WiHPCA News

By Hoven Consulting – WiHPCA’s lobbying firm

• WiHPCA Supports Bill Allowing New Health Care Professionals to Receive Preliminary Occupational Credentials

At its March meeting, the WiHPCA Legislative Committee agreed to support legislation to help previously unlicensed individuals in the health care field – particularly new graduates – to start work right away by requiring the state Department of Safety and Professional Services (DSPS) to grant these individuals preliminary occupational credentials.  In order to qualify for such a preliminary credential, the applicant will need to have recently completed the requirements to obtain such a credential, submit a credential application and be engaged by an employer in the health care field.  The applicant and the employer will need to inform DSPS that the applicant meets all relevant credentialing requirements.  The preliminary credential will take effect when the employer submits this attestation to DSPS and will expire when the individual’s application for a permanent or training credential is granted or denied. 

The Assembly Committee on Regulatory Licensing Reform held a hearing on this bill on April 12.  WiHPCA’s Madison lobbyists will continue to monitor this legislation during the 2023-2024 legislative session. 

• Temporary Health Care “Act 10” Occupational Licenses Will Continue to Be Available

During the COVID-19 pandemic, Governor Tony Evers signed into law legislation that became 2021 Wisconsin Act 10.  This legislation allowed health care professionals who are licensed in good standing in other states to work in Wisconsin immediately, without obtaining a permanent occupational credential.  This was to ensure that Wisconsin had enough health care professionals to treat Wisconsinites during the pandemic.  These temporary licenses are known as “Act 10 licenses.”

This state law was tied to the end of the pandemic-related Presidential Emergency Declaration.  On April 10, 2023, President Biden signed federal legislation that ended this emergency declaration.  According to state law, the “Act 10 licenses” expire 30 days after the Presidential Emergency Declaration ends – which is May 10, 2023 – unless the license holder applies for a permanent license by that date.  If a license holder applies for a permanent license by that date, that individual will still be allowed to practice in Wisconsin.

In addition, there is a provision in 2021 Wisconsin Act 10 that could benefit out-of-state health care professionals who seek Wisconsin licensure after May 10, 2023, and wish to practice immediately in the state.  If an individual’s out-of-state license is in good standing, that professional could apply simultaneously in Wisconsin for an “Act 10 license” and a permanent license and would be able to practice immediately in Wisconsin. 

For more information on “Act 10 licenses,” please go to the state Department of Safety and Professional Services’ FAQ page. 

The WiHPCA Legislative Committee is charged with developing the association’s legislative priorities and providing direction and support on public policy that impacts hospice and palliative care in Wisconsin. The committee, which meets once a month, also evaluates legislative and regulatory issues of importance as they arise and leads WiHPCA’s lobbying and grassroots advocacy efforts.

As mentioned above in the Government Affairs Report provided by Hoven Consulting (WiHPCA’s lobbying firm), the committee recently voted to support Assembly Bill 144, legislation to address the state’s health care workforce challenges by expediting occupational licensing  for Wisconsin health care professionals. In addition, the WiHPCA Legislative Committee recently approved a member-driven grassroots advocacy campaign to encourage the WI Legislature to provide $10 million in additional funding to boost the state’s Nurse Educators program.

The Wisconsin Nurse Educators program was established two years ago to support nursing education and increase the number of nurses in Wisconsin by providing grants to nurses enrolled full-time in doctor of nursing or mater of nursing programs. Grant recipients must commit to teaching at an approved Wisconsin nursing school for at least three years post-graduation. Providing additional funding for this program is more important than ever, as nursing education programs across the state are struggling to turn out enough graduates to meet the growing demand for nurses in Wisconsin.

Please be on the lookout for a WiHPCA Advocacy Action Alert asking you to contact your state lawmakers and urge them to support $10 million in funding for the Wisconsin Nurse Educators program as part of the state budget bill.

WiHPCA’s grassroots advocacy program is critical to the success of the association’s overall government affairs program. It allows our members to have a voice and influence in shaping public policy that impacts hospice and palliative care in Wisocnisn.

With that in mind, we are pleased to report about WiHPCA’s latest legislative advocacy outreach effort. WiHPCA Board Chair Lynne Sexten recently hosted state lawmaker Rep. Ellen Schutt (R-Clinton) at Agrace Hospice in Janesville to discuss WiHPCA and the importance of hospice and palliative care to Wisconsin patients and their families. The meeting, which also included WiHPCA Advocacy Director Michael Welsh, provided a great opportunity to educate a key state policymaker about hospice and the challenges the industry faces daily.  Rep. Schutt did have a basic understanding of hospice, given she had a grandmother who received hospice care, but the meeting allowed us to provide detailed information about hospice and dig into WiHPCA policy priorities.

Lynne did a great job briefing Rep. Schutt on the value of hospice and palliative care, as wells as WiHPCA’s state legislative priorities, which focused primarily on the industry’s workforce challenges. WiHPCA would like to thank Lynne for making time to host the meeting. As usual, she did a wonderful job leading the discussion. She also provided Rep. Schutt with a great tour of the Agrace facility.

As mentioned above, 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. The meeting with Rep. Schutt was just the latest endeavor in WiHPCA’s objective to connect members with their local legislators. WiHPCA encourages all members to participate in this critical grassroots advocacy program. If you or your organization is interested in hosting a state lawmaker, please contact the WiHPCA office at wihpca@badgerbay.co.  

Late last month, the Centers for Medicare and Medicaid Services (CMS) released the 2024 Hospice Payment Rate Proposed Rule, which would update Medicare hospice payments, the aggregate hospice cap, and other hospice regulations.

Under the proposed rule, the hospice payment update percentage would be 2.8%, which is an increase of roughly $720 million in payments from 2023. This is a result of the 3% market basket percentage increase reduced by a 0.2 percentage point productivity adjustment.

The National Hospice and Palliative Care Organization (NHPCO) issued a statement in response to the proposed rule, which offered both their concerns and potential opportunities stemming from the proposed rule:

Concern:

• The 2.8% proposed rate increase for hospices is not enough to support the care hospices provide. Hospices are dealing with inflation rates that are at least twice that high, compounded by historical and ongoing workforce challenges. In 2024, pre-determined sequestration cuts will further reduce hospice reimbursement to a de facto increase of about 1%. Americans are increasingly choosing hospice for end-of-life care. Intentionally underfunding that care should be a non-starter.

Opportunities:

• CMS is using the proposed rule to advance hospice program integrity measures, curb fraudulent and abusive practices within the system, advance health equity, and increase hospice utilization. These efforts are in line with NHPCO’s ongoing work, including 34 program integrity recommendations made in January. NHPCO will work with the hospice community and CMS to help shape the following efforts:

Public comments on the 2024 Hospice Payment Rate Proposed Rule will be accepted through May 30, 2023. WiHPCA will work with NHPCO and our other national stakeholders to submit public comments that reflect the thoughts and concerns of WiHPCA members and the greater hospice community across Wisconsin and throughout the country.

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.