October 23, 2014
MHA Capitol
Advocacy Center
110 W. Michigan Ave.
Ste. 1200
Lansing, MI 48933
Phone: (517) 703-8601
Fax: (517) 703-8620
www.mha.org
www.hospitalsact.org
Learning Session on
Compounding
2
Pharmacy Laws
Available Online
Waiver Available
for DEA Rule on
Disposal of Controlled Substances
2
Pending State
Legislation
3
Hospitals-ACT
3
Health PAC
4
Regulatory
4
MHA Legislative
Policy Panel
4
Advocacy Briefing
Your Vote is Vital to Michigan’s Healthcare Future
Election Day
is Nov. 4, and
Michigan’s healthcare
future depends upon
the involvement of
Michigan hospitals,
patients and
communities in the
general election. This
year, Michigan voters
will elect one U.S. senator, all 14 U.S. House of
Representative seats, the governor, the attorney
general, the secretary of state, all 38 Michigan
Senate seats, all 110 Michigan House of
Representative seats, and three of the seven
Michigan Supreme Court justices.
In the 2010 gubernatorial election, only
44 percent of Michigan’s registered voters
participated in the general election. In the last
two weeks leading up to the election, the active
involvement of healthcare leaders will help elect
healthcare champions, which are candidates who
will best support healthcare in Lansing and
Washington, DC. Your vote can make a
significant difference to the future of healthcare
in Michigan, so please be sure to make your
voice heard. For more information about
the election, visit http://www.mha.org/mha/
elections.htm.
Remaining 2014 Michigan Health Endowment Fund Listening
Tour Dates Set
The Board of Directors of the Michigan
Health Endowment Fund is conducting a
listening tour to gain a better understanding of
the health issues confronting Michigan children
and seniors. Several sessions have been
completed, and the final three tour dates and
locations have been set. The sessions will be
held Oct. 14 at the Grand Traverse Resort &
Spa, Acme (near Traverse City); Oct. 20 at the
UAW-GM Center for Human Resources,
Detroit; and Nov. 21 at the Salvation Army
Kroc Community Center, Grand
Rapids. Registration and driving directions are
available online.
The listening tour is an opportunity for
participants to respond to questions about
health concerns in their community, the barriers
preventing people from achieving good health,
and approaches that are working well to
improve the health and well-being of children
and older adults, as required by the endowment
fund’s statutory authorization. Requests for
funding are not being accepted at this time and,
based on conversations at previous sessions,
comments that focus on a broad set of
recommendations are well received; specific
funding suggestions for narrowly designed
interventions were viewed as too limited.
http://www.mha.org/mha/public_site/advocacy/documents/abriefing.pdf
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Learning Session on Compounding Pharmacy Laws Available Online
The MHA recently held a federal
and state compounding pharmacy laws
learning session to summarize Public Act
(PA) 280 of 2014, which contains
amendments to the pharmacy licensure and
drug control provisions of the Michigan
Public Health Code. Kathleen Reed, an
attorney with the Dykema law firm who
specializes in healthcare law, presented key
compliance issues in state and federal law that took effect
Sept. 30. Members who were unable to participate in the
learning session can view it online or review MHA Advisory
Bulletin #1341 that details the changes set forth in PA 280.
PA 280 was enacted in response to the New
England Compounding Center’s criminal
activity that caused the disastrous
outbreak of fungal meningitis in 2012. The
act creates a definition of compounding
pharmacies and establishes new limits on
compounding activities and requirements
for recordkeeping related to
compounds. The MHA and its members
worked closely with the attorney general’s
office and bill sponsors to ensure no unnecessary burden was
placed on hospital pharmacists, since hospitals differ greatly
from stand-alone compounding pharmacies. This law applies
to preparation of intravenous drug solutions and impacts
nearly every Michigan hospital.
Waiver Available for DEA Rule on Disposal of Controlled Substances
The U.S. Department of
Justice’s Drug Enforcement
Administration (DEA) final rule on
disposal of controlled substances
took effect, with potentially adverse
consequences for hospital employees
and patient care. The American
Hospital Association
(AHA) alerted its members that
certain provisions of the rule are incompatible with established
employee and patient safety protocols. In addition, the final
rule includes new, unrealistic record-keeping requirements
that will compel hospitals to reassign and retrain employees
and, possibly, hire additional staff members.
In a letter to the DEA, the AHA and other national
hospital organizations asked the agency to delay enforcement
of these provisions to allow time for providers to comply with
the arduous requirements. Suggesting there may be more
practical ways to meet the DEA’s objectives, the organizations
asked the agency to meet with hospitals as soon as possible to
discuss “practical solutions to these issues that can both
accomplish the laudable goals in the law and effectively
addresses (sic) the employee and patient safety concerns as
well as those related to excessive costs and disruption.”
Meanwhile, hospitals that cannot currently comply
with the new regulations may submit a written request
specifying that it is for a waiver of the provisions in the Sept. 9,
2014, Final Rule on Disposal of Controlled Substances that
took effect Oct. 9 and are applicable to the hospital’s disposal
of controlled substances. The AHA suggests the following
wording when requesting the waiver:
[Hospital] is requesting a waiver of the Methods of
Destruction under 21 CFR sec. 1317.90 requiring that
the destruction meet the "non-retrievable" standard.
[Hospital] is not equipped to comply with this new
standard and [Hospital's] current procedures for
destruction and disposal are compliant with longstanding federal, state and local requirements.
[Hospital] also seeks a waiver of the "on-site
destruction" requirement requiring two employees to
handle or observe handling and witness the
destruction. 21 CFR 1317.95(d). This requirement is
impractical for hospitals given DEA's narrow definition
of "employees." It is also unnecessary given that
[Hospital] has previously and will continue to utilize
appropriate personnel and individuals associated with
the hospital to perform these tasks.
The request should be mailed to Joseph Rannazzisi,
deputy assistant administrator, Drug Enforcement
Administration, Office of Diversion Control/OD, 8701
Morrissette Drive, Springfield, VA 22152.
http://www.mha.org/mha/public_site/advocacy/documents/abriefing.pdf
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Pending State Legislation
No-Fault Insurance
(SB 251) Establishes a $50,000 Personal Injury
Protection benefit for auto insurance coverage
Status: Senate Insurance
MHA POSITION: OPPOSE
Health Exchange Navigators
(SB 324/HB 4576) Licensing and regulation
for navigators who will assist citizens with the
healthcare exchange established by the
Conscientious Objector Legislation
Affordable Care Act
(SB 136) allow health care payers, health
Status: House Health Policy
facilities and health providers to decline or pay
MHA POSITION: SUPPORT CONCEPT
for certain health care services that violate
ethical, moral or religious principles, or
Low-cost Auto Insurance
beliefs.
(SB 326) Allows households having a gross
Status: Senate Floor
annual income equal to 300% of the federal
MHA POSITION: OPPOSE
poverty guidelines to apply for low-cost
automobile insurance. This insurance does not
Advanced Practice Registered Nurses
provide benefits that are provided under the
(SB 2) Eliminates provisions regarding the
Michigan policy of no-fault insurance capping
specialty certification of nurse midwives and
the coverage at $50,000.
nurse practitioners and, instead, provide for
Status: Senate Insurance
the licensure of advanced practice registered
MHA POSITION: OPPOSE
nurses (APRNs), including certified nurse
midwives, certified nurse practitioners and
certified clinical nurse specialists
Status: House Health Policy
MHA POSITION: NO POSITION
CRNA Supervision Requirement
(SB 180) Adds “administration of anesthesia”
by certified registered nurse anesthetists
(CRNAs) to the practice of nursing to allow
CRNAs to practice without direct physician
supervision
Status: Senate Health Policy
MHA POSITION: SUPPORT
Concealed Weapons Exemption Repeal
(SB 213) Eliminates list of specified premises
on which a person licensed to carry a
concealed weapon may not carry
Status: Senate Natural Resources,
Environment and Great Lakes
MHA POSITION: NEUTRAL
Medical Malpractice
(HB 4354) Health care professional or health
facility is not liable in emergency treatment
rendered in a hospital
Status: House Judiciary
MHA POSITION: NEUTRAL
Auto No-Fault
(HB 4612) Drastically decreases coverage in
Michigan’s Auto No-Fault Insurance and
Nurse Staffing Ratios
(SB 228/HB 4311) Requires development of an dissolves the Michigan Catastrophic Claims
Association
acuity system and staffing plan for nurses
Status: House Floor
Status: Senate Health Policy
MHA POSITION: OPPOSE
MHA POSITION: OPPOSE
Senior Opt-out of Auto No-Fault
(HB 4959) Allows seniors on Medicare to opt
out of purchasing Personal Injury Protection
(PIP) as part of their auto insurance
Status: House Insurance
MHA POSITION: OPPOSE
Health Care Professional ID Cards
(HB 4524) Requires all health care
professionals to wear identification cards
when providing direct patient care
Status: House Health Policy
MHA POSITION: OPPOSE
Respiratory Therapist Licensure Repeal
(SB 514) Repeal the licensure of Respiratory
Therapists
Status: Senate Regulatory Reform
MHA POSITION: TBD
Create a Michigan Patient Care Board
(SB 568) Consolidate regulations and
oversight of physicians of medicine and
osteopathic, physician assistants and advanced
practice registered nurses
Status: Senate Health Policy
MHA POSITION: NEUTRAL
Hospital Chargemaster Transparency
(SB 627/HB 5094) Requires hospitals to post
charge description master on their website
Status: Senate Health Policy
MHA POSITION: SUPPORT CONCEPT
Auto No-Fault Fraud Authority
(SB 647) Expands the automobile insurance
placement facility to include automobile
insurance fraud
Status: Senate Insurance
MHA POSITION: SUPPORT
E-cigarette Sales to Minors
(HB 5393) Prohibit sales of e-cigarettes or
other devices that provide vaporized nicotine
to minors and also require the products to be
sold in child-proof containers
Status: House Regulatory Reform
MHA POSITION: SUPPORT
Hospitals–ACT
Hospitals Advocating Care Together (Hospitals-ACT) is a grassroots initiative dedicated to helping MHA members
achieve public policies that protect access
to affordable health care for all Michigan
residents.
Hospitals-ACT brings together
hospital employees, trustees and volunteers
to deliver advocacy messages to state lawmakers, Gov. Snyder and the media.
These voices - the voices of
lawmakers’ constituents - truly
complement and enforce the MHA’s
overall advocacy efforts.
To learn more, please visit the Web
site at www.hospitalsact.org.
http://www.mha.org/mha/public_site/advocacy/documents/abriefing.pdf
3
OCTOBER
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leaders must recognize the crucial
role that community hospitals
play in the future well-being of
The 2014 Health PAC fundraising this state. Funding from the Health PAC
campaign had another successful year, yet assists the MHA and members in
again reaching an all-time high of more
developing relationships and sharing
than $375,000. Elected officials and state
information with key legislators. The MHA
4
Health PAC Board strongly encourages
those hospitals/health systems that have
not met or exceeded their organizational
goals to take the necessary steps to
complete their fundraising campaigns.
Members with questions should contact
Stacy Dowdy at the MHA.
Regulatory Update: Certificate of Need
Certificate of Need is a state
regulatory program intended to balance
cost, quality and access issues and
ensure that only needed services and
facilities are developed in Michigan. The
11-member, governor-appointed state
Certificate of Need (CON)
Commission meets quarterly to review
standards that regulate covered health
care services, beds, new construction
and renovation. Proposed standards
receive a public hearing, and then if
approved by the CON Commission, are
forwarded to the legislature and
executive branch for final approval
before taking effect. The Michigan
Health & Hospital Association supports
the Certificate of Need law as a means
of maintaining access and preserving
high-quality care in the community
hospital setting, while restraining the
proliferation of unnecessary facilities
and services.
The Commission met last on
Sept. 25, 2014 and action items included
approval of new county designations to
reflect recent federal census changes,
consideration of proposed language to
amend the standards governing nursing
homes and hospital long-term-care
units largely supported by the industry,
and review of proposed amendments to
the hospital bed standards that would
clarify the definition of a hospital
campus to include the grounds within
250 yards of the facility. A public
hearing has been scheduled for Oct.
23rd to obtain comments on the draft
language for both standards. Written
comments may be submitted
electronically to the CON Commission
through 5 pm on Oct. 30th. The
commission also called for bylaws
changes to allow for more flexibility in
the appointment of experts on Standard
Advisory Committees and set an Oct.
15 date to begin receiving public
comments on standards slated for
review in 2015.
Information about the criteria and
deadlines for seeking an appointment to
a Standard Advisory Committee, as well
as information about proposed
standards, upcoming CON Commission
meetings, public comment deadlines,
agendas, workgroups, CON application
forms, and lists of approved and
disapproved applications can be
accessed via the state’s CON website
at www.michigan.gov/con. The next
CON Commission meeting is Dec. 11,
2014.
MHA
Advocacy
Staff
David Finkbeiner
Senior Vice President, Advocacy
(517) 703-8604 ▪ [email protected]
Laura Appel
Senior Vice President, Strategic Affairs
(517) 703-8606 ▪ [email protected]
Amy Barkholz
General Counsel
(517) 886-8224 ▪ [email protected]
Stacy Dowdy
Manager, Grassroots Advocacy &
Health PAC
(517) 703-8648 ▪ [email protected]
Paige Fults
Manager, Advocacy
(517) 703-8616 ▪ [email protected]
Chris Mitchell
Vice President, Advocacy
(517) 703-8622 ▪ [email protected]
Stephanie Yager
Executive Assistant
(517) 703-8629 ▪ [email protected]
MHA Legislative Policy Panel
The MHA Legislative Policy Panel
(LPP) reviews emerging health care
legislation in a timely and efficient manner
and recommends an appropriate
association response to the MHA Board of
Trustees. In addition, the LPP is active in
identifying new legislative initiatives for the
association to champion. Peter Karadjoff,
President of Providence Park Hospital will
served as chairperson of the LPP during
the 2014-2015 program year. Vice
chairperson will be Diane Postler-Slattery,
President & CEO of MidMichigan Health.
The next meeting of the program
year will be held Dec. 11, 2014 at the
MHA Capitol Advocacy Center, 110 W.
Michigan Ave., Ste. 1200, Lansing.
For more information about the
meetings, please contact Chris Mitchell at
(517) 703-8622 or [email protected].
http://www.mha.org/mha/public_site/advocacy/documents/abriefing.pdf