precautions in all long term care facilities. CDC guidance now recommends the use of eye protection through face shields or eye goggles for all areas where there is moderate to substantial transmission. MDHHS Guidance (updated 8/6/2020) requires eye protection for all long term care settings across the state.


8/21/2020









MDHHS Guidance on Placement of Medicaid Residents








This is a reminder that placement of Medicaid Beneficiaries into non-Medicaid beds is still allowed under MSA 20-16. Recently, the Department issued L 20-44 to clarify how to transition back to normal use of beds.

L-20-44 includes a log that was issued in pdf format to be used to document placement, payer sources, and dates that Medicaid beneficiaries into non- Medicaid beds. There is now a ‘fillable’ excel file to be used for that purpose.


8/20/2020













LTC Ombudsman to Resume In-Person Visits













The Aging and Adult Services Agency with the Michigan Long Term Care Ombudsman Program have developed guidance for in-person visits. Ombudsman visits are no longer restricted according to the MDHHS Epidemic Order issued on June 30. The links documents below provide more information about this new guidance.

 



8/18/2020





























MDHHS Update on Provider Relief Funds





























Today, MDHHS issued a program letter describing the requirements for Provider Relief funds through the CARES Act. The deadline for applications has been extended to 8/28/2020. Eligibility requirements include:

• Medicare fee for services billed for during CY2019 or
• Medicare Part A Providers who experienced a change in ownership and billed in 2019 or 2020 but precluded from receiving Phase 1 payments or
• Medicaid services billed during CY2018 or CY 2019

Additional requirements
• Filed a federal income tax return for FY 2017, 2018, 2019 or be exempt
• Provided services after January 31, 2020 (including health care, services and supports provided in a medical setting, at home, or in community
• Did not permanently cease service provision
• Did not receive a total distribution to date equal to 2% of annual patient care revenue
Applications must be submitted to the portal by 8/28/2020.

Resources
Information on the Provider Relief Fund
FAQs about the Provider Relief Fund
>> Click on “FAQs”
CARES Act Provider Relief Fund Payment Attestation Portal
Slide Deck on Application Process
Application Instructions
Updated Application

Contact the HRSA Provider Support Line at 1-866-569-3522 for questions.


8/12/2020







LARA Updates HFA/AFC FAQs







Yesterday, the Bureau of Community Health Systems updated its Frequently Asked Questions document related to COVID to address Executive Orders 2020-156 and 2020-169. It appears that the only changes include updates to the new executive orders that replaced earlier executive orders and no content changes are identified. However, we will review the FAQs at our next Safe and Calm Webinar on August 19.


8/12/2020

















Antigen Testing Update

















Today, MDHHS sponsored a conference call with Michigan providers who are prioritized to receive the first Point of Care Testing Equipment through HHS. Although antigen tests have less sensitivity and specificity than PCR testing, they are very rapid and cost effective.

These tests can be conducted using nasopharyngeal, nasal or oral swab and looks for a specific protein of the virus. In order to use the test, providers will need to have a CLIA certificate waiver. The tests are not meant to necessarily replace PCR testing, but can be helpful in certain situations. They can provide a rapid result for symptomatic persons in areas where there is high transmission, in areas where there is an acute outbreak, to triage care and services, testing in congregate care settings where there are confirmed cases, and in remote areas where access to laboratory testing may be difficult.

The test is not meant as a screening for asymptomatic individuals. We will discuss POC testing during our next Safe and Calm Webinar on 8/19/2020.


8/12/2020






Assisted Living Provider Relief






LeadingAge continues to collect information about private pay assisted living providers who have not received provider grants to date. HHS may (it is not confirmed) provide some provider relief grants to these types of grants. Members who fall into this category and have not yet submitted can complete this template and send to Nicole Fallon at nfallon@LeadingAge.org.


8/11/2020








Governor Issues Executive Order 169








Late yesterday, Governor Whitmer extended the provisions in Executive Order 148 by issuing EO 169. The press release noted the Governor’s ongoing concern with the health and safety of Michigan nursing home residents. This extends the requirement to cancel communal dining and group activities, with some protections for both staff and residents in nursing homes, homes for the aged, adult foster care, and assisted living through September 7. Minimal changes were made to the provisions in alignment with updated CDC guidance.


8/11/2020









MSA-20-57









Today, the Medical Services Administration (Medicaid) issued a bulletin that provides temporary flexibilities in terms of Medicaid payment for COVID specimen collection for specific provider types. Members should note that nursing homes and home health agencies are not included in the list of providers eligible to receive Medicaid payments. Members should also note that this is completely separate from the current reimbursement process for specimen collection supported by state funding. Reimbursement for specimen collection and testing will continue as those payments are supported by grant funding.


8/6/2020








Nurse Aide Clinical Training








Although we have been awaiting guidance from MDHHS and perhaps MDLARA about allowing nurse aide clinical training, BCHS has issued guidance on nurse aide training that identifies that clinical training in SNFs is allowed. The Bureau of Community and Health Systems has issued an alert for training programs that allows them to use alternative clinical sites other than SNFs if a SNF chooses to restrict entrance to students. Or they recommend training programs attempt to find another SNF.


8/6/2020


















Nurse Aide Virtual Classroom Hours


















The Bureau of Community and Healthcare Systems has approved an alternative option to the in-person, face to face classroom requirements for all state approved nurse aide training programs. During the state of emergency, the Bureau will approve online, virtual classroom sessions for those programs that wish to offer an alternative to in-person classroom education.

These online classes must provide the opportunity for students to interact and engage with the instructor teaching the lesson. The nurse aide trainer must be present and available during each session. Each program that wishes to use online classes must track and audit classroom hours to ensure that they meet the minimum requirements of 34 hours. This audit must be maintained and available for review by the Bureau.

All laboratory and clinical requirements remain in effect. Programs should submit a nurse aide training program application, indicating a change, and then detail that change to the classroom hours in a separate piece of paper for approval by the Bureau.


8/6/2020







Attorney General Focuses on Long Term Care Facilities






This morning, Attorney General Dana Nessel issued a press release detailing efforts to enforce Executive Order 2020-148 that includes protections for residents in nursing homes, homes for the aged, adult foster care, and assisted living facilities. As part of these efforts, MDLARA will refer complaints involving violations of various protocols as outlines in the executive order who will launch a formal complain if needed.


8/3/2020




















Attorney General Focus on Long Term Care




















Today, LeadingAge Michigan received a draft press release from the Attorney General’s office that focuses on enforcement of Michigan Executive Orders governing the response to the pandemic by long term care facilities. They have informed us that at this point, there is a plan to issue this press release on Wednesday. The documents cite Executive Order 2020-148 that outlines protections for residents and staff, and identifies requirements for transfers related to COVID-19.

Additionally, they call out the need to cancel communal dining and group activities, implement disinfection and sanitation regimens, availability of personal protective equipment, sharing of pertinent information about COVID status, and barring evictions for non-payment.

The Attorney General’s office is coordinating this effort with MDHHS and MDLARA. MDLARA will be referring any complaints received involving potential violations of safety protocols outlined in EO 2020-148 to the Attorney General’s Office. Willful violations of an Executive Order are considered a misdemeanor, punishable by a $500 and/or 90 days in jail.



7/31/2020















Attorney General’s Office Plans Compliance for LTC














Today, LeadingAge Michigan was informed by the Attorney General’s Office that they along with MDHHS and MDLARA will be working together to enforce compliance of executive orders in long term care facilities. Specifically mentioned was communal dining, group activities, evictions, and how consumers can file complaints. The AG also wanted to remind members that a violation of the Governor’s Executive Orders is a misdemeanor with the possibilities of a $500 fine and 90 days in jail.

The Attorney General will be issuing a press release on Monday and we will continue to monitor details as they are known. LeadingAge Michigan will be drafting some talking points, so please continue to monitor the Association Listservs.

Politics in Lansing and Michigan overall are running high right now related to long term care facilities and we wanted to get this information out as soon as possible.


7/31/2020




Governor Vetoes SB 956 – The Lucido Bill





This afternoon the Governor vetoed the legislation intended to create eight dedicated regional hub facilities for post-acute and long term care residents who are positive for COVID. These facilities were to be the only facilities to serve these residents.


7/31/2020






















MDHHS Again Updates SNF Reporting FAQs 7/31/2020






















The Department has highlighted the most recent changes to the Frequently Asked Questions.

• MDHHS uses the same definitions as the CDC for all shared data elements as reported on the NHSN Report. Facilities are encouraged to check the resources on the CDC NHSN LTC COVID Module website weekly.
• Individuals who test positive as part of the facility pre-employment process does not have to be reported into EMResource (just as negatives would not be included). Once the new employee would be subject to regular testing, only then would the results be included in daily EMResource Reporting.
• MDHHS does not have the ability to make historical data corrections to data that is pushed to the National Healthcare Safety Network. Facilities must log into the NHSN and manually correct any data reporting errors. There are two methods for data correction in the NHSN portal.
Correcting a single data
Correct Multiple Errors

MDHHS Updates DCW Supplemental Payments FAQs 7/30/2020
• Facilities may submit for reimbursement of initial testing costs that occurred as early as Governor Whitmer’s declaration of state of emergency (March 10, 2020). Documentation in the facility Testing Plan must substantiate the initial testing time period requested for reimbursement.


7/30/2020







MI Safe Start Order Revised







On Wednesday, Governor Whitmer issued Executive Order 2020-160 and 2020-161 that respectively amend both the MI Safe Start Order and work place safeguards. Starting on Friday, July 31, indoor gatherings are limited to ten persons and bars will be closed for all indoor service if they earn more than 70% of sales from alcoholic beverages. The Governor tied the need for additional protections to a resurgence in transmission related to social gatherings. Click here for a summary.


7/29/2020










Be Prepared to Vaccinate










MDHHS today issued a notice that the COVID-19 vaccine is expected to be available in the near future. Long Term Care facility residents and direct contact staff will be considered a high priority for vaccination. All vaccine administration must be reported to MCIR – the Michigan Care Improvement Registry. Please ensure that your facility is enrolled in MCIR.

Staff can assist with the registration process and training on reporting of influenza vaccinations in preparation for COVID – 19 vaccinations. Steps to register prior to training can be viewed by clicking here.


7/27/2020










































MDHHS Updates Guidance for Test Reimbursement









































In response to member concerns and questions about Medicare A FFS consolidated billing requirements in nursing homes, MDHHS has updated its guidance for COVID test reimbursement. Updated documents can be found on the Long Term Care website.

Highlights from the FAQ:
• When a new COVID infection is identified in a health care professional or nursing home onset case in a resident, viral testing should be performed for all residents and staff as soon as possible. Continue repeat viral testing of all previously negative residents and staff, generally between every three and seven days, until the testing identifies no new infections among residents or staff for a period of at least 14 days since the most recent positive result. CDC has provided updated guidance and FAQs regarding retesting residents or staff who have tested positive:
o If resident or staff was confirmed positive within the past three months and are now asymptomatic do not retest as part of facility wide testing. (Do NOT repeat testing for three months following onset if asymptomatic.)
o After three months, include in facility wide testing.
o If positive resident becomes symptomatic within three months of a positive test after recovering from initial illness, evaluate. Retesting may be warranted
o For residents who become symptomatic AFTER three months beyond onset, retest and if positive consider potentially infections and remain in isolation precautions until discontinuation or return to work criteria have been met.
o A test based strategy should be conducted for anyone who has tested positive and who are severely immunocompromised. For all others, a test based strategy is no longer recommended except in rare instances.
• Testing:
o When exposure has been identified, facilities should test all other residents and staff as soon as possible. Depending on the timing, the next scheduled weekly round of testing may be the most practical.
• Labs should bill for residents covered under all Medicaid and Medicare products except patients under a Medicare Part A stay, rather than billing Medicare. MDHHS has updated its final guidance to reflect that MDHHS will reimburse the full lab cost of the test for private pay residents, residents under a Medicare Part A stay and staff tests. MDHHS will not reimburse testing for Medicaid residents and Medicare residents not covered under a Part A stay – these should be covered and billed by the laboratory. For testing of staff with Medicaid as insurance, Medicaid should be billed.

Note that MDHHS has yet to issue final guidance, and that the process and policy have been derived through meetings and the issuance of a FAQ document. The entire process and updates will be reviewed in our next Wednesday Safe and Calm Webinar.

7/23/2020











Connect to Care











Several weeks ago, MDHHS issued a notice that encouraged long term care providers to use CONNECT to CARE, a network that is designed to assist job seekers and facilities with staffing needs. Shortly after, MDHHS noted that the network was not yet ready. A press release issued today publicized the network with acknowledgement that MDHHS was promoting it. This employment website will match job seekers with licensed long term care facilities that have need for short and long term positions, including CNAs, RNs, and LPNs. The website allows licensed facilities to identify gaps that they have on particular days and professionals can register their availability and willingness to fill shifts. Visit www.ConnectToCareJobs.com.


7/22/2020















MDHHS Applications for Provider Relief Funds















Today, the Department issued L20-40 to detail specifics about the Medicaid Targeted Distribution funding for COVID 19. The deadline has been extended to 8/3/2020 Webinars to explain about the opportunity will be held on Monday, July 27.

• MDHHS Webinar: Monday, July 27 at 1:00. Event Registration (registration not required). Event Login.
• HHS Health Resources and Services Administration: Monday, July 27 at 3:00 Event Registration.

Providers can visit www.hhs.gov/providerrelief for more information.

L 20-40-rev 7-22-20



7/20/2020







MI Safe Start Map Revised







As of today, July 20, 2020 – many of the eight regions have demonstrated increased risk across the state: Lansing and Grand Rapids Regions continue to have high risk; Detroit continues to be in medium-high risk, and Kalamazoo, Jackson, Saginaw, and the Upper Peninsula have all also moved to medium-high risk. Only the upper portion of the lower peninsula (Traverse City Region) is now at medium risk.


7/20/2020






Direct Care Worker Wage Increase







MDHHS has issued a FAQ Document that describes how nursing facilities are to pay and receive reimbursement for the Direct Care Worker Wage Increase. The guidance and reimbursement form are listed below.

Direct Care Worker Wage
MDHHS SNF COVID-19 FAQs


7/13/2020














MDHHS Updates Guidance for Testing and Reporting













Late on Friday, MDHHS sent out updated resource documents for Nursing Home Testing and Reporting. Note that the new testing reimbursement form now includes laboratory expenses. Updates have also been made to the FAQs. We will review these updates during our Wednesday Safe and Calm Webinar.



7/13/2020











Recent Michigan Executive Orders Impact Members











Today, Governor Whitmer issued executive orders pertinent to LeadingAge Michigan members. The first was EO 2020-148 which rescinds EO 2020-123, an extension of the requirements to use dedicated units and regional hubs for COVID care. This order covers requirements for nursing homes, assisted living, AFCs, and HFAs. There has been no change to the overall guidance which is now extended to August 10.

Executive Order 2020-150 was also issued today as a revision to EO 2020-61, which is now rescinded. The order rescinds most of what was included in 2020-61 except for exemptions to credentialing requirements. Click here for a detailed review of provisions that have been rescinded.


7/13/2020





Michigan Issues Workplace Safety Toolkit






Through Executive Order 2020-147, Governor Whitmer addresses that businesses must require persons to wear a face covering while accessing indoor public services. Today, the Administration has posted several resources to support that order and for workplaces to meet the requirements. Electronic resources for WorkPlace Safety and Best Practices are available.


7/9/2020





Implicit Bias Training for Health Professionals





This afternoon, the Governor signed an Executive Directive that will require training on Implicit Bias Training for health professionals who are licensed or registered in the state of Michigan. The Department of Licensing and Regulatory Affairs will be developing rules in the near future.


7/6/2020

















MDHHS Rapid Response Staffing

















The Department is offering Rapid Response Staffing in select counties to assist long term care facilities who may be experiencing staffing shortages. This option is open to nursing homes, assisted living centers, homes for the aged, and adult foster care in the following counties:

• West Michigan: Kent, Ottawa, Allegan, Muskegon, Newaygo, Montcalm
• Southeast Michigan: Wayne, Oakland, Macomb, Livingston, Washtenaw

Up to 72 hours of consecutive staffing assistance can be provided by 22nd Century Technologies – and facilities may request up to one RN and four CNAs per shift. Facilities must demonstrate that they meet the criteria and complete a survey within 24 hours of requesting staffing resources. If a facility fails to meet the criteria or fails to submit the survey within 24 hours of requesting staffing, the facility will be billed by MDHHS for the staffing costs.

Questions can be directed to MDHHS-LTCStaffing@michigan.gov.


7/6/2020

















MLARA and Health Facility License Renewals

















Nursing Facilities and hospice agencies/residences must renew their license on or before July 31, 2020. Licenses that are not renewed by that date will be null and void on 8/1/2020. Process for renewal includes the following steps:

1. Go to www.michigan.gov/elicense
2. Scroll down to bottom of the page and select Renew a Health Facility License.
3. Enter the license number in the Permanent ID field and select the Login button by clicking on it. Note: Pushing the return button on the keyboard will not work for this step.
4. Select Pay For License on the menu on the left side.
5. Select Continue in the upper left corner of the box containing the license information.
6. Follow the prompts to provide electronic payment information for the license renewal fee.
7. Print the receipt for the payment, this is the only opportunity to print a receipt for the payment.


7/1/2020






















Nursing Home Testing Guidance – UPDATED TODAY!!





















MDHHS has posted an updated Nursing Home COVID-19 Testing Financial Guidance to Nursing Home COVID-19 Plan. Please note in particular the following change in submission email below and important reminder about submission of confidential or sensitive data:

  • Effective July 6th, all Nursing homes should begin submitting their testing reimbursement forms to the Bureau of Audit at: MDHHS-SNF-Testing-Financial@michigan.gov.
  • Please submit the testing reimbursement forms only. Please do NOT send any confidential information or beneficiary specific data to the above email.

Documents attached include:

Please note that the email for submitting testing reimbursement forms has changed to the above.

7/1/2020

















MIHAN/ MSP Communications 

















During this pandemic emergency, MDHHS has been sending out many of its updates through MIHAN – the Michigan Health Alert Network. This is a web-based communication system established by MDHHS and other entities to alert key public health, healthcare and public safety

personnel to situational awareness and important, but non-emergency health related information.

We have recently noted that some members may not be familiar with or registered with MIHAN; and some have found the registration process difficulty and lengthy. We are working with MDHHS to determine how best to assist members in registering and will provide updates as we receive information.

Many communications have also been issued via the Michigan State Police – as part of the pandemic response. The first messages about the Visitation Guidance were received through that mechanisms. Members who wish to receive their alerts can sign up here.


7/1/2020






















Senate Bill 690 Signed Today






















Moments after our Wednesday, July 1 Safe and Calm Webinar, Governor Gretchen Whitmer signed Senate Bill 690 into law. As reviewed in detail in our June 19th edition of the latest wrinkle, Senate Bill 690 distributes $880 million of the states COVID-19 relief funds. Long term care highlights include $120 million for an increase in hazard pay for direct care workers, $25 million in grant funds for PPE and Testing and $1.5 million for Infection Control surveys overseen by LARA.

Currently, very little is known about how these funds will be distributed. The bill puts the direct care worker funds and grant funds under the preview of MDHHS who is currently working to interpret the legislative intent behind the funds and design an effective process to release the funds to providers. LeadingAge Michigan is currently working with the department and has suggested feasible solutions for the rollout of these programs. Suggestions include:

• The $2 per hour increase for Hazard pay begin recognized as a wage pass through in order for it not to effect the reimbursement system
• A PPE and Testing Grant application and process that includes the full continuum of care when allocating grant finds.

Questions can be directed to Dalton Herbel at Dalton@leadingagemi.org.



6/30/2020


















MDHHS Issues Updated Guidance on Visitation


















Visits may be made to residents in residential care and independent living facilities only for the following purposes:

• To ensure effective communication for those with hearing, vision, or speech impairments that could assist with addressing resident’s condition such as refusing to eat or to allow assistance with feeding to ensure adequate nutrition.
o Visitors must wear a mask at all times and use appropriate procedures for any assigned ADL tasks. The facility must ensure compliance through training.
o Such visits must be scheduled in advance and for individualized ADL tasks
o And must occur in the resident’s room if private, or in a room designed
• When a resident in in serious or critical condition or in hospice care, consistent with EO 2020-136
• For residents who need ADL assistance from families, facilities must attempt to contact the resident’s next of kin to establish arrangements
• There are numerous additional visitation rules
For purposes of this order, residential care facilities include nursing homes, assisted living, homes for the aged, adult foster care, independent living, hospice and substance abuse disorder facilities

6/30/2020







Governor Maintains Risk Levels







Governor Whitmer today stated that she planned to move the state into lower risk categories by the July 4 holiday, but cannot do so since there are increases in new COVID cases across the state – most notably in Lansing and Grand Rapids. Lansing moved from a medium risk area to a high risk area. And Grand Rapids moved to a medium-high risk area. While many of the instances can be traced to local events, there is also community spread occurring.


6/30/2020





















FY2020 Budget Shortfall Resolved





















This past weekend and late Sunday evening word starting leaking out about a bi-partisan budget agreement between the Michigan legislature and the Governor’s Office for FY 2020.

We have attached for your review a short one page summary that is presently being circulated around town explaining how the $3B budget shortfall has been resolved even without projections from the much-anticipated revenue estimating update scheduled for August. In general, it looks like the General Fund shortfalls will be backfilled by funds from the CARES Act and other transfers and shifting of funds to make the numbers add up.

The next challenge is the FY2021 budget that must be finalized in September. We suspect that this current agreement for FY2020 will kick the hard decisions to the FY2021 Budget and those who in the House will need to use the summer to campaign on those issues. Selfishly, we want to make sure that our member’s Medicaid rates and reimbursement models are not disrupted. LeadingAge Michigan has already reached out to MDHHS to initiate preliminary discussions knowing that there will be approximately an 18% savings in the Nursing Home Medicaid line due to lower utilization.



6/30/2020

























Provider Relief Fund and Medicaid

























Michigan Medicaid providers who meet the following criteria can apply for relief through the CARES Act:

• Must not have received any payments from the $50 billion General Distribution
• Must have directly billed Medicaid for healthcare services during CY2018 or CY2019 or own a subsidiary that has done so either through a FFS or managed care mechanism
• Must have provided patient care after January 31, 2020
• Must not have permanently ceased providing patient care
• Must have filed a federal income tax return for either 2017, 2018, 2019 or exempt
• Individual providers must have gross receipts from provider care reported on Form 104, schedule C, line 1, excluding income reported on a W-2 as an employee

Applications must be made through the CARES Act Provider Relief Fund Payment Attestation Portal by July 20, 2020. Providers must attest to certain conditions in order to receive funding.

Resources

 

6/29/2020




MDHHS Extends Dates for Nursing Facility Satisfaction Data



Today, the Department issued a Medicaid Letter (L 20-36) identifying that the annual Resident Survey Data necessary for the Quality Measure Initiative must be submitted electronically by September 18 to MDHHS-NFQMI@MIchigan.gov.


6/29/2020























MDHHS Extends CMP Grant Deadline























The Department has extended the deadline for applications for CMP funding in support of telecommunications to August 1, 2020. MDHHS today sent the following message to providers:

You must send the CMS application template and Excel spreadsheet. Please note:

1. Send the Excel spreadsheet, not a PDF of the spreadsheet.
2. One nursing home per application.
3. Include a contact person at the nursing home.
4. Include the NPI.
5. Large facilities may submit a request for more than $3,000 if it fully complies with the guidance.
6. Please check your math. Avoid having your application returned to you.

Send your applications to MDHHS-CMPGRANTS@Michigan.gov. The subject line of the email should include the facility name and “CMP electronic device grant”
The application and spreadsheet can be downloaded from the MDHHS CMP webpage.

Or Michigan Department of Health and Human Services >Doing business with MDHHS>Health Care Providers > Civil Monetary Penalty (CMP) Grant Program.



6/26/2020

















MDHHS Issues Updates on Testing

















Yesterday, MDHHS issued testing updates via MIHAN. These documents include funding plans and other updated FAQs. Members should note that while MDHHS encourages facilities in Regions 1 through 5 and 7 to complete testing as soon as possible, MDHHS will not engage in enforcement actions if compliance is achieved by July 17. LeadingAge Michigan will continue to review the implications of these updates, and review during our next Wednesday Safe and Calm Webinar.

 

6/26/2020


















Executive Orders Extend the Status Quo


















Governor Whitmer issued two executive orders addressing Michigan nursing facilities at this point in the ongoing pandemic. Executive Order 136 is a direct extension of EO 108. As written, there are no changes to visitation for nursing homes, assisted living, homes for the aged, adult foster care, or independent living. MDHHS has voiced concerns that while the caseload numbers are rising, this may not be the time to reopen visitation to vulnerable seniors.

However, in a call with Kate Massey from MDHHS this afternoon, the state remarked on their plans to send out additional guidance early next week that is more in alignment with the recent CMS FAQs. More details will be available at that time.

Additionally, through Executive Order 135, a bipartisan task force has been created to ‘analyze relevant data on the threat of COVID in nursing homes and making recommendations’. David Herbel, LeadingAge President and CEO will be sitting on that Task Force.



6/24/2020













Michigan Executive Orders and MDHHS and Reimbursement for Testing












MDHHS is working with provider groups in developing process to assist members in recouping costs for serial staff testing and we are in the process of discussing their process for covering nursing home costs. Members can look for Guidance this week (hopefully) we have communicated that there is significant work in getting all staff tested (in certain regions) by July 3 and that close deadline seems unrealistic.

LeadingAge Michigan anticipates hearing about EO 108 and whether or how the Governor may wish to extend that visitation guidance. Members can review the workgroup recommendations that went to the Governor and MDHHS/MDLARA below. EO 108 is due to expire on 6/26/2020. EO 123 that defines use of Regional Hubs and other restrictions is still in force until 7/12/2020.



6/24/2020










Resumption of Testing for CNAs











Jim Wiggins, BCHS, has informed the Association that “Prometric has 62 tests scheduled for July at 12 different locations. They can test a maximum of 8 at each test and location, so they can only do 496 candidates in July. They are looking to ramp it up and have more locations and testing in August. Many of the previous testing centers either are waiting to open or have decided they no longer wished to be testing centers. Prometric will be looking to replace those that didn’t so as to get more tests done. It is going to take probably at least 3-4 months to get through the candidates already waiting. More test centers will be opening. It’s my understanding there are more than 1800 waiting to test right now.”



6/22/2020









MDLARA Planning for Infection Control Inspections








The Michigan Department of Licensing and Regulatory Affairs is currently drafting a plan for infection control surveys in accordance with Michigan legislation providing $1.5 million for these additional activities. They are currently reviewing a three phased approach – hiring, consultative visits, and unannounced inspections. Note that these inspections are state driven and in addition to any federally required survey inspections. The Department plans to share its planning and obtain input from LeadingAge Michigan and other providers.



6/22/2020




Governor Extends State of Emergency to July 16



 
In Executive Order 2020-127, Governor Whitmer extended the Michigan State of Emergency to July 16, citing the need to continue aggressive action to contain the virus which slowly reopening the businesses within the state.


6/18/2020




 
6/16/2020



Executive Order 2020-123 extends 2020-50/95 to July 12, 2020.


This order describes the requirements for transferring and discharging residents, and use of regional hubs. There are no new provisions in this guidance.


6/11/2020



























Bureau of Fire Safety will Resume Onsite Inspections


























Effective June 15, the Bureau of Fire Safety will be resuming onsite inspections for regulated healthcare facilities. Inspections will restart with priority to the most overdue for annual visits. Normal inspection rotations will resume for facilities who have not experienced delays in inspections. These inspections will be allowed under Executive Orders that limit certain visitors to healthcare facilities.

  • All inspections will be scheduled with the facility no more than 24 hours in advance. Inspectors will wear a mask, maintain social distancing (when possible) and take other precautions while onsite. The inspector will go over information needed for the inspection, additional precautions and procedures that we will be using during the inspection.
  • Prior to confirming the inspection, the inspector will verify if there are any Covid-19 positive residents or staff in the facility or if there are any suspected Covid-19 that is waiting on confirmation. If Covid-19 is present or suspected, an inspection will not be conducted at this time and you will be requested to complete a self-inspection checklist. It will not be counted as your regular inspection and licensing is aware of these delays in your fire safety inspections.
  • System inspections (fire alarm, sprinkler, hood, etc.) may be out of date due to visitor restrictions. BFS will not be taking adverse actions against facilities until restrictions are lifted and facilities have a period of time to come into compliance. Temporary approvals may be issued in those instances.
6/11/2020








Michigan Works to Contain COVID-19 








UK’s Imperial College has released a report demonstrating that through aggressive actions, Michigan was able to lower the spread of COVID significantly and few states dropped their infection rate as low for as long as Michigan. Social distancing was a critical element in reducing transmission, and careful monitoring and mitigation is critical to avoiding a resurgence, according to the Governor’s press release.



6/1/2020






Executive Order 2020-108 Extends Restriction for Health Care Facilities





On Saturday, Governor Whitmer extended the provisions of EO 2020-72 through June 26, 2020. EO 2020-108 continues restrictions on visitation and the need for screening persons entering the facility for nursing homes, adult foster care, homes for the aged, and independent living facilities. The directive also continue to require that all persons where a mask when in public indoor venues.


6/1/2020























Governor Moves Michigan to Phase IV
























This afternoon, Governor Whitmer announced the relaxation of the Stay at Home orders, through Executive Order 110. Michiganders are no longer required to stay at home. Certain businesses will remain closed. Any work that is capable of being performed remotely must be performed remotely.

Workplace rules as identified in EO 2020-97 still apply as indicated in that directive. Retailers will be allowed to resume operations on June 4. Stores may resume normal operations subject to capacity constraints and standards in EO 2020-97. Restaurants and bars may reopen fully on June 8, also subject to the requirements in EO 2020-97.

Michiganders must continue to wear face coverings when in enclosed public spaces and should continue all social distancing. Indoor social gatherings and events of more than ten persons are prohibited. Outdoor social gatherings are permitted when persons maintains a six foot distance and the assembly consists of no more than 100 persons. Indoor social gatherings continue to be restricted up to ten persons. Public swimming pools may open on June 8 with 50% capacity. Libraries and museums may open on June 8. Still closed will be theaters, gyms, non-essential personal care services, casinos, and amusement parks.

Health care facilities, residential care facilities, and congregate care facilities are not included in this directive.



5/29/2020










Resources for Homebound Seniors










The MDHHS Aging & Adult Services Agency is working with Area Agencies on Aging and federal and local partners on a number of food programs during the pandemic. One new program is the U.S. Department of Agriculture Farmers to Families Food Box. Through this program, Van Eerden Foodservice of Grand Rapids and LaGrasso Bros. Produce of Detroit will provide homebound older Michiganders with fresh fruit and vegetable boxes on weekly basis through the area agencies on aging. Information on any area agencies on aging food program can by obtained by calling the Elder Locator at 800-677-1116.



5/27/2020










Data Reporting Training for Nursing Homes










MDHHS will hold a webinar to provide an overview of the COVID-19 reporting requirements through EMResource. Data will be transmitted automatically into NHSN for those providers who have agreed to participate in that process. The training is scheduled for May 28, 2020 at 1:00 p.m.

To attend the webinar click Join Microsoft Teams Meeting
Conference phone line: 248-509-0316
Conference ID: 588 227 231#



5/27/2020


COVID-19 Reporting Instructions and Definitions for AFCs/HFAs/Assisted Living


5/27/2020









COVID-19 Reporting Requirements in Survey Gizmo for Adult Foster Care Facilities, Home for the Aged, and Assisted Living Facilities








Effective May 22, 2020, the Michigan Department of Health and Human Services (MDHHS), and in partnership with the Department of Licensing and Regulatory Affairs (LARA), requires all longterm care facilities (including Adult Foster Care Facilities, Home for the Aged, and Assisted Living Facilities; excluding skilled nursing facilities) to report specific data elements identified by the Centers for Medicare and Medicaid Services (CMS) and MDHHS. These data elements include, but are not limited to, Personal Protective Equipment (PPE) available onsite, information related to COVID-19 cases, and staff shortages. MDHHS implements this requirement pursuant to Executive Order 2020-95 (EO 20-95).


5/26/2020


A Plan to Re-Engage Michigan's Economy

 
 
5/26/2020





Governor Whitmer Issues 2020-104 





Today the Governor expanded testing availability by creating a new category of community testing site were persons can be tested without an advance order and without any out of pocket cost. Additionally, a new online dashboard has been created to inform the public of the status of the pandemic in Michigan.


5/21/2020







Whitmer Wins in Court







Just this afternoon, Judge Stephens ruled that the Emergency Powers of the Governor Act provides the authority to act and extend a state of emergency in response to legislative Republicans concerns that it was unconstitutional. However, if acting under the Emergency Management Act she would have to obtain approval from the Legislature.

 

5/21/2020












Michigan Reporting













Today, MDHHS issued provider letter L-32 that defines how the Department will transmit CMS required SNF data to the NHSN system using information collected through EMResource. Facilities can opt to continue to submit data through NHSN if they choose, but still must complete the state-required elements into EMResource.

Members wishing to take advantage of this coordination of data collection but submit additional information into EMResource on a one time basis: facility name, CMS certification number (CCN), and NHSN facility identification number. If this is not completed, MDHHS will not be able to transmit your data to NHSN. Review the updated guidance for detailed instructions on submitting data along with a few revisions.



5/21/2020










Governor Updates Executive Order 2020-50/2020-84










Last evening, Governor Whitmer re-issued her orders on protections for resident and employees in nursing facilities related to the COVID pandemic. While much of the language remained unchanged, and continued to define provisions for long term care facilities, the orders only apply to AFCs/HFAs/assisted living to a very minor degree. In a follow-up meeting with MDHHS today, Kate Massey confirmed that regional hubs continue to be designated for hospital post-acute admissions and transfers from other nursing facilities. Additionally, reporting mechanisms continue to be developed for those settings and further guidance is anticipated soon.



5/18/2020










MDHHS Continues Work on Testing Plan 










Since the National Guard completed testing of LTC Facilities in the Upper Peninsula, they will begin testing this week in Oakland, Genesee, and Kent Counties. These counties comprise Phase I of the next tier that includes Wayne, Muskegon, and Washtenaw (Phase II) and Ingham, Detroit City, Wayne, and Macomb (III). The Michigan State Police and National Guard will coordinate with local health officials in each area. Understanding that some testing has been completed, local health officials will be helping to prioritize facilities in each area where testing still needs to be completed. Orders for testing will be completed under each Medical Directors order, and testing is voluntary.



5/18/2020






Governor Opens Retail, Restaurants, and Offices in Northern Michigan






EO 2020-92 allows for the reopening of retail businesses, office work that cannot be done remotely, and limited opening of restaurants and bars. Starting on May 22, MERC Regions 6 and 8 are open to the above businesses and EO 2020-91 identifies the workplace precautions that must be taken.




5/13/2020















MDLARA Surveys AFCs/HFAs on Testing Capacity















In follow up to last week’s survey sent to nursing homes on their capacity to test residents and staff for COVID, the Department of Licensing and Regulatory Affairs has sent a similar survey to AFCs/HFAs. This information will be used to help identify where local health departments should be focusing their efforts. Currently MDHHS has a goal of 100% testing of staff and residents. Both departments will use this information, along with AFC/HFA COVID case reporting soon to be implemented as required in EO 2020-50, to prioritize need for assistance from both local health departments and iPRAT teams. Although the target date for completion of the survey is past, AFCs and HFAs can still submit their information. The link is https://dhhshivstd.iad1.qualtrics.com/jfe/form/SV_5tHPiyPwFYrwtVP. Members can contact MDHHS-ProviderQualificationCode@michigan.gov for questions and issues.





5/13/2020












Executive Order 2020-50 Expires Today 












One of the Governor’s more controversial orders, 2020-50, expires today but at this point we have no idea about how the provisions in that directive may evolve. This morning, MDHHS Director Robert Gordon, MDLARA Director Orlene Hawks, and staff responded to concerns from legislators serving on the Michigan Senate Committee on Oversight about placement of COVID positive residents in Michigan nursing homes, alongside persons who do not have the disease. Accuracies and delays in reporting were also issues, however, Director Gordon stated that the data should be improving. While significant concerns were raised about the MDHHS plan for handling persons with COVID who have post-acute or long term care needs, there was no discussion about Department next steps or potential changes in these provisions.



5/13/2020

















Governor Issues Executive Order 2020-82

















 

Today, Governor Whitmer issued EO2020-82, which extends an earlier executive order (2020-49) to June 9, 2020. This order continues previous flexibilities to address staffing and surge needs.

  • MDHHS may issue emergency certificates of need and defer strict compliance
  • MDLARA may grant hospital waivers to stand up temporary or mobile facilities
  • MDLARA may issue temporary registration as a CNA if course completed but exam not passed
  • MDLARA may renew licenses without satisfying continuing education credits
  • MDLARA may recognize hours responding to COVID-19 panic toward continuing education
  • MDLARA may allow a non-nursing assistant such as activity coordinator, social worker, volunteer to help feed or transport in alignment with care plan



5/7/2020





MDHHS Volunteer Staffing List





The Department has solicited many volunteers over the past several weeks in order to address the staffing crises caused by the pandemic. While the program has had limited success to date, interested members can use this form to request a volunteer.


 
5/7/2020





COVID-19 Health Care Jobs Portal





MDHHS and the Department of Labor and Economic Opportunity have launched a new portal to make it easier for health professionals to apply for jobs. Members interested in using this avenue to post positions can find more information here.




5/6/2020





















CDC Symptom Based Strategies and MDHHS Testing 




















Recent CDC guidance this week includes a shift from test-based to symptom-based criteria for both return to work and for discontinuation of transmission based precautions to symptom-based criteria. They state that continued testing for staff and residents may be impractical where there is continued community transmission. They have moved to a time-since-illness onset and time-since-recovery protocol although they note that practical application of a symptom based strategy will likely not prevent all infections.

Although the CDC has moved away from preferences for testing for returning to work and for removing transmission based precautions, only testing can identify the community burden since many persons are asymptomatic but may be infecting others. Currently, MDHHS is asking for detailed information about provider capabilities in terms of testing to better understand the barriers each organization may face. Yesterday, they sent a survey to all nursing home administrators in Michigan to be completed and returned by 5/7/2020 end of day. The link for the survey is included here - https://dhhshivstd.iad1.qualtrics.com/jfe/form/SV_5q0z8TV5mXV4Ilf

LeadingAge Michigan has been working with the Department to ensure that members have the support and supplies that they need. We encourage everyone to complete the survey so that the state can identify member immediate needs.

5/4/2020












Testing for Staff and Residents 












With the creation of iPRAT (Infection Protection Resource and Assessment Teams), the Department is looking closely at best ways to use these resources to assist with analyzing and mitigating COVID spread throughout residential care facilities. Since testing has lagged since the beginning of the pandemic, there is a strong focus on fostering COVID testing for staff and residents in facilities in order to determine the extent of spread. They are working with the Michigan State Police and local health coalitions to determine how much testing is going on in long term care residential settings. They will use this information to prioritize areas of need for first testing and then also additional assistance. The Department’s plan is still in draft form and we will keep members up to date as policies develop.



5/4/2020








Medical Services Administration Extends End Dates for NFLOC Determinations








On Friday, the Department issued L – 20-19 that extends the end dates for NFLOC Determinations that end between March 1, 2020 and June 30, 2020. The revised end-dates will be available in CHAMPS. Beneficiaries with existing NFLOCDs using Doors 1-8, 67, 77 with end states between March 1 and April 30 will be extended 180 days. Beneficiaries with existing NFLOCDs using Doors 1-8, 67, 77 with end dates between May 1 and June 30, 2020 will be extended 120 days. Providers must ensure that beneficiaries continue to meet eligibility criteria, and are responsible to conduct a new LOCD if there is a significant changes in condition.


5/4/2020









Michigan Executive Order 2020-72 Continues Visitation Restrictions









Late Sunday, Governor Whitmer issued EO 2020-72 which continues the restriction on visitation to health care facilities. The order specifically extends all provisions within 2020-37 to May 31, 2020 and adds that all staff and visitors of a residential care facility, congregate living facility, or juvenile just facility must wear a face covering over their nose and mouth when indoors or within six feet of another person. For purposes of this order, residential care facility means homes for the aged, nursing homes, adult foster care facilities, hospice facilities, substance abuse disorder residential facilities, independent living facilities, and assisted living facilities.


4/25/20

 

 

 

 

 



 

 

Executive Order 2020-59 - 4/24/2020

 

 

 

 

 

 

 

 

Through executive order issued yesterday, Governor Whitmer has extended stay at home provisions, while loosening some requirements for certain businesses. In general, the order does not directly affect senior living providers, although one section states that persons are allowed to visit an individual under the care of a health care facility, residential or congregate care facility, to the extent otherwise permitted. Please note that this does not mean that the visitation restrictions have changed, but that persons who are currently allowed to visit under special circumstances can do so.

 

4/25/20

 

 

 

 

 

 

 

 

 

 

 

 

MDHHS Publishes Nursing Home COVID Case Data

 

 

 

 

 

 

 

 

 

 

 

On 4/24, MDHHS issued its first publicly reported nursing home data and its current list of Regional Hub facilities. Regional Hubs include:

  • Medilodge of Grand Traverse County
  • Medilodge of Frankenmuth
  • The Lodge at Taylor
  • Advantage Living Center Northwest
  • Advantage Living Center Redford
  • Samaritan Manor

Currently there is a total of 2108 cases in nursing homes as of 4/24/20.

These topics will be discussed in greater detail during our Weekly Wednesday Safe and Calm Webinar on April 29.

 

4/23/20

 

 

 

 

 

 

 

 

 

 

 

MDHHS Refines Nursing Home Reporting Requirements

 

 

 

 

 

 

 

 

 

 

Starting on April 21, MDHHS required nursing homes to submit information to MDHHS through the use of EMResource. Members who do not currently have access to that program should contact their local public health department or local healthcare coalition.

Today, April 23, the Department has issued further guidance that expands the information required for the two categories: “COVID-19 Daily LTC Bed Availability & PPE” and “COVID-19 Daily Clinical Summary” events. All data fields in these two categories must now be completed. The reporting period includes 24 hours ending at midnight the previous night and information must be submitted by noon. This data must be submitted every day, including weekends.

 

4/22/20

 

 

 



 

 

 

 

 

 

 

 

 

MDHHS Provides Additional Testing Announcement

 

 

 

 

 

 

 

 

 

 

 

 

 

MDHHS would like to alert you to significant available testing capacity throughout the state including NxGen Laboratories, a Grand Rapids laboratory certified by CLIA for high complexity testing that uses a method of COVID-19 testing that has received Food and Drug Administration Emergency Use Authorization.

NxGen Laboratories is able to provide specimen collection materials, shipping from the collection site to their laboratory, and 48-hour turnaround on results.

MDHHS strongly encourages health care providers interested in COVID-19 testing to reach out to Laboratories as a potential partner and to promote broad COVID-19 testing for patients who may need it, especially given recent expansions in testing priority criteria.

MDHHS will alert health care providers regularly as new laboratory and specimen collection capacity becomes available in the state.

 

4/22/20

 

 

 

Clarifications for Implementation of Executive Order 2020-50

 

 

For a summary of recent updates regarding the implementation of Executive Order 2020-50, members are encouraged to review thewebinar andpowerpoint from today’s Safe and Calm Webinar.   

 

4/21/20

 

 

 

 

Latest Update on Executive Order 2020-50 and Regional Hubs

 

 

 

Last evening, MDHHS issued an emergency order to address several areas of concern during the COVID-19 crisis in Michigan. In summary, they identified that regional hubs will accept only transfers from hospitals and other nursing facilities.

 

4/21/20

 



 

 

 

MDHHS Seeks Waivers for Home and Community Based Services

 

 



 

MDHHS is seeking several temporary changes to its HCBS programs including MI Choice and MI Health Link that would increase payment rates for direct care givers, expand meal services and telehealth, cover protective equipment, relax some training requirements, and modify services to address care and safety issues during the pandemic.

 

4/20/20

 



 

 

MDHHS Details on New Reporting Requirements

 

 

 

 

Effective April 21, 2020 MDHHS will implement its new reporting requirements that nursing facilities must report. These requirements are in addition to the standard reporting to Local Health Departments. The reporting must be completed through EMResource at https://emresource.juvare.com/login.

 

4/20/20

 

 

 

 

 

 

 

MDHHS Expands Testing

 

 

 

 

 

 

 

Today, MDHHS announced that it is expanding the priority for COVID testing to include all essential workers still reporting to work in person, whether they have symptoms or not, and launched a large-scale effort with more than 2,000 volunteers to expand contact tracing capacity. This will help identify asymptomatic cases who may still be spreading the virus as they report to work. Volunteers can to assist public health efforts in contact testing at Michigan.gov/fightcovid19.

 

4/20/20

 

 

 

 

 

 

More on Michigan Executive Order 2020-50

 

 

 

 

 

After Governor Whitmer issued Executive Order 2020-50 last Wednesday evening, MDHHS held a conference call on Friday to solicit feedback and issues from the provider community. During that call, concerns about several areas were shared. This order was intended to both ensure appropriate post-acute and long term services and supports for COVID-19 affected persons as well as safeguard senior communities and their staff.

 

4/20/20

 

 

 

 

Governor Whitmer Issues EO 2020-55

 

 

 

 

Through this Executive Order, the Governor has created a task force to address the disproportionately impacted communities of color. African Americans represent 40% of COVID related deaths. The task force will be led by Lt. Governor Gilchrist and includes a long list of health care experts.

 

4/17/20

 

 

 

 

 

 

 

Executive Order 2020-50 Creating Concern

 



 

 

 

 

LeadingAge Michigan has been in frequent discussions with MDHHS about the need to provide care and services to our seniors who are highly vulnerable to COVID-19 and at the same time, protect our current residents and staff, as well as provide immunity for our members during this time of continued pandemic crisis. We believe it important to find a mechanism to deliver appropriate reimbursement and resources to providers who serve COVID-19 affected persons.

 

4/17/20

 

 

 

 

 

MSA 20-27 - MDHHS Policy for Regional Hubs

 

 

 

 

 

Regional Hubs are designed to address the care needs of the growing senior population who have contracted COVID-19. The program is intended to support hospital capacity by balancing caseload, provide capabilities needed to serve the COVID-19 population, and preserve staffing. The primary criteria for admission is the diagnosis of COVID-19 and the need for medical care or additional support.

 

4/17/20

 

 

 

 

 

 

 

 

 

 

 

 


 

Midwest Governors Partner

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yesterday, Governor Whitmer announced that the Michigan will be working with other Midwest states to coordinate reopening the economy. The Governor’s announcement focused on prioritizing worker health in that process, and using a fact-based and data-driven approach.

The Governor’s have landed on the following four factors as basic to the reopening plan:

  • Sustained control of the rate of new infections and hospitalizations
  • Enhanced ability to test and trace
  • Sufficient health care capacity to handle any resurgence
  • Best practices for social distancing in the workplace

LeadingAge Michigan will continue to monitor these developments and their potential impact on the health and safety of Michigan Seniors and our mission-based members who serve them.

 

4/17/20

 

 

 

 

 

 

 

 

LeadingAge Michigan Conference Call with Mike Shirkey

 

 

 

 

 

 

 

This week, LeadingAge Michigan held a conference call with Senate Majority Leader Mike Shirkey who shared this thinking on current Michigan budget issues and the potential for workers to return to employment. He anticipates a budget deficit between $1 billion and $4 billion. Our conversations have indicated that the potential budget impact will be between the $2.5-$3.0 billion range. As a result, the Senate has begun working on a budget plan that includes a 20% overall reduction in available funds.

 

4/16/20

 

 




Executive Order 2020-50

 




 

LeadingAge Michigan's initial review of the Governor's Executive Order 2020-50. Although we know that this EO has immediate effect, we do anticipate further guidance from MDHHS as discussions evolve.

 

4/14/20

 

 

 

 

 

 

 

 

MDHHS Testing Priorities

 

 

 

 

 

 

 

 

Along with the Governor's announcement of expanded testing capabilities in Michigan and the revised priority system issued last week, MDHHS has developed a COVID-19 test site finder at Michigan.gov/Coronavirus to assist individuals regarding testing. Testing priorities continue to be focused on 1) hospitalized person, 2) health care workers with symptoms, 3) persons in congregate settings with symptoms, 4) other persons with symptoms, and 5) persons with only mild symptoms. 


4/14/20

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Whitmer Discusses Re-opening the State

 

 

 



 

 

 

 

 

 

 

 

 

 

 

 

Yesterday, during a press conference, the Governor discussed criteria for when she will consider relaxing the Stay at Home Order once the pandemic comes under better control. The order recently was extended through April 30 and at that point she identified the following elements to be reviewed to make this decision:

  • Current incidence and prevalence of COVID-19 infections and the rate of spread,
  • Whether sufficient medical personnel and hospital resources are available to meet medical need,
  • The availability of PPE for health care workers,
  • State capacity to conduct testing, and
    The economic conditions in the state.


On Monday, she included the ability to trace the virus and the development of best practices in the workplace. Last Saturday, the Governor announced expanded drive-up testing operations in 13 cities, including high risk areas such as Detroit and Flint.  

4/9/20



 



Whitmer Extends Stay at Home Order through April 30

 

 

 

As expected, today Governor Whitmer extended the executive order that mandates persons stay at home with some exceptions through April 30. The order originally was set to sunset on April 13.

 

 

4/8/20

 




 

MDHHS Updates: COVID Testing Priorities

 



 

Effective April 8, the following prioritization criteria for COVID-19 testing is in place, clarifying the definitions for Priority 1: Healthcare Facility Workers with Symptoms and Priority 2: Patients in Long Term Care Facilities.

 

4/8/20

 



 



 

 

 

Michigan Congressman Introduces Tax Breaks for Health Care Personnel

 




 

 

 

 

US Representative Bill Huizenga introduced the HEROES Act to provide a four month federal income tax holiday for workers on the frontlines, covering February 15 through June 15. This would apply to workers in counties with at least one positive case of COVID-19 for: Law Enforcement Officers; Corrections Officers; Firefighters, EMTs, and paramedics; Pharmacists; Nurses and Nurse Practitioners; Physician Assistants; Hospital and Licensed Medical Support Staff; and Senior Care Facility Staff.



4/7/20

 

 

 

 

Michigan Paycheck Protection Program

 

 



The Governor's staff and current president of the Small Business Association Brian Calley have launched a new website to provide key resources to assist with applying for the Paycheck Protection Program.



4/6/20

 

 

 

 

 

 

 

 

 

 

 

Executive Order 2020-37 Extends Visitation Restrictions to Independent Living

 

 

 

 

 

 

 

 

 

On Sunday, Governor Whitmer extended restrictions to certain healthcare facilities; effective immediately and through May 3, 2020. Staff screening and visitor restrictions remain unchanged.  However, for the first time the Governor defined residential settings to include independent living facilities. The question of the ability to limit visitation in independent living had until this time been difficult with strong consideration of resident rights.  Some experts have stated that visitor movement into the facilities could be restricted but not outright visitation. This executive order applies the same restrictions and staff screening guidelines to independent livingRead More.

 

 

4/6/20

 

 

 

 

 

 

Governor Issues New Executive Orders 

 

 

 

 

 

 

Under Executive Order 2020-36, any and all individuals who test positive for COVID-19 or who display one or more of the principal symptoms – fever, atypical cough and atypical shortness of breath – must remain in their home or place of residence until three days have passed since their symptoms resolved or seven days since symptoms first appeared or were swabbed for a test that came back positive.

 

4/6/20

 

 

Medicaid Bulletin Suspends All Medicaid Closures

 

 

4/2/20

 

 

 

 

 

 

 

 

 

 

 

 

SNF Infection Control Focused Surveys and Entrance Conference Worksheet 

 

 

 

 

 

 



 

 

 

Michigan surveyors initiated their COVID-19 focused surveys in at least two member facilities this week – and to date, no issues were found. There was a sense that surveyors were learning through the process that includes only one or two surveyors, and focuses most review from recent information about infection control issues on that campus with little time spent in the actual facility. Survey teams who approach a facility with active COVID-19 will contact the State Agency, State Health Department, and CMS Regional Office. Follow up actions will depend on CDC guidance about entering the facility or delay. CMS has developed an Entrance Conference Worksheet specifically for these surveys. Remember that although the survey is focused on infection control, surveyors will still cite any issues that appear to rise to the level of immediate jeopardy. To date, exit conferences have been held by phone.

4/2/20


 

 



 

 

Fingerprinting Suspended in Nursing Homes 

 

 





 

Executive Order 2020-30

In accordance with Executive Order 2020-30 of March 29, 2020, the LARA Bureau of Community and Health Systems is issuing the following background check guidance for nursing homes, county medical care facilities, and inpatient psychiatric hospitals and units.



4/2/20

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HUD and MSHDA Resources During the Pandemic

 

 

 

 

 

 

 

 

 

 

 

 

 

 


 

 

 

 

 

 

 

The US Department of Housing and Human Development has created a webpage addressing the numerous issues facing members.

Additional links to resources:  



4/2/20

 


 

MDHHS Relief Hospital and Alternative Setting Guidance

 


This guidance covers the use of Relief Healthcare Facilities including hospitals and nursing homes. The guidance may change as resource availability and demands for healthcare services change.

 

4/2/20

 

 

MDHHS UpdatesPPE Optimization Guidance


 

4/1/20

 





 

MDLARA HFA/AFC Conference Call Summary

 





 

On April 1, LeadingAge Michigan participated in a conference call with MDLARA Director Jay Calewarts regarding the HFA/AFC Q&A document issued on 3/31/2020. The Department anticipates that the Q&A document will be updated in the near future.



4/1/20

 

 

 

 

 

 

Governor Extends State of Emergency and Announces State of Disaster - Executive Order 2020-33

 

 

 

 

The Governor today declared a state of emergency and disaster across the state which will terminate when conditions have reverted and appropriate programs implemented for recovery. Additionally, she has requested the Legislature to extend the state of emergency by 70 days. This order rescinds EO 2020-04, but other expiration dates in previous executive orders remain.



4/1/20

 

 

Medical Services Administration Bulletin 20-17

 

MDHHS today issued MSA 20-17 to address coding guidance and test coverage for COVID-19.

 

4/1/20



LARA Publishes Q&A for the Pandemic

 


3/30/20


 

 

 

 

 

MDHHS/MDLARA Conference Call - 3/30/20

 




 

 

Late Monday, MDHHS and MDLARA held a conference call with provider associations concerning nursing home challenges with COVID-19 patients. Please note that some of the discussion included a slightly different message when it comes to hospital discharges of COVID-19 patients. The Department is looking at nursing home financial and funding issues every 30 days.

 

3/30/20

 

 

 



LTSS Providers and the MDHHS Transfer Form

 



 

 

Today, MDLARA and MDHHS convened a call to discuss the VOLUNTARY use of an MDHHS approved transfer form to assist in communication with hospital for discharges to nursing facilities. The tool can be found among MDHHS resources (under What Protocols Should I use to Treat a COVID-19 Patient).

 

3/30/20

 

 

 

 

 

 

 

 

 

Trump Approves Michigan Disaster Request

 



 

 

 

 

 

 

The Trump Administration approved the request for federal assistance to Michigan on Friday by declaring that a major disaster exists in our state. The state has received over 100,000 N95 masks on Saturday morning. Federal funding will be available for crisis counseling for affected persons, and support for emergency protective measures such as transporting and positioning equipment, medical supplies, medical care and transport, and child care. The Governor’s request for hazard mitigation assistance to help provide relief during planning for recovery is still under review by the administration.

 

3/30/20





 

 

 

 

 

 

 

Governor Whitmer Signs Supplemental Bills




 

 

 

 

 

 

 

Today the Governor signed to supplemental appropriations bills for $125 million to help the state respond to the pandemic. She also struck down $80 million (leaving over $312 million in additional funding for state programs) in a second supplemental through line item vetoes to prioritize spending on the impact of COVID-19. Many of the vetoes were for small funded projects and agencies; additional funding for Medicaid Home Health care, a senior community health grant, federal qualified health care transitions, and positions for independent living were the only LTSS related vetoes. Pure Michigan again was unfunded with a $16 million line item veto.

 

3/30/20

 





 

Whitmer Suspends Scope of Practice Laws - Executive Order 2020-30

 




 

On Sunday, Governor Whitmer temporarily suspended Michigan scope of practice laws, a move designed to allow licensed, registered and certified health care professions to support the facility response to the pandemic as appropriate to their license and background and in consultation with facility medical leadership.

 

3/29/20

 

 




 

 

 

 

 

Bureau of Fire Safety Inspections Postponed

 



 

 

 

 

 

 

The Bureau of Fire Safety (BFS) has temporarily postponed routine inspections of Homes for the Aged and Adult Foster Care Facilities (licensed for 7 or more) but will be investigating complaints of serious nature. When asked for clarity, BFS agreed that postponing sprinkler and alarm testing by vendors at this time would be a wise choice. Currently, there is a 60-day suspension for now and BFS will reassess if the crisis extends beyond that.

This communication assumes members will continue to immediately address any issues with their fire equipment and panel.

 

3/26/20

 

 

Governor Whitmer Declares Michigan a Major Disaster Area

 

More information to come

 

 

3/26/20

 

 

 

 

 

MDHHS Issues Recommendations for Caregivers of Older Adults

 

 

 

 

With the recent issuance of Executive Order 2020-21 that requires 'sheltering in place' for Michigan residents, MDHHS has provided the following recommendations for caregivers. "Actions for Caregivers of Older Adults During COVID-19" includes safeguards for direct caregivers in order to contain further spread of COVID-19.

 

3/26/20

 



 

 

 

 

2023-NF-P

 

 

 

 



 

Yesterday, MDHHS issued its proposed policy for nursing home beds intended to address access issues during the viral outbreak. 2023-NF-P is intended to provide facility flexibility in order to better meet emergent needs. The policy does not allow for providers to exceed their licensed bed limits, however MDLARA is working on streamlining the process to add beds should they be needed.

 

3/26/20

 



 

 

 

MDLARA Issues Notice of Temporary Registration

 

 




 

In alignment with Executive Order 2020-13, MDLARA has issued a document that can serve as a notice of temporary registration. This document will be posted on the BCHS website and will cover anyone who meets the criteria. Members will have to keep a log of persons covered under this temporary registration.



3/26/20

 

 




 

 

Governor Whitmer signs Executive Order 2020-25

 

 

 



 

Executive Order 2020-25 provides for emergency prescription refills for up to 60 days for non-controlled substances and allows pharmacists to substitute therapeutic equivalents without prescriber approval for drug shortages. Prescribers must be notified in writing of any refill dispensed under this order. This flexibility is effective through April 22, 2020.



3/26/20

 



 

Governor Whitmer signs Executive Order 2020-24





Executive Order 2020-24 allows persons seeking unemployment benefits to request a registration and search waiver from employers and extends benefits for up to six weeks for those with active unemployment claims.

 

3/26/20

 

 

Governor Whitmer signs Executive Order 2020-23



Temporarily allows administrative hearings to be held by video conference or telephone, in place of in-person hearings

 

3/25/20

 

Governor Whitmer signs Executive Order 2020-22

 

Extends the deadline to complete the canvass of the March 10 primary to April 24

 

3/25/20

 



 

 

MDHHS Letter to Personal Care Services Providers

 

 



The Governor’s Executive Order 2020-21 directs all businesses to temporarily suspend in person operations that are not necessary to sustain or protect life. MDHHS has issues a letter to further explain the role of personal care workers as critical infrastructure workers.

 

3/24/20

 

 

 

 

 

MDHHS Temporary Changes for Prior Authorization

 





The Department has initiated changes to prior authorization processes for 30 days during the viral outbreak. Effective immediately, we ask that you submit your requests electronically through the CHAMPS system to help minimize delays in authorization.



3/23/20



Governor Whitmer signs Executive Order 2020-21

 

Shelter in Place for Michigan and LeadingAge Michigan's Summary

 

3/23/20

 

 

 

 

MDHHS Plans Temporary Changes to Medicaid Bed Use

 

 



The Department is currently working on provider letters that delineate new temporary flexibilities in order to enhance bed availability. As of today, the letter is scheduled to go out later this week and this link provides a summary of possible options.



3/23/20




 

MDHHS Nursing Home Provider Conference Call



 

The Department held a provider conference call on Friday that delineated plans for survey and certification as well as testing and other updates.



3/23/20

 


 

 

MDLARA Issues Guidance for Healthcare Workers




 

 

The Department of Licensing and Regulatory Affairs today issued two sets of guidance for healthcare workers. As the spread of the outbreak continues, it is important to closely review these requirements and implement in ways that work.


  

3/23/20



Governor Whitmer signs Executive Order 2020-20

 

Temporary restrictions on the use of places of public accommodation

 

3/23/20



 

Governor Whitmer signs Executive Order 2020-19

 

 

Provides a temporary prohibition against entry to premises for the purpose of removing or excluding a tenant or mobile homeowner from their home

 

3/23/20



Governor Whitmer signs Executive Order 2020-18

 

Enhances restrictions on price gouging



3/20/20

 

MDHHS Proposes Medicaid Telehealth Policy

 

 

3/20/20

 

Governor Whitmer signs Executive Order 2020-17

 

Temporary restrictions on non-essential medical and dental procedures

 

3/19/20

 

 

Governor Whitmer signs Executive Order 2020-14



Temporary extension of deadline to redeem property for nonpayment of delinquent property taxes

 

3/19/20

 



Governor Whitmer signs Executive Order 2020-15

 

 

Temporary authorization of remote participation in public meetings and hearings and temporary relief from monthly meeting requirements for school boards

 

3/19/20



Governor Whitmer signs Executive Order 2020-16

 

Expanding childcare access during the COVID-19 emergency

 

3/19/20



 

 

BCHS Call Summary

 



 

The Bureau of Community Health Systems has announced changes to nursing home survey and other licensed setting requirements during a conference call this morning (3/19). A summary has been provided for your review.

 

3/19/20



Medicaid Bulletin MSA 20-12 and Announcement

 

Discusses COVID-19 Response: Relaxing Face-to-Face Requirement 

 

3/18/20

 

 

Michigan Senate passes HB 4729



Michigan Senate passes HB4729 with $125 Million to assist with COVID-19. It will now go to the House.

 

3/18/20



Governor Whitmer signs Executive Order 2020-13

 

 

3/18/20

 

MDHHS L Letter 20-16

 

 

3/18/20

 

LTC Ombudsman Virtual Visit Memo

 

 

3/17/20



 

Governor Whitmer signs Executive Order 2020-07



 

Temporary restrictions on entry into health care facilities, residential care facilities, congregate care facilities, and juvenile justice facilities Rescission of Executive Order 2020-6

 

3/17/20



Governor Whitmer signs Executive Order 2020-08

 

Enhanced restrictions on price gauging



3/17/20



Governor Whitmer signs Executive Order 2020-09

 

Temporary restrictions on the use of places of public accommodation

 

3/17/20



Governor Whitmer signs Executive Order 2020-10

 

Temporary expansions in unemployment eligibility and cost-sharing

 

3/16/20


 

Governor Whitmer signs Executive Order 2020-11



Temporary prohibition on large assemblages and events, along with temporary school closures

 

3/17/20



Governor Whitmer signs Executive Order 2020-12

 

Enhanced support for deliveries



3/16/20

 

Governor Whitmer signs Executive Order 2020-04

 

Declaration of a State of Emergency



Ongoing


 

 


 

 

 

State of Michigan Coronavirus Updates

 



 



 

This state website is based on that of the CDC and provides many links to that document. Most helpful for members might include Michigan’s activities to date accessed through the banner. Health professionals can access reporting forms, interim guidance for health care facilities, and most importantly Strategies to prevent the spread in long term care facilities.



3/11/20



 

MDHHS Interim Recommendations for communities and health care

 

 

 

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