Governor Whitmer Extends State of Emergency & Issues Executive Orders:

Last evening, Governor Whitmer extended the State of Emergency through October 27, 2020.  The extension will allow the state to continue to mobilize resources and continue provisions designed to protect Michiganders and their families. 

In addition to extending the State of Emergency, Governor Whitmer also issued additional Executive Orders that impact the long term care community.  This evening, Executive Order 2020-191 was released, continuing provisions and restrictions related to long term care facilities.  EO 2020-191 rescinds Executive Order 2020-179 which was due to expire at midnight tonight, and extends most of the prior provisions along with identifying new and updated guidance.  The EO is effective immediately and is in effect until rescinded.  The primary changes include:

• Communal dining and activities may be conducted following the Centers for Medicare & Medicaid Services (CMS) and Michigan Department of Health & Human Services (MDHHS) guidance.  The CMS guidance is included in S&C Memo QSO-20-39-NH.
• As soon as possible, and not later than 12 hours after identification inform employees and residents of the presence of a confirmed COVID positive employee or resident
• As soon as possible, and not later than 24 hours after identification inform legal guardians or representatives of residents of the presence of a confirmed COVID positive employee or resident
• No later than 24 hours after identification, post a notice in a conspicuous area near the main entrance indicating the presence of a confirmed positive COVID employee or resident.  The notice must be displayed unit 14 days following the last COVID positive test is identified
• Adopt a protocol to inform prospective residents and staff of the presence of a confirmed COVID positive employee or resident
• Report the presence of a confirmed COVID affected residents to the local health department within 24 hours of identification
• Once a long term care resident has been hospitalized due to COVID symptoms and becomes medically stable, a hospital must conduct testing consistent with CDC guidance prior to discharge
• Hospital discharge may be made to any of the following: A Care & Recovery Center (CRC), the facility where the resident resided prior to hospitalization, an alternate care facility, or an available swing bed
• If a hospitalized resident wishes to return to their prior residence, they may only be discharged back to the facility if capable of safely isolating the resident consistent with CDC and MDHHS guidance
• Until an acceptable discharge destination is identified, the individual must remain in the care of the hospital where they reside

Assisted living setting providers should note the CMS guidance regarding communal dining and activities is not applicable to their settings.  ALs should utilize CDC guidance published for congregate care settings and assisted living settings.  This guidance provides an excellent resource for infection control practices and controls within the AL settings. 

Simultaneous to the release of Executive Order 2020-191, MDHHS released Medicaid Bulletin MSA 20-66.  This bulletin is based on recommendations from the Michigan Nursing Home COVID-19 Task Force and establishes policy to establish Care & Recovery Centers (CRCs) to care for COVID positive patients discharging from a hospital, as well as residents from nursing facilities that are unable to care for COVID affected residents that require transmission based precautions but do not require hospitalization. 

 

Nursing facilities may be considered for CRC designation if the following minimum participation criteria are met:

• A CMS 5 Star Staffing rating of 3 or higher
• No active Denial of Payment for New Admissions (DPNA) in effect
• No abuse citations resulting in an Abuse Icon on Nursing Home Compare

Facilities interested in applying for CRC designation must also meet standards that cover physical plant capabilities, staffing, infection control, COVID testing, communication with community partners, and performance standards related to the current pandemic such as outbreak history and death to case rates.

The CRC application process and financial/reimbursement guidance has not been released as of yet.

 

Other Orders

In addition to these orders, Executive Order 2020-187 extends through October 31, 2020 the previous order allowing business to be conducted remotely through expanded use of e-notaries and e-signatures.
 

Executive Order 2020-188 extends the restrictions on the entry of individuals into health care facilities, residential care facilities, congregate care facilities, and juvenile justice facilities. The Order also provides for the Michigan Department of Health & Human Services (MDHHS) to continue to issue orders & guidance regarding exceptions to this order.   As of now, MDHHS and the Department of Licensing & Regulatory Affairs (LARA) continue to work with the Centers for Medicare & Medicaid Services (CMS) to clarify the conflicts between state and federal regulations regarding long term care visitation.  HCAM will share additional updates as this evolves.

 

For questions or concerns please contact Cathy Sunlin at CathySunlin@HCAM.org.

 

September 30, 2020