WiHPCA News

By Hoven Consulting – WiHPCA’s Government Affairs Firm

The Wisconsin State Legislature will be back in session in September. After passing the biennial state budget bill in late June, lawmakers did not hold floor sessions in July and August. Typically, legislators utilize the summer months to engage with constituents in their districts and prepare bills for the fall and winter sessions.

However, legislative committees have been quite active in the past eight weeks as they held public hearings on bills likely to come to the floor during the fall session days.

The Assembly Committee on Health held a marathon public hearing in late July lasting nearly 6 hours on eleven separate pieces of legislation. These bills touched on a number of topics from newborn screenings to Medicaid reimbursement for pharmacist services to scope of practice for advanced practice registered nurses. The Senate Health Committee also heard a public hearing in July on similar bills.

While there will surely be a fair share of health care legislation that makes its way to the floors of both the Assembly and Senate, the big story of the fall will be legislative redistricting.

Wisconsin received its final census data numbers in August, triggering the beginning of the redistricting process. The Republican legislature will look to pass a bill this fall defining legislative district boundaries for the next ten years. However, the bill will almost surely be vetoed by Democratic Governor Tony Evers, which will then put the bill in the in hands of the Courts.

Census data showed significant population growth in Democratic-stronghold Dane County with some analysts predicting the county could pick up an entirely new Assembly seat. Conversely, Milwaukee County, another solid stronghold for Democrats, lost population. This means longtime Democratic districts will need to grow in geographic size out into more conservative Milwaukee suburbs.

Stay tuned for more updates on relevant health care legislation and the redistricting fight throughout the fall. 

• Republican William Penterman won the July 14 special election to represent the 37^th Assembly District, which includes portions of Dodge and Dane Counties. Penterman, a former legislative aide, captured 54 percent of the vote in defeating Democrat Pete Adams, who finished with 44 percent of the vote. With Penterman’s victory, Republicans will hold a 61-38 seat majority in the state Assembly.

• Lt. Gov. Mandela Barnes has announced he is running for U.S. Senate in 2022, meaning he won’t be seeking a second term as Wisconsin’s Lt. Gov. Barnes is the eighth Democratic to announce plans to run against Republican incumbent Senator Ron Johnson (if he chooses to run). Other Democrats seeking the seat include state Treasurer Sarah Godlewski, state Senator Chris Larson (Milwaukee), Outagamie County Exec Tom Nelson, and Milwaukee Bucks executive Alex Lasry.

• Gov. Tony Evers recently signed a bill (AB 406) into law to prevent any increase in unemployment insurance (UI) contribution rates paid by employers through the end of calendar year 2023. Under the law, the “UI tax freeze” will be offset by transferring $60 million in general fund revenue to the UI trust fund in each of the next two fiscal years. 

• In a rare bipartisan effort, U.S. Representatives Scott Fitzgerald (R-Juneau) and Gwen Moore (D-Milwaukee) have sent a letter to the U.S. Treasury Department requesting more guidance on spending federal COVID-19 relief. More specifically, they asked for greater clarification on how state and local governments can spend the federal funds without violating restrictions. Click here to read a recently released Legislative Fiscal Bureau memo on Wisconsin’s State and Local Fiscal Recovery Funds Under the American Rescue Plan Act.

• It was announced this week that Wisconsin could receive up to $400 million as part of a tentative $26 billion national legal settlement stemming from the opioid crisis. The proposed agreement would resolve the lawsuit states (including Wisconsin) brought against pharmaceutical manufacturers and distributors for their role in creating the opioid epidemic.

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 issues important to hospice and palliative care professionals and their patients.

Please click here for more information on the program.

As was reported in previous editions of the WiHPCA Advocacy Newsletter, WiHPCA has launched a Legislative Key Contact Program, which can be a highly effective grassroots advocacy tool to help build and nurture strong on-going relationships between WiHPCA members and lawmakers in Wisconsin. Ultimately, the program can help us help shape new policies important to our members.

The program is now live on the WiHPCA website and members can easily and quickly sign-up as a Key Contact.

As a Key Contact, you can help influence the legislative process at both state and federal levels by cultivating relationships with elected officials. By taking advantage of existing relationships and making new contact with members of the Wisconsin Legislature and the Wisconsin Congressional  Delegation, you can help us educate lawmakers on industry issues and influence legislation.

But the program will not succeed without strong member participation, so please take a few moments to read more about it – and learn how simple it is to “enlist” and participate as a Key Contact. The time commitment is minimal and your responsibility as a key contact depends on your level of comfort and willingness to engage.

Remember, lawmakers are often eager to hear input from their constituents, and as an expert in your field, you can make a real difference in the policy process as a Key Contact. CLICK HERE to sign-up by filling out and submitting a brief online survey.

The Wisconsin Department of Health Services (DHS) has submitted a plan to the federal Centers for Medicare and Medicaid Services (CMS) to use American Rescue Plan Act (ARPA) funds to improve and enhance Wisconsin’s home and community-based services under Medicaid. DHS estimates it will receive approximately $350 million under this part of ARPA. Key components of the plan that support Wisconsin’s caregiving workforce include increasing rates for home and community-based services and expanding the professional advancement opportunities for the workers who provide these services.

“Strengthening our caregiver workforce and making investments in the services that many seniors and people with disabilities rely on across our state are critical steps we must take to support our economic recovery from the pandemic,” said Governor Tony Evers. “We are fortunate to have access to these federal funds to move these efforts forward since many of the proposals to support and strengthen our caregiving workforce included in my proposed state budget were removed by the legislature and not included in the budget that was recently passed.”

In consultation with key stakeholders and partners, DHS assembled a plan that will continue to advance Wisconsin’s successful record of implementing innovative programs that enable older adults and people with disabilities to live independently in their homes and communities. In Wisconsin, these efforts include the Family Care, Family Care Partnership, IRIS, PACE and the Children’s Long-Term Support programs, as well as personal care, private duty nursing, home health, and rehabilitative services provided to eligible Medicaid members.

“Wisconsin has long been a national leader in developing and implementing programs that allow the elderly and people with disabilities to live their best lives in their homes and communities. In 2021, we achieved a major milestone by fully eliminating the adult waiting list for home and community-based services,” said DHS Secretary-designee Karen Timberlake. “The ARPA funds designated by Congress and President Biden to support state home and community-based services will help us continue to build on that success and help stabilize and the services people depend upon as well as the workforce needed to provide them.”

Foundational to Wisconsin’s plan is a commitment to ensuring all eligible people in Wisconsin have access to home and community-based services by addressing health disparities and focusing on equity in program design and access. In addition to working with the Governor’s Health Equity Council to support implementation of the approved plan, DHS will work alongside community-based organizations that share our commitment to addressing disparities within the home and community based service system for Black, Indigenous, and people of color, people with varying abilities, people living in extremely rural areas, and other historically underserved and disadvantaged communities. Wisconsin is also engaging in individual conversations with each of the 11 federally recognized tribes to identify ways to enhance HCBS services for tribal members under the proposals in the submitted plan.

CMS is currently reviewing Wisconsin’s plan, along with those plans submitted by other states. Implementation efforts will begin once CMS approval is received.

Learn more by visiting the Proposed Funding for Home and Community-Based Services.

Gov. Tony Evers (D) earlier this month signed the 2021-2023 state budget bill into law. Before signing the bill, Evers used his broad veto authority to make 50, mostly minor changes to the state’s two-year spending plan, which was largely reshaped by the Republican-controlled Legislature over the past few months. Click here to review the Governor’s full veto message.

The final $87.5 billion budget bill contains more than $2 billion in individual income tax cuts, $650 million property tax relief, and provides $129 million in broadband funding. In addition, the budget includes a number of health care-related items that may be of interest to WiHPCA members, including:

• Medicaid
• • Home Health Reimbursement Rate: Provide a budgeted sum of $473,300 as the state share of payments, and provide the matching federal share of payments, in 2021-22, and by a budgeted sum of $960,200, as the state share of payments and provide the matching federal share  of payments, in 2022-23, for the Department to increase the Medical Assistance rates paid for nursing care in home health agencies for dates of services beginning January 1, 2022. Specify that funding is to support licensed practical nurses, registered nurses, and nurse practitioners in home health agencies that are licensed under s. 50.49 of the statutes.
  • Medical Assistance Cost-to-Continue Estimate: Provide funding of $1,361,991,300 in 2021-22 and $1,258,573,900 in 2022-23. In addition, adjust the cost-to-continue reestimate to provide $25,900,000  in 2021-22 and $51,400,000 in 2022-23, reflecting the impact of the Department's proposed rate increase to managed care organizations providing services under Family Care, PACE, and Partnership, subject to approval by the federal Centers for Medicare and Medicaid Services.  
  • Nursing Home Reimbursement: Provide $82,034,300 in 2021-22 and $170,375,400 in 2022-23 to increase reimbursement rates paid to skilled nursing facilities and intermediate care facilities for individuals with intellectual disabilities. 
  • Direct Care Workforce Funding: Provide $53,835,800 in 2021-22 and $50,403,200 in 2022-23 to increase funding for the direct care workforce funding supplement.  
  • Personal Care Reimbursement: Provide $18,904,300 in 2021-22 and $59,369,300 in 2022-23 to increase hourly rates paid for personal care services to $20.69 on January 1, 2022, and to $22.35 on January 1, 2023. 
  • Postpartum Eligibility Extension: Provide $2,500,000 in 2022-23 to reflect the estimated cost of extending benefits, for women enrolled in MA as pregnant women, until the last day of the month in which the 90th day after the last day of the month that the end of the pregnancy falls, instead of the 60th day under current law.
  • Outpatient Mental Health and Substance Abuse Services and Child-Adolescent Day Treatment Reimbursement: Provide $6,628,100 in 2021- 22 and $13,256,200 in 2022-23 for a 15% increase to reimbursement rates for outpatient mental health and substance abuse services, effective January 1, 2022; and provide $1,335,600 in 2021-22 and $2,671,200 in 2022-23 for a 20% increase to reimbursement rates for child and adolescent day treatment services, effective January 1, 2022.  
  • Medication-Assisted Treatment: Provide $1,224,400 in 2021-22 and $2,448,700 in 2022-23 to increase MA reimbursement rates for opioid treatment providers by 5% and increase rates for opioid-related patient evaluation and management (office visits) provided by primary care providers by $5 per visit.
  • MA Dental Reimbursement: Provide $15,432,800 in 2021-22 and $30,865,800 in 2022-23 to increase MA dental reimbursement rates by 40%, effective January 1, 2022. 
• Public Health
• • Community Health Center Grants: Increase grant funding for federally qualified health centers (FQHCs) by $1,000,000 annually.  
  • Grants to Free and Charitable Clinics: Increase grant funding for free and charitable clinics by $1,000,000 annually.  
  • Lead Screening and Outreach Grants: Provide $50,000 annually to increase a grant for lead screening and outreach activities provided by a community based human service agency that provides primary health care, health education, and social services to low-income individuals in the City of Milwaukee, from $125,000 to $175,000. 
• Elder and Disability Services
• • Birth to 3: Provide $1,125,000 annually in order for the Department to meet its federal Individuals with Disabilities Education Act (IDEA) maintenance of effort (MOE) requirement for the Birth to 3 program in the 2021-23 biennium.  
• Community Based Behavioral Health
• • Child Psychiatry Consultation Program: Provide $500,000 in 2022-23 to increase from $1,500,000 to $2,000,000 the funding for the child psychiatry consultation program in that year.
  • Medication-Assisted Treatment Expansion: Provide $500,000 in 2021-22 and $1,000,000 in 2022-23 in the Joint Committee on Finance supplemental appropriation for medication-assisted treatment.  
  • Methamphetamine Addiction Treatment Grants: Provide $150,000 in 2021-22 and $300,000 in 2022-23 in the Joint Committee on Finance supplemental appropriation for training for substance use disorder treatment providers on treatment models for methamphetamine addiction.
  • Substance Use Disorder Treatment Platform: Provide $300,000 in 2022-23 in the Joint Committee on Finance supplemental appropriation for development of a substance use disorder treatment platform that allows for the comparison of treatment programs in the state.  
  • Behavioral Health Bed Tracker: Provide $50,000 in 2021-22 and $20,000 in 2022-23 to expand the purposes of the current psychiatric bed tracking system to include information on the availability of space for peer run respite beds and crisis stabilization beds.  
  • Behavioral Health Trainee Provider Grants: Provide $250,000 GPR in 2022-23 in the appropriation for treatment program grants, to increase total funding for the program in that year to $750,000. Modify the program to: (a) specify that the Department may expend any available federal moneys received for this program; (b) require the Department to distribute a total of $750,000 per year, beginning in 2022-23; and (c) renumber the appropriation so that it is included as an appropriation under mental health and substance abuse services instead of under public health.  
• Department of Children and Families:
• • Wisconsin Shares Child Care Subsidies: Increase funding for direct child care subsidies by $11,000,000 FED in 2021-22 and by $18,200,000 in 2022-23 so that the reimbursement rates would fully pay the price of at least 65 percent of the slots for children within the licensed capacity of all child care providers. 

By Representative Amy Loudenbeck (R-Clinton)

Vice Co-Chair of the Joint Committee on Finance

Wisconsin’s 2021-23 biennial budget makes significant investments across a wide spectrum of health care priorities, including raising Medicaid reimbursement rates for numerous providers who hadn’t seen increases in over a decade and targeted investments to increase access to care and improve health care outcomes.

Over the last year, long-term care facilities and their staff have been strained by the COVID-19 pandemic. In addition, for the past several years many of these facilities have been experiencing a critical workforce shortage and were also struggling with low Medicaid reimbursement rates that didn’t even cover the cost of care. The budget invests nearly $440 million in long-term care facilities and the workforce that staffs them.

Ambulance Service Providers (EMS) will see an increase in reimbursement rates of over $16 million. This additional funding will help to sustain many of our EMS providers across the state and will help avoid service deserts.

To ensure residents have access to high-quality dental care when they need it, this budget invests over $46 million to expand dental access across Wisconsin.

The budget increases Medicaid reimbursement for autism services by over $14 million. These services are intended to teach children with autism spectrum disorders the skills that children would usually learn by imitating others around them, such as social interaction and language skills, and there is a significant waiting list for services.

Nearly two-thirds of hospitals will continue to receive state funding in the form of Disproportionate Share Hospital payments to hospitals that serve low-income patients. This funding helps reduce cost-shifting to individuals with private insurance to cover losses.

The budget also boosts Medicaid reimbursement rates for Skilled Home Health Care Services, Emergency Room Physicians, Speech-Language Pathologists, Audiology Services, Chiropractic Services, Physical Therapy Services, and the Child Psychiatry Consultation Program. These investments are intended to increase access and to ensure providers are compensated appropriately for their work.

Federally-Qualified Health Centers and Free and Charitable Clinics, non-profit organizations that provide comprehensive primary health care to underserved areas and populations, also receive a boost. These providers will receive an additional $4 million over the biennium (each category will share $1 million/year in financial support).

In addition, the budget includes an increase of $6 million to expand the Dementia Care Specialist Program statewide by funding 18 dementia care specialist positions at Aging and Disability Resources Centers around the state, as well as seven tribal dementia care specialist positions.

Finally, this budget increases funding for psychological testing, diagnosis, psychotherapy, and counseling for individuals, groups, and families, as well as mental health day treatment services for children. The budget also includes over $3 million for medication-assisted treatment (including patient evaluation as well as methadone and other opioid abuse treatment medications) for individuals with substance abuse disorders.

Overall, the 2021-23 biennial budget will ensure that health care service providers and their employees will be well positioned to continue providing quality care across the health care continuum so all residents across Wisconsin can access a wide range of health care settings and services. 

The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of WiHPCA.

William Penterman, a legislative aide in the State Capitol and a member of the U.S. Army reserve narrowly won an eight-way Republican special primary in the 37th Assembly District. The district includes portions of Dane, Dodge, Jefferson, and Columbia counties as well as parts of the cities of Columbus, Waterloo, and Watertown.

Peterman received 758 votes, gaining a slim 16-vote victory of local university professor Jennifer Meinhardt. If officially declared the winner, Penterman will face Democratic candidate Peter Adams and Independent candidate Stephen Ratzlaff Jr. in the July 13 special general election.

The seat became vacant when then Representative John Jagler (R-Watertown) was elected to represent the 13th Senate District that was previously held by former Senate Majority Leader Scott Fitzgerald, who was elected to Congress last November.

Republicans currently hold a 60-38 seat majority in the Assembly, with the one vacancy in the 37^th Assembly District.

For the past eight years, I have worked as an Advanced Practice Nurse Practitioner (APRN) in the State of Wisconsin and have operated my own independent clinic. My passion for affordable, accessible healthcare has permeated nearly every aspect of my hectic life, including my new role as a state legislator.

Over the course of my time as a nurse, the healthcare industry has changed drastically. I have worked for large health systems, small ones, clinics, and everything in between. At the end of the day, I got in to nursing so that I can care for my patients, not feed a massive healthcare system. That is why I started my own business: so that I can provide healthcare to those who may not fit into the large systems, if they have astronomical deductibles, or if they do not have insurance at all.

I believe this model of small clinics, operated by nurses, can be replicated across the state and dramatically cut healthcare costs for folks who need it the most. For example, all of the prices for procedures and appointments are posted directly on my clinic’s website – there is not some mystical formula that only the system can understand. The logic is simple: you would never go through a McDonald’s drive-thru for them to only tell you at the end your burger costs $25. You would go down the road to Burger King or Wendy’s, where the prices you know are more competitive. This is how we can bring some sanity back to the healthcare field – the more competitive it is, the market will do its job to cut costs. Just imagine having dozens of these clinics in our area.

One obstacle in the way of this, however, is the fact that nurses in the State of Wisconsin have their hands tied. They are required to pay astronomical prices for collaborating physicians to even have their doors open – and if that physician dies or disappears, they need to immediately shut down. Collaboration is not the issue. I collaborate every day with specialists in nearly every aspect of healthcare for the good of my patients. The issue is the price and risk of having to close my doors because of someone who I may not even talk to on an annual basis somehow vanishes. This has turned off many fellow APRNs from replicating clinics like mine throughout our cities and rural areas.

Currently, 24 states and 2 territories have full practice authority (FPA) for Nurse Practitioners (NPs). Wisconsin made steps towards this goal when Governor Evers issued his COVID-19 emergency order, which eliminated the restrictions placed on NPs to practice without that collaboration requirement. Unfortunately, after the emergency orders were overturned by the Wisconsin Supreme Court, all restrictions were re-instated on the profession. During the COVID-19 pandemic, we learned NPs can have FPA without the negative consequences that some feared. In fact, studies have shown that an NPs outcomes for management of acute and chronic disease are equivalent if not better than a physicians.

Assembly Bill (AB) 396/Senate Bill (SB) 394 brings Wisconsin up-to-date with 24 other states to give Nurse Practitioners FPA. Passing these bills will allow NPs to continue to prioritize patient care and allow NPs to continue excellence in their nursing practice without unnecessary and undue restrictions.

Those opposing these bills have raised concerns about the unlikely event an NP goes “rogue” and attempts to practice outside of the scope of their training. As nurses, this is not how reality works. I have collaborated with physicians and other professionals in every instance that is deemed necessary. To do otherwise would open me up to severe liability issues and lawsuits, just as it would for a physician who practices outside of their scope.

At the end of the day, all nurses are asking for is a level playing field. We want the freedom to do what we do best: care for our patients.

State Representative Rachael Cabral-Guevara (R-Appleton) represents the 55th Assembly District in the Wisconsin Legislature. Her Assembly district is in Winnebago County and includes the City of Neenah and parts of Appleton.

NOTE: The views and opinions expressed in this article are those of the author and do not reflect the official policy or position of WiHPCA. Furthermore, the opinion piece allows WiHPCA to gain a better understanding of a health care-related bill from the author’s perspective, but in no way indicates support or opposition to the proposal.

A group of Republican state lawmakers – including Sen. Pat Testin (R- Stevens Point) and Representative Rachael Cabral-Guevara (R-Appleton) – recently introduced an advanced practice registered nurse bill (AB 396 / SB 394). The proposal creates a new license issued by the Wisconsin Board of Nursing for advanced practice registered nurses (APRNs), which includes Nurse Practitioners, Clinical Nurse Specialists, Certified Registered Nurse Anesthetists, and Certified Nurse Midwives.  

The bill’s authors and supporting nursing organizations claim the legislation and is necessary to help address Wisconsin’s health care provider shortage and provide clarity to the scope of practice of APRNs. They believe it will help provide regulatory flexibility and assist with removing barriers to allow these providers to practice within their scope in underserved areas of the state.

However, other health care provider groups, including the Wisconsin Medical Society have raised concerns over numerous provisions in the bill. They believe the legislation will improperly expand the APRN scope of practice by eliminating the requirement for these practitioners to collaborate with physicians and allow them to diagnose and treat patients independently from a physician.

The legislation, which was introduced earlier this month and is currently under consideration by the Assembly and Senate Health Committees, is supported by the Wisconsin Nurses Association, the Wisconsin Association of Nurse Anesthetists, WPS Health Insurance, and United HealthCare Services. Opposition to the proposal includes the state medical society and the Wisconsin Society of Anesthesiologists.