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COVID-19 Vaccination Program for Providers FAQ
CDC COVID-19 Vaccination Program Frequently Asked Questions for Provider Organizations
How does an Organization participate in the CDC COVID-19 Vaccination Program? You can access the registration tool at www.MICovidVaccineProviders.org or by visiting the Resources tab at https://www.michigan.gov/Coronavirus.
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What if the Provider is not in the Michigan Care Improvement Registry (MCIR)? Not every health care provider uses MCIR, but in order to administer the COVID-19 Vaccine, providers must register with MCIR. To begin registration in MCIR, Providers need to complete a MCIR Usage Agreement. The completed form then needs to be faxed to 517-763-0370. Once your site is registered, MCIR Training can be arranged from the MCIR Regional Office Staff. Already a MCIR registered site but do not remember your MCIR ID? Log into the MCIR application (via MILogin) and use this job aid link to assist with finding your MCIR ID.
Who should complete the CDC COVID-19 Vaccination Program Provider Agreement? The Organization information may be completed by the Vaccination Coordinator or other administrative professional. The Agreement (Section A) must be signed by the Chief Executive Officer (CEO) or Chief Fiduciary Officer AND the Chief Medical Officer.
Who should complete the CDC COVID-19 Vaccination Site – Provider Registration? The CDC COVID-19 Vaccination Site-Provider Registration may be completed by the Organization’s Vaccine Coordinator, Location Practice Manager or other appropriate delegate. The Pharmacy Director or Medical Director must sign the Provider Registration.
Do we have to complete a CDC COVID-19 Vaccination Site – Provider Registration tool for each location
expected to administer COVID-19 vaccinations? Yes, each vaccination site must complete and submit a Vaccination Site - Provider Registration tool/survey to be eligible to administer vaccine. Each site must have a unique MCIR ID.
Do I need to complete a new Vaccination Site – Provider Registration tool if a provider leaves, changes location
or we hire a new provider? No, once you have submitted the Provider Registration tool, there is no need to update it or resubmit unless requested by MDHHS.
If a Provider serves multiple sites, will they need to be listed for each Vaccination Site? No, once a Provider is listed for one Vaccination Site they do not need to be listed on additional sites.
How can we review or access our Vaccination Site – Provider Registration tool/survey after it is submitted?
When you submit the tool/survey, you’ll receive a confirmation email that your application has been received. The confirmation email will include a link to access the information submitted.
Does completing the CDC COVID-19 Vaccination Program Agreement ensure we will be approved to administer
COVID-19 vaccine? No, applications will be reviewed by MDHHS and approved locations will be notified. Not all approved Providers will be able to receive COVID-19 vaccine immediately or in quantities ordered as specified in the State of Michigan COVID-19 Vaccination Plan.
If you have additional Provider-related questions about the Michigan CDC COVID-19 Vaccination Program, please email: MDHHS-COVIDVaccineProviders@michigan.gov
IN MEMORY Please keep the families of those who passed in your prayers.
Minoo Khurshed Rao, MD, 02/16/1938 - 11/23/2020 of Linwood passed away following complications due to Alzheimer's. Dr. Rao was born in Multan, India. Covenant HealthCare named Dr. Rao the 2004 Distinguished Physician of the Year, after being nominated by many of his colleagues. Dr. Rao earned his medical degree from MGM College in India in 1961. He began practicing medicine at Saginaw hospitals in 1972, following his surgical residency and fellowships in thoracic surgery and cardiac catheterization at Henry Ford Hospital in Detroit. He also completed a fellowship in pediatric cardiovascular surgery in 1973 in Toronto, ON. Beyond surgery, Dr. Rao's passion was training residents in his field. He was very proud to have won the Outstanding Volunteer Educator award four times from residents at Synergy Medical Education Alliance of Saginaw. Dr. Rao was a member of the medical staff at both the former St. Luke's and Saginaw General Hospitals. Additionally, he was chief of staff at Saginaw General Hospital in 1994 and 1995. He served as chief of the Surgery and Thoracic/Vascular Section and was a member of the St. Mary's Hospital medical staff. Dr. Rao held leadership positions with both the Saginaw County Medical Society and the Saginaw Surgical Society. He retired in 2004, and became a member of the Covenant HealthCare Emeritus Medical staff. Minoo is survived by his wife of 24 years, Kandy; his daughter Tara (Troy) of Pittsburgh and their son Spencer; his son Steven (Laura) of Buffalo, and their children Noah, Griffin, Maya and Sydney; his sister Farida (Sterling Heights); his cousin Dr. Jehangir Rao (Bloomfield Hills); best buddy Dr. Surendra Kaul (Midland) and many loving cousins, nephews, nieces and friends. The family extends heartfelt gratitude to all of the staff at Bayfield Assisted Living & Memory Care of Bay City and Residential Hospice for their devoted care of Minoo. Those planning an expression of sympathy are asked to consider the East Side Soup Kitchen of Saginaw, P.O. Box 330, Saginaw, MI 48606. For online tributes and to pay respects, please visit www.cremationsocietymidmi.com.
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Donald J. Cady MD, husband, father, grandfather and great-grandfather passed away on Tuesday, December 1, 2020. Born in Saginaw on April 12, 1924, the son of the late Frederick J. and May (Sanders) Cady. One of five siblings, Don graduated from Saginaw High School in 1941, attended the University of Michigan for eight years earning his undergraduate and his medical degree, graduating in 1947. After serving his internship and residencies, Don practiced in Florida for one year. He served his country in the United States Army for two years before returning to Saginaw and opening his private practice in internal medicine in the mid 50’s. He continued his practice for the next 50 years, retiring in 2003. He married Janice Nachtweih on September 28, 1985, at Second Presbyterian Church in Saginaw. She survives him. They made their home at Linwood Beach, overlooking the Saginaw Bay. Don had a long association with St. Mary’s Hospital, serving in many capacities in its history to Saginaw. Don had a passion for reading books of all genre. He loved race-sailing and participated in over 30 Bayview Mackinaw races, sailing from Port Huron to Mackinaw Island. He was an avid sports fan, especially the University of Michigan football and baseball teams. He is survived by his wife, Jan; six sons, Donald Jr., Robert, Daniel, Timothy, Andrew, and Patrick; foster son Charles (Hong Soon) Lee; twelve grandchildren; three great-grandchildren; sister, Geraldine (Charles) O’Laughlin of Chicago; brother, Dean (Lois) Cady of Milwaukee and many nieces and nephews. He also leaves behind many friends inside and outside the medical field. Don was preceded in death by his brother, Frederick (Beverly) Cady II; brother, David Cady; and his first wife and mother of his children, Mary Ellen (Blunt) Cady. Don was loved and respected by his family and his community; he returned the love and respect to them twofold. Funeral services took place on Saturday, December 5, 2020 with committal service following at Roselawn Memorial Gardens. Those planning an expression of sympathy may wish to consider memorials to a charity of their choice.
Lisa Lapham, CEO of HealthSource
Saginaw - The world lost a treasured wife, mother, daughter, sister and friend, Lisa (Heric) Lapham, on November 3, 2020. Lisa stood up to breast cancer with great courage, and never let it stop her from living and loving life. Lisa died at M.D. Anderson while recuperating from brain surgery. Lisa was born in Marquette on June 10, 1971. She was happily raised by her proud, loving parents, Vincent & Nancy (Ghiardi) Heric, who instilled strong Catholic values. Lisa graduated from Gwinn High School in the U.P. of Michigan in 1989, and with honors from Central Michigan University in 1992. She married Ronald Lapham on August 21, 1993. Lisa took great pride in her family and always enjoyed encouraging her children in school and sports. She also loved boating, skiing, hiking and cheering on the Packers. She made everyone feel welcome and loved shaking drinks to share, and occasionally wowed friends with her flash cooking. Lisa was so much more than CEO to her colleagues at HealthSource Saginaw; she was their friend. She was extremely dedicated to her work, working longer hours than most. Regardless of her high position and standards, she insisted that she be treated the same as all other employees. Lisa is survived by her fun-loving husband Ron; children, Jacob, Allison and Joshua; mother Nancy (Robert) Van Stee; siblings, Rick Heric and Lynn (Steve) Rodgers; best friend, Jen Chichester; as well as, many aunts, uncles, nieces, nephews and cousins. She was preceded in death by her father, Vincent Heric; maternal grandparents, Martin and Vera Ghiardi; and paternal grandparents, Vedo and Margaret Heric. Funeral services were held on Thursday, November 12 at St. Brigid Catholic Church in Midland, followed by burial at City of Midland Cemetery. Those planning an expression of sympathy are asked to consider donating in Lisa’s honor to your local women’s shelter, mental health clinic or breast cancer research.
Nijole Vince Rice, loving mother and grandmother passed away Wednesday, November 4, 2020, at the Toni and Trish House in Auburn, Michigan at the age of 86. The daughter of the late Vince and Vaclava Sarka, Nijole was born May 25, 1934, in Lithuania, immigrated to America in 1950 and settled in Detroit. She was married to Dr. William T. Rice. He predeceased her on November 17, 1996. Nijole was a nurse in Detroit where she met her husband and moved to Saginaw where they spent the
rest of their lives. She volunteered in the community for years. Painting was her passion and she loved walking, sunshine and beaches. Nijole was colorful, bold, strong and generous. She had a strong faith, and was a member of Faith Lutheran Church. Nijole fought to the end to be independent and stay at home in the city she loved so much. Surviving to cherish her memory are one daughter, Inga and Bryon Stephens; one son, Eric and Kimi Rice; five grandchildren, Rachel, Andrea and Katie Stephens, Carew and Luke Rice; one niece, Diana Cernis and her husband, Roger Wohlman; and one nephew, Victor Cernis. Nijole was preceded in death by her sister, Izolda Cernis. Honoring Mrs. Rice’s wishes cremation has taken place and a memorial service will take place at Oakwood Cemetery in the summer of 2021. Those planning an expression of sympathy may wish to consider memorials to the Vasculitis Foundation www.vasculitisfoundation.org or the Toni and Trish House, www.toniandtrishhouse.org.
Ilse E. Letson, age 77, passed away on Friday, November 27, 2020. She was surrounded by her loving family who helped her peacefully transition into heaven with God's loving grace. Ilse was born on January 18,1943, in Dortmund, Germany to Marianne and Rudolph Friederich. She spent her childhood and teenage years in Hamburg, Germany. She had a keen interest in marketing and publishing, leading her to an internship with the renowned Axel Springer Publishing Company, and she continued working there until her departure to the United States. Her determined, adventurous, independent spirit prompted her to set off on her own, at the age of 20, moving to the U.S. where she integrated with the Cox family in the Main Line of Philadelphia as an Au Pair. She lovingly looked after their four children for several years. A year later, she attended Bryn Mawr College both as a student and Lab Technician in the Psychology Department but left to raise her own family. However, in a constant quest for the value of her higher education, at the age 57, she returned to school and she graduated from Northwood University with highest honors in 2000. In 1965, Ilse married James A. Letson, Jr. MD. She is survived by their children, James A. Letson III (wife Tammy), Lisa Conlee, Kristin Snyder (husband James) and Andrew Letson, as well as, her beloved grandchildren, Elise Letson and Wolfgang Snyder. A brother (Rudolf Friederich) and grandsons, Hunter and Connor Letson, preceded her in death and greeted her in heaven. According to Ilse's wishes, cremation has taken place. Her ashes will be buried under a special Dogwood Tree this Spring. She wanted to let her beloved family and friends know that she always appreciated their love, generosity and support in her many endeavors. Friends who would like to share time with the family and other close friends are invited for a "Celebration of Life" the weekend of Mother's Day 2021 when hopefully we can gather safely to honor her loving legacy (place TBD). Those planning an expression of sympathy are asked to consider a donation in her name to "Doctors Without Borders" (888-392-0392) or to the City Rescue Mission in memory of Ilse Letson, checks made payable to City Rescue Mission, PO BOX 548, Saginaw MI 48606 or donate online www.rescuesaginaw. org. "Would have traded all tomorrows for one more today"-Ilse Phil. 4:4.7
2020 END-OF-THE-YEAR LEGISLATIVE REPORT
As with everything else in 2020, the COVID-19 pandemic brought about many challenges and changes to the legislative process. While much of the legislature’s focus was shifted to the state’s pandemic response, several other health care related items remained at the forefront of legislative and regulatory action throughout the year. Below is a briefing prepared by MSMS staff of several issues of consequence to physicians and patients that MSMS has been tracking throughout the year. If you have any questions
or comments regarding information included in this report, please contact MSMS Department of State and Federal
Government Relations at (517) 336-5737.
Surprise Out-of-Network Billing
Debate around Surprise Out-of-Network (OON) medical bills by the Michigan Legislature began during the mid-to-latter part of 2019 and continued through 2020. Few would argue these circumstances don’t occur; however, varied opinions with respect to how pervasive this problem is in Michigan exist. On October 22, 2020, HB’s 4459, 4460, 4990 and 4991 were signed into law, prohibiting OON physicians and other health care providers from balance billing patients in certain situations, such as the receipt of emergency care or care received without an option to choose an in-network provider. Instead, nonparticipating providers will be paid pursuant to a specified fee schedule. Additionally, in cases of elective or planned procedures, OON providers are required to provide advance notice to patients of the estimated cost of the health care service(s). The thrust of MSMS’s concerns were related to the mandatory fee schedule imposed on OON physicians, which was originally set at 125 percent of Medicare, the lack of an independent dispute resolution (IDR) process, creation of an unequal playing field significantly favoring insurers, impact on health care access and challenging administrative requirements. While the version of the bills that were signed into law remain problematic, MSMS was able to secure important changes throughout the process to improve the legislation including the following: • Fairer fee schedule to include the median contracted rate for the region and specialty or 150 percent of Medicare, whichever is greater; • Inclusion of an arbitration process when there are cases with complicating factors; • Elimination of barriers to disputing payment such as proving the insurer did not have an adequate network, thereby allowing providers access to this process; and • Removing patients from the middle of disputes by ensuring payments are sent directly from the insurance company to the physician.
MSMS Position/Action: Opposed. In lieu of the current price-fixing approach, MSMS continues to strongly advocate for a comprehensive approach to surprise OON billing that holds insurance companies accountable for the products they sell to patients, and allows insurance companies and providers to negotiate in good faith with an IDR process as backstop. MSMS will continue pursuing these common-sense changes in 2021.
Prior Authorization, Step Therapy: Health Can’t Wait
Over the course of the last couple years, MSMS created a campaign to reform prior authorization and step therapy in Michigan. In that time, MSMS also assembled a coalition that has grown to 50 organizations, collectively known as the Health Can’t Wait (HCW) coalition. The group includes partners from physician specialty organizations, other provider associations and patient groups. The HCW campaign officially kicked off in March of 2019, and since then, MSMS has worked closely with coalition partners to lay the groundwork for a legislative remedy to address issues arising from insurance company prior authorization and step therapy practices. Senate Bill 612, introduced by Senator Curt VanderWall (R-Ludington) on October 29, 2019, was the culmination of that initial groundwork. The bill covers all benefits, including services and pharmaceuticals, and is built on the core principles of transparency and fairness; clinical validity, timeliness and administrative efficiencies; continuity of care; and alternatives and exemptions. On December 16, the Senate passed a revised, and deeply flawed version of SB 612 on to the House. At the last minute, several provisions were added that completely undermine the bill. With the addition of this new language, the bill no longer adequately addresses the initial goals of the legislation - timeliness of treatment; increased transparency and accountability; and shared decision-making between patients and their physicians. Specifically, the new version: • Allows insurance companies to reset the "clock" on decision deadlines (one business day for urgent requests
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and five business days for non-urgent requests) EVERY TIME they ask for further information; • Removes language requiring prior authorization criteria at point of care; • Provides a major loophole for third-party vendors who are financially incentivized when prior authorizations are denied to develop the clinical review criteria; • Removes the requirement for physician consultation or review when non-physician health professionals deny a prior authorization request; • Removes the requirement for specialty-specific physician review of appeals; • Excludes physician input when medication prior authorizations are established or changed (only pharmacist input is required); • Expands the scope of practice of pharmacists by requiring them to authorize prior authorizations denials for medications instead of physicians; and • Removes all language requiring insurers to publicly post data on prior authorization approvals and denials (this is key to providing increased transparency and accountability).
VOTED IN FAVOR OF SB612 AS AMENDED:
Senate Democrats: Alexander, Ananich, Bayer, Bullock, Chang, Hertel, McCann, McMorrow, Moss and Polehanki State Republicans: Barrett, Bumstead, Daley, Horn, Johnson, LaSata, Lauwers, Lucido, MacDonald, MacGregor, McBroom, Outman, Runestad, Schmidt, Shirkey, Stamas, Theis, VanderWall (BILL SPONSOR), Victory and Zorn
VOTED AGAINST SB612 AS AMENDED:
Senate Democrats: Brinks, Geiss, Hollier, Irwin, Santana and Wojno State Republicans: Bizon and Nesbitt
All of these changes undermine timely patient care and ultimately patient safety. On December 21, the House formally adjourned for the session, effectively ending the possibility of this flawed version of SB 612 becoming law. Looking ahead to 2021 and the beginning of a new legislative sessions, HCW will continue its fight to address this important issue. Prior authorization is still an abused and overused practice that insurance companies use to deny patients the care and treatment they need.
Medical Liability Immunity
The COVID-19 pandemic created unprecedented health care challenges that not only put physicians’ physical wellbeing at risk, but their financial well-being too. Physicians and other health care providers were left to treat patients without adequate supplies of Personal Protective Equipment (PPE), ventilators and clinically tested drugs. The stay-athome order and cancellation of elective procedures resulted in care delays. Additionally, governmental and regulatory guidance changed rapidly throughout the pandemic, forcing providers and facilities to constantly implement new procedures and protocols. After Governor Whitmer's declaration of a state of emergency, she signed Executive Order 2020-30 on March 29, 2020, which included immunity language for health care professionals providing medical or other services to COVID-19 patients, or otherwise in support of the state’s response to the COVID-19 pandemic. An extension of the order was signed under EO 2020-61 on April 26, 2020; however, it was later rescinded on July 13, 2020. There have also been legislative efforts to address medical liability immunity. Senate Bill 899, introduced by Senator Mike MacDonald (R-Macomb) on April 29, 2020, proposed to extend liability protections during the period from March 10, 2020, to January 1, 2021, to any death or injury arising out of or resulting from any act or omission by a health care provider or health care facility while engaging in one or more of the following activities, which would constitute health care services rendered in support of the state’s response to the COVID-19 pandemic: • Rendering COVID-19-related health care services to a person with presumed, suspected or confirmed COVID-19. • Arranging, scheduling, rescheduling, canceling or postponing the rendering of health care services, including a decision to use telehealth or other remote services instead of an in-person encounter, in reliance on or in compliance with any administrative or governmental agency, division, or department policy, rule, or directive or any executive order or law regarding health care services provided by a health care provider or health care facility. continued on page 28
continued from page 27 • Acts, omissions or decisions resulting from a shortage of necessary resources, including blood products, medical equipment, pharmaceuticals or staffing.
Status: Passed Legislature. Vetoed by Governor Whitmer on August 10, 2020, stating the “bill goes much further in ways that are directly counter to the interests of those receiving care.”
MSMS Position/Action: MSMS supported Senate Bill 899 after successfully securing liability protections for issues arising from delays in care. The bill was ultimately House Bill 6159, introduced on September 2, 2020 by Rep. Roger Hauck (R-District 99). The bill codified EO 2020-30 by creating the "Pandemic Health Care Immunity Act" to provide protection from liability for health care providers and health care facilities rendering health care services related to the COVID-19 pandemic, subject to exceptions. Under the bill, a health care provider or health care facility that provided
MSMS REIMBURSEMENT ADVOCATE ALERT
MSMS provides periodic updates to members and their offices on new and relevant payer policies. Please find some recent highlights below. For a comprehensive accounting of a health plans announcements, please consult the payer’s official communications.
Final Policy, Payment and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2021
The final rule is packed with information regarding the Medicare Physician Fee Schedule for Calendar year 2021. Some key areas affecting physicians: • CY 2021 PFS Rate-setting and Conversion Factor • Medicare Telehealth and Other Services Involving Communications Technology • Remote Physiologic Monitoring Services • Immunization Services • Direct Supervision by Interactive Telecommunications Technology • Payment for Office/Outpatient Evaluation and Management (E/M) and Analogous Visits • Policies Regarding Professional Scope of Practice and Related Issues • Supervision of Diagnostic tests by Certain Nonphysician Practitioners (NPPs) • Pharmacists Providing Services Incident to Physicians’ Services health care services in support of the State's response to the COVID-19 pandemic would not be liable for an injury, including death, sustained by an individual by reason of those services, regardless of how, under what circumstances, or by what cause those injuries were sustained, unless it was established that the provision of the services constituted willful misconduct, gross negligence, intentional and willful criminal misconduct, or intentional infliction of harm by the health care provider or health care facility. Liability protections would be provided retroactively for the period of March 29, 2020 to July 13, 2020.
Status: Governor Whitmer signed House Bill 6159 into law on October 22, 2020.
MSMS Position/Action: MSMS believes it is imperative that clinicians are provided the appropriate civil and criminal liability protections as they provide medical care to a growing
number of Michiganders during the COVID-19 pandemic. • Therapy Assistants Furnishing Maintenance Therapy • Medical Record Documentation • PFS Payment for Services of Teaching Physicians and Resident “Moonlighting” Services • Medicare Coverage for Opioid Use Disorder Treatment Services Furnished by Opioid Treatment Programs (OTPs) • Section 2002 of the Support Act • Section 2003 of the Support Act • Medicare Shared Savings Program
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CPT Code 99072
The AMA recently announced a new CPT code to account for medical services sparked by the public health response to COVID-19 pandemic.
CPT Code 99072 – Additional supplies, materials and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when performed during a Public Health Emergency as defined by law, due to respiratory-transmitted infectious disease. MSMS has been advocating with all Michigan and national payers, to reimburse this code. Many payers indicated they are waiting for CMS to act before making policy on this code. The AMA is also advocating with national payers and the CMS for reimbursement of CPT code 99072. Please contact Stacie Saylor or 517-336-5722 for questions or concerns.
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