WiHPCA News

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.

Republican Paul Melotik (R-Grafton) defeated Democrat Bob Tatterson (D-Mequon) in a special election held on July 18 to fill the vacant 24th Assembly District –which includes portions of Ozaukee, Washington, and Waukesha Counties.

Melotik won the historically Republican-leaning district with 53.7% of the vote, compared to Tatterson’s 46.3% vote total. The Melotik victory gives the GOP a 64-35 majority in the 99-member Assembly.

Melotik, an accountant, small business owner, and former local official who has served on the Ozaukee County Board and Town of Grafton Board, will replace Dan Knodl (R-Germantown) in the Assembly. Knodl was elected to the state Senate (8th Senate District) in an April 4 special election.

From the Desk of the National Hospice and Palliative Care Organization(NHPCO)

The National Hospice and Palliative Care Organization (NHPCO) and its advocacy affiliate, the Hospice Action Network (HAN) are pleased to support the reintroduction of the Palliative Care and Hospice Education and Training Act (PCHETA) in the U.S. Senate. This bipartisan legislation (S. 2243) would meet the growing demand for serious-illness care by investing in training, education, and research for the palliative care and hospice workforce.

The bill has been introduced by Senator Tammy Baldwin (D-WI) and Senator Shelley Moore Capito (R-WV). This bill is also co-sponsored by Senators Kyrsten Sinema (I-AZ), Lisa Murkowski (R-AK), Jeff Merkley (D-OR), Mike Rounds (R-SD), Jack Reed (D-RI), Cindy Hyde-Smith (R-MS), Kirsten Gillibrand (D-NY), Marsha Blackburn (R-TN), John Boozman (R-AR), Roger Marshall (R-KS), Maria Cantwell (D-WA), and Angus King (I-ME).

“Having served as my grandmother’s primary caregiver, I know the difference quality palliative and hospice care can make for a loved one who is battling a serious illness,” said Senator Baldwin. “Our bipartisan Palliative Care and Hospice Education and Training Act will make an overdue investment in education and research to ensure doctors, nurses, and health care professionals have the tools they need as they work tirelessly to keep patients with serious or life-threatening illnesses comfortable and safe. This legislation will help more Americans get the training they need to provide palliative care, help strengthen our health care workforce, and also ensure those with serious illness get the care they deserve.”

“The need for high quality palliative and hospice care services—which are vital for patients and their families—continues to grow, making passage of our bill needed now more than ever,” said Senator Capito. “As a caregiver for parents that suffered from Alzheimer’s disease, I saw firsthand just how valuable these services can be. In order to preserve access to this care, our bill would strengthen training and education opportunities for individuals working in these fields. I look forward to working with Senator Baldwin and my colleagues in the Senate to pass this legislation.”

Palliative and hospice care focus on improving patients’ quality of life and relieving suffering from serious illnesses and pain management. Findings from a recent study on the Value of Hospice Care, by NORC at the University of Chicago, show that at any length of stay, palliative and hospice care benefits patients, family members, and caregivers, including enhanced quality of life, increased satisfaction, reduced physical and emotional distress, improved pain control.

“Every American facing a serious or life-limiting illness deserves access to quality hospice and palliative care. We desperately need to train more professionals in the field of palliative medicine. Without efforts to address the existing workforce shortage, there will be only one palliative physician for every 26,000 seriously ill patients by 2030,” said COO and interim CEO of National Hospice and Palliative Care Organization, Ben Marcantonio. “Thank you to Senators Baldwin and Capito for your leadership in reintroducing the Palliative Care and Hospice Education and Training Act.”

PCHETA is a critical next step in training and education to address the healthcare workforce crisis as the American population continues to age.

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).

Department of Health Services

The budget bill signed into law by the Governor increased DHS spending by $3.1 billion overall over Fiscal Year 2023-2025. 

Good news – The approved budget includes $2.5 million to expand allied health professional education and training grants.  It also expanded eligibility to registered nurses. 

• Medicaid/Medical Assistance

• o    Nursing Home Support Services:  Provide $73,200,000 in FY2023-24 and $73,200,000 in FY2024-25 to increase the support services portion of Medical Assistance program reimbursement for nursing homes. Require DHS to establish and implement a priced rate for nursing home support services based on median facility costs, plus 25 percent.
• o    Nursing Home Ventilator Dependent Rate:  Provide $5,000,000 in FY2023-24 and $5,000,000 in FY2024-25 to increase the all-encompassing ventilator-dependent resident reimbursement rate for nursing home care. Require DHS to increase the reimbursement rate under the Medical Assistance program for an authorized facility treating a resident of the facility who has received prior authorization for ventilator-dependent care reimbursed under the all-encompassing ventilator dependent resident reimbursement rate by $200 per patient day.

• Elder and Disability Services

• o    Aging and Disability Resource Centers (ADRCs):  Provide $2,513,700 in FY2023-24 and $5,027,400 in FY2024-25 in funding increases.
• o    Complex Patient Pilot Program:  Provide $5,000,000 in FY2023-24 on a one-time basis to help facilitate the transfer of complex patients from acute care settings, such as hospitals, to post-acute care facilities, such as nursing homes.

• Public Health

• o    Allied Health Professional Training:  Provide $2,500,000 annually to expand allied health professional education and training grants.  Expand eligibility for the program to include registered nurses.
• ·         Behavioral Health
• o    Telemedicine Crisis Response Pilot Program:  Provide $2,000,000 in FY2023-24 for a telemedicine crisis response pilot program.

Department of Safety and Professional Services

• Occupational Credentialing
• • Software:  $3.57 million for occupational credentialing software and related maintenance.
  • License Processing Staffing:  7 license processing contract workers (on a four-year employment contract).
  • Customer Service Call Center Staffing:  6 license processing-focused customer service call center contract workers (on a two-year employment contract).

• Prescription Drug Monitoring

• o    $1.1 million for software improvements, electronic health records integration, and licensing costs for the state’s electronic Prescription Drug Monitoring Program (ePDMP). 

New effort explores ways to support Wisconsinites living at home longer, for better health outcomes

The Wisconsin Department of Health Services (DHS) announces the launch of the Independent Living Supports Pilot program, which will provide eligible Wisconsinites with critical resources allowing them to continue to live independently in their homes rather than entering a Medicaid long-term care program. Funded by the American Rescue Plan Act (ARPA), the pilot will take place in select areas of the state. Those who enroll will have access to program benefits for up to 12 months.

"We’ve designed the Independent Living Supports Pilot program to offer short-term, flexible services and supports for older adults and people with disabilities," said DHS Secretary-designee Kirsten Johnson. "Helping people access services sooner can help maintain their health and living situation for a longer period of time, which not only improves health outcomes, but is also cost effective."

The pilot will provide invaluable insights into how people seek information about services and supports, as well as help identify potential barriers in accessing these services.

To be eligible, participants must:

·        Be a Wisconsin resident and a U.S. citizen or eligible immigrant.

·        Live in a pilot service area.

·        Be over age 18.

·        Not be currently enrolled in Medicaid long-term care programs or living in a licensed or certified residential or long-term care facility.

·        Earn less than 300% of the federal poverty level with no deductible or consideration of spousal income.

·        Have at least one eligible functional need.

·        Have a qualifying diagnosis (may be a long-term disability) if under age 55.

"The Independent Living Supports Pilot aims to empower Wisconsin residents to maintain their independence within their communities," said Medicaid Director Jamie Kuhn. "By offering targeted support to people who might otherwise enter long-term care, this initiative is a cost-effective strategy that delays the need for that care and also provides valuable insights to inform future policy decisions related to independent living supports."

The pilot will offer up to $7,200 in one-time, periodic or continuing services based on the needs of participants. Possible supports reflect the broad range of what people might need, including:

·        Specialized medical equipment and assistive technology

·        Home and vehicle modifications

·        Personal care, care management, or supportive home care

·        Personal emergency response systems

·        Internet/Wi-Fi services

·        Financial management and legal assistance, and more

Aging and disability resource centers (ADRCs) in the following counties applied and were selected to operate the pilot program in their areas:

·        Adams, Green Lake, and Waushara Counties

·        Brown County

·        Chippewa County

·        Columbia County

·        Dane County

·        Dodge County

·        Dunn County

·        Eau Claire County

·        Kenosha County

·        Milwaukee County

·        Sauk County

·        St. Croix County

·        Walworth County

·        Washington County

Each ADRC will find eligible participants in their area, help them enroll in the pilot, and coordinate one-time and ongoing services. The ADRCs will also help participants transition to other services when the pilot ends.

"We are excited about the potential impact of this pilot program on the lives of Wisconsin residents and look forward to sharing updates and results as the program progresses," said Johnson.

For more information, visit the Independent Living Supports Pilot Program page on the DHS website.

People who receive services and others who are interested can share ideas about how to improve programs for the next five years

From now until August 1, the Wisconsin Department of Health Services (DHS) is seeking input about how we can make the Family Care and Family Care Partnership programs the best they can be. DHS will use the input to make proposed changes to the Family Care and Family Care Partnership waivers.

Family Care and Family Care Partnership are Medicaid long-term care programs for older adults and adults with disabilities. The goal is to get members the services they need to live in a home setting when possible. Together, the programs serve about 57,000 people across Wisconsin.

“Family Care is such an important, innovative program for people who have disabilities, are older, or have a chronic illness,” said DHS Secretary-designee Kirsten Johnson. “This is an opportunity to get direct feedback from the people who are served by Family Care on how it can be even better.”

Renewing the Family Care and Family Care Partnership waivers is required by the federal Centers for Medicare & Medicaid Services (CMS) every five years. A waiver is a request made to the federal government to design flexible, innovative Medicaid programs like Family Care. With the waivers, DHS can fund services and supports to help program members stay in their homes and communities.

DHS must submit the proposed waiver application to CMS by September 2024 and, after CMS approval, the changes will be in effect January 2025. Feedback from the following groups is essential to ensure proposed changes are equitable and support member choice, self-determination, and access to high-quality services:

·        Family Care and Family Care Partnership members

·        Families and caregivers

·        Providers

·        Managed care organizations

·        Advocates

Not every aspect of the Family Care and Family Care Partnership programs can change with the waiver renewal.

Changes DHS can make, include:

·        Which services are covered

·        What is included with covered services

·        Qualifications required by providers

Changes DHS can't make, include:

·        Provider rates (how much providers are paid)

·        Updates that are not allowed by state or federal law

DHS is collecting written input in an online survey, available in English, Hmong, and Spanish. It takes 10 minutes to complete. For those who prefer verbal communication, DHS will be hosting online public input sessions in July.

For more information about the waiver renewal, the survey, and timeline, visit the Family Care and Family Care Partnership Waiver Renewal webpage.

By Hoven Consulting – WiHPCA’s lobbying firm

• Fiscal Year 2023-2025 State Budget Update – Department of Health Services

On June 15, the Legislature’s Joint Finance Committee (JFC) approved Fiscal Year 2023-2025 funding levels for the Department of Health Services (DHS).  The approved DHS budget increased spending by $3.1 billion overall over the biennium.

Good news – JFC agreed to include $2.5 million to expand allied health professional education and training grants.  It also expanded eligibility to registered nurses.

The following are highlights of the DHS budget, as approved by JFC:

Medicaid/Medical Assistance

 

Elder and Disability Services

 

Public Health

 

Behavioral Health

 

The DHS budget was adopted by the committee on a party line vote of 11-4. While these items will be included in the Legislature's budget proposal, they will only be enacted if the budget bill is passed by both the Assembly and Senate and the bill is signed by Governor Evers.

• Fiscal Year 2023-2025 State Budget Update – Department of Safety and Professional Services (Occupational Credentialing)

On June 8, the Legislature’s Joint Finance Committee (JFC) held a committee meeting and approved the Fiscal Year 2023-2025 budget for the state Department of Safety and Professional Services (DSPS).  This agency is responsible for occupational credential processing, the state’s electronic Prescription Drug Monitoring Program, as well as other matters.  In recent years, DSPS has struggled with processing a backlog of applications for new and renewed occupational credentials. 

During this meeting, committee Republicans proposed funding the following:

The committee approved this funding package and did not approve an alternate funding package advanced by committee Democrats.   

During this committee meeting, committee Democrats criticized GOP JFC members for not including funding for more credential processing staff, bearing in mind the ongoing credential processing backlog at DSPS.  JFC Republicans responded by noting that the agency will improve its output with fewer employees due to the increased use of technology. 

The DSPS budget was also adopted by the committee on a party line vote of 11-4. While these items will be included in the Legislature's budget proposal, they will only be enacted if the budget bill is passed by both the Assembly and Senate and the bill is signed by Governor Evers.

• Changes to Local Health Officer Authority

On June 14, both the Assembly and Senate approved legislation that increases the amount of tax revenue the state government shares with counties and municipalities.  This legislation reflected a compromise between Assembly Republicans, Senate Republicans and Governor Tony Evers.  This legislation was sent to the Governor on June 15, and he signed it into law on June 20.  This new law also limits the authority of local health officers to close businesses due to the spread of communicable diseases.  Prior to the shared revenue legislation, there were no such limitations on local health officers in state law.  In particular, the new law makes the following changes: