WiHPCA News

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

·         Citing Competition and Consumer-Protection Concerns, CMS Makes Hospice-Ownership Data Publicly Available

• By Robert Holly | April 20, 2023

In what the agency is calling an effort to promote industry competition and protect consumers, the U.S. Department of Health and Human Services (HHS) is making hospice-ownership data publicly available. HHS is also releasing ownership data for all Medicare-certified home health agencies, the department specified in a Thursday announcement. Federal health care officials had already implemented a similar measure for the nation’s skilled nursing facilities (SNFs).

Read more…

·         How Hospice Labor Pressures Can Impact Regulatory Compliance

By Holly Vossel | April 20, 2023

Industry-wide staffing woes are bleeding into hospices’ compliance programs.

Many hospices are struggling not only operationally, but also financially to comply with regulations, according to Norbert Hudak, partner at in90Group, a Los Angeles-based business marketing and strategy development company. Read more…

·         NHPCO: Proposed 2.8% Hospice Payment Hike Insufficient

• By Jim Parker | April 18, 2023

The 2.8% base payment rate increase recently proposed by the U.S. Centers for Medicare & Medicaid Services (CMS) is insufficient to support hospice patients’ care needs, a major industry group said. CMS earlier this month released its 2024 hospice proposed rule, which included the 2.8% increase — an estimated total of $720 million. If finalized as written, the rule would also raise the aggregate payment cap to $33,396.55, up from $32,486.92 this year. Read more…

·         Younger Generations of Hospice Workers Value Career Paths, Work-Life Balance

• By Holly Vossel | April 17, 2023

Hospices that are shaping their recruitment and retention strategies around work-life balance and career development have a fighting chance against competitors for sparse clinical staffing resources. As workforce shortages mount throughout the health care system, competition in the labor market has intensified. Hospices are increasingly competing with other health care providers for clinical staff as more reach retirement age without enough younger workers stepping in to fill the gap. Some also leave the field due to burnout, or because they found higher compensation or a better career path elsewhere. Read more…

·         CMS Working on Health Equity-Focused Hospice Quality Measures

• By Jim Parker | April 14, 2023

The U.S. Centers for Medicare & Medicaid Services (CMS) is moving towards the development of health equity quality measures for hospices. Last year, the agency convened a technical expert panel (TEP) to study the issue, according to language in its 2024 proposed hospice rule. Among the questions the panel has considered is the addition of new measures to the Hospice Quality Reporting Program (HQRP). Read more…

·         Palliative Care the Next Generation: How the Service May Grow and Evolve

• By Holly Vossel | April 20, 2023

Based on current trends, risk-based payment systems will likely shape the future of palliative care. The palliative care market is projected to swell during the next decade. However, no standardized definition exists for “palliative care.” Providers use a range of approaches to providing the service, from consults with advance care planning to short-term transitional care or longer-term symptom management for the chronically ill. 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 most recent WiHPCA sponsored quarterly meeting with the Division of Quality Assurance was held April 12. The meeting provided valuable information for our members and the opportunity to engage with state regulators. During the meeting, DQA provided an overview of the following CMS documents, which are linked below for your review:

• Revisions to Hospice-Appendix M of the State Operations Manual and the Hospice Basic Surveyor Training: QSO-23-08-HOSPICE.pdf
• Hospice: CMS Flexibilities to Fight COVID-19: Hospice- CMS Flexibilities to Fight COVID-19.pdf

More information is available on the WiHPCA website including registration for future quarterly calls.

By Hoven Consulting – WiHPCA’s lobbying firm

• WiHPCA Supports Draft Occupational Credentialing Reciprocity Bill

At its March meeting, the WiHPCA Legislative Committee agreed to support legislation to establish reciprocal occupational credentialing in Wisconsin, so that people who have occupational licenses in other states are able to more easily practice their profession in Wisconsin.  In addition, this would likely improve the continuing occupational credentialing processing backlog at the state Department of Safety and Professional Services. 

• Governor Evers Appoints New Secretary of State

Effective on Friday, March 17, longtime Wisconsin Secretary of State Doug La Follette resigned his position.  He had held that position for more than 40 years and was re-elected to a four-year term in November 2022.  Also, on Friday, March 17, Governor Evers appointed former State Treasurer Sarah Godlewski as the new Secretary of State.  Godlewski will serve out the remainder of La Follette’s term, which will end in January 2027. 

• Senate Committee Advances Medical Examining Board Nominees

Earlier this month, the Senate Health Committee voted unanimously to advance the nominations of Gregory Schmeling, MD, of Brookfield, and Michael Parish, MD, of Wauwatosa, to serve on the Medical Examining Board (MEB), which has the authority to issue occupational licenses to physicians, as well as generally regulate this profession.  Doctor Schmeling’s nomination lasts until July 2025 and Doctor Parish’s nomination lasts until July 2023.  The next and final step is for the full Senate to vote on approving their nominations. 

• State Senate Confirms State Insurance Commissioner

On March 22, the state Senate voted unanimously to confirm Nathan Houdek as the state Insurance Commissioner.  Prior to Governor Evers nominating him to this position, he served as the Deputy Insurance Commissioner and then interim Insurance Commissioner, upon the retirement of Insurance Commissioner Mark Afable in December 2021. 

• State Budget Public Hearings Scheduled for April

Earlier this month, the State Legislature’s Joint Committee on Finance – the committee that writes the state budget – announced that it will hold four public hearings throughout the state to give Wisconsin residents the opportunity to testify on issues related to the Fiscal Year 2023-2025 state budget.  The Joint Committee on Finance’s public hearing schedule is as follows:

For more information about these hearings, click on one of the links above.

Earlier this month, the WiHPCA had the opportunity to ask State Representative Clint Moses (R-Menomonie), Chair of the Assembly Health, Aging and Long-Term Care Committee, what his health care-related policy goals are for the 2023-24 legislative session. Here is what he had to say:

“My health priorities this session is to address the healthcare workforce shortage and to help make healthcare more affordable and accessible for Wisconsin citizens. Throughout Wisconsin, the health care workforce shortage has reduced accessibility to quality care. We have seen reduced service options and closures of clinics. In many cases, people are driving over an hour plus for a routine checkup. This creates a challenging situation for patients, especially for our aging population who face increasingly difficult decisions when it comes to their healthcare. I have been spending time learning about regulations surrounding Senior Care, IRIS, Nursing Homes, and Hospitals services across the state. I have also been on numerous tours in health care facilities and have met with many health care providers. I look forward to working with all the stakeholders to make Wisconsin a healthy state for all ages.”

Representative Clint Moses (R-Menomonie) represents the 29^th Assembly District in northwestern Wisconsin, which includes portions of Dunn and St. Croix Counties. He was first elected to the Assembly in 2020 and was reelected in 2022. He currently serves at the Chair of the Assembly Health, Aging and Long-Term Care Committee. Rep. Moses, who resides in Menomonie with his wife and four daughters, is a chiropractor by trade. He operates Red Cedar Chiropractic with his wife, Dr. Nora Moses, and has been caring for residents of Dunn County for 20 years. He is a member of the Chiropractic Society of Wisconsin, Community Foundation of Dunn County, lifetime alumni member of Northwestern Health Sciences University, and has served on the Colfax Health & Rehabilitation Board.

To ensure the voice of citizens is heard across state government, it is critical for Wisconsin residents to understand our electoral process, and even more important for them to cast their vote on election day. And a big election is right around the corner… Wisconsin’s 2023 Spring Election will take place on Tuesday, April 4, and voters will head to the polls to cast their ballots in the WI Supreme Court Race, which could decide the ideological direction of the court for years to come.

In the Feb. 21 Spring primary, Milwaukee County Circuit Judge Janet Protasiewicz and former Supreme Court Justice Daniel Kelly captured the most votes in the four-way race and will face-off in the April 4 general election. Protasiewicz took 46% of total votes cast, with Kelly coming in a distant second, capturing 24% of the votes. Again, the winner of the general election will decide the ideological direction of the 7-seat high court, which is currently controlled 4-3 by conservative-leaning justices.

In addition, for those of you who live in the 8th Senate District (in southeastern Wisconsin), there is a special election to replace Sen. Alberta Darling (R) who retired from the Wi Senate late last year.  Republican State Representative Dan Knodl is running against Democrat environmental attorney Jodi Habush Sinykin.

For more information about the April 4 Spring Election, including your polling place and which candidates and referendum questions will be on your ballot, simply CLICK HERE. 

WiHPCA works closely with our national partners, including the National Partnership for Healthcare and Hospice Innovation (NPHI), on federal government affairs issues important to our members. Here is the latest federal government affairs news from NPHI:

• NPHI Submits Information to Senate HELP Committee in Response to Healthcare Workforce Crisis RFI

Earlier this month, NPHI responded to the Senate Health, Education, Labor, and Pensions (HELP) Committee Request for Information (RFI) regarding the healthcare workforce crisis. NPHI's response detailed the current status of the end-of-life care workforce, highlighted existing legislation that would address various components of the issue, and proposed additional policy ideas for lawmakers to consider. Specifically, NPHI proposed that the committee consider:

NPHI looks forward to working with the Senate HELP Committee and other Congressional stakeholders to advance practical, bipartisan solutions to address the ongoing workforce challenges impacting healthcare providers. NPHI's full response to the Committee can be found here.

• NPHI and National Hospice Organizations Request Clarification from CMS Regarding Use of Telehealth to Deliver RHC Following the Termination of the COVID-19 PHE

On Monday, NPHI, joined by LeadingAge, NHPCO, and NAHC, sent a joint letter to CMS requesting clarification on how routine home care (RHC) delivered via telehealth services would be adjudicated following the end of the COVID-19 PHE on May 11, 2023.

During the PHE, CMS affirmed that hospice providers were allowed to provide services to a Medicare patient receiving routine home care through telecommunications. Included in this interim change were details of how hospices were to document the use of these telecommunication services (e.g., they had to be included in the plan of care, tied to patient-specific needs, etc.) 

In February, CMS COVID-19 flexibility guidance for hospices declared that “This interim regulatory change (providing hospice routine home care through telehealth) will expire at the end of the PHE.” Hospice providers now face confusion regarding what tools they’re allowed to use to supplement in-person care as they have for years.

As such, the letter requests that CMS clarify the ways that hospices can continue to use communication options to supplement in-person care as they did prior to the PHE. 

• Value-Based Insurance Design (VBID) Model

The CMS Center for Medicare and Medicaid Innovation (CMMI) recently announced that the Value-Based Insurance Design (VBID) Model will be extended through calendar year 2030. Additionally, CMMI plans to introduce changes intended to more fully address the health-related social needs of patients, advance health equity, and improve care coordination for patients with serious illness.

Whether this extension will include the Hospice Benefit Component (MA Carve-in) element of the original model or not remains to be seen. NPHI expects to receive additional information from CMMI and will share those developments as soon as possible.

For more information on the current model design, please see CMMI's overview CY24 RFA fact sheet or contact the model team at VBID@cms.hhs.gov.

By Jim Parker | Hospice News | March 22, 2023

Despite years of scrutiny over the duration of hospice care, new data show that longer stays reduce health care costs in the last year of life by as much as 11%.

All told, hospice care — regardless of length of stay — saves Medicare approximately $3.5 billion for patients in their last year of life, a 3.1% reduction. But those with stays of six months or more yielded the highest percentage of savings.

A trio of organizations published these findings Wednesday in a joint report, including the National Hospice & Palliative Care Organization (NHPCO), the National Association for Home Care and Hospice (NAHC), and NORC at the University of Chicago. Read more…

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 grassroots advocacy. In effort to capitalize on our greatest advocacy resource – our membership – WiHPCA has established 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 policy issues important to you and the patients and families you serve.

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

By Hoven Consulting – WiHPCA’s lobbying firm

• Governor Evers Submits FY2023-2025 Budget Request to Legislature

On Wednesday, February 15, Governor Tony Evers unveiled his budget bill proposal for the Fiscal Year 2023-2025 budget biennium. The budget bill outlines how the State of Wisconsin will administer tax dollars, program revenue, and federal aid dollars over the next two years. In total, the budget aims to spend $103.8 billion ($52.1 billion in FY2023-2024 and $51.7 billion in FY2024-2025) on state government programs.  For fiscal year 2023-2024, that's a $7.9 billion increase (17.9 percent) over the budget proposed by Evers in 2021. 

The most significant increase in state tax dollar spending is in the following state agencies/areas:

LARGEST BIENNIAL GPR (General Purpose Revenue) INCREASES OVER 2021-2023 FUNDING LEVELS

·        Department of Public Instruction:  $2.809 billion

·        Shared Revenue and Tax Relief:  $1.099 billion

·        Department of Administration:  $1.019 billion

·        Public Service Commission:  $755 million

·        Department of Health Services:  $716 million

·        Department of Children and Families:  $512 million

·        Department of Workforce Development:  $265 million

·        All Other Changes:  $1.656 billion

·        TOTAL:  $8.831 billion

The bill has now been sent to the Wisconsin legislature where it will be reviewed by the Joint Committee on Finance (JFC). The committee will review and amend the budget bill after having several public hearings across the state at which citizens may testify. After JFC has passed the bill, it will then be sent to the State Assembly and Senate for passage, likely in June.

It's important to note that Republican legislative leaders have stated publicly that they do not support the Governor's budget proposal.  Republicans control both houses of the legislature and major changes to the proposal are expected.

• WiHPCA Sends Legislative Priorities Letter to All Legislators

On February 2, WiHPCA’s lobbyists sent an introductory letter to all Wisconsin state legislators.  In the letter, we provided background information on the difference between hospice care and palliative care.  In addition, we shared WiHPCA’s legislative agenda for the 2023-2024 legislative session.  WiHPCA provided legislators with a “legislative leave-behind” document that includes background information on WiHPCA, as well as our legislative agenda.

• Former Milwaukee Health Commissioner Kirsten Johnson Appointed DHS Secretary

On February 6, Governor Tony Evers announced that he is appointing Kirsten Johnson as the new state Department of Health Services (DHS) Secretary.  Until recently, she served as the City of Milwaukee Health Commissioner.  She has over two decades of experience in the public health sphere, including as the head of the Washington-Ozaukee Public Health Department, an advisor for former Congressman Ron Kind, and a program manager at the Healthy Wisconsin Leadership Institute at the Medical College of Wisconsin.  Kirsten will start work on February 27, 2023.  She replaces DHS Secretary-designee Karen Timberlake, who resigned in early January 2023.

• DHS Releases State Health Improvement Plan

On February 2, DHS released its 2023-2027 State Health Improvement Plan.  Under state law, DHS is required to craft a public health agenda for the state at least once per decade – this plan meets that requirement.  Further, this plan helps maintain DHS as an accredited state health department, per the requirements of the Public Health Accreditation Board. 

In summary, the report recommends the following three “foundational shifts” in how Wisconsin addresses public health:

·        Institutional and systemic fairness

·        Representation and access to decision-making

·        Community-centered resources and services

Also, it highlights the following priority areas – areas that are critical to ensuring the wellness of Wisconsinites:

·        Social and community conditions

·        Physical, mental, and systemic safety

·        Person and community centered health care

·        Social connectedness and belonging

·        Mental and emotional health and well-being

The full report may be viewed on the DHS website. 

As mentioned above, Gov. Evers recently introduced his 2023-25 budget proposal – the state’s two-year spending plan – before a Joint Session of the Wisconsin Legislature. Although the Republican-controlled Legislature is expected to scrap most of the Evers budget and craft their own version by working off current spending levels, it is likely the Legislature will adopt some of the governor’s proposals.

According to Evers, his budget includes proposals that would increase access to affordable healthcare coverage, improve the quality of healthcare services in the state, and expand the scope of benefits available through Medicaid. Please find below a brief overview of items included in governor’s budget proposal that may be of interest to WiHPCA members:

• Expand Medicaid eligibility for parents and adults from 100% of the federal poverty line ($27,750 annually in 2022 for a family of four) to 138% of the federal poverty line ($38,300 annually in 2022 for a family of four). According to the Evers Administration, this expansion would result in 89,700 low-income individuals becoming eligible for Medicaid, of which approximately 30,300 are uninsured. Under this proposal, the state would realize a savings of over $1.6 billion and draw down an additional $2.2 billion in federal funding over the two-year budget cycle. Republicans who control the Legislature are firmly opposed to this proposal.

• Provide $200 million in additional funding for Wisconsin Innovation Grants, a current program previously funded with federal dollars to design and implement plans to address workforce challenges. This proposal includes a $100 million allocation to specifically focus on fortifying the state’s healthcare workforce by providing grants to healthcare employers and related organizations.

• Provide $22.5 million to establish an ongoing Innovation Grant program for healthcare employers to engage in improved recruitment and retention of long-term care providers.

• Provide $10 million to expand the state’s nurse educators program.

• Provide $5 million GPR in additional funding for the Worker Advancement Initiative to support efforts by technical colleges and nursing schools to reduce barriers to graduation and assist students in becoming career ready.

• Provide $8 million for continuation of the WisCaregiver Careers program, which aims to address the shortage of certified nursing assistants in the state by supporting recruitment, training and retention of individuals to care for nursing home residents across Wisconsin.

• Provide over $900,000 to the Department of Workforce Development to support healthcare profession apprenticeship curriculum development and to advance new collaborations related to healthcare workforce.

• Provide nearly $4 million and increased staffing to the Department of Safety and Professional Services to streamline the state’s credentialling process for licensed professionals and provide more efficient processing of license applications.

The WiHPCA Government Affairs Team will continue to analyze the recently introduced budget bill and keep the membership updated throughout the budget process.