WiHPCA News

By Hoven Consulting – WiHPCA’s lobbying firm

• WiHPCA Testifies at Assembly Health Committee on Death Reporting Legislation

On August 10, the state Assembly Committee on Health, Aging and Long-Term Care held a hearing on Assembly Bill 189 (AB189).  This bill would require all individuals or organizations that are currently required to report certain deaths to medical examiners or coroners to also notify these officials of ALL persons who have died within 24 hours of admittance or presentment to a hospital or other facility – including a hospice – even deaths not currently included under existing reportable circumstances listed in state law.  This bill would impact hospices, as a significant number of expected deaths occur within 24 hours of admission to hospice care.

If AB189 becomes law as introduced, it would not only dramatically increase the workload of hospice nurses and staff during a time when surviving family members may need their support, it would also increase the workload of county medical examiners and coroners to unnecessarily review expected deaths. 

On behalf of WiHPCA, Jennifer Flugaur – who serves as the vice president of clinical excellence at Agrace – testified at the August 10 hearing to share these concerns on behalf of WiHPCA.  In particular, she discussed WiHPCA’s request for an amendment to exempt hospice from this legislation since a substantial number of expected deaths occur within 24 hours of admission to hospice care. 

• Governor Requests Special Legislative Session to Provide Funding for the Healthcare Workforce Shortage

On August 8, Governor Tony Evers announced that he was calling the Legislature into session on Wednesday, September 20, 2023, to provide funding for several of his major budget priorities that were not included in the FY2023-2025 state budget, including over $300 million for childcare programs, the creation of a paid family and medical leave program, and almost $60 million to help address the shortage of healthcare workers.  The funding to address the healthcare worker shortage includes:

However, very soon after this announcement, Republican legislative leaders stated that they opposed this special session.  As such, they will very likely call the Legislature into session on September 20 and then quickly adjourn the session, as they have done in the past when Governor Evers has called for a special session. 

• State Rep. Deb Andraca Appointed to Legislature's Joint Finance Committee

On August 16, state Assembly Minority Leader Greta Neubauer (D-Racine) appointed Rep. Deb Andraca (D-Whitefish Bay) to serve on the Legislature’s budget-writing Joint Committee on Finance for the rest of the 2023-2024 legislative session.  Rep. Andraca, who represents much of the north shore Milwaukee suburbs, will replace Rep. Evan Goyke (D-Milwaukee), who is departing the committee to focus on his campaign for the position of Milwaukee City Attorney.

• DHS Announces Free Online Program to Train 10,000 Caregivers

On August 8, the state Department of Health Services (DHS) announced an initiative to train 10,000 Wisconsinites as certified direct care professionals (CDCP).  These individuals provide personal/supportive home care to senior citizens and disabled people.

Wisconsinites interested in receiving the CDCP certification may sign up to receive free training and then will need to pass an online test in order to be certified.  Certified individuals who obtain employment with an eligible employer may earn up to $500 in combined hiring and retention bonuses. 

More information may be found on the DHS website.

• DHS Creates Webpage Detailing Statewide BadgerCare Plus & Medicaid Enrollment Data

During the COVID-19 pandemic, the federal government put in place a continuous coverage requirement for Medicaid enrollees.  Now that the pandemic-related federal public health emergency has ended, those Wisconsinites who benefit from BadgerCare Plus and Medicaid and want to continue to participate in these programs will need to renew their enrollment.  DHS has created a webpage that tracks this data, which will be updated on the third Thursday of each month. 

• DHS Launches "UpliftWI" Peer Support Phone Line

On July 31, the state Department of Health Services (DHS) unveiled “UpliftWI,” which is a new peer support phone line for individuals who are experiencing mental health and substance use challenges.  This phone line may be reached at 534-202-5438, seven days a week between the hours of noon and midnight.  There is no charge to use this service and those who call for assistance will not be required to disclose their name, address or other identifying information.  DHS intends to expand the phone line’s hours of operation to 24 hours a day by the end of 2024.  More information may be found at the UpliftWI website. 

“All Copays Count” applies discounts and other assistance toward patients’ out-of-pocket costs 

Guest Column by WI Senator André Jacque

Patients would receive protections from rising health care costs by ensuring that health plans count copay assistance toward a patient’s maximum out-of-pocket cost or annual deductible, under bipartisan “All Copays Count” legislation (Senate Bill 100) I introduced with several of my colleagues earlier this session.

Amid nationwide inflation, health plans have increasingly shifted costs to patients and created barriers between individuals and the medications on which they rely.  For advocates of Wisconsin patients and the providers who care for them, this bill is a clear solution to help those individuals afford the critical medications their physicians prescribe to them to manage their health.

Copay assistance programs often act as a lifeline to help patients afford specialty medications they need to treat serious health conditions. Sixteen other states have already enacted such protections.

Just when patients think they’ve reached their out-of-pocket limit, insurers and benefit managers keep moving the goalposts, and folks wind up paying more.  For someone suffering from a complex disease, the financial hit is especially hard, leaving them to choose between groceries, utilities and mortgage payments - and the prescription medications that keep their condition under control.

In 2020, the average deductible for single coverage was $1,364, which is a 364% increase from 2006. Over the past five years, the percentage of covered workers with a general annual deductible of $1,000 or more for single coverage has grown from 23% to 57%.  Further, in 2020 more than one in four covered workers was enrolled in a plan with a deductible of $2,000 or more.

Many of these patients rely on copay coupons and vouchers to afford their prescribed treatments at the pharmacy counter.  Insurers should not have the power to prevent that copay assistance from counting toward their out-of-pocket expense or deductible.  If patients can’t afford their medications, they may choose to skip doses or stop treatment altogether, which can lead to increased costs in the overall healthcare system.  And worse.

The All Copays Count legislation would ensure that the copay assistance programs patients use to afford their medications count toward their out-of-pocket costs.  It would also close the loophole that allows insurers to define prescription drugs as non-essential and therefore not eligible to count toward their deductible.  At the same time, under this initiative Wisconsin insurers would retain flexibility with their plans, while making sure patients can continue to afford the medications they need.

If you have cancer, epilepsy or any other serious health condition, the last thing you should have to worry about is whether you’ve met your deductible.  “All Copays Count” is about giving patients peace of mind that they can pay for their prescriptions. 

Senator André Jacque represents Northeast Wisconsin’s First Senate District, consisting of Door and Kewaunee Counties and portions of Brown, Calumet, Manitowoc, and Outagamie counties.

Earlier this month, Janet Protasiewicz was sworn in as a new justice of the Wisconsin Supreme Court. Protasiewicz, who has positioned herself as a judicial liberal, defeated former Justice Dan Kelly in the April 4 spring general election, replacing two-term Justice Patience Roggensack, who did not seek reelection.

More notably, Protasiewicz’s addition to the state’s high court shifted it from a majority conservative court to a majority liberal one. With the ideological swing to a 4-3 advantage in favor of liberals for at least the next two years, the court is expected to issue several high-profile judicial decisions that could impact the political landscape in Wisconsin.

Among the hot-button issues that may be determined by the court include voting and election rules, redrawing legislative district maps, the future of abortion and reproductive rights in Wisconsin, and overturning the law that eliminated bargaining rights for most state and local government employees.

The Hospice Action Network, an affiliate of the National Hospice and Palliative Care Organization (NHPCO), is charged with implementing NHPCO’s public policy agenda through direct lobbying, grassroots advocacy, and by empowering Hospice Advocates to share their hospice story with Congress. The Hospice Action Network’s mission is to advocate, with one voice, for policies that ensure the best care for patientsand families facing serious illness and the end of life.

Please CLICK HERE to review federal legislation the Hospice Action Network is lobbying on during the 118^th Congress (2023-24).

The Boards of Directors of the National Association for Home Care & Hospice (NAHC) and the National Hospice & Palliative Care Organization (NHPCO) signed a non-binding Letter of Intent earlier this week to jointly explore the formation of a new as-of-yet unnamed organization that combines the strengths of NAHC and NHPCO, creating a better and more powerful advocate for the entire home care, hospice, palliative care, and serious illness community.

The purpose of combining the two leading organizations serving providers of care to America’s elderly, disabled, and dying is simple: to better serve you. Both Boards voted for this course of action following the recommendations of a Steering Committee composed of member and staff leaders from both organizations. The Steering Committee’s recommendations were informed by consultation with members of both organizations. The Committee has been working, with the support of association consulting firm McKinley Advisors, since the March 8, 2023 joint announcement (NAHC website, NHPCO website) that NHPCO and NAHC would explore opportunities for deeper collaboration.

“The collaborative process of the NHPCO and NAHC Boards over the last five months has brought the two organizations closer together,” said Kenneth Albert, R.N., Esq., NAHC Board Chair, and President and CEO of Androscoggin Home Healthcare + Hospice. “In addition to the Board-level discussions, our organizations have been collaborating on multiple advocacy efforts, as well as projects such as the Value of Hospice research. Through these efforts, it has become crystal clear that we can do more on behalf of our members by working together. If the current discussions do not lead to a new, combined organization, the outcome will nevertheless be closer working relationships on behalf of community-based and home care providers.”

“The American healthcare system is shifting, and home and community-based care options are increasing in a multitude of forms across the country,” said Melinda Gruber, PhD, MBA, CNA, NHPCO Board Chair, and President of Caring Circle/Vice President, South Region, Medical Group and Continued Care of Corewell Health. “With decades of experience in hospice and home care, NHPCO and NAHC members are the long-standing experts, and they are evolving to meet patient needs in a shifting environment. As we look ahead, we see an opportunity for the organizations representing those providers to evolve. In this time of change, we are acting with intention and care to continue meeting the needs of providers, patients, families, and communities well into the future.”

To facilitate an effective process, both Boards have decided to suspend elections for new Directors this year.

We know our members may have many questions about this process and how a new combined organization will affect them. NAHC and NHPCO will be updating and consulting our members throughout this process to address your questions and concerns as quickly as possible.

Many details are still being determined and in the coming months, the NAHC and NHPCO Boards of Directors will work together, in consultation with member volunteers from both organizations, to determine how a consolidated organization could represent the best interests of the combined memberships. The organizations expect this process to take six to ten months, but getting it done right will be more important than getting it done quickly. McKinley will continue to support the process as an independent, third-party advisor.

In the meantime, you may be assured that staff of both organizations will continue to work as hard as possible to serve your needs, advocate for your interests, and strengthen the entire hospice, home care, and home health community.

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

·         How Emerging Hospice Regulations Could Impact Providers

• By Holly Vossel | Aug. 24, 2023

Increased hospice oversight aimed at curbing fraud in the industry could come with a mixed bag of financial and operational impacts for providers. The U.S. Centers for Medicare & Medicaid Services (CMS) has honed in on hospice program integrity, rolling out a swath of new measures to reduce fraud, waste and abuse in the space. During the past two years, CMS has introduced new regulations, updated survey process, increased auditing activity and enhanced reviews of providers’ claims, patient eligibility and quality data. Read more…

·         CMS: Nearly 400 Hospices Considered for ‘Administrative Action’ as Program Integrity Efforts Heat Up

• By Jim Parker | Aug. 22, 2023

The U.S. Centers for Medicare & Medicaid Services (CMS) is considering administrative action against 400 hospices, which could include revocation of their Medicare certification. The agency has been mobilizing against hospice fraud this year. In addition to new regulations and updated survey processes, CMS has been conducting unannounced onsite visits. To date, CMS personnel have appeared at 7,000 locations, with plans to visit every hospice site in the country. Read more…

·         Continuity of Palliative Care Often Disrupted at Hospital Discharge

• By Jim Parker | Aug. 22, 2023

Patients who receive palliative care in a hospital often have trouble finding a provider to continue those services after they return home. The number of hospitals that offer palliative care has grown exponentially during the past two decades. As of 2020, more than 83% of U.S. hospitals with 50 or more beds had a palliative program, up from 25% in 2000, according to the Center to Advance Palliative Care (CAPC). Read more…

·         Hospice Advocacy Groups Call on CMS to Delay, Revise Special Focus Program

• By Jim Parker | Aug. 21, 2023

A coalition of industry groups has spoken out about the design of the U.S. Centers for Medicare & Medicaid Services (CMS) forthcoming Special Focus Program (SFP) for hospices. CMS initially pitched the idea in 2022 but instead convened a Technical Expert Panel (TEP) to further guide development. The TEP completed its work late last year, and now, per the 2024 proposed home health rule, the agency wants to move ahead with it next year. Read more…

·         CMS Proposed 2024 Physician Fee Schedule Introduces New Supports for Family Caregivers, Social Determinants

• By Jim Parker | Aug. 18, 2023

The U.S. Centers for Medicare & Medicaid Services (CMS) has proposed new pathways to support family caregivers for patients with serious illnesses. The agency’s 2024 physician fee schedule proposed rule contains a number of provisions related to caregiver assistance, health equity, interdisciplinary care and social determinants of health. Read more…

·         What Hospices Can Learn from Home Health Agencies on New Program Integrity Rules

• By Jim Parker | Aug. 8, 2023

Hospices seeking to gauge the potential impact of new regulatory actions in the space can look to their counterparts in the home health field. The steps that the U.S. Centers for Medicare & Medicaid Services (CMS) has put forth to strengthen hospice program integrity mirror rules implemented in years past for home health providers, including medical review processes and rules for when a provider can sell their business. Read more…

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

The WiHIPCA 2023 Annual Conference features a combination of dynamic keynote presentations and impactful breakout sessions of interest to all hospice and palliative care professionals. Invited speakers include leading subject experts from Wisconsin and across the country. The conference will be held Sept. 26 at the Glacier Canyon Lodge at the Wilderness Report in the Wisconsin Dells. REGISTER TODAY!

By Hoven Consulting – WiHPCA’s lobbying firm

• Fiscal Year 2023-2025 Finalized State Budget Highlights

The following are highlights of the finalized Fiscal Year 2023-2025 state budget, which was signed into law by Governor Tony Evers on July 5, 2023. 

Department of Health Services (DHS) – The approved DHS budget increased spending by $3.1 billion overall over the biennium. 

Department of Safety and Professional Services

• WiHPCA Requests Hospice or Palliative Care Provider to be Appointed to DHS Complex Patient Program Advisory Group

On July 17, WiHPCA leadership sent a letter to Wisconsin Department of Health Services (DHS) Secretary-designee Kirsten Johnson requesting that a hospice or palliative care provider be appointed to the advisory group for the new complex patient pilot program.  This pilot program, which was funded at $5 million in the recently enacted FY2023-2025 state budget, is focused on successfully transferring patients with complex medical needs from acute care facilities to post-acute care facilities.  WiHPCA made this request as hospice and palliative care providers have extensive experience providing post-acute care in community settings, are well acquainted with the nuances associated with caring for those with complex medical needs and are also well-versed in the financial and administrative elements of myriad government programs. 

• Improved Finances for State Medicaid Fund

DHS has projected that the state Medicaid fund ended state fiscal year 2023 with a $875.5 million surplus compared to the FY2021-2023 budgeted amount.  In addition, the surplus is $79.1 million more than what DHS projected this past spring.  This surplus was due to a number of factors, including lower costs for prescription drugs and long-term health care.  Once the surplus amount is finalized and confirmed at the end of July 2023, surplus funds will be transferred to the state’s general fund. 

• DHS Annual Adjustment to Patient Health Care Record Fees

Each year on July 1, DHS is required by state law to adjust the maximum fees (factoring in the change in the consumer price index) that health care providers may charge for patient medical records.  The updated fee schedule may be viewed on the Legislature’s website. 

On Aug. 10, the Assembly Health, Aging and Long-Term Care Committee will hold a public hearing on Assembly Bill 189, legislation that would create new requirements regarding the reporting of deaths to a medical examiner or coroner. More specifically, the bill would require a person that is currently obligated to report deaths and has knowledge of a death that occurred within 24 hours after an individual has been  admitted to a hospital or similar institution to contact the medical examiner or coroner to determine whether the death is reportable under current state law.

WiHPCA is seeking an amendment to the bill to exempt hospice agencies from the legislation’s  requirement to notify a medical examiner or coroner of deaths that occur within 24 hours. The bill as written would create additional stress and an administrative burden on hospice staff, as there are numerous (and expected) deaths that occur at hospice facilities within 24 hours of admittance. According to one mid-size agency located in southern Wisconsin, they have between 15 to 20 death a month that would require them to contact the coroner or medical examiner under the bill’s provisions.

The WiHPCA Government Affairs Team is currently working with lawmakers on the amendment described above. In addition, WiHPCA will be testifying at the hearing and will be asking select members to contact their legislators on the amendment.

Earlier this month, WiHPCA leaders met with the Wisconsin Department of Health Services’ Office of Inspector General (OIG) to discuss the growing – and highly concerning – trend of hospice fraud in other states and how Wisconsin can avoid similar fraud.

WiHPCA Board members Lynne Sexten (Chair) and Karen Carrig met with Inspector General Anthony Baize and his team to pass along critical information on new types of hospice fraud that has been seen across the country – starting in California a few years ago and spreading to Nevada, Texas, and Arizona, among a handful of other states. They also shared critical data and a sampling of national articles regarding hospice fraud that the OIG can use to help prevent similar fraud in Wisconsin.

The OIG appreciated the information and said they found the meeting highly valuable. They also expressed a desire to continue an open line of communication with WiHPCA and our members to help tackle potential hospice fraud.