WiHPCA News

(Alexandria, VA) Congress has released the text of the Consolidated Appropriations Act, 2023, an omnibus funding package that will fund the government through Fiscal Year 2023. As NHPCO advised its members in a Member Alert this morning, the legislation contains measures that will affect hospices positively and negatively. We expect the legislation to pass and be signed into law later this week.

Key developments in this legislation include the following.

• Telehealth extension: The legislation extends hospice telehealth flexibilities through the end of 2024, which were initially enacted as part of the CARES Act in 2020. This allows hospice patients and providers to continue to use telehealth for low touch, face-to-face visits prior to recertification for the hospice benefit. Patients will also be able to continue to participate in telehealth visits from home. 
• Continued slowdown of hospice caps: The legislation extends the cap calculation methodology implemented by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. For years that measure has slowed the growth of the hospice aggregate cap, reducing the total amount a hospice can be reimbursed for care provided to patients, as compared to the rates set prior to the IMPACT Act. The FY23 omnibus extends that IMPACT Act aggregate cap methodology by another year to 2032, meaning that for the next decade many hospices will have to do more with less to continue providing patient care.
• Cap cut avoided: Beyond extension of the IMPACT Act methodology, there was some consideration to MedPAC’s recommendation to outright decrease the hospice aggregate cap by 20 percent. That cut was averted, protecting hospice patients and providers.
• Expanded definition of the IDT: The legislation will allow hospices, starting in 2024, to use marriage and family therapists (MFTs) and mental health counselors (MHCs) as part of the hospice interdisciplinary team. There is no requirement for hospices to use MFTs or MHCs and a social worker is still required if needed under a patient’s plan of care.
• Focus on Grief and Bereavement: Noting that more Americans are experiencing grief due to COVID-19 losses, the bill designates $1,000,000 for assessing the feasibility of developing consensus-based quality standards for high-quality bereavement and grief care. It also directs the U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE) to collaborate with other health officials to evaluate and report on the scope of need for high-quality bereavement and grief services, including a focus on the role of hospices in community services.

“This package is a mixed bag for hospices. On the one hand, NHPCO members have been actively advocating for telehealth extension, against a 20 percent cap cut, and for national approaches to supporting grief and bereavement services. Those provisions are wins for patients, families, and communities across the country, as is the inclusion of marriage and family therapists and mental health counselors as part of the hospice interdisciplinary team,” said NHPCO COO and interim CEO, Ben Marcantonio “Thank you to everyone who has reached out to their elected officials on these issues. On the other hand, Congress has extended the slowdown of the growth of the hospice aggregate cap, even though the evidence shows that the seven percent reductions already implemented through the IMPACT Act have limited access to hospice care among patients with Alzheimer disease and other dementias.”

Marcantonio continued, “Avoiding an across-the-board cap cut, while facing continued slowdown of cap growth is like two steps forward, one step back. Forty years after the creation of the Medicare Hospice Benefit, in bleak economic times, Congress has decided to put to the next ten years of hospice care at risk by continuing to recklessly use hospice as an ATM.”

WASHINGTON, D.C. — U.S. Senator Tammy Baldwin (D-WI) joined her fellow co-chairs and co-founders of the Senate Comprehensive Care Caucus, Senators Jacky Rosen (D-NV), John Barrasso (R-WY), and Deb Fischer (R-NE), in passing a bipartisan resolution recognizing November 2022 as National Hospice and Palliative Care Month. National Hospice and Palliative Care Month, observed in November, honors the work and dedication of long-term and palliative care providers and volunteers, and the critical services they provide to families and their loved ones facing serious illnesses. This resolution is endorsed by the Coalition to Transform Advanced Care (C-TAC) and the National Hospice and Palliative Care Organization (NHPCO).

“Serving as my grandmother’s primary caregiver as she grew older, I know the world of difference it makes in someone’s life to have compassionate palliative care,” said Senator Baldwin. “I’m proud to have passed this bipartisan resolution to recognize the importance of palliative and hospice care, and look forward to continuing our work to improve the quality of life for the millions of Americans facing serious illnesses.”

“I am proud to have passed this resolution to designate November as National Hospice and Palliative Care Month,” said Senator Rosen. “As someone who took care of my parents and in-laws when they aged, I know just how critical access to quality long-term care and supportive services is. This resolution will recognize all the ways in which hospice and palliative care providers improve the quality of life of so many patients and their caregivers.”

“I have experienced hospice care as both a doctor and family member,” said Senator Barrasso. “Hospice lets patients enjoy the highest quality of life when they need it most. Our bipartisan resolution recognizes all of the dedicated hospice providers in Wyoming and across the country.”

“By marking November as National Hospice and Palliative Care Month, we can raise awareness about the benefits this type of care can provide,” said Senator Fischer. “Through our bipartisan work in the Comprehensive Care Caucus, we’ll continue to promote access to quality health care.”

“It means a great deal to our providers to have this congressional honor from the Senate,” said NHPCO COO and Interim CEO, Ben Marcantonio. “This year marks the fortieth anniversary of the first Proclamation recognizing November as National Hospice Month. Hospice and palliative care providers work tirelessly to meet patients and their families where they are with compassionate care that places the individual at the heart of their own healthcare decisions. We thank Senators Rosen, Barrasso, Baldwin, and Fischer for continuing this important tradition of honoring and supporting the hospice and palliative care community. ”

“Once again, Senators Rosen, Barrasso, Baldwin, and Fischer should be commended for drawing attention to serious illness and the tremendous value of palliative care and hospice services for millions of individuals and their families across the nation,” said Jon Broyles, CEO of the Coalition to Transform Advanced Care. “Thank you for the introduction and passage of this bill to designate November as National Hospice and Palliative Care Month. We believe in access to high-quality, equitable serious illness care that reflects individual care preferences. This should cover needed palliative care and community-based services and supports, and hospice care. For C-TAC, educational efforts to share information on the value and need for palliative care and hospice and the staff and volunteers that provide this essential care is a year-round effort, and we are so pleased to have these issues highlighted each November by our friends in the U.S. Senate.”

Senator Baldwin has been committed to improving the quality of life for palliative care patients and their families. Senator Baldwin leads the bipartisan Palliative Care and Hospice Education and Training Act with her colleague Senator Capito (R-WV) and in 2021, she introduced the bipartisan Expanding Access to Palliative Care Act with Senators Barrasso, Fischer, and Rosen. The legislation would allow palliative care to be covered concurrently with curative treatment for illness under Medicare.

An online version of this release is available here.

WiHPCA Legislative Outreach Program

Grassroots advocacy is the most powerful tool WiHPCA has at its disposal to shape public policy – and building relationships with lawmakers is the most important aspect of advocacy. In effort to capitalize on our greatest advocacy resource – our membership – WiHPCA has unveiled our Coffee Conversations with Legislators advocacy program.

The initiative is designed  to help connect members with their local legislators. Under the program, the WiHPCA Government Affairs Team will set-up in-district meetings between WiHPCA members and state lawmakers who represent them in the Legislature. These meetings, which can be located at your facility, or a local coffee shop provide a tremendous opportunity for WiHPCA members to build or strengthen their relationships with local legislators and to educate them on hospice and palliative care and on policy issues important to hospice professionals and their patients.

WiHPCA encourages all members to participate in this critical grassroots advocacy program. If you’re interested in participating in the program, contact the WiHPCA office at wihpca@badgerbay.co if you’re interested in participating.

WiHPCA Legislative Key Contact Program

If you were not yet aware, we would like to remined you about WiHPCA’s Legislative Key Contact Program, which can be a highly effective grassroots advocacy tool to help build and nurture strong on-going relationships between WiHPCA members and lawmakers in Wisconsin. Ultimately, the program can help us help shape new policies important to our members.

The program is now live on the WiHPCA website and members can easily and quickly sign-up as a Key Contact. With the campaign season winding down, and the 2023-24 legislative session right around the corner, it’s more important than ever for WiHPCA to have a robust Key Contact Program. It is essential to raising our profile in the State Capitol and beyond.

As a Key Contact, you can help influence the legislative process by cultivating relationships with elected officials. By taking advantage of existing relationships and making new contact with members of the Wisconsin Legislature (as well as the Wisconsin Congressional  Delegation), you can help us educate lawmakers on industry issues and influence legislation.

But the program will not succeed without strong member participation, so please take a few moments to read more about it – and learn how simple it is to “enlist” and participate as a Key Contact. The time commitment is minimal and your responsibility as a key contact depends on your level of comfort and willingness to engage.

Remember, lawmakers are often eager to hear input from their constituents, and as an expert in the home health care field, you can make a real difference in the policy process as a Key Contact. CLICK HERE to sign-up by filling out and submitting a brief online survey.

Don’t miss out on  WiHPCA’s next quarterly meeting with the WI Department of Health Services’ Division of Quality Assurance (DQA), which is scheduled for Thursday, January 12, 2023, at 10:00 A.M. The meeting will be held virtually and is open to all WiHPCA members and hospice professionals across Wisconsin. Registration will open soon on the WiHPCA Events page.

The purpose of the DQA quarterly meetings is to create an opportunity for hospice and palliative care professionals to build and maintain a strong working relationship with a key state regulatory agency that can impact our industry. For members who have not had an opportunity to attend previous quarterly meetings, they provide members with valuable regulatory information and updates, as well as a unique chance to engage DQA staff, asks questions, and request guidance. Here are the meeting details:

• Date: Thursday, January 12, 2023
• Time: 10:00 A.M. – 11:00 A.M.
• Location: Virtual meeting

In the meantime, you can CLICK HEREto visit the DHS Hospice Statistics webpage, which includes vital hospice regulatory data for the calendar year through 2021.

WiHPCA is happy to remind members about and provide links to the latest articles and information from Hospice News and other publications:

·         22 States Petition CMS to End COVID-19 Vaccine Mandate

• By Jim Parker | November 17, 2022

Attorneys General from 22 states have petitioned the U.S. Centers for Medicare & Medicaid Services (CMS) to eliminate the COVID-19 vaccine requirement for health care workers. CMS instituted the mandate last December, requiring that all health care personnel that enter a care setting or come into contact with patients, families or caregivers be vaccinated for COVID-19.

Read more…

·         OIG Rolls Out Provider Relief Fund Audits for Hospices

• By Holly Vossel | November 12, 2022

The U.S. Department of Health & Human Services (HHS) Office of the Inspector General (OIG) recently began to probe hospices in its initial phase of Provider Relief Fund (PRF) audits. More than two years after the CARES Act established the $175 billion PRF, federal regulators are moving forward on audits that closely examine the ways that providers spent these dollars.

Read more…

·         Lawmakers Introduce Bill to Break Down Advance Care Planning Barriers

• By Holly Vossel | November 11, 2022

U.S. Sen. Susan Collins (R-Maine) and Mark Warner (D-Va.) recently introduced legislation aimed at improving access to advance care planning services among patients with serious illness. The Improving Access to Advance Care Planning Act would expand utilization of these services by removing Medicare payment barriers faced by both providers and patients. Read more…

·         Meticulous Documentation a Hospice’s Best Defense in HIS Audit Appeals

By Holly Vossel | November 9, 2022

Hospices that are meticulous and vigilant with documentation see the best results when appealing payment cuts associated with Hospice Item Set (HIS) audits. The U.S. Centers for Medicare & Medicaid Services (CMS) developed HIS as a tool to gauge a patient’s overall care experience. The agency requires hospices to submit HIS data for each patient served. Those who do not report those data risk a payment cut of 2% across the board. Read more…

Hospice News, which is part of the Aging Media Network, is a leading source for news and information covering the hospice industry.

Meetings with U.S. Representatives Bryan Steil and Scott Fitzgerald Part of WiHPCA Effort to Meet with the Entire Wisconsin Congressional Delegation

In August, WiHPCA leadership met with staff from U.S. Senator Tammy Baldwin’s office to thank her for her efforts on the Palliative Care and Hospice Education and Training Act – which aims to strengthen the hospice and palliative care workforce – and to discuss several other federal regulatory and federal issues important to the industry. In addition, WiHPCA presented Senator Balwin with the association’s “Champion of Hospice and Palliative Care” legislative award.

But our federal grassroots advocacy efforts did not end with the Baldwin meeting. WiHPCA’s goal is to meet with all members of Congress from Wisconsin, and we moved closer to that objective earlier this month. Our leadership team, which included WiHPCA President Lynne Sexten and board members Karen Carrig, Rita Hagen, and Carrie Schepp, met with U.S. Representatives Bryan Steil (R – WI-1) and Scott Fitzgerald (R – WI-5).

The meetings with Steil and Fitzgerald focused on educating the lawmakers and their staff members on the importance of hospice and palliative are, as well as discussing WiHPCA’s most pressing federal issues. Those issues included concerns with the CMS Value-Based Insurance Design (VBID) “Hospice Carve-In” pilot program, the administrative and financial burden of the nursing home room and board Medicaid pass-through billing requirement, and the need for expanded hospice telehealth flexibility.

On November 2, the state Department of Health Services launched a free telehealth service to ensure rapid access to COVID-19 antiviral drugs.  With this service in place, any Wisconsinite 18 years of age or older who tests positive for COVID-19 is able to receive a telehealth consultation with a health care professional within 30 minutes, seven days a week during the hours of 8:00AM – 8:00PM.  If the patient is eligible for treatment, the patient will receive a prescription for a COVID-19 antiviral drug that may be filled at a pharmacy.  If the patient does not have access to a pharmacy, the prescription drug will be shipped overnight to the patient.  More information may be found on the DHS website.   

On October 20, the state Department of Health Services (DHS) unveiled a flu vaccine online “dashboard”.  In addition to providing data on a statewide basis, the dashboard breaks down data by county, age, race, gender and ethnicity.  Also, it shows seasonal trends over the last few years.  This dashboard may be accessed on the DHS website. 

By Hoven Consulting  – WiHPCA’s lobbying firm

·         November General Election Results – State Legislature

o   State Assembly: In the 2023-2024 legislative session, Republicans will have 64 members and the Democrats will have 35 members.  Republicans gained a net of four Assembly seats.  One of these Assembly seats is located in the western Milwaukee suburbs, two are located in far northwest Wisconsin, and the other is a district that is between Milwaukee and Madison and also includes the southcentral Wisconsin city of Milton.

o   State Senate: During the next legislative session, Republicans will have 22 members and the Democrats will have 11 members.  Senate Republicans gained one Senate seat that was held by Democrats.  This seat is located in far northwest Wisconsin and includes the community of Superior. 

·         Assembly and Senate Elect Leadership

On November 10, both the Senate and Assembly Republican caucuses met to elect their respective leadership teams for the 2023-2024 legislative session. 

Senate Republicans re-elected their current senior leadership team:

o   Senate President – Chris Kapenga (Delafield)

o   Senate President Pro-Tempore – Patrick Testin (Stevens Point)

o   Majority Leader – Devin LeMahieu (Oostburg)

o   Assistant Majority Leader – Dan Feyen (Fond du Lac)

The Assembly Republican caucus elected several members to new senior leadership roles.  The new senior leadership members are:

o   Assembly Speaker – Robin Vos (Rochester)

o   Assembly Speaker Pro Tempore – Kevin Petersen (Waupaca)

o   Majority Leader – Tyler August (Lake Geneva)

o   Assistant Majority Leader – Jon Plumer (Lodi)

During the week of November 14, both the Assembly and Senate Democratic caucuses elected their respective leadership teams for the 2023-2024 legislative session.  Senate Democrats also elected new members to their leadership team.  Their new senior leadership team is:

o   Minority Leader – Melissa Agard (Madison)

o   Assistant Minority Leader – Jeff Smith (Brunswick)

Assembly Democrats re-elected the following members to their current leadership roles:

o   Minority Leader – Greta Neubauer (Racine)

o   Assistant Minority Leader – Kalan Haywood (Milwaukee)

·         Occupational License Study Committee Update

On Tuesday, November 15, the Legislative Council Study Committee on Occupational Licenses held its November public meeting.  Included in the agenda for this hearing was testimony from a number of individuals, including representatives from the state Department of Safety and Professional Services (DSPS) – which processes most occupational credentials in the state – as well as discussion on several draft bills intended to improve the ongoing occupational credential processing backlog.  Most of the testimony from the DSPS representatives focused on this backlog. 

During the hearing, DSPS representatives repeatedly underscored their need for more staff – particularly call center staff and occupational credential processing staff.  They also discussed the need to offer higher salaries in order to attract and retain employees.  Committee chair/Senator Rob Stafsholt (R-New Richmond) indicated that he is open to possibly providing more funding in the 2023-2024 state budget to DSPS to hire more staff.  However, he underscored the committee’s prior request for more data on the processing backlog, which would help him justify that funding request.  DSPS representatives stated a few times during the hearing that they would need to re-task credential processing employees to gather that data, which would likely increase the backlog.  Chair Stafsholt stated that he realized that but obtaining that data would be critical to help to possibly secure additional staff funding for the agency.  Committee Vice Chair/Representative Shae Sortwell (R-Two Rivers) also appeared to be open to providing funding for additional agency staff but also agreed that DSPS needed to provide them with more data on the backlog first.

DSPS representatives appeared to be supportive of committee draft legislation increasing credential renewal periods from two years to four years, as well as legislation that removes the requirement for the agency to review certain types of minor criminal offenses.  However, they also noted that several of the committee’s other draft bills would require additional staffing to accomplish. 

After hearing all of the testimony, the committee was scheduled to have a discussion among themselves regarding their various draft bills addressing this processing backlog.  However, as the DSPS testimony and questioning ran much longer than anticipated, the committee agreed to adjourn and postpone discussion on these draft bills to their next public meeting, which is scheduled for December 13. 

NOTE:  If your hospice/palliative care agency has employees who are experiencing delays in receiving their occupational licenses, please contact WiHPCA’s government affairs professionals – either Nathan Butzlaff at (608) 310-8833 or nathan@hovenconsulting.com or Tim Hoven at (414) 305-2011 or tim@hovenconsulting.com. 

·         Uniform Death Reporting Standards Study Committee Update

The Legislative Council Study Committee on Uniform Death Reporting Standards held a meeting on October 17 in Madison.  Senator Joan Ballweg (R-Markesan) and Representative Jesse James (R-Altoona) serve as chair and vice chair, respectively, and heard various presentations, which are summarized below.   

Representatives from the state Department of Health Services (DHS) were the first to present at this hearing.  They discussed the National Violent Death Reporting System (NVDRS) and the State Unintentional Drug Overdose Reporting System (SUDORS).  In response to questions from committee members, DHS representatives noted:  (1) DHS requests NVDRS data from all counties, and most participate, though such participation is not required and (2) a significant majority of physicians continue to use a “fax attestation form” when certifying the cause and manner of natural deaths, rather than submitting that information as an electronic user of the State Vital Records Information System (SVRIS).

The second presentation featured representatives from the state Department of Justice.  Much of this presentation covered the types of death investigation training offered in Wisconsin.  In particular, they discussed: (1) the death investigation training provided at police academies, (2) an annual 80-hour course for death investigators organized by DOJ and (3) an annual four-day death investigation symposium organized by the Wisconsin Association of Homicide Investigators. 

Following the presentations, committee members discussed various issues.  Committee members expressed interest/support for the following:

o   Expanding the death record to include different data points, including noting whether substance abuse contributed to the death.

o   Requiring physicians to receive training on how to properly certify cause and manner of death, including training how to address the types of death that must be reported to coroners or medical examiners.

o   Requiring all those who certify deaths (e.g., physicians) to submit the medical certification electronically using the State Vital Records Information System (SVRIS).

o   Creating a state statute governing fatality review teams in a manner codifying current practice (allowing counties to decide which types of teams, if any, are created).

Last week, US Department of Health & Human Services (HHS) Secretary Xavier Becerra announced the renewal of the public health emergency (PHE) due to the ongoing COVID-19 pandemic. The PHE was originally declared on January 31, 2020 and has been renewed continuously since then. Renewal of the PHE keeps a number of important waivers and flexibilities active. The current PHE declaration will last 90 days from its effective date of October 13, 2022.