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Long Term Care COVID-19 Plan
The state's long-term care facilities have faced immense challenges since Michigan recorded its first COVID-19 cases in March 2020. To respond to those concerns and provide essential protections to both residents and staff in residential care facilities, the State of Michigan leveraged authority granted by Executive Order and the Michigan Public Health Code. By designated authority, the Michigan Department of Health and Human Services (MDHHS) has acted to prevent and control the spread of COVID-19 by implementing a variety of strategies in the areas of infection control, diagnostic testing, data collection and reporting, and emergency staffing response.
MDHHS and other state partners continue to address and adapt to the changing impact of COVID-19 across the state. Expand the titles below to learn more about each component of the MDHHS Long-Term Care COVID-19 Plan.
Michigan law imposes on the Michigan Department of Health and Human Services (MDHHS) a duty to continually and diligently endeavor to "prevent disease, prolong life, and promote public health," and gives the Department "general supervision of the interests of health and life of people of this state." MCL 333.2221. Pursuant to the responsibility to protect vulnerable individuals and ensure the health care system can provide care for all health issues, MDHHS issued iterative emergency orders to continue mitigation techniques to restrict gatherings and require procedures in order to reduce the spread of the virus within Michigan's residential care facilities.
The current emergency order dated May 21, 2021 provides criteria for permitting idoor visitiation within nursing homes and other residential facilities in Michigan. MDHHS provides additional guidance through resources linked below to support facilities in implementing procedures to be followed during the COVID-19 epidemic to insure continuation of essential public health services and enforcement of health laws.
Residential Care Facilities May 21, 2021 Order Guidance - Updated 5/23/2022
Given the significant risk of COVID-19 outbreaks in long-term care facilities, MDHHS has issued an Emergency Order requiring that nursing facilities, homes for the aged, and adult foster care facilities licensed to care for 13 or more individuals conduct diagnostic testing in certain circumstances, to the best of their ability. Under the current testing order, revised October 12, 2021 facilities are required to follow testing guidance issued in CMS QSO 20-38-NH (revised).
Please see the following resources for more details and guidance on testing requirements, implementation, and reimbursement:
Use the online Antigen Supply Request Form to request test supplies two weeks in advance of testing.
Use the online Antigen Reporting Form to report completion of individual tests.
Standing Order for Testing dated October 15, 2021
On May 21, 2020 the Michigan Department of Health and Human Services (MDHHS) released guidance detailing Federal and State COVID-19 reporting requirements for Skilled Nursing Facilities. Data received as part of this requirement has ensured that MDHHS has had the information necessary to respond to the COVID-19 outbreak, providing an understanding of the impact on residents and facilities, and identified resource needs and supported prioritization of public health action.
Following the recommendations from Governor Whitmer's appointed Nursing Home COVID-19 Preparedness Task Force, MDHHS issued updated guidance to maintain effective reporting on an ongoing basis. Effective October 28, 2020, all skilled nursing facilities, home for the aged and adult foster care facilities licensed for 13 or more individuals are required to report weekly COVID-19 surveillance data to the state, including information on resident and staff cases and deaths. To enhance the quality of this reporting, MDHHS conducts ongoing data validation in collaboration with the Michigan State University Institute for Health Policy and other partners. Data and more information on this project are located on the MDHHS Coronavirus Long-Term Care Data web page.
Please see the following resources for more details and guidance on reporting requirements and implementation:
Skilled Nursing Facilities
- Provider Letter L 21-33 dated 04/29/21
- EMResource NHSN Module Quick Guide
- SNF Data Validation Error Guide - NEW
- SNF Annual 2022 Data Audit
Home for the Aged and Adult Foster Care Facilities
Skilled Nursing Facility EMResource Office Hour Sessions
MDHHS hosts regular office hour sessions for skilled nursing facilities and state partners to review technical components of the required COVID-19 surveillance reporting process and platform. Recordings of recent sessions are provided below:
- 5/26/2022 - NHSN Changes and Annual Data Audit
- 3/31/22 - Updates on the CDC's Community Transmission Maps, EMResource 4.0 Updates
- 3/17/2022 - General Reminders: POC Result Reporting, IPRAT; JUVARE 4.0
- 3/03/2022 - CRF Update, COVID-19 Community Levels vs. Transmission Rates (Testing), EMResource 4.0
- 2/17/2022 - Infection Control, NHSN Rules and Updates, Testing Supplies Update
- 1/20/2022 - Data Validation and LARA Updates
- 01/06/2022 - HCW Isolation Guidance and CRF Policy
- 11/18/2021 - CRF Reminders, POC Federal Submission and Bulk Upload Process
- 08/26/2021 - COVID-19 Booster & 3rd Doses, Monoclonal Antibodies, EMResource Enhancements
- 07/29/2021 - New CDC Masking Recommendations & Reminder on Data Pass Through
- 07/15/2021 - EMResource Audit Process and Upcoming NHSN Changes
- 7/01/2021 - Annual COVID-19 Surveillance Data Audit Phase I & II Review
- 06/17/2021 - NHSN Vaccine Module Reports
- 06/03/2021 - Overview of Supply Board and NHSN Vaccine Status
Direct Care Workforce
The direct care workforce serving Michigan's aging population has been on the frontlines of the COVID-19 pandemic, ensuring health, safety, and well-being of the most vulnerable. In recognition of the critical care direct care workers (DCW) provide in long-term care settings and in the community, Governor Whitmer, alongside the Michigan legislature supported several appropriations over the course of state fiscal years, 2020, 2021 and 2022 to provide increased reimbursement to these essential workers. The funds appropriated to the Michigan Department of Health and Human Services are available to qualifying DCW staff through direct reimbursement to qualifying employers. The supporting policies, frequently asked questions, and reimbursement resources are catalogued below.
Adult Foster Care & Home For the Aged Facilities
- Frequently Asked Questions
- Reimbursement Forms
Home Help, MI Choice Waiver, MI Health Link, & Behavioral Health Service Providers
- Other Resources
Skilled Nursing Facilities
Infection Prevention and Control
A collaboration between the Michigan Department of Health and Human Services and the Centers for Disease Control and Prevention to provide infection prevention education and technical assistance. The series includes educational topic specific videos and live question and answer sessions where infection prevention experts will discuss virus basics and answer questions. For more information visit the Project Firstline webpage.
MDHHS Infection Prevention Resource and Assessment Team
The MDHHS Infection Prevention Resource and Assessment Team (IPRAT) is providing both remote and onsite technical assistance, education and training to long-term care facilities and other congregate care settings. Facilities or local health departments can request assistance at firstname.lastname@example.org. Additionally, Michigan.gov/iprat contains guidance and information for LTC facilities. The IPRAT team, in partnership with local health departments, has been using the CDC Infection Control and Assessment Response (ICAR) Tool to assist congregate care settings in mitigating the risk of infection from COVID-19 and other special pathogens.
CRC and CRF Programs
The Care and Recovery Center and the COVID-Relief Facility Programs were established under Michigan Public Act 231 of 2020. These programs were designed to ensure Michigan's nursing homes were prepared to provide care to individuals who have tested positive for coronavirus under transmission-based precautions within the guidelines and best practices from Centers for Disease Control and Prevention. Michigan's nursing homes must be reviewed by the Michigan Department of Health and Human Services to ensure they meet the minimum criteria outlined within the legislation and associated MDHHS policies. For more information on these programs, please see below:
- Nursing Facility Resident Movement: CRC and CRF Options (Diagram)
- Nursing Facility Resident Movement: CRC and CRF Options (Narrative)
Care and Recovery Centers
- Current MDHHS Policies
- Additional Program Details and Current Facility List
- Current MDHHS Policy
- Current Provider Letters:
- FY2022 (October 1, 2021 - September 30, 2022) Application - Application Open through February 28, 2022
- FY 2022 CRF Application Information
- Tier 1 (Retain) Application - For facilities that did not receive FY2022 CRF determination between 10/1/21-2/28/22.
- Tier 2 (Retain and Admit) Application CLOSED
- COVID-Relief Facility Capacity Change Notice - Facilities currently determined as 2022 COVID Relief (CR) Tier to submit desired capacity changes such as increase/decrease bed count or moving COVID unit to MDHHS for review.
- Facility Change Request - Tier 1 to Tier 2 Designation
Adaptations to the Regional Hub Model
In April, MDHHS launched the COVID-19 Regional Hub strategy. These facilities are dedicated to caring for COVID-affected long-term care facility residents who no longer need hospitalization, or to individuals who have not been hospitalized and cannot be safely isolated or cared for in the nursing facility where they live. More information about Regional Hubs is located on the Nursing Facilities page.
Through this strategy, MDHHS created partnerships with nursing facilities that had the capacity to contribute to local need for services, proximity to acute care facilities experiencing high COVID-19-related demand and ability to effectively quarantine COVID-19-affected residents. To facilitate these partnerships, MDHHS worked alongside Licensing and Regulatory Affairs to ensure all facilities had adequate physical space planning, and met safety and infection control protocols to perform in this enhanced role.
MDHHS has enhanced Regional Hub reporting requirements in alignment with national nursing facility reporting efforts. Additionally, to augment self-reported data from facilities, MDHHS has prioritized Regional Hub facilities for review and support with the Infection Prevention Resource and Assessment Team (IPRAT). This effort ensures Hub facilities have all resources and necessary support to maintain infection control protocols as they continue operations. Regional Hubs are also subject to weekly monitoring and oversight audits conducted by MDHHS staff.
The information gathered from these efforts is used to inform how MDHHS identifies the changing landscape, the need for new Regional Hub locations and when to begin reducing capacity in areas where the need no longer exists. MDHHS has established a process for facilities to begin decommissioning some Regional Hub space in light of the reduced regional needs at this time.
Michigan Nursing Homes COVID-19 Preparedness Task ForcePast Meetings & ResourcesThursday, July 23, 2020Thursday, July 30, 2020Thursday, August 6, 2020Thursday, August 13, 2020Thursday, August 20, 2020Thursday, August 27, 2020Please note that these recommendations are being further developed and revised by workgroups. Everything on this list may not appear in the final recommendation report to the governor.
If you have any questions please contact us at: MDHHS-MSA-COVID19@michigan.gov
CHRT Nursing Home Evaluation
The Center for Health & Research Transformation at the University of Michigan was engaged to conduct an evaluation of the state’s regional nursing home hub COVID-19 strategy, comparing Michigan’s approach and outcomes to those in other states. In addition, they conducted extensive research to provide recommendations for preparedness in the event of another COVID-19 surge and further considerations to minimize infections, morbidity, and mortality across the continuum of long-term care services. They have compiled their findings and recommendations in a detailed report and presentation. The State of Michigan is leveraging this report in conjunction with the Nursing Homes Preparedness COVID-19 Task Force recommendations to enhance the strategies they currently use support and protect residents across the long-term care continuum.
We want to make sure you have access to important communication resources as you work to educate your communities about the safe and effective COVID-19 vaccine. This toolkit includes graphics, videos and handouts that are ready to share with your networks in newsletters and on social media. New content will be added frequently. For more information about vaccines for long term care residents, visit: COVID-19 Vaccines for Long-Term Care Residents.
Within this folder, there are two very important infographics. One explains how MrNA works. The other talks about how a new vaccine is developed, approved and manufactured. These are translated in Arabic, Spanish and Chinese. Print, include in a presentation or email as an attachment.
This folder will be continuously updated with quick facts on the COVID vaccine. It's an easier way for people to get their questions answered without looking through a full FAQ. These are sized to fit in a Facebook post but they can also be printed or put into a presentation. Each fact card will be translated in Spanish, Arabic and Chinese. More translations coming soon!
You can place these files on your website. Once placed, make sure that when someone clicks on the file, it will link to Michigan.gov/COVIDvaccine. The website is the best place for members of our community to find the most up-to-date information.
This folder has print ads that can be shared with local publications, printed out as handouts or a poster or included in a presentation. The ads are translated in Arabic, Spanish and Korean.
This Frequently Asked Questions document can be emailed, printed or you can cut pieces of it that are relevant to include in a presentation. These are translated into Arabic, Spanish and Chinese.
This folder has all the produced TV spots. They are ready to be shared on social media through Facebook or Twitter.