Home2019-01-17T20:58:16-05:00

IN OUR VIEW: We’re All COVID Long Haulers (and maybe that’s okay)

By PAUL NATINSKY
Not long ago, it seemed the solution to the COVID-19 pandemic was simple in concept, but daunting in execution. Wear masks, socially distance and wait for a vaccine that could be years away.

Now, with very effective vaccines widely available, we struggle with variants from across the globe that are more contagious than the original bug. We see unanticipated complications in young people, and we see long-lasting aftereffects among adults who have survived the virus’ initial ravages—the long haulers.

As this pandemic’s onion-like nature leaves increasing layers of questions in place of solid core answers, one thing is clear. Our lives have forever changed.

Much like universal precautions in the wake of the AIDS/HIV threat of the 1980s and ‘90s, and the unceasing travel and security precautions in place since the terrorist attacks of 2001, it appears that COVID-19 will have lasting effects on how we congregate, eat, greet, travel and socialize.

Likely gone forever are the handshake, the casual greeting hug-and-kiss, the incredible energy of the large close crowds at ballgames, concerts, weddings and other celebrations.

Likely here to stay are social distancing, ubiquitous hand sanitizer, tests and temperature checks, plexiglass everywhere.

We’ll get used to it. Many of us already have. We’ll vaccinate, separate and hibernate when [Read More]

ON POINT WITH POs: Reactive Disaster Planning For Physician Practices? Follow These Tips

By EWA MATUSZEWSKI
Did you catch the oxymoron in the headline? Reactive disaster planning – or reactive planning of any sort – of course is not planning. But writing this so close to what we can only hope was and is the worst disaster of our lifetime, we mut be honest and admit that our responses to the myriad disasters wrought by the pandemic were rarely planned. Some of us may have been quicker to act than others, more willing to admit that indeed a crisis of heretofore unknown proportions was upon us. But still, we reacted. We had not adequately planned.

In Michigan, we were at the epicenter of our nation’s outbreak, and primary care practices in particular – with their normally busy offices of over-scheduled patient visits – were in a tizzy as the degree of the severity of this crisis came to be understood. While most primary care physicians and their practice teams did not have a basic emergency preparedness plan in place there is no excuse not to have create one now for future disasters.

First, understand that disasters take many forms beyond public health. They can be an electric grid failure, or weather-related, such as a tornado or a dam break (like the [Read More]

COMPLIANCE CORNER: OIG Announces Reviews Of Telehealth Services Provided During COVID-19 Emergency

By DUSTIN WACHLER, ESQ.
Prior to the COVID-19 public health emergency, Medicare coverage of telehealth was restricted to a limited set of services provided via interactive audio and video telecommunications systems between a healthcare provider at a “distant site” and a beneficiary at an “originating site” as defined by Medicare. In order to qualify as an “originating site,” the beneficiary was required to be in a physician office, healthcare facility, or other authorized site located in either a county outside a Metropolitan Statistical Area (MSA) or a rural Health Professional Shortage Area (HPSA) in a rural census tract. In addition to Medicare requirements, telehealth arrangements must also comply with state telemedicine rules, physician licensure laws, and other state laws based on the specifics of a given arrangement (e.g., e-prescribing).

In response to the COVID-19 public health emergency, the Centers for Medicare & Medicaid Services (CMS) significantly expanded access to telehealth services. Specifically, Medicare waived the location requirements to allow beneficiaries to receive care via telemedicine in any location, including at home. Medicare providers may now treat both new and established patients via telemedicine. CMS also drastically increased the types of services that may be provided via telemedicine, including emergency department visits, initial nursing facility and discharge visits, [Read More]

LEGAL LEANINGS: IRS Attack On ‘Zero Out’ In Recent Tax Court Cases

By RALPH Z. LEVY JR.
Taxpayer losses in two recent Tax Court cases serve as reminders that physician and other incorporated medical practice groups should take care in the “zero out” approach to the payment of compensation to the group’s owners and that success in this area may depend on whether the practice is organized as a “C” corporation or has elected to be taxed as an “S” corporation and if the practice group is owned by one or more professionals.

Regardless of whether the practice group is organized under local law as a professional corporation (PC) or a professional association (PA), is taxed as a “C” corporation or as an “S” corporation for federal tax purposes, the entity typically compensates its physicians or other licensed professional shareholders by payment of base compensation that constitutes an advance estimate of a pre-determined percentage of budgeted annual operating profits.

Once actual year-end operating results are determined (or reasonably estimated), prior to its taxable year–end, the PC or PA pays a bonus to members of the practice group based on its distributable cash using the formula adopted by the practice group members to pay annual compensation to and among its professionals. These bonuses “take into account” the amounts previously paid to [Read More]

IN MY VIEW: Another Misunderstanding

By ALLAN DOBZYNIAK, MD
So many of the organizations alleging to represent a consensus of individual physicians simply do not. The narrative that equates all physicians with the organizations that claim to represent them is just wrong. Unfortunately, this narrative has become repetitive and increasingly common.

Consider that the American Medical Association has only a membership of around 12 percent of practicing physicians; hence, it does not represent the majority. It has unquestionably become increasingly political in its views. The organization and leadership have moved to the progressive left. Priorities such as “systemic racism,” “social justice” and “equity” have been engaged to clarify its organizational identity of “wokeness.” It has recently dismissed one of its founders with an accusation of past racism. Does anybody want to be judged only by the worst things they have done? I certainly hope that the good things I have done are taken into account when I die. By digging deeply enough into the history of anything or anyone you can always find something to pretend to be upset about, if that is your objective. Dressing up so-called policy to perpetuate an organization’s political and perceived cultural status is self-serving. Doing it dressed in the lofty robes of “morality” is pathetically transparent. [Read More]

Lansing Lines

Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.

Mental Health Crisis Management Program Brought To Teachers Under Bill

The Michigan Department of Education would need to create a professional development course on mental health crisis management and rapid response for educators under Sen. Sylvia Santana’s (D-Detroit) latest legislation.

Already, the MDE has advocated for the doubling—at a minimum—of funding of intermediate school districts (ISDs) for distributing mental health amenities to students. Under Santana’s SB 0321, the department would join forces with the Michigan Department of Health and Human Services in fostering a program that equips teachers for mental health challenges.

“The mental and emotional toll of this stressful time will stay with our children for the rest of their lives, and it will have a profound effect on their growth,” Santana said in her press release on the bill. “If we want all students to reach their potential, we need to ensure they’re not just physically healthy, but mentally healthy, too.”

In a study led by Daniel Whitney, a postdoctoral fellow in the Department of Physical Medicine and Rehabilitation at the University of Michigan, 17.6 percent of Michigan children and adolescents have been diagnosed with either depression, anxiety or Attention Deficit Hyperactivity Disorder [Read More]

OUR VIEW: One Year Later, COVID Brings Chaos From Unexpected Corners

By PAUL NATINSKY
In early February 2020, the news stories and warnings began to appear about a virus in China emerging from a “wet market” in a city of 11 million whose name I’d never heard. My first thought was here we go again. Just like MERS or SARS—and seemingly every winter’s inevitable exaggerated blizzard forecast—I figured it was another alarmist health scare that would never reach American shores.

In mid-March, it became clear that this time it was real—the “coronavirus” had arrived, was spreading fast and was going to wreak havoc in our lives. Even at first and amid the confusion of mixed messages and unclear science, I suspected this disease was going to infect many and have long-term consequences.

As our school district struggled along with neighboring districts about whether to close schools, I applauded Gov. Gretchen Whitmer stepping up and taking the heat off of local school boards about whether or not to shut down. The locals were under pressure keep schools open, in no small part so that parents could go to work and hot meals continued for kids who needed them.

I saw the immediate wisdom of shutting down offices, restaurants, gyms, barbers—any business that created a virus-spreading risk. I saw the wisdom in [Read More]

House Health Policy Spotlights Drug Price Hikes

The rising cost of prescription medicine was the issue of the day before the House Health Policy Committee as it took up two bills March 4, one to bar so-called copay “accumulators” and a second to require drug makers to report price increases to the state.

HB 4353, sponsored by Rep. Bronna Kahle (R-Adrian), would require all copays to count toward an insured’s deductible and out-of-pocket costs. HB 4347, by Rep. Angela Witwer (D-Delta Twp.), would require manufacturers to report price increases to the Department of Insurance and Financial Services.

The bills are reintroductions of legislation considered last term.

Sarah Procario of the Hemophilia Foundation of Michigan told the committee many patients rely on copay assistance programs run through nonprofits or the drug manufacturers themselves in order to be able to afford their medicines.

“Unfortunately, . . . a growing insurance trend is jeopardizing the benefits of copay assistance,” Procario said. “Copay accumulator adjustment programs bar all copay assistance from counting toward patients’ out-of-pocket costs making it harder for them to access their life-saving and life-enhancing medications.”

Insurance companies don’t prohibit the use of copay assistance, she explained, “but when it runs out, typically a few months into the year, the patient will still be responsible for their full deductible [Read More]

Coronavirus Deranges Immune System In Complex, Deadly Ways

By LIZ SZABO
There’s a reason soldiers go through basic training before heading into combat: Without careful instruction, green recruits armed with powerful weapons could be as dangerous to one another as to the enemy.

The immune system works much the same way. Immune cells, which protect the body from infections, need to be “educated” to recognize bad guys — and to hold their fire around civilians.

In some covid patients, this education may be cut short. Scientists say unprepared immune cells appear to be responding to the coronavirus with a devastating release of chemicals, inflicting damage that may endure long after the threat has been eliminated.

“If you have a brand-new virus and the virus is winning, the immune system may go into an ‘all hands on deck’ response,” said Dr. Nina Luning Prak, co-author of a January study on covid and the immune system. “Things that are normally kept in close check are relaxed. The body may say, ‘Who cares? Give me all you’ve got.’”

While all viruses find ways to evade the body’s defenses, a growing field of research suggests that the coronavirus unhinges the immune system more profoundly than previously realized.

Some covid survivors have developed serious autoimmune diseases, which occur when an overactive immune system attacks [Read More]

ON POINT WITH POs: The Ides of March Revisited: A Pandemic Look-back

By EWA MATUSZEWSKI
“If they close a door, go through the window. If the window is closed, check the chimney.” When faced with an obstacle, these were the words of wisdom from my mother, a native of Poland who spent time in a displaced persons’ camp after World War II. While I haven’t gone down the chimney yet, I’ve certainly gone through many windows in the past year. So now, a look back.

Mid-March 2020 adds another meaning to the famed Ides of March, which alternatively refers to the assassination of Julius Caesar, a lunar celebration in ancient history marking a new year, or simply a very bad omen – which would fittingly describe a looming pandemic. One year in, it is still with us, although it appears we have tamed the beast to a significant degree, thanks to multiple effective COVID-19 vaccination options. My mind wanders down various paths when I think of all that I have learned or observed, yet several words or phrases capture the essence of my observations: leadership, partnerships, trust, bureaucracy, and patient advocacy. I highlight key take-aways:

-Leadership: Its definition is broad and varied, but true leaders didn’t wait to be asked; they took charge. Whereas typical times may have presented bureaucratic [Read More]

COMPLIANCE CORNER: COVID-19 Testing Insurance Requirements Gain Clarity

By STEPHEN SHAVER
In an effort to increase the availability of COVID-19 testing and decrease the cost of testing to individual consumers, Congress required group health plans and commercial health insurers to provide coverage for COVID-19 testing with no cost-sharing, prior authorization, or other medical management requirements. However, months of ambiguous guidance have opened the door for inconsistent implementation and left providers, especially the clinical laboratories doing the testing, in a precarious position.

Congress’s efforts began with the Families First Coronavirus Relief Act (FFRCA), enacted on March 18, 2020. The FFCRA required group health plans and commercial insurers to provide coverage of FDA-approved tests “for the detection of SARS–CoV–2 or the diagnosis of the virus that causes COVID–19,” as well as items and services relating to a visit that results in such a test, at no cost to the beneficiary. Congress built on this requirement in the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), enacted on March 27, 2020. The CARES Act expanded the types of approved tests that were covered by the FFCRA and set the reimbursement rate for COVID-19 testing by out-of-network laboratories. Under the CARES Act, an insurer must reimburse an in-network laboratory at the negotiated rate that existed before the [Read More]

LEGAL LEANINGS: FDA Authorization of COVID Vaccines – What Does it Mean?

By BILLEE LIGHTVOET WARD, ESQ.
One year ago, in March of 2020, the Secretary of the U.S. Department of Health and Human Services (Secretary) declared that, because of the public health emergency resulting from the number of confirmed cases of 2019 Novel Coronavirus (COVID), circumstances exist to justify the authorization by the Food and Drug Administration (FDA) of emergency use of drugs and biological products during the COVID-19 pandemic. This action followed similar declarations permitting so-called “Emergency Use Authorizations” or “EUAs” for in vitro diagnostics and for ventilators, respirators and other medical devices. Since that time, the FDA has issued hundreds of EUAs for the use of various medical products in the diagnosis, treatment or prevention of COVID. Last week, the FDA issued an EUA authorizing the use of a third vaccine for the prevention of COVID. There are now 3 COVID vaccines available for use in the prevention of COVID in Americans over 18 years of age (note that the Moderna and Janssen vaccines are authorized for individuals 18 and older, while the Pfizer vaccine is authorized for individuals 16 and older).

Americans have experienced different stages of “pandemic-life” over the past year, and are currently experiencing differing stages of opportunity in relation to the [Read More]

LANSING LINES

Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.

Pressure Builds On DHHS Director Confirmation Vote

Three more Republican senators urged for the rejection of the appointment of Department of Health and Human Services Director Elizabeth Hertel March 4, while Democratic legislators are beginning to rally around her confirmation.

Sens. Tom Barrett (R-Potterville), Jim Runestad (R-White Lake) and Dale Zorn (R-Ida) joined three other colleagues in urging for a vote to reject Hertel based on her support, in part, on “her absurd and blatantly unconstitutional belief” that DHHS directors can, theoretically, issue public health orders that restrict public movement “forever.”

“The Senate should decline to consent to Director Hertel’s appointment and advise Gov. (Gretchen) Whitmer to appoint a director who will uphold the separation of powers and collaborate with the Legislature to address public health issues,” the letter reads.

Meanwhile, Senate Minority Leader Jim Ananich (D-Flint) stood up for Hertel as someone “qualified, capable and dedicated” to the state.

“Her resume is a mile long and she’s proven to be extremely successful working with Republicans and Democrats, in the private and public health sectors, in both policy and administration,” Ananich said.

“Should Senate Republicans manipulate the advice and consent process to achieve a political goal, that [Read More]

Michigan COVID Restrictions Tougher Than Most . . . But Not Abnormally So

Michigan is ranked 42nd among the states according to how much it’s reopened from COVID-19 restrictions, according to one site tracking pandemic-related restrictions on a state-by-state basis.

However, Michigan isn’t necessarily an outlier among the states when it comes to particular COVID-related restrictions, according to a MIRS review of sites tracking restrictions, such as the Kaiser Family Foundation (KFF), the National Academy for State Health Policy (NASHP), The New York Times and USA Today.

The state openness rankings compiled by Virginia-based government relations firm Multistate is based on a score derived from 11 factors, ranging from whether state residents are under a stay-at-home order, to the extent of specific restrictions on industries like bars and restaurants and large crowd venues, for instance.

On a scale of 0 to 100, with zero the equivalent of a full lockdown, Michigan scored 49, which was tied with Colorado and New York, and ahead of states like Vermont, Oregon, Hawaii, Illinois, Washington, California and New Mexico, with the lowest score belonging to New Mexico with 28.

According to the other sites MIRS reviewed, Michigan is in the majority of states when it comes to requiring masks broadly. All but a handful of states mandate masks, according to this map from the NASHP.

Michigan is [Read More]

Why The U.S. Is Underestimating COVID Reinfection

By JONEL ALECCIA
Kaitlyn Romoser first caught COVID-19 in March, likely on a trip to Denmark and Sweden, just as the scope of the pandemic was becoming clear. Romoser, who is 23 and a laboratory researcher in College Station, Texas, tested positive and had a few days of mild, coldlike symptoms.

In the weeks that followed, she bounced back to what felt like a full recovery. She even got another test, which was negative, in order to join a study as one of the earliest donors of convalescent blood plasma in a bid to help others.

Six months later, in September, Romoser got sick again, after a trip to Florida with her dad. This second bout was much worse. She lost her sense of taste and smell and suffered lingering headaches and fatigue. She tested positive for COVID once more — along with her cat.

Romoser believes it was a clear case of reinfection, rather than some mysterious reemergence of the original infection gone dormant. Because the coronavirus, like other viruses, regularly mutates as it multiplies and spreads through a community, a new infection would bear a different genetic fingerprint. But because neither lab had saved her testing samples for genetic sequencing, there was no way to confirm her [Read More]

LANSING LINES

Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.

School Outbreaks, Sports Guidance
The number of ongoing COVID outbreaks in school settings went up for the fourth week in a row, according to numbers released by the state Feb. 8.

With 32 new outbreaks among the 131 overall the first week of February, that eclipses the 105 from last week, the 70 from Jan. 25, and the 60 the week before that.

The 32 new outbreaks in schools were down from the 35 new ones reported the prior week, however. Before that, the numbers had been on the rise, up from the 26 from the week of Jan. 25, which was up from the nine reported from the week of Jan. 18. There were three reported the week of Jan. 11.

Youth Sports
Youth sports are back on, but the state is encouraging athletes to refrain from pre- or post-game handshakes, hugs, fist bumps, high fives, or other celebrations involving contact.

The Michigan Department of Health and Human Services issued its COVID-19 guidance for resuming youth sports after Gov. Gretchen Whitmer said competitions were a go starting Feb. 8.

As announced in early February, the newest order allowing sports requires masks to be worn during practices [Read More]

ON POINT WITH POs: Michigan PCPs Deserved A Seat At Vaccination Strategy Table

By EWA MATUSZEWSKI
I hope as you are reading this that Michigan primary care physicians are vaccinating their patients against COVID-19. However, as I write this, the primary care community has been shut out of offering solution-oriented strategies for maximizing vaccinations among Michigan residents. Note, I do not include publicly traded primary care companies here, which was tapped early on by large health systems for vaccination administration assistance. If you sense irritation on my part, you are correct.

For those vaccines that do not require polar temperature refrigeration, the physician’s office should not have been overlooked. Not only are primary care physicians experienced in vaccination storage, monitoring and distribution, they know their patient population and can easily identify their most vulnerable patients for vaccinations by using their electronic patient registry platforms.Further, they can immediately log in each vaccination through the state’s MCIR data base.

Michigan is supported by an outstanding network of primary care physicians and Advanced Practice Providers (APP) who lead the nation in following the patient-centered medical home model. Our PO member physicians and APP were trained by the state (MCIR training) through internally developed webinars and other communication channels earlier this year on how to prepare for large scale vaccination initiatives. Not one physician or [Read More]

COMPLIANCE CORNER: HIPAA Updates Expected In 2021

By ROLF LOWE
The Department of Health and Human Services (HHS) released proposed changes to the Health Insurance and Portability Accountability Act (HIPAA) Standards for Privacy of Individually Identifiable Health Information (the Privacy Rule) on December 10, 2020. The proposed modifications to the Privacy Rule are intended to address existing standards HHS has identified as impeding the transition to value based care, while continuing to protect the privacy and security of individuals’ protected health information (PHI). HHS specifically identified obstacles currently in place hindering care coordination and case management communications among individuals and covered entities, (which include hospitals, physicians, other health care providers, payors and insurers). The proposed rule changes also address unnecessary burdens associated with communicating PHI between covered entities and individuals.

Some of the major changes to the Privacy Rule include:

-Defining electronic health records (EHR) and personal health application;

-Modifying rules concerning an individuals’ right of access to their PHI;

-Amending the definition of health care operations to broaden the permitted use and disclosure of PHI for care coordination and case management;

-Creating an exception for “minimum necessary” standard for the purpose of care coordination and case management;

-Clarification of the rules covering the ability to disclose PHI to social service agencies, community-based organizations, home and community-based services [Read More]

LEGAL LEANINGS: The Regulatory Sprint To Value-Based Care

By JEREMY BELANGER
On Dec. 2, 2020, the CMS and the OIG published the rules modifying the safe harbors under the Anti-Kickback Statute and exceptions under the Stark Law . This article presents an overview of the value-based rules, which became effective on Jan. 19, 2021.

CMS and OIG coordinated many aspects of the value-based rules, and this section will align them as much as possible. It is important to remember that these rules do not protect remuneration based on ownership interests, only for compensation.
A value-based arrangement must be designed to achieve: (i) coordination and management of care; (ii) improve the quality of care; (iii) reduce the costs to, or growth in expenditures of, payors without reducing the quality of care; or (iv) transition from fee for service to the quality of care and control of costs of care. Cost savings that are not passed onto payors are not covered by the new rules. The arrangement must be reasonably designed to achieve one of these purposes, but failure to achieve them does not necessary violate the safe harbor or exception.

The arrangement must be designed to serve a target patient population. A “target patient population” is an identifiable patient population, developed through “legitimate and verifiable criteria,” set [Read More]

Health Workers Unions See Surge In Interest Amid COVID

By ANERI PATTANI
The nurses at Mission Hospital in Asheville, North Carolina, declared on March 6 — by filing the official paperwork — that they were ready to vote on the prospect of joining a national union. At the time, they were motivated by the desire for more nurses and support staff, and to have a voice in hospital decisions.

A week later, as the COVID-19 pandemic bore down on the state, the effort was put on hold, and everyone scrambled to respond to the coronavirus. But the nurses’ long-standing concerns only became heightened during the crisis, and new issues they’d never considered suddenly became urgent problems.

Staffers struggled to find masks and other protective equipment, said nurses interviewed for this story. The hospital discouraged them from wearing masks one day and required masks 10 days later. The staff wasn’t consistently tested for COVID and often not even notified when exposed to COVID-positive patients. According to the nurses and a review of safety complaints made to federal regulators, the concerns persisted for months. And some nurses said the situation fueled doubts about whether hospital executives were prioritizing staff and patients, or the bottom line.

By the time the nurses held their election in September — six months after they [Read More]

Coulter, Hackel Criticize Vaccine Rollout; Gov Wants To Directly Buy Pfizer Doses

It’s not just Republicans complaining about Michigan’s COVID-19 vaccination rollout so far.

Democratic leaders of some of Michigan’s population centers – Oakland County Executive Dave Coulter and Macomb County Executive Mark Hackel – have publicly railed against the speed of the distribution so far.

Gov. Gretchen Whitmer, for her part, announced she’s now asked the feds for permission to directly purchase up to 100,000 doses. She said her letter to the feds asking for more vaccines to be released hasn’t seen a response.

“We remain ready to accelerate distribution to get doses into arms,” Whitmer said she wrote in the letter. “Toward that end, I am writing to request permission for the state of Michigan to make a one-time purchase of up to 100,000 doses of COVID-19 vaccine directly from Pfizer to be distributed and administered consistent with CDC guidelines and the FDA’s Emergency Use Authorization (EUA) for the Pfizer COVID-19 Vaccine.”

Coulter, on WJR with Paul W. Smith, said from what he’s read, “if we kept up at this pace” of the vaccination rollout, “it would take 10 years to get everyone vaccinated . . . this cannot continue.”

The 10-year projection was made by NBC News back in late December and was related to the complete Operation Warp [Read More]

ON POINT WITH POs

PO’s Adoption of BCBSM’s Blueprint for Affordability Reflects Value Of Trusted Partnerships

By EWA MATUSZWEWSKI
Amid the flurry of pandemic responses and mitigation initiatives that physician organizations added to their plates in 2020 was a separate event that had been under consideration since just before the pandemic. I’m referring to Blue Cross Blue Shield of Michigan’s Blueprint for Affordability program, which was launched in January 2020.

Designed to hold the line on healthcare costs as it enables improved care quality, coordination of care, and outcomes for patients, Blueprint for Affordability is a value-based compensation model where each physician organization partner has annual cost-of-care targets and clinical quality benchmarks to meet. The targets are tailored to each organization’s unique patient population. If an organization optimizes patient health to keep its overall cost below target and meets its quality performance metrics, it will receive additional financial rewards from Blue Cross. If quality metrics are not met, driving costs above target, the organization will rebate Blue Cross, and ultimately its customers, a portion of the overage.

Seven physician organizations signed on initially, but I’ll admit our organization wasn’t completely on board at the outset. Frankly, it was a risky venture and our leadership team wanted to make sure we were well positioned [Read More]

COMPLIANCE CORNER

CMS Releases New Measures to Address Social Determinants of Health

By KAITLIN A. NUCCI
On January 7, 2020, CMS published a State Health Official letter to provide guidance in the adoption of policies to address social determinants of health in both Medicaid and Children’s Health Insurance Program (CHIP). The reasoning behind such strategy stems from the fact that even though the United States spends more money than almost any other country in the world on healthcare, the United States is often is outperformed on key health indicators such as life expectancy, reducing chronic heart disease, and maternal and infant mortality rates. This is due to a range of social, environmental and economic factors that have major influences on health, sometimes even more influence than the delivery of healthcare services.

This letter provides the guidance needed for states to use existing flexibilities under federal law and regulations to address social determinants of health and the adverse outcomes that are often associated with these factors. States are encouraged to enact programs and/or provide benefits that can in the long term reduce the cost of caring for high-risk populations.

Through this guidance, CMS acknowledges that social determinants of health, such as access to nutritious food, accessible housing, education, and meaningful employment, [Read More]

LANSING LINES

Baraga County Tells Whitmer: We’re Done
Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.

The sum of Baraga County government passed a resolution telling Gov. Gretchen Whitmer it will no longer be participating in any more shutdown orders designed to protect the population from COVID-19.

All five county commissioners signed a resolution Jan. 11 along with the county’s sheriff, prosecutor, clerk, and treasurer that “we have no intention of participating in the unconstitutional destruction of our citizen’s economic security and liberty.”

The county officials also said they will “take no action whatsoever in furtherance of this terribly misguided agenda.”

County Commission Chair Bill Rolof said the people in his county are beyond upset. Businesses are being shut down, likely to never reopen again. Meanwhile, they feel as if they have taken every safety precaution voluntarily.

“Enough is enough,” Rolof said. “The people up here are ready to move on.”

The roughly 8,500-person county has had 476 confirmed cases of COVID-19 since the pandemic began and 29 deaths. That’s roughly 5.6% of the population to test positive, putting it 18th among the state’s 83 counties in contraction rates.

Still, MIRS found other Upper Peninsula counties are in the same boat, tired of the Governor and her administration putting [Read More]

LEGAL LEANINGS

Employers Can Mandate Employees Have the COVID-19 Vaccine…With Restrictions

By SARA H. JODKA
On December 16, 2020, the Equal Opportunity Employment Commission’s (EEOC) issued “What You Should Know About COVID-19 and the ADA, the Rehabilitation Act, and Other EEO Laws” (the Guidance). The Guidance does not even specially address the question as to whether employers can mandate employees have the vaccine, rather, the Guidance jumps right in assuming employers already knew they could have mandatory vaccine policies and goes into the limited restrictions as to when an employer may have to pause and engage the employee in interactive discussion regarding the employee’s medical, religious or other reasons for not wanting the vaccine.

Specially, Section K of the guidance discussion “Vaccinations” and provides a handful of helpful Q&As that succinctly guide employers. Here are some highlights:

How should an employer respond to an employee who indicates the employee is unable to receive the vaccine because of a disability?

The ADA allows employers to have a qualification standard that includes “a requirement that an individual shall not pose a direct threat to the health or safety of individuals in the workplace.” When dealing with a vaccine, which screens out or tends to screen out an individual with a disability, the employer [Read More]

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