Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.
MDHHS: Masks No Longer Needed At Schools, Indoors
Department of Health and Human Services officials announced that it is dropping the suggestion that masks be worn in schools or indoors as COVID-19 cases continue to fall.
The health department reported 4,271 new cases and 312 new deaths of COVID-19 over a two-day period this month. The two-day average of cases was 2,136, marking a decline in new cases across the state.
The report prompted the health department to revise guidance for wearing masks indoors to prevent the spread of the virus.
“This is good news for Michigan,” Gov. Gretchen Whitmer said. “While Michigan hasn’t had statewide mask policies since last June, this updated guidance will underscore that we are getting back to normal. Let’s keep working together to build on our momentum so we can keep our kids learning in person.”
The guidance would not be dropped for nursing homes, homeless shelters, jails, prisons and other health care facilities. Officials also still recommended masks for people in isolation or quarantine after exposure to COVID-19.
Health department officials stated that school administrators and other organizations should continue working with county health departments to determine local risk for school.
Michigan Republicans called the decision a win for students, but stated they believed the decision was made because of the election year.
“As Gretchen Whitmer continues making decision out of fear, we’ll work to make sure voters remember the impact of her authoritarian rule,” said Gustavo Portela, communications director for the Michigan Republican Party.
Rep. Beau LaFave (R-Iron Mountain) wondered what took the governor so long after initially saying in 2020 that masks would be recommended to stop the surge.
“While I am happy to learn about the MDHHS and its recent decision that masks are no longer necessary in schools or other indoor settings, this should have happened sooner than after ‘700 days to slow the spread,” he said.
Health department officials stated COVID-19 transmission was still being assessed and would adjust guidelines if cases increased and continued to urge everyone to get vaccinated.
The news comes as daily COVID contraction numbers continued their slide in Michigan to levels not seen since September. The daily average of new cases in Michigan over five days in February was 1,930 per day. The Saturday-Wednesday average the previous week was 3,486. The week prior it was 8,009. Between Jan. 22-26, it was 13,359.
COVID-death numbers haven’t changed as rapidly. The daily average five days was 74. The Saturday-Wednesday average from the prior week also was 74. The week prior it was 78. Between Jan. 22-26 the daily average of COVID deaths was 83.
Nationally, COVID numbers have fallen precipitously, as well. Every state in the union is reporting drops in COVID numbers over the a 14 day period, according to The New York Times, which has Michigan’s drop at 72%.
Pharmacists Can Share Lower, Generic Drug Costs Under Senate-Passed Bill
Pharmacies would be prohibited from participating in contracts that bar them from disclosing prescription drug costs and the price tags of similar products, under legislation that unanimously passed the Senate.
In 2017, the state of Michigan reported 32% of residents aged 19 to 64 years-old stopped taking their medication as prescribed due to the costs. Simultaneously, a pharmacy could be enwrapped in a contract with a pharmacy benefit manager with a preference for a specific drug product, based on the negotiations they conducted behind the scenes.
To kick off 2022, the Senate Health Policy and Human Services Committee prioritized PBM reform, with aspirations of reducing drug expenses and delivering more transparency on how the price sticker on a medication product comes to be.
PBMs are responsible for setting up arrangements with drug manufacturers and pharmacies. Nationally, they have been placed into a negative limelight. A 2020 report found more than half of the total spending on brand-named drug products were infused into the supply chain, which includes PBMs instead of the manufacturers.
The state’s Prescription Drug Task Force – which was initiated by Gov. Gretchen Whitmer’s office – has recommended authorizing pharmacists to talk about cheaper generic drug options with consumers.
Additionally, the U.S. Food and Drug Administration illustrated that, on average, generic medications can cost up to 85% less than their brand-named counterparts. Those supporting the legislation argue that HB 4351 by Rep. Karen Whitsett (D-Detroit) and HB 4352 by Rep. Sue Allor (R-Wolverine) could offer relief as out-patient prescription costs are projected to jump by 8.5% this year – including specialty medications.
“I find the practice of these contractual clauses abhorrent to a patient-centered system of care,” said Director Andrew Sebolt of HomeTown Apothecare. “While we do not engage in these clauses at Apothecare, I thank the committee for working on a bill that seeks to remove them. A pharmacist has the inherent right and duty to take care of his or her patients, and this includes educating them on a medically appropriate and less expensive drug.”
Sebolt, a general manager of an Oceana County pharmacy, submitted a letter to the Senate committee, warning that the lawmakers should make sure PBMs are also outlawed from creating anti-disclosure contracts as a safety measure for pharmacies and their abilities to compete.
The legislation as passed in the Senate would additionally:
– Prohibit a PBM from obligating a patient to pay a copay that was greater than the selling cost of the drug dispensed to the patient;
– Ban PBMs from charging pharmacies differently based on whether or not one is a 340B entity, meaning they can be flexible with federal resources and provide to more eligible patients.
“It doesn’t matter who you represent – if it’s the Upper Peninsula or it’s the city of Detroit—this is affecting all,” said Senate Health Policy and Human Services Committee Chair Curtis VanderWall R-Ludington) in a January interview. “What we’re looking at now is the continued cost of healthcare and he fear of – number one – the state of what the pandemic has done…and some of these bills reel in the way PBMs themselves have accountability.”
On Tuesday, the Senate unanimously passed HB 4348, mandating PBMs file a yearly transparency report with the Michigan Department of Insurance and Financial Services Director. The department would later compile the reports and submit them to the Legislature. The process is estimated to require three extra DIFS employees to serve a full-time operation.
“This bipartisan legislation will help us lower the cost of prescription drugs for Michigan families,” Whitmer said in an official statement. “We must continue working together to improve transparency in health care, hold accountable people and corporations profiting from skyrocketing prices and make life-saving, essential medication like insulin affordable for every Michigander who needs it.”
The governor said she looks forward to signing the PBM legislation.
Transparency Reform For Pharmaceutical ‘Middlemen’ Passes Senate
The Senate unanimously passed pharmacy benefit manager mandates to combat overvalued drug osts, after “well over” 250 meetings hosted by Senate Health Policy and Human Services Chair Curtis VanderWall (R-Ludington).
PBMs are popularly described as the middlemen of the pharmaceutical world, orchestrating the prescription drug programs of health insurance plans. Because of the dimensions of their role, PBMs influence manufacturer rebates and how prescription drugs are price-tagged.
“This is a groundbreaking win for Michigan pharmacies, which have suffered for so long at the hands of unscrupulous PBMs,” said Mark Glasper, the chief executive officer of the Michigan Pharmacists Association, in a statement. “However, not all of our concerns are addressed in this bill, and we believe work still needs to be done at the federal level to address pharmacy claims in Medicare Part D.”
The reform from Rep. Julie Calley (R-Portland), which passed the House 97-10 in March 2021, would ban PBMs from compensating an affiliated pharmacy more than they would one that wasn’t linked with them.
As for heightening transparency, the legislation would require PBMs to carry out an annual transparency report for the state’s Department of Insurance and Financial Services (DIFS), in addition to issuing renewal applications, fees and network adequacy reports to the department.
VanderWall acknowledges that HB 4348 exemplifies the concept that “you can’t make everyone happy.”
Though Michigan is one of 17 states that don’t regulate PBMs, some stakeholders argue that this reform either fails to extend accountability to drug manufacturers, fails to regulate practices that were misconceptions around the PBM community or will allows so much wiggle room that patients can still be taken advantage of.
“We had three points of contention that we worked on. First, the classification of what specialty drugs were. The other part was how do we deal with the classification of retail pharmacies and how does that affect our hospital pharmacies and some of the (others),” VanderWall told the media.
A substitute that was passed at today’s session – without opposition – also featured clarification around direct and indirect remuneration (DIR) fees, including rebates financed by manufacturers; and “clawbacks,” occurring when a patient’s copay is larger than the pharmacy’s cost for the drug.
The substitute:
– Bumped the effective date from Jan. 1, 2023 to Jan. 1, 2024
– Eliminated the refund floor of the National Average Drug Acquisition Cost (NADAC) along with a dispensing fee
– Removed the requirement for PBMs to report the difference they paid between what health plans were being charged for medications and what pharmacies were receiving for those items.
“HB 4348 is the first meaningful PBM reform bill filed in Michigan. It’s also one of the most far-reaching and comprehensive PBM bills ever filed,” said Michael Wright, the vice president of government affairs for American Pharmacies. “We are ecstatic that we got this bill through the Senate with 90% of what we wanted. It’s a great first step for Michigan and we’ll certainly build on this foundation in future sessions.”
When asked what is the first thing residents will see if HB 4348 is eventually signed off on in the Governor’s office, VanderWall illustrated it’ll be the newfound knowledge of how much PBMs were charging the pharmacies for a drug product and what they were making off of that product.
“We’re going to see what they’re actually making, how they got to that and how they derived that price,” he said. “Second part – we’re going to see the pharmacies are actually going to be able to be more competitive. We’re going to see our small retail pharmacies be able to compete inside the marketplace, and when I say small retail, we’re still talking about the Meijer’s of the world, the Walgreens and the CVS’…all of them will be able to compete.”
He also underscored that small, local independent pharmacies will be able to survive through the system provided under the revamped HB 4348.
He said his committee continued to work closely with the House on the alterations, “so nothing surprised them, and I’m hoping that we can have almost 100% support through there so it goes to the Governor and she gets it signed and we can see true reform.”
Nursing Homes Ask Legislature To Get Inspectors Off Their Backs
Nursing homes are calling for modifications to the state’s certification, survey and evaluation requirements, arguing Michigan’s over-zealous inspectors are chasing away staff, driving up costs and putting them out of business.
Rep. Bronna Kahle (R-Adrian)’s HB 5609 attempts to address the situation by creating statewide reporting requirements for incidents in nursing homes and appointing a quality assurance monitor for annual survey teams.
Currently, nursing homes “operate under thousands of federal regulations that are meant to protect the safety and well-being of its residents,” said Kahle during testimony before the House Health Policy Committee. These regulations are then enforced by the state department of Licensing and Regulatory Affairs.
But Kahle said regulations and surveys are inconsistent and “plagued with delays,” resulting in citations that don’t reflect the level of care being provided.
“The current regulatory environment is affecting the ability for nursing facility providers to continue providing quality care and support for their communities,” Kahle said.
The number of citations for facilities in Michigan is double the national average, said Richie Farran, the vice president of government services for the Health Care Association of Michigan.
Farran said nursing homes exceeded the national average for quality care, but still paid over $14 million in fines in 2020.
Nursing home surveys are still dependent on the opinions of each individual surveyor, he said.
“Providers continue to experience uncoordinated and untimely revisits for annual and complaint surveys, leaving survey cycles open,” Farran said. “This results in increased enforcement actions, including financial penalties and denial of payment for new admissions.”
The fines and payment delays put providers into unsustainable economic situations and may lead to facility closures, Kahle said.
Bob Norcross, the CEO of Prestige Healthcare, told the committee that he’s “probably not going to be in Michigan a lot longer.”
Norcross said his annual budget for denial of payment and fines is $2.2 million across 78 facilities, 49 of which are in Michigan.
“Two million will be budgeted for Michigan,” he said. “$200,000 will be budgeted for the other six states I operate in.”
But the economic impact isn’t the only concern for Norcross.
“More so than the money, we are losing staff,” he said. “I have never lost as many staff in my 43 years as I have in the last four years, to citation issues, disrespect and difficulty with the enforcement agency.”
The survey process impacts the morale of staff already experiencing burnout, Farran said.
Norcross said staffing is an issue across the state and mentioned multiple statements from the department saying it is short staffed and not able to follow up complaints.
But Michigan isn’t the only state that’s short staffed, he said, and many others allow desk reviews.
“This enforcement does not advance excellence in care,” Norcross said. “It removes workforce. It builds hostility. I have more staff talking about surveys than suffering.”
Farran said he wants the department to improve the regulatory process and avoid unnecessary adverse effects on facilities.
The Department of Licensing and Regulatory Affairs opposes the bills as written, according to note turned in at the committee hearing.
“We’re not asking for less oversight or a change in any regulations,” Farran said.
But Rep. Laurie Pohutsky (D-Livonia), expressed concern with a portion of the bill that would eliminate reporting to the legislature on the average time for the department’s response to a complaint filed.
“That one in particular, given the testimony we just heard, seems very crucial,” Pohutsky said.
Farran said the proposed change was due to sifting through data that led to inaccurate reports.
“We understand that there’s some work to be done with the bill,” he said.
COVID Accounted For 11% Of Michigan’s Deaths In 2021
Slightly more Michiganders died in 2021 than 2020, but in both years Michigan hit mortality rates not seen since the 1920s, according to statistics published by the Department of Health and Human Services.
Based on the monthly mortality tables, Michigan lost 115,663 people in 2021 and 115,521 in 2020, roughly 18% higher than in 2019 when total deaths were under 100,000. The actual mortality rate of 11.7 per 1,000 people is higher than its been in about 90 years.
Through most of the 1980s, 1990s and 2000s, Michigan consistently averaged between 8.1 to 8.8 deaths per 1,000 people every year. The number gradually rose in the 2010s until it jumped from 9.9 deaths in 2019 to 11.7 in 2020.
The monthly mortality tables show heart disease continues to be the No. 1 killer in Michigan. In 2021, it accounted for 22% of the deaths. In 2020, it was 23% of the deaths. Cancer was at 19.6% in 2021 and 18% in 2020.
COVID-19 accounted for 11% of the deaths in 2021 and 9.7% in 2020. Strokes caused 5% of the deaths last year and the flu 2%.
The deadliest month in Michigan from COVID-19 remains the first full month of the pandemic, April 2020, when 3,442 died of the virus. The second-most deadliest month was December, when 3,093 died. COVID was the No. 1 killer of Michiganders in three of the 21 full months since the pandemic began.
In July, 94 people died of COVID-19, which was less than the 96 who died from the flu for that month. Since then, COVID deaths are 2 to 20 times higher than that of the flu, according to DHHS numbers. Flu numbers didn’t vary too much in 2021 – between 80 to 150 per month. Monthly COVID-19 death numbers show wide swings from as few as 94 a month to 3,093.
In other news, new COVID-19 case numbers are continuing to drop based on DHHS’ Wednesday numbers. The daily average of new cases over the last five days is 3,485, down from the 8,009 new daily cases reported per day the corresponding five-day window last week.
The average number of deaths remains fairly steady, however. From Jan. 29 to Feb. 2, the average number of daily COVID-19 deaths was 78. From Feb. 5 to Feb. 9, the average number of daily COVID-19 deaths is 74.
No Comment From LARA On Nursing Home Facility Reporting Requirements
The voices of those who inspect state nursing and adult foster care facilities matter to the state Legislature, and if two bills make it through and across the governor’s desk, those voices would be heard.
The two “simple, commonsense” bills reported out of the House Oversight Committee today would require that the Department of Licensing and Regulatory Affairs obtain feedback from field inspectors on whether state and federal guidelines are working.
“It is clear from LARA’s own answers that they were not asking their surveyors or inspectors for feedback on how things are working out regarding the state and federal regulations,” Rep. Jeff Yaroch (R-Richmond) said in the committee meeting.
“If we don’t force the people who make decisions to reach out to those people and say, ‘how is this working?’ It is very easy to go, ‘OK, well, I don’t hear anything so it’s all good,’” he said.
HB 5659 and HB 5660 were introduced on Dec. 29. Bill sponsors include Yaroch and Reps. Bob Bezotte (R-Howell), Timothy Beson (R-Kawkawlin) and Gregory Markkanen (R-Hancock).
During testimony in the Oversight Committee on Jan. 27, Yaroch said he drafted the bills in response to the lack of transparency and competency shown by Larry Horvath, director of the Bureau of Community and Health Systems, during a February 2021 LARA subcommittee meeting, which Yaroch chairs.
At that meeting, Horvath expressed confusion when asked for his position on Gov. Gretchen Whitmer’s nursing home plan rolled out in June 2020. The policy placed COVID-19 positive patients in the same nursing homes with residents who did not have the coronavirus.
“You can watch the video,” Yaroch said. “(Horvath) kept saying, ‘What plan?’ And I said, ‘what was your view on the plan that was in effect June of 2020.’ And he said, ‘Well, I don’t know what plan you’re talking about.’
“Here’s the director of the BCHS. He can’t even articulate what the plan is,” he said. “I will say that based on the long-term care answers, I feel that … Director Horvath is either incompetent, or … frankly, I think it’s bordering on lying to us.”
Yaroch estimated that there are about 80 field inspectors for Michigan’s Adult Foster Care/Homes for the Aged Facilities. He wants these frontline workers to be given a voice on what isn’t working, so changes can be made when federal and/or state guidelines for these facilities are inadequate.
Rep. John Reilly (R-Oakland) likened the process to department suggestion boxes.
“I think we have to kind of prompt that initiative for people at lower levels to speak out,” he said.
One of the issues raised regarding the reach of the bills was by Rep. Julie Brixie (D-Meridian Township), who said on Jan. 27, the language of the bills did not give a “matrix” of questions to be asked and instead allowed for broad feedback on the adequacy/inadequacy of the federal and state guidelines.
“When we pass laws, we’re telling departments to do things,” Brixie said. “So, what specific information do you want reported?”
Yaroch originally pushed back and replied that “the problem is, if I give you a matrix and say, ‘Tell me about bathroom facilities,’ they’re only gonna tell me about bathroom facilities.” He said that he wanted to keep the feedback loop as open as possible.
However, the bills reported out of committee did include substitutes that tightened questions of inspectors to only pertain “to the areas that the individual inspects.”
Brixie asked for a one-week extension on the vote, saying she still had reservations. She said she thought the bills were being rushed, and she had heard from the Department of Licensing that morning it had concerns with the bills.
Rep. Stephanie Young (D-Detroit) also requested that the vote be held over so she could do “a little bit more homework” as she had heard from opponents earlier, too.
Along with the Department of Licensing, The Healthcare Association of Michigan, which represents long-term care facilities, opposes the bills.
Rich Farran, vice president of government services for the Healthcare Association, submitted a card of opposition on Jan. 27. In an email statement to MIRS, he wrote that the federal regulations and nursing care facilities are constantly being evaluated.
“They are under a tremendous amount of scrutiny,” Farran said. “The state agency is tasked with evaluating nursing facility compliance. This review should be objective, with an eye on adherence and quality, not on subjective interpretations of the efficacy of the regulations.”
Requests to hold the vote over were denied by Chair Rep. Steven Johnson (R-Wayland Twp.).
“We’re not rushing anything along,” Johnson said. “The testimony was two weeks ago, for crying out loud.
“We’re being told … by other members, ‘Oh, hey, they have issues.’ That’s fine. But you need to talk to the bill sponsor, talk to the chair of the committee instead of behind-the-scenes last minute to a couple of members,” he said.
The bills were reported out of committee with Brixie voting no and Young passing on the vote.
LARA did not respond to requests for comment.
House Votes Against Using Aborted Fetuses For Research; Supports CON Transparency
No part of an aborted fetus could be used for research purposes under legislation that moved out of the House today on a strict 55-51 party-line vote.
Under HB 5558, sponsored by Thomas Albert (R-Lowell), and HB 5559, sponsored by Bronna Kahle (R-Adrian), anyone caught using or testing portions of an aborted embryo, fetus or neonate would face a five-year felony.
“This is a horrific and barbaric practice that has led to the creation of an industry that revolves around the commodification of human beings,” said Albert. “I could go into excruciating detail about the horrifying aspects of this practice, but I decided it is best to spend my time (today) to address the question from my colleagues: Why not allow something good to come out of a tragic situation like abortion? There is an abundance of effective and ethical alternatives that can be used in place of aborted fetal tissue.”
Michigan allows women who undergo an abortion to consent to donating the remains for medical research. The physician could not profit off the transaction. The House Fiscal Agency reports that state and federal law sets rigid protocols for research on human cells and tissues. The issue is relevant since President Joe Biden’s administration reversed Donald Trump-era policies that stopped funding for medical research using human fetal tissue.
Among the 51 nay voters for both bills were Laurie Pohutsky (D-Livonia), Julie Brixie (D-Meridian Township) and Christine Morse (D-Texas Twp.). All three stood up against the bill during floor discussion, urging the rest of the House to vote against the abortion bills. In the end, all of the Democrats voted no. All of the Republicans voted yes.
According to Pohutsky, the bills are unconstitutional.
“There is research that virtually everybody here has relied upon in one way or another,” said Pohutsky. “In fact, just yesterday, somebody was talking about how great it was that we funded monoclonal antibody treatment. That is research done on the fetal tissue and fetal cell lines.”
According to Brixie, leading medical organizations are opposed to this duo of bills. Brixie said the fetal tissue research is to thank for some of the biggest medical advancements in modern history.
“Countless lives have been saved by treatments that we may never have discovered without fetal tissue research,” said Brixie. “This research was used to develop the Polio vaccine, which successfully eradicated a disease that used to paralyze 35,000 American each year.”
CON Transparency Bills Clear House Unanimously
A public hearing must be held 30 days before the Certificate of Need (CON) takes final action on its review standards and a copy of the proposed changes must be made publicly available 30 days before that hearing, under legislation that passed the House unanimously, 106-0.
HB 5074, HB 5075, HB 5076, and HB 5077 also require each member of a CON legislative oversight committee to receive a copy of the proposed final action and a summary of the expected impact within 30 days following the meeting.
CON is an administrative committee under the Department of Health and Human Services that must approve all high-dollar medical equipment and facilities that a hospital or a health care provider wants to spend money on.
The bills also require:
– CON to hold an annual review meeting where it goes over all of the action it took the preceding year and the impact it had on access, quality and cost of care.
– DHHS to make its annual reports regarding the work it does for CON available within seven days after it is presented to the Commission.
– Notice of CON meetings must be available a week prior to a meeting.
– A publicly available transcript, audio/video recording and report of the meeting must be made available seven days after a meeting is adjourned.
“Understanding how current laws and regulations are impacting our health care market today is critical to ensuring Michiganders have a personal option to access affordable, high-quality health care in the future,” said Diana Pritchard, policy director for Americans for Prosperity-Michigan. “AFP-MI is proud of the legislature’s continued bipartisan commitment to increasing transparency at all levels of government. We look forward to seeing these bills in committee in the Senate soon.”