WiHPCA News

The Wisconsin Department of Health Services (DHS) has submitted a plan to the federal Centers for Medicare and Medicaid Services (CMS) to use American Rescue Plan Act (ARPA) funds to improve and enhance Wisconsin’s home and community-based services under Medicaid. DHS estimates it will receive approximately $350 million under this part of ARPA. Key components of the plan that support Wisconsin’s caregiving workforce include increasing rates for home and community-based services and expanding the professional advancement opportunities for the workers who provide these services.

“Strengthening our caregiver workforce and making investments in the services that many seniors and people with disabilities rely on across our state are critical steps we must take to support our economic recovery from the pandemic,” said Governor Tony Evers. “We are fortunate to have access to these federal funds to move these efforts forward since many of the proposals to support and strengthen our caregiving workforce included in my proposed state budget were removed by the legislature and not included in the budget that was recently passed.”

In consultation with key stakeholders and partners, DHS assembled a plan that will continue to advance Wisconsin’s successful record of implementing innovative programs that enable older adults and people with disabilities to live independently in their homes and communities. In Wisconsin, these efforts include the Family Care, Family Care Partnership, IRIS, PACE and the Children’s Long-Term Support programs, as well as personal care, private duty nursing, home health, and rehabilitative services provided to eligible Medicaid members.

“Wisconsin has long been a national leader in developing and implementing programs that allow the elderly and people with disabilities to live their best lives in their homes and communities. In 2021, we achieved a major milestone by fully eliminating the adult waiting list for home and community-based services,” said DHS Secretary-designee Karen Timberlake. “The ARPA funds designated by Congress and President Biden to support state home and community-based services will help us continue to build on that success and help stabilize and the services people depend upon as well as the workforce needed to provide them.”

Foundational to Wisconsin’s plan is a commitment to ensuring all eligible people in Wisconsin have access to home and community-based services by addressing health disparities and focusing on equity in program design and access. In addition to working with the Governor’s Health Equity Council to support implementation of the approved plan, DHS will work alongside community-based organizations that share our commitment to addressing disparities within the home and community based service system for Black, Indigenous, and people of color, people with varying abilities, people living in extremely rural areas, and other historically underserved and disadvantaged communities. Wisconsin is also engaging in individual conversations with each of the 11 federally recognized tribes to identify ways to enhance HCBS services for tribal members under the proposals in the submitted plan.

CMS is currently reviewing Wisconsin’s plan, along with those plans submitted by other states. Implementation efforts will begin once CMS approval is received.

Learn more by visiting the Proposed Funding for Home and Community-Based Services.

Gov. Tony Evers (D) earlier this month signed the 2021-2023 state budget bill into law. Before signing the bill, Evers used his broad veto authority to make 50, mostly minor changes to the state’s two-year spending plan, which was largely reshaped by the Republican-controlled Legislature over the past few months. Click here to review the Governor’s full veto message.

The final $87.5 billion budget bill contains more than $2 billion in individual income tax cuts, $650 million property tax relief, and provides $129 million in broadband funding. In addition, the budget includes a number of health care-related items that may be of interest to WiHPCA members, including:

• Medicaid
• • Home Health Reimbursement Rate: Provide a budgeted sum of $473,300 as the state share of payments, and provide the matching federal share of payments, in 2021-22, and by a budgeted sum of $960,200, as the state share of payments and provide the matching federal share  of payments, in 2022-23, for the Department to increase the Medical Assistance rates paid for nursing care in home health agencies for dates of services beginning January 1, 2022. Specify that funding is to support licensed practical nurses, registered nurses, and nurse practitioners in home health agencies that are licensed under s. 50.49 of the statutes.
  • Medical Assistance Cost-to-Continue Estimate: Provide funding of $1,361,991,300 in 2021-22 and $1,258,573,900 in 2022-23. In addition, adjust the cost-to-continue reestimate to provide $25,900,000  in 2021-22 and $51,400,000 in 2022-23, reflecting the impact of the Department's proposed rate increase to managed care organizations providing services under Family Care, PACE, and Partnership, subject to approval by the federal Centers for Medicare and Medicaid Services.  
  • Nursing Home Reimbursement: Provide $82,034,300 in 2021-22 and $170,375,400 in 2022-23 to increase reimbursement rates paid to skilled nursing facilities and intermediate care facilities for individuals with intellectual disabilities. 
  • Direct Care Workforce Funding: Provide $53,835,800 in 2021-22 and $50,403,200 in 2022-23 to increase funding for the direct care workforce funding supplement.  
  • Personal Care Reimbursement: Provide $18,904,300 in 2021-22 and $59,369,300 in 2022-23 to increase hourly rates paid for personal care services to $20.69 on January 1, 2022, and to $22.35 on January 1, 2023. 
  • Postpartum Eligibility Extension: Provide $2,500,000 in 2022-23 to reflect the estimated cost of extending benefits, for women enrolled in MA as pregnant women, until the last day of the month in which the 90th day after the last day of the month that the end of the pregnancy falls, instead of the 60th day under current law.
  • Outpatient Mental Health and Substance Abuse Services and Child-Adolescent Day Treatment Reimbursement: Provide $6,628,100 in 2021- 22 and $13,256,200 in 2022-23 for a 15% increase to reimbursement rates for outpatient mental health and substance abuse services, effective January 1, 2022; and provide $1,335,600 in 2021-22 and $2,671,200 in 2022-23 for a 20% increase to reimbursement rates for child and adolescent day treatment services, effective January 1, 2022.  
  • Medication-Assisted Treatment: Provide $1,224,400 in 2021-22 and $2,448,700 in 2022-23 to increase MA reimbursement rates for opioid treatment providers by 5% and increase rates for opioid-related patient evaluation and management (office visits) provided by primary care providers by $5 per visit.
  • MA Dental Reimbursement: Provide $15,432,800 in 2021-22 and $30,865,800 in 2022-23 to increase MA dental reimbursement rates by 40%, effective January 1, 2022. 
• Public Health
• • Community Health Center Grants: Increase grant funding for federally qualified health centers (FQHCs) by $1,000,000 annually.  
  • Grants to Free and Charitable Clinics: Increase grant funding for free and charitable clinics by $1,000,000 annually.  
  • Lead Screening and Outreach Grants: Provide $50,000 annually to increase a grant for lead screening and outreach activities provided by a community based human service agency that provides primary health care, health education, and social services to low-income individuals in the City of Milwaukee, from $125,000 to $175,000. 
• Elder and Disability Services
• • Birth to 3: Provide $1,125,000 annually in order for the Department to meet its federal Individuals with Disabilities Education Act (IDEA) maintenance of effort (MOE) requirement for the Birth to 3 program in the 2021-23 biennium.  
• Community Based Behavioral Health
• • Child Psychiatry Consultation Program: Provide $500,000 in 2022-23 to increase from $1,500,000 to $2,000,000 the funding for the child psychiatry consultation program in that year.
  • Medication-Assisted Treatment Expansion: Provide $500,000 in 2021-22 and $1,000,000 in 2022-23 in the Joint Committee on Finance supplemental appropriation for medication-assisted treatment.  
  • Methamphetamine Addiction Treatment Grants: Provide $150,000 in 2021-22 and $300,000 in 2022-23 in the Joint Committee on Finance supplemental appropriation for training for substance use disorder treatment providers on treatment models for methamphetamine addiction.
  • Substance Use Disorder Treatment Platform: Provide $300,000 in 2022-23 in the Joint Committee on Finance supplemental appropriation for development of a substance use disorder treatment platform that allows for the comparison of treatment programs in the state.  
  • Behavioral Health Bed Tracker: Provide $50,000 in 2021-22 and $20,000 in 2022-23 to expand the purposes of the current psychiatric bed tracking system to include information on the availability of space for peer run respite beds and crisis stabilization beds.  
  • Behavioral Health Trainee Provider Grants: Provide $250,000 GPR in 2022-23 in the appropriation for treatment program grants, to increase total funding for the program in that year to $750,000. Modify the program to: (a) specify that the Department may expend any available federal moneys received for this program; (b) require the Department to distribute a total of $750,000 per year, beginning in 2022-23; and (c) renumber the appropriation so that it is included as an appropriation under mental health and substance abuse services instead of under public health.  
• Department of Children and Families:
• • Wisconsin Shares Child Care Subsidies: Increase funding for direct child care subsidies by $11,000,000 FED in 2021-22 and by $18,200,000 in 2022-23 so that the reimbursement rates would fully pay the price of at least 65 percent of the slots for children within the licensed capacity of all child care providers. 

By Representative Amy Loudenbeck (R-Clinton)

Vice Co-Chair of the Joint Committee on Finance

Wisconsin’s 2021-23 biennial budget makes significant investments across a wide spectrum of health care priorities, including raising Medicaid reimbursement rates for numerous providers who hadn’t seen increases in over a decade and targeted investments to increase access to care and improve health care outcomes.

Over the last year, long-term care facilities and their staff have been strained by the COVID-19 pandemic. In addition, for the past several years many of these facilities have been experiencing a critical workforce shortage and were also struggling with low Medicaid reimbursement rates that didn’t even cover the cost of care. The budget invests nearly $440 million in long-term care facilities and the workforce that staffs them.

Ambulance Service Providers (EMS) will see an increase in reimbursement rates of over $16 million. This additional funding will help to sustain many of our EMS providers across the state and will help avoid service deserts.

To ensure residents have access to high-quality dental care when they need it, this budget invests over $46 million to expand dental access across Wisconsin.

The budget increases Medicaid reimbursement for autism services by over $14 million. These services are intended to teach children with autism spectrum disorders the skills that children would usually learn by imitating others around them, such as social interaction and language skills, and there is a significant waiting list for services.

Nearly two-thirds of hospitals will continue to receive state funding in the form of Disproportionate Share Hospital payments to hospitals that serve low-income patients. This funding helps reduce cost-shifting to individuals with private insurance to cover losses.

The budget also boosts Medicaid reimbursement rates for Skilled Home Health Care Services, Emergency Room Physicians, Speech-Language Pathologists, Audiology Services, Chiropractic Services, Physical Therapy Services, and the Child Psychiatry Consultation Program. These investments are intended to increase access and to ensure providers are compensated appropriately for their work.

Federally-Qualified Health Centers and Free and Charitable Clinics, non-profit organizations that provide comprehensive primary health care to underserved areas and populations, also receive a boost. These providers will receive an additional $4 million over the biennium (each category will share $1 million/year in financial support).

In addition, the budget includes an increase of $6 million to expand the Dementia Care Specialist Program statewide by funding 18 dementia care specialist positions at Aging and Disability Resources Centers around the state, as well as seven tribal dementia care specialist positions.

Finally, this budget increases funding for psychological testing, diagnosis, psychotherapy, and counseling for individuals, groups, and families, as well as mental health day treatment services for children. The budget also includes over $3 million for medication-assisted treatment (including patient evaluation as well as methadone and other opioid abuse treatment medications) for individuals with substance abuse disorders.

Overall, the 2021-23 biennial budget will ensure that health care service providers and their employees will be well positioned to continue providing quality care across the health care continuum so all residents across Wisconsin can access a wide range of health care settings and services. 

The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of WiHPCA.

William Penterman, a legislative aide in the State Capitol and a member of the U.S. Army reserve narrowly won an eight-way Republican special primary in the 37th Assembly District. The district includes portions of Dane, Dodge, Jefferson, and Columbia counties as well as parts of the cities of Columbus, Waterloo, and Watertown.

Peterman received 758 votes, gaining a slim 16-vote victory of local university professor Jennifer Meinhardt. If officially declared the winner, Penterman will face Democratic candidate Peter Adams and Independent candidate Stephen Ratzlaff Jr. in the July 13 special general election.

The seat became vacant when then Representative John Jagler (R-Watertown) was elected to represent the 13th Senate District that was previously held by former Senate Majority Leader Scott Fitzgerald, who was elected to Congress last November.

Republicans currently hold a 60-38 seat majority in the Assembly, with the one vacancy in the 37^th Assembly District.

For the past eight years, I have worked as an Advanced Practice Nurse Practitioner (APRN) in the State of Wisconsin and have operated my own independent clinic. My passion for affordable, accessible healthcare has permeated nearly every aspect of my hectic life, including my new role as a state legislator.

Over the course of my time as a nurse, the healthcare industry has changed drastically. I have worked for large health systems, small ones, clinics, and everything in between. At the end of the day, I got in to nursing so that I can care for my patients, not feed a massive healthcare system. That is why I started my own business: so that I can provide healthcare to those who may not fit into the large systems, if they have astronomical deductibles, or if they do not have insurance at all.

I believe this model of small clinics, operated by nurses, can be replicated across the state and dramatically cut healthcare costs for folks who need it the most. For example, all of the prices for procedures and appointments are posted directly on my clinic’s website – there is not some mystical formula that only the system can understand. The logic is simple: you would never go through a McDonald’s drive-thru for them to only tell you at the end your burger costs $25. You would go down the road to Burger King or Wendy’s, where the prices you know are more competitive. This is how we can bring some sanity back to the healthcare field – the more competitive it is, the market will do its job to cut costs. Just imagine having dozens of these clinics in our area.

One obstacle in the way of this, however, is the fact that nurses in the State of Wisconsin have their hands tied. They are required to pay astronomical prices for collaborating physicians to even have their doors open – and if that physician dies or disappears, they need to immediately shut down. Collaboration is not the issue. I collaborate every day with specialists in nearly every aspect of healthcare for the good of my patients. The issue is the price and risk of having to close my doors because of someone who I may not even talk to on an annual basis somehow vanishes. This has turned off many fellow APRNs from replicating clinics like mine throughout our cities and rural areas.

Currently, 24 states and 2 territories have full practice authority (FPA) for Nurse Practitioners (NPs). Wisconsin made steps towards this goal when Governor Evers issued his COVID-19 emergency order, which eliminated the restrictions placed on NPs to practice without that collaboration requirement. Unfortunately, after the emergency orders were overturned by the Wisconsin Supreme Court, all restrictions were re-instated on the profession. During the COVID-19 pandemic, we learned NPs can have FPA without the negative consequences that some feared. In fact, studies have shown that an NPs outcomes for management of acute and chronic disease are equivalent if not better than a physicians.

Assembly Bill (AB) 396/Senate Bill (SB) 394 brings Wisconsin up-to-date with 24 other states to give Nurse Practitioners FPA. Passing these bills will allow NPs to continue to prioritize patient care and allow NPs to continue excellence in their nursing practice without unnecessary and undue restrictions.

Those opposing these bills have raised concerns about the unlikely event an NP goes “rogue” and attempts to practice outside of the scope of their training. As nurses, this is not how reality works. I have collaborated with physicians and other professionals in every instance that is deemed necessary. To do otherwise would open me up to severe liability issues and lawsuits, just as it would for a physician who practices outside of their scope.

At the end of the day, all nurses are asking for is a level playing field. We want the freedom to do what we do best: care for our patients.

State Representative Rachael Cabral-Guevara (R-Appleton) represents the 55th Assembly District in the Wisconsin Legislature. Her Assembly district is in Winnebago County and includes the City of Neenah and parts of Appleton.

NOTE: The views and opinions expressed in this article are those of the author and do not reflect the official policy or position of WiHPCA. Furthermore, the opinion piece allows WiHPCA to gain a better understanding of a health care-related bill from the author’s perspective, but in no way indicates support or opposition to the proposal.

A group of Republican state lawmakers – including Sen. Pat Testin (R- Stevens Point) and Representative Rachael Cabral-Guevara (R-Appleton) – recently introduced an advanced practice registered nurse bill (AB 396 / SB 394). The proposal creates a new license issued by the Wisconsin Board of Nursing for advanced practice registered nurses (APRNs), which includes Nurse Practitioners, Clinical Nurse Specialists, Certified Registered Nurse Anesthetists, and Certified Nurse Midwives.  

The bill’s authors and supporting nursing organizations claim the legislation and is necessary to help address Wisconsin’s health care provider shortage and provide clarity to the scope of practice of APRNs. They believe it will help provide regulatory flexibility and assist with removing barriers to allow these providers to practice within their scope in underserved areas of the state.

However, other health care provider groups, including the Wisconsin Medical Society have raised concerns over numerous provisions in the bill. They believe the legislation will improperly expand the APRN scope of practice by eliminating the requirement for these practitioners to collaborate with physicians and allow them to diagnose and treat patients independently from a physician.

The legislation, which was introduced earlier this month and is currently under consideration by the Assembly and Senate Health Committees, is supported by the Wisconsin Nurses Association, the Wisconsin Association of Nurse Anesthetists, WPS Health Insurance, and United HealthCare Services. Opposition to the proposal includes the state medical society and the Wisconsin Society of Anesthesiologists.

By Hoven Consulting – WiHPCA’s Government Affairs Firm

The Legislature's Joint Finance Committee (JFC) finished its work on reshaping Gov. Tony Evers' 2021-23 state budget proposal. While the Finance Committee completed their work on time, it was a challenging budget process with numerous moving pieces, including split government, billions of dollars in federal COVID-19 relief aid, and a projected $4.4 billion state budget surplus. 

The budget bill must still be approved by the full Legislature and signed into law by Evers, who could also veto the legislation in part or in whole. However, both houses of the Legislature are likely to adopt the budget approved by JFC with minimal changes. 

While the Finance Committee did not include Medicaid Expansion in its spending plan, it did include over $1.5 billion in total funding the state’s Medicaid program and increased spending on several specific initiatives. Of potential interest to hospice and palliative care agencies, the committee approved increases for home health care, personal care, and direct care workers as follows:

• Home Health Care Skilled Nursing Services: Provide more than $1.4 million over the two-year budget cycle to increase Medicaid rates for home health care skilled nursing services by 10 percent. The rate boost would begin on January 1, 2022 and will support care offered by licensed practical nurses, registered nurses, and nurse practitioners in home health agencies.

• Direct Care Workforce Funding: Provide $53,835,800 in 2021-22 and $50,403,200 in 2022-23 to increase funding for the direct care workforce funding supplement.  

• Personal Care Reimbursement: Provide $18,904,300 in 2021-22 and $59,369,300 in 2022-23 to increase hourly rates paid for personal care services to $20.69 on January 1, 2022, and to $22.35 on January 1, 2023. 

Please find below an overview of additional Department of Health Services and Medicaid-related provisions included in the JFC-approved version of the budget bill:

Medicaid

• Medical Assistance Cost-to-Continue Estimate: Provide funding of $1.3 billion in 2021-22 and $1.25 billion in 2022-23. In addition, adjust the cost-to-continue re-estimate to provide $25,900,000  in 2021-22 and $51,400,000 in 2022-23, reflecting the impact of the Department's proposed rate increase to managed care organizations providing services under Family Care, PACE, and Partnership, subject to approval by the federal Centers for Medicare and Medicaid Services.  

• Nursing Home Reimbursement: Provide $82 million in 2021-22 and $170 million in 2022-23 to increase reimbursement rates paid to skilled nursing facilities and intermediate care facilities for individuals with intellectual disabilities. 

• Postpartum Eligibility Extension: Provide $2.5 million in 2022-23 to reflect the estimated cost of extending benefits, for women enrolled in MA as pregnant women, until the last day of the month in which the 90th day after the last day of the month that the end of the pregnancy falls, instead of the 60th day under current law.

• Outpatient Mental Health and Substance Abuse Services and Child-Adolescent Day Treatment Reimbursement: Provide $6.6 million in 2021- 22 and $13.2 million in 2022-23 for a 15% increase to reimbursement rates for outpatient mental health and substance abuse services. In addition, provide $1.3 million in 2021-22 and $2.6 million in 2022-23 for a 20% increase to reimbursement rates for child and adolescent day treatment services. 

• Medication-Assisted Treatment: Provide $1.2 million in 2021-22 and $2.4 million in 2022-23 to increase MA reimbursement rates for opioid treatment providers by 5% and increase rates for opioid-related patient evaluation and management provided by primary care providers by $5 per visit.

• MA Dental Reimbursement: Provide $15.4 million in 2021-22 and $30.8 million in 2022-23 to increase MA dental reimbursement rates by 40%. 

• Home Health Reimbursement Rate: Provide a budgeted sum of $473,300 as the state share of payments, and provide the matching federal share of payments, in 2021-22, and by a budgeted sum of $960,200, as the state share of payments and provide the matching federal share  of payments, in 2022-23, for the Department to increase the Medical Assistance rates paid for nursing care in home health agencies for dates of services beginning January 1, 2022. Specify that funding is to support licensed practical nurses, registered nurses, and nurse practitioners in home health agencies that are licensed under s. 50.49 of the statutes.

Public Health

• Community Health Center Grants: Increase grant funding for federally qualified health centers (FQHCs) by $1,000,000 annually.  

• Grants to Free and Charitable Clinics: Increase grant funding for free and charitable clinics by $1,000,000 annually.  

• Lead Screening and Outreach Grants: Provide $50,000 annually to increase a grant for lead screening and outreach activities provided by a community based human service agency that provides primary health care, health education, and social services to low-income individuals in the City of Milwaukee, from $125,000 to $175,000. 

Community Based Behavioral Health

• Child Psychiatry Consultation Program: Provide $500,000 in 2022-23 to increase from $1,500,000 to $2,000,000 the funding for the child psychiatry consultation program.

• Medication-Assisted Treatment Expansion: Provide $500,000 in 2021-22 and $1,000,000 in 2022-23 in the Joint Committee on Finance supplemental appropriation for medication-assisted treatment.  

• Methamphetamine Addiction Treatment Grants: Provide $150,000 in 2021-22 and $300,000 in 2022-23 in the Joint Committee on Finance supplemental appropriation for training for substance use disorder treatment providers on treatment models for methamphetamine addiction.    

• Substance Use Disorder Treatment Platform: Provide $300,000 in 2022-23 in the Joint Committee on Finance supplemental appropriation for development of a substance use disorder treatment platform that allows for the comparison of treatment programs in the state.  

• Behavioral Health Bed Tracker: Provide $50,000 in 2021-22 and $20,000 in 2022-23 to expand the purposes of the current psychiatric bed tracking system to include information on the availability of space for peer run respite beds and crisis stabilization beds.  

Behavioral Health Trainee Provider Grants: Provide $250,000 in 2022-23 in the appropriation for treatment program grants to increase total funding for the program in that year to $750,000. Modify the program to: (a) specify that the Department may expend any available federal moneys received for this program; (b) require the Department to distribute a total of $750,000 per year, beginning in 2022-23; and (c) renumber the appropriation so that it is included as an appropriation under mental health and substance abuse services instead of under public health.

Earlier this year, WiHPCA fulfilled one of our main organizational goals for 2021 when we began quarterly meetings with the Division of Quality Assurance (DQA) at the Wisconsin Department of Health Services. In addition to building a positive relationship with an important regulatory agency that oversees the hospice and palliative care industry, the specific purpose of the meetings are to review and discuss survey deficiencies, examine avenues for improvement, and seek regulatory guidance from DQA.

The initial meeting held on March 11 was well attended and opened a great line of communication between WiHPCA members and DQA staff. The June 10 second quarter meeting was also successful and provided attendees with a wealth of important regulatory information. Please find below an overview of the June 11 meeting:

Survey Report:

• Number of surveys performed (Oct. 1, 2020-March 31, 2021)

i.      Number of complaint surveys – 14

ii.      Number of recertification surveys performed – 8

Complaint surveys topics – Top 5 concern areas:

iii.      Quality of Care and Treatment

iv.      Patient Rights

v.      Nursing Services

vi.      Admission/Transfer/Discharge Rights

vii.      Infection Control

Question and Answer Overview:

• Will the Public Health Emergency – and the associated COVID-19 waivers (CMS 1135) that apply to hospice care – remain in place until Dec. 31, 2021? While guidance continues to be sought, a 90-day extension of the public health emergency (PHE) was signed effective April 15, 2021. 
• • See: https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page.  DQA will receive the same notice that providers receive related to an end date for the PHE or any changes to the waivers that occur prior to the end of the PHE. 
  • CMS provided this website for more information about 1135 waivers: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/1135-Waivers
• How many new hospice organizations have begun operations in Wisconsin in 2021?
• • One hospice newly licensed in 2021. The Hospice statewide directory is found here: https://www.dhs.wisconsin.gov/guide/hospice.htm.
• How many applications are pending approval?
• • There are currently two hospice applications pending approval.
• Does DQA plan to re-write hospice and facility interface documents or convene a task force to revise the interface in the near future?
• • Jessica Tomczak, the DQA Nurse Consultant for Hospice, is working on this project. Any ideas for updates can be e-mailed to her at: Jessica.Tomczak@dhs.wisconsin.gov.  
• Has there been any coordination of care issues with nursing homes or assisted living in general, or as it specifically relates to infection control?
• • F-774 - The hospice plan of care must identify the care and services that are needed and specifically identify which provider is responsible for performing the respective functions that have been agreed upon and included in the hospice plan of care. 
  • F-774 was cited one time recently (May 2021) related to the Plans of Care for patients residing in Nursing Homes or Assisted Living Facilities not specifying which provider was responsible for which care areas on the Plan of Care.
• 1135 Waivers will continue through the Feds through 12/31.  This was confirmed through 20-003 for hospices.  We are working with the Biden Administration through NHPCO to look at extending some aspects such as telehealth visits past the PHE.  Will telehealth visits be codified through the state of WI for NP and physicians visits for our palliative care programs?
• • CMS response – Since the PHE is ongoing, CMS has not issued any further information regarding telehealth as it relates to Hospice.  We will update you if we receive any further guidance.
  • WI response – DHS established a temporary telehealth policy to ensure access to health services during the COVID-19 pandemic. The temporary policy flexibilities for telehealth services related to COVID-19 are not tied to the federal or state declaration of a public health emergency. DHS is in the process of drafting emergency and permanent telehealth rules.  The current policy will continue until emergency telehealth rules go into effect.  For Medicare certified providers, please follow the guidance from CMS.
• CMS recently changed their guidance in QSO-20-38-NH to allow to not routinely test staff that have been fully vaccinated.  They did reiterate that unvaccinated staff needed to be tested according to the percent positivity rate in their county.  DHS guidance in the past has been that all routine testing had to be performed a minimum of every 2 weeks.  We have not seen any adjustment to this DHS guidance (unless we missed it) allowing for NOT testing vaccinated staff, etc.  Are we correct in assuming that DHS is allowing this even though their previous guidance was more restrictive? 
• • DHS released updated testing guidance (see attached) on 6/9/21 to align with the guidance provided in CMS QSO Memo 20-38 revised 4/27/21.
  • The current DHS COVID-19: Nursing Home testing guidance links to the revised CMS QSO Memo -20-38 and recommends routine testing of unvaccinated staff based on the county positivity rate in the last week:
  • • Low – Positivity rate of < 5% - Once a month testing
    • Medium – Positivity rate of 5% - 10% - Once a week testing
    • High – Positivity rate of > 10% - Twice a week testing

First elected to the state Assembly in 2012, Representative Dan Riemer (D-Milwaukee) is serving his fifth term representing the 7th Assembly District, which includes portions of the cities of Milwaukee and West Allis, as well as the Village of West Milwaukee.

Rep. Riemer holds a law degree from UW-Madison and is a full-time lawmaker. He currently serves on the Assembly Health Committee, and during his time in the Legislature has worked on numerous health care-related proposals.

Rep. Riemer took a few minutes to talk with us about a handful of topical health care issues facing Wisconsin and what health care policy priorities he believes should be pursued during the 2021-22 legislative session:

Question 1

As a long-time member of the Assembly Health Committee and a legislator who has worked on numerous health care-related polices during your time in the Legislature, what do you believe are the largest health care-related challenges facing the state? In addition, what policy solutions do you believe are needed to address those challenges? Lastly, what key health care policy proposals is the Assembly Democratic Caucus focusing on for the 2021-22 legislative session?

Answer: The single biggest health care challenge facing Wisconsin is the failure to expand Medicaid. This would increase the number of Wisconsinites with health insurance, and lower health care costs for newly Medicaid-covered individuals between 100%-133% of the Federal Poverty Line. Medicaid provides better benefits than Affordable Care Act plans or other plans and provides Wisconsin’s government with over one billion additional dollars, some of which could be devoted to other health care priorities.

As I have done for many years through legislation, Governor Evers has also repeatedly proposed Medicaid expansion. The Assembly Democratic Caucus has again made this a priority, as have Democrats in the State Senate. The time has come for the Republican majority in the Wisconsin Legislature to agree. That’s the simple solution to our biggest health care challenge.

Question 2

The cost of healthcare continues to rise, for both individuals and employers. In fact, a recent survey by the Kaiser Family Foundation and the Purchaser Business Group on Health found that 85 percent of large employers believe the government must take a bigger role in managing healthcare costs and coverage. Another survey found that 55 percent of small business owners say the cost of providing health insurance to their employees is the biggest challenge they face. What types of policies or future legislation do you believe are necessary to help drive down the overall costs of health care?

Answer: In addition to Medicaid expansion, which will reduce what Wisconsin’s taxpayers and government must pay for health care for a large sector of our population (a form of lowering costs), I strongly support other measures to lower the overall cost of healthcare in Wisconsin.  One step that I support would be to require that the Wisconsin State Employee Health Plan (WSEHP) be used as the vehicle by which all government employees obtained health insurance. 

A careful analysis of WSEHP by University of Wisconsin-Madison La Follette Professor of Economics John Mullahy and others compared the WSEHP’s experience in Dane County vs. Wisconsin’s other 71 counties. The study showed that  when a very large percentage of the employees in a county are offered a choice among competing health care plans, they have incentives to enroll in the lower-cost plans, because while higher-cost plans are always available, they must pay a modest additional premium to enroll in higher-cost plans. Given the choices, health care premiums and costs are held down.

If WSEHP served as the vehicle for enabling all government employees to obtain health insurance in the same way, it should be possible to replicate much of WSEHP’s unique success in Dane County in constraining health care premiums and costs.  One of the benefits of this is that, as the Dane County story suggests, it is not only the WSEHP and those it helps obtain health insurance for who experience reduced costs.  The model’s incentives put pressure on the competing plans to become more cost effective in general, which helps private employers as well.

Question 3

Skilled home health care offers a wide range of health care services, which are provided by skilled non-physician practitioners, such as nurses in a patient’s home. Not only does skilled home health offer patients with greater convenience, increased quality of life, and better outcomes, it is also typically less expensive than care delivered in a hospital or other facility. Unfortunately, despite the many benefits of home health care, the Wisconsin Medicaid reimbursement rate for home-based skilled nursing has not been increased in over a decade. With that in mind, would you support increasing the Medicaid reimbursement rate for home health skilled nursing services by 10 percent?

Answer:  I certainly would be concerned if the current Medicaid reimbursement rate for home health skilled nursing services is resulting in a reduction in the number of providers or the quality of care.

This is not an issue, however, that I know much about. I would welcome the opportunity to learn more.

 

The views and opinions expressed in this interview are those of the individual that was interviewed and do not necessarily reflect the official policy or position of the organization.

Governor Tony Evers has called a special session of the legislature to take up a proposal to expand the Wisconsin Medicaid program, which would capture an extra $1 billion in federal funds and cover more than 90,000 additional Wisconsin residents under the program.

The legislation would also use $850 million of the additional federal dollars for numerous economic development-related projects and transfer the rest to the state’s budget stabilization fund.

The Republican-controlled Legislature has said they would immediately gavel out the special session without taking up the proposed legislation.