WiHPCA News

We are pleased to report WiHPCA continues to maintain and strengthen our relationship with the Division of Quality Assurance (DQA) at the Wisconsin Department of Health Services. On March 10, we held our latest quarterly meeting with the regulatory agency.  As has been the case at past meetings, DQA provided participants with a review and discussion of numerous key issues, including survey deficiencies, complaint topics, and the number of new hospice applications.

DQA staff also provided an comprehensive briefing on the COVID-19 vaccine survey requirements, as surveyors will be reviewing COVID vaccination policies and employee tracking on every survey to ensure that all health care facility staff are at 100% vaccination rate or have approved exemptions or delays. Survey protocols were discussed, as were the following documents related to the health care staff COVID-19 vaccination requirements:

• QSO Memo 22-07-ALL

https://www.cms.gov/files/document/qso-22-07-all.pdf

• Attachment C - Hospice

https://www.cms.gov/files/document/qso-22-07-all-attachment-c-hospice.pdf

• CDC - Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic

https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html

Please see below a brief overview of what DQA reported on as it concerns surveys performed and complaint survey topics:

• Number of surveys performed in the last quarter:
• • Number of complaint surveys – 4
  • Number of recertification surveys – 2
  • Number of follow-up surveys – 1

• Complaint surveys topics – Top concern areas:
• • Patient Rights
  • Quality of Care and Treatment
  • Admission/Transfer/Discharge Rights
  • DNR Status Failure

The next quarterly meeting is scheduled for June. Stay tuned for more details and the opportunity to register. We certainly encourage participation from all WiHPCA members, as the meeting provides invaluable information and regulatory guidance from DQA.

Hospice News, which is part of the Aging Media Network, is a leading source for news and information covering the hospice industry. WiHPCA is happy to remind members about and provide links to the latest articles and information from Hospice News:

·         Competitive Labor Market Lights a Fire Under Hospice Employers

By Jim Parker | March 18, 2022

Hospice providers now compete for new hires as fiercely as they do for market share. 

And with that competition heating up this year, the largest home health and hospice companies are streamlining their recruitment and onboarding processes to enable more clinicians to hit the ground running. Read more…

·         MedPAC: Cut Hospice Payment Cap by 20%, Report Telehealth on Claims

By Jim Parker | March 15, 2022

Repeating similar calls in prior years, the Medicare Payment Advisory Commission (MedPAC) has recommended to Congress that Medicare hospice payment rates remain at current levels next year. The commission also called on the U.S. Centers for Medicare & Medicaid Services (CMS) to apply the wage index to the hospice aggregate cap, followed by a 20% cut. Read more…

·         Providers Seek Palliative Care Quality Measures to Demonstrate Value

By Holly Vossel| March 18, 2022

The lack of standardized quality measures for palliative care complicates efforts to expand access to those services. This means community-based palliative care providers have limited ways to benchmark their performance and further demonstrate their value. Read more…

·         The Devil in Details of Hospice Strategic Collaboratives

By Holly Vossel| March 21, 2022

Nonprofit hospices are increasingly banding together in varying types of collaboratives to create workforce, operational and cost-effective synergies. As this trend picks up steam, hospices will need to fine-tune the details of these affiliations and choose partners carefully. Read more…

President Joe Biden recently signed into law a $1.5 trillion omnibus spending bill that funds the federal government through the end of September 2022. Among the bill’s numerous provisions is an extension of the use of telehealth services to recertify patient eligibility for hospice. Please find below an overview of the bill’s telehealth provision provided by the National Partnership for Healthcare and Hospice Innovation (NPHI):

• An extension of the CARES Act provision allowing the use of telehealth services in place of the face-to-face encounter required to recertify patient eligibility for hospice.
• The telehealth extension is to last for 151 days following the end of the current COVID-19 Public Health Emergency (PHE). The extension is expected to last through the end of the year.
• The full text of the omnibus package can be found here, and the specific provision referenced above can be found on page 1908.

The federal omnibus spending bill referenced above did not include a provision to extend the moratorium on Medicare sequestration that is set to expire on March 31, 2022. As a result, a 1% reimbursement cut will phase back in on April 1, 2022, and a second 1% cut totaling 2% will phase back in on July 1, 2022.

Earlier this month, the Medicare Payment Advisory Commission (MedPAC) released their March 2022 Report to Congress. Please find below an overview of the report provided by NPHI:

• Chapter 11 of the report focuses exclusively on hospice services and offers two unanimous recommendations from the Commission to Congress and HHS.
• First, the Commission recommends that for fiscal year 2023, the Congress should eliminate the update to the 2022 Medicare base payment rates for hospice and wage adjust and reduce the hospice aggregate cap by 20 percent.
• Second, the Commission recommends that the Secretary should require that hospices report telehealth services on Medicare claims.

By Hoven Consulting  – WiHPCA’s lobbying firm

WiHPCA Legislative and Regulatory Priorities Survey

Earlier in March, the WiHPCA Government Affairs Team sent out a legislative and regulatory priorities survey to all WiHPCA members via email.  The intent of this survey is to find out what hospice and palliative care government policy topics are a priority to you and your organization.  WiHPCA leadership will use this data to craft our legislative and regulatory agenda for 2023-2024.  Once this agenda is prepared, WiHPCA will provide it to all members and will be used as our framework as the association advocates on hospice and palliative care policy before the legislature and state government agencies.  If you have completed this survey, thank you for doing so.

Bill Protecting Health Care Providers and Staff Advances

On February 23, the full Assembly unanimously passed Assembly Bill 960, which makes it a felony to threaten or physically attack a health care provider, a staff member of a health care facility or a family member of either, if the threat or attack is related to an official act of the provider or is related to an occurrence at the health care facility.  Both the Assembly and Senate have passed this bill.  It will now go to the Governor for his consideration. 

WiHPCA supports this bill.  As such, it joined various health care organizations and sent a joint memo to the State Assembly requesting that they support this bill. 

Recent Marquette University Poll

On March 2, Marquette Law School released a new poll that surveyed Wisconsin voters on their opinions of various national and statewide elected officials, as well as candidates for statewide office. 

U.S. Senate Election 

With respect to those voters who intend to vote in the Democratic primary for U.S. Senator Ron Johnson’s seat, Lieutenant Governor Mandela Barnes was the leading candidate with 23 percent, and Alex Lasry followed with 13 percent.  The other candidates only received support in the single digits, while 48 percent of Democratic primary voters have not decided whom they will support. 

Gubernatorial Election

In this poll, Republican gubernatorial candidate Rebecca Kleefisch led her primary rivals with 30 percent of Republicans and Republican-leaning voters selecting her, eight percent selecting former U.S. Senate candidate Kevin Nicholson and five percent selecting State Representative Tim Ramthun.  However, 54 percent of these voters responded that they did not know whom they will support in the Republican primary. 

At this time, Governor Tony Evers leads in popularity among elected statewide officials with 50 percent approving and 41 disapproving.  President Biden has a 43 percent approval rating and a 52 percent disapproval rating.  With respect to Wisconsin’s two U.S. Senators, Senator Tammy Baldwin has a 42 percent approval rating and a 36 percent disapproval rating, while Senator Ron Johnson has a 33 percent approval rating and a 45 percent disapproval rating. 

State Supreme Court Ruling on Redistricting

At the beginning of each decade, each state redraws state legislative and congressional district lines based on data from the most recent federal census.  After the Governor vetoed the legislature’s proposed legislative and congressional district maps last year, this dispute ended up in the courts.  On March 3, 2022, the Wisconsin Supreme Court decided that Governor Evers’ updated state legislative and congressional maps will be used as they make fewer changes to district boundaries than the Legislature’s proposed maps. 

On Monday, March 7, the Legislature appealed this ruling directly to the U.S. Supreme Court.  And just this week, the nation’s highest court threw out the state legislative maps drawn Governor Evers and adopted by the Wisconsin Supreme Court. The U.S. Supreme Court said the state court’s approval of Evers’ maps was flawed, as it did not adequately consider whether certain newly crafted Assembly Districts in Milwaukee complied with the federal Voting Rights Act. The maps were sent back to the Wisconsin Supreme Court for further consideration.

Politicians on the Move - Update

• On February 24, State Rep. Mike Kuglitsch (R-New Berlin) announced that he will not run for re-election in 2022.  He was first elected to the Assembly in 2010.  He serves as the Chair of the Assembly Energy and Utilities Committee and also serves on the following Assembly committees:  Environment; Government Accountability and Oversight; and State Affairs. 

• On March 3, State Rep. Gordon Hintz announced that he will not run for re-election this year.  He used to serve as Assembly Minority Leader and was first elected to the Assembly in 2006. 

• State Sen. Roger Roth (R-Appleton) has announced that he is running for lieutenant governor.  He has served in the Senate since 2015 and also served in the Assembly in 2007-2008.  He chairs the Senate Committee on Universities and Technical Colleges and is vice chair of the Committee on Utilities, Technology and Telecommunications. 

• State Rep. Rachael Cabral-Guevara (R-Appleton) announced on March 17 that she is running for Senator Roth’s seat.  She is a nurse and was elected to the Assembly in 2020.  She is the vice chair of the Assembly Mental Health Committee and is a member of the following Assembly committees:  Health, Colleges and Universities, Public Benefit Reform, and Regulatory Licensing Reform. 

• State Sen. Dale Kooyenga (R-Brookfield) announced on March 8 that he will not run for State Senate this year since this year’s redistricting process relocated his home from his current district to a different Senate district that is not up for election until 2024.  [Note:  The redistricting is based on a March Wisconsin Supreme Court ruling.  However, it is worth noting that this ruling is being appealed to the U.S. Supreme Court, which has not yet decided whether to take this case.]  He was first elected to the Senate in 2018 and served in the Assembly from 2011 through 2018.  He is currently the chair of the Senate Committee on Financial Institutions and Revenue. 

• State Sen. Janis Ringhand (D-Evansville) announced on March 9 that she will not run for re-election this year.  She was first elected to the Senate in 2014 and served in the Assembly in 2011 through 2012.  She serves as the Assistant Minority Leader and serves on the following Senate committees:  Economic and Workforce Development; Financial Institutions and Revenue; and Insurance, Licensing and Forestry.

• State Rep. Mark Spreitzer (D-Beloit) subsequently announced that he will run for Sen. Ringhand’s seat.  He has served in the Assembly since 2015.  He currently serves as the Assembly Minority Caucus Chair and is a member of the following Assembly committees:  Agriculture, Campaigns and Elections, Local Government, and Sporting Heritage. 

• State Rep. Timothy Ramthun (R-Campbellsport) has announced that he will run for Governor this year.  He has served in the Assembly since 2019.  He is the Vice Chair of the Children and Families Committee and is a member of the following Assembly committees:  Constitution and Ethics, Education, Judiciary, Transportation, and Ways and Means. 

• State Sen. Jerry Petrowski (R-Marathon) has announced that he will not run for re-election in 2022.  He was first elected to the Senate in 2012 and served in the Assembly from 1999 to 2012.  He serves as the chair of the Senate Committee on Transportation and Local Government, is vice chair of the Committee on Sporting Heritage, Small Business and Rural Issues and is a member of the Committee on Agriculture and Tourism. 

• State Sen. Brad Pfaff (D-Onalaska) has announced that he is running for Congressman Ron Kind’s (D) seat in 2022.  He was first elected to the Senate in 2020 and currently serves on the following Senate committees:  Utilities, Technology and Telecommunications; Universities and Technical Colleges; Transportation and Local Government; Economic and Workforce Development; and Agriculture and Tourism.  [Note:  If he does not win his congressional race, he will still remain a member of the State Senate as his current term does not run out until 2024.] 

• State Sen. Patrick Testin (R-Stevens Point) has announced that he is running for Lieutenant Governor.  He currently serves in Senate leadership as the President Pro Tempore.  He was first elected to the Senate in 2016 and was re-elected in 2020.  He currently is chair of the Senate Health Committee, is vice chair of the Economic and Workforce Development Committee and is also a member of the Senate Agriculture and Tourism Committee.  [Note:  If he does not win his race for lieutenant governor, he will still remain a member of the State Senate as his current Senate term does not run out until 2024.]

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 advocacy. In effort to capitalize on our greatest advocacy resource – our membership – WiHPCA has unveiled 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 provides a tremendous opportunity for WiHPCA members to build or strengthen their relationships with local legislators and to educate them on home health care and on policy issues important to home health care professionals and their patients.

Obviously, the surge in COVID-19 cases currently makes it difficult for some in-person meetings, but as cases subside and depending on your comfort level with meeting face-to-face, WiHPCA would encourage you to participate in this critical grassroots advocacy program.

Please click here for more information on the program.

Stay informed… Stay Involved…

Register today for WiHPCA’s virtual Legislative and Advocacy Update event, which will be held on February 16, 2022, from 2:00 PM to 3:00 PM.

As you know, WiHPCA provides comprehensive, bipartisan government relations services, representing the legislative and regulatory interests of our members. More specifically, WiHPCA’s direct lobbying and grassroots advocacy efforts aim to successfully pursue policies and programs that provide members with the necessary tools to promote your profession, better serve your patients and their families, and advance the hospice and palliative care industry as a whole.

By participating in the Legislative and Advocacy Update event, you will learn about the latest political and policy developments in the State Capitol, receive updates on key legislation of interest, and learn how you can be an effective advocate for WiHPCA and hospice and palliative care in Wisconsin.

The National Hospice and Palliative Care Organization (NHPCO) is currently endorsing two important pieces of federal legislation to  help address workforce challenges facing the palliative care industry – and WiHPCA members. As such, NHPCO is encouraging our members – as well as your colleagues across the country – to contact your Members of Congress and urge them to support these two proposals:

• The Provider Training in Palliative Care Act
  This bipartisan bill (S. 2890) will leverage programs of the National Health Service Corps (NHSC), which provides tuition assistance and loan repayment options to medical students in exchange for them providing primary care services in underserved communities, in order to expand the number of doctors and nurses knowledgeable in palliative care. The bill will allow individuals enrolled in NHSC’s Scholarship Program or Loan Repayment Program to defer their obligated service in order to receive training in palliative care for up to a year, thus building a cadre of healthcare providers with a both palliative care and community service experience.

• The Healthcare Workforce Resilience Act
  This bipartisan bill (H.R. 2255 and S. 1024) will help address a shortage of doctors and nurses in the United States, which has been exacerbated by the COVID-19 pandemic. The bill will “recapture” unused work visas, enabling up to 25,000 nurses and up to 15,000 doctors to apply for visas. Congress annually authorizes thousands of visas for USCIS to admit foreign nationals to work in the United States and eventually pursue citizenship. Each year, unused visas are wasted, and since 1992 there have been more than 200,000 such wasted visas. Under this legislation, the U.S. Citizenship and Immigration Services (USCIS) could repurpose a fraction of those unused visas for nurses and doctors.

It only takes a few minutes to contact your Members of Congress on these two bills through the National Hospice and Palliative Care Organization’s Hospice Action Network. The network is completely automated. You simply need to enter your name, address, and limited contact information and the Network takes care of the rest. CLICK HERE to be an advocate for strengthening the palliative care workforce.

• Protecting Medicare and American Farmers from Sequester Cuts ActOn December 10, President Biden signed the Protecting Medicare and American Farmers from Sequester Cuts Act (S. 610) into law, addressing multiple policies expected to drastically cut  physician Medicare reimbursement in 2022. More specifically, the act does the following:
• • Provides a 3 percent increase to the Medicare Physician Fee Schedule (MPFS) conversion factor in 2022, which provides relief from the scheduled expiration of a 3.75 percent increase passed as part of the Consolidated Appropriations Act, 2021. 
  • Extends the suspension of the automatic 2 percent cut to Medicare reimbursement, known as the sequester, until March 31, 2022.
  • Delays an additional 4 percent cut stemming from the Statutory Pay-As-You-Go Act of 2010 (PAYGO) until at least 2023.

• Supreme Court Blocks Biden’s COVID Vaccine Mandate Rule for Large Businesses; Upholds Health Worker Requirement
  As has been widely reported, the U.S. Supreme Court recently handed down a split decision on two Biden administration COVID-19 vaccine requirement workplace rules: 1.) An OSHA rule requiring businesses with at least 100 employees to compel their workers to get vaccinated or wear masks and test negative at least once per week; and 2.) The CMS rule mandating most health care workers to be vaccinated against COVID-19. The High Court struck down the OSHA Rule on a 6-3 decision, but it upheld the CMS mandate on a 5-4 decision.

By Hoven Consulting  – WiHPCA’s lobbying firm

• All Health Plans to Cover Cost of At-Home COVID-19 Tests
  On January 13, Governor Evers and Insurance Commissioner Nathan Houdek announced that all health insurance plans will be required to cover the cost of at-home rapid, diagnostic COVID-19 tests, starting on January 15, 2022.  This is required by the federal government.  These tests may be free or reimbursable to patients, depending upon arrangements health plans and insurance companies make with retailers/pharmacies.  Health plans and insurance companies will be required to cover up to eight such diagnostic tests per person, per month. 

• State Improves Prescription Drug Monitoring Program
  In December, the state Department of Safety and Professional Services (DSPS) announced that the U.S. Department of Justice awarded $1,648,000 to the Wisconsin Enhanced Prescription Drug Monitoring Program (ePDMP).  These dollars will be used to help connect the ePDMP with existing electronic medical records systems in Wisconsin. DSPS intends to focus these efforts on medical providers in rural and underserved regions in our state. 
  
  
• Medicaid Program Surplus Projected
  On December 30, 2021, the Department of Health Services informed the legislature that it projects that the state will have a $184.9 million surplus in the Medicaid program by the end of the 2021-2023 state budget.  The state budget expires at the end of state fiscal year 2023, which ends on June 30, 2023.  This increase is largely due to the extension of the federal COVID-19 public health emergency and the additional 6.2 percent Medicaid match rate, which is provided by the federal government while the emergency declaration is in place. 
• Politicians on the Move
• • On January 10, State Representative Gordon Hintz (D-Oshkosh) stepped down as Assembly Minority Leader.  He was first elected to the Assembly in 2006 and was elected as Assembly Minority Leader in 2017.  On January 10, State Representative Greta Neubauer (D-Racine) assumed the role of Assembly Minority Leader.  Rep. Kalan Haywood (D-Milwaukee) was elected to serve as the next Assistant Minority Leader and will take over from State Rep. Dianne Hesselbein (D-Middleton), who will run for the seat of State Senator Jon Erpenbach (D-West Point), who is retiring this year.   
  • State Representative Beth Meyers (D-Bayfield) recently announced that she will not run for re-election in 2022.  She was first elected in 2014.  She is a member of the Assembly Democratic leadership team as the Minority Caucus Secretary and is also a member of the Aging and Long-Term Care Committee.  On January 10, new Assembly Minority Leader Greta Neubauer appointed Rep. Meyers to a seat on the Joint Finance Committee for the rest of the 2021-2022 legislative session.   
  • State Representative Jim Steineke(R-Kaukauna), the current Assembly Majority Leader, recently announced he will not seek re-election in 2022. Steinke was first elected in 2010, and quickly rose through the ranks of the Assembly GOP leadership. He has served as Majority Leader since 2015.
  • State Senator Kathy Bernier (R-Chippewa Falls) announced on January 7 that she will not run for re-election this year.  She was elected to the Senate in 2018 and previously served in the Assembly from 2011-2018.  She currently chairs the Senate Committee on Elections, Election Process Reform and Ethics and serves on the Joint Finance Committee.   

By Hoven Consulting – WiHPCA’s Government Affairs Firm

The state’s Medicaid program will carry forward many of the temporary telehealth provisions it put in place at the start of the COVID-19 pandemic in a permanent policy that will take effect January 1, 2021.

“What you see right now is in many cases the same rule that you’re going to see in the future, with I think some improvements actually,” Medicaid Director Jim Jones said at a Wisconsin Health News virtual panel in September.

Jones said improvements include paying originating sites, like a pharmacy or medical office, to provide a place for Medicaid members to receive telehealth. They’re also looking at expanding tele-dentistry and doctor-to-doctor teleconsultation. 

Other changes like covering asynchronous telehealth, where patients, for instance, send a photo to their provider, are still being developed. 

A state law enacted in November 2019 requires that the Department of Health Services to treat telehealth the same as in-person care and mandates that Medicaid reimburse the same telehealth services that Medicare covers. The Department of Health Services initially anticipated taking six to nine months to roll out the law. 

But when the pandemic struck in March 2020, DHS “ripped the Band-Aid off” and moved quickly to set up a temporary policy to ensure members could still get access to services, Jones said. They've spent the time since working on a permanent rule.

Rep. Amy Loudenbeck, R-Clinton, who wrote the law, said it helped plant “the seed of what telehealth could be,” particularly in how it could boost access to mental healthcare. 

“This test period that we’re in has been really helpful and will inform rule-making,” she said. 

She’s now working on legislation that would apply the Medicaid definition for telehealth to the state occupational licensing law.

Jim Castellano, telehealth and virtual care manager at Marshfield Clinic Health System, said state and federal flexibilities boosted their ability to provide telehealth.

“In some ways, I think this was a unique opportunity for everybody to just really get down and dirty with the technology and see what it’s capable of,” said Dr. John Schneider, chief medical officer at the Milwaukee County Behavioral Health Division. 

He said telehealth has helped them reach more people, including easing the pivot from at-home visits to telecalls. He said there could be challenges with reimbursement in the future. 

John Nygren, Wisconsin Association of Health Plans executive director, said their members have embraced the use of telehealth, calling it the “one of the best things” that has come out of the pandemic.