WiHPCA News

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:

Rainbow Hospice Care recently opened their doors to State Rep. Scott Johnson (R-Jefferson), providing the first-term Wisconsin legislator with a tour of their state-of-the-art inpatient center in Johnson Creek, WI.

Founded in 1990 by a dedicated group of volunteers, Rainbow Hospice Care is one of the state’s few remaining local, independent non-profit programs and remains committed to giving back to the communities it serves.

Led by WiHPCA board member and Rainbow Hospice President and CEO Karen Carrig, the Rainbow Hospice team spent well over an hour with Rep. Johnson discussing the value of hospice and palliative care in communities across Wisconsin, the mission of WiHPCA, and the regulatory and legislative challenges faced by the hospice industry. In addition, Rep. Johnson was able to see firsthand the tremendous care provided at Rainbow Hospice’s inpatient center.

WiHPCA thanks Karen and her dedicated team for hosting Rep. Johnson and participating in WiHPCA’s

legislative advocacy outreach program. Our advocacy efforts aim to connect members with their local state legislators and members of Congress to advocate for programs and polices that improve the delivery of hospice and palliative care, support hospice care professionals, and enhance services provided to patients and their families.

For more information on local legislator visits to your agency, please contact wihpca@badgerbay.co.

Last month, WiHPCA joined hospice stakeholders across the country in singing-on to a National Association for Home Care and Hospice (NAHC) letter to provide input to the Centers for Medicare & Medicaid Services (CMS) on the agency’s proposed 2024 Hospice Wage Index and Payment Rate Update rule.

While the proposed rule contains numerous items of interest and concern to the hospice community, which are laid out in the NAHC letter, WiHPCA is specifically concerned about the rule’s proposed 2024 Hospice Payment Update Percentage. The rule’s 2.8% increase includes a market-basket percentage increase of 3% and a 0.2 percentage point productivity adjustment. While WiHPCA members appreciate any increase, the 2.8% update fails to keep pace with the rising costs that are being absorbed by hospice providers in Wisconsin and across the country.

Please CLICK HERE to read the NAHC/WiHPCA letter to CMS.

WiHPCA recently signed-on to a national stakeholder letter urging members of Congress to support the most recent version of the Palliative Care and Hospice Education and Training Act (PCHETA). The letter was spearheaded by the National Association for Home Care and Hospice (NAHC)

The 2023-24 version of PCHETA, which will be introduced in the Senate by Senators Tammy Baldwin (D-WI) and Shelley Moore-Capito (R-WV), would make major investments to increase and bolster the hospice and palliative care interdisciplinary workforce and promote awareness of the benefits of palliative care among patients and providers.

Please CLICK HERE to read the PCHETA support letter.

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

·       U.S. Senators Reintroduce Telehealth Bill, Would Make Permanent Hospice Recertification Waiver

• By Jim Parker | June 21, 2023
•  

U.S. Sen. Chuck Grassley (R-Iowa) and 59 bipartisan co-sponsors have reintroduced legislation that would expand Medicare coverage of telehealth and make permanent flexibilities implemented during the COVID-19 public health emergency. If enacted, the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act would remove all geographic restrictions on telehealth services and expand originating sites to include the home, among others. It would also permit health centers, rural health clinics and eligible health care professionals to provide telehealth services. Read more…

·       OIG Launches Audit of Inappropriate General Inpatient Hospice Billing

• By Holly Vossel | June 21, 2023

 

The U.S. Department of Health & Human Services (HHS) Office of the Inspector General (OIG) recently announced plans to launch a new audit that will focus on general inpatient hospice services. Longer general inpatient hospice stays and high-cost issues are reasons for the audit, dubbed the “Audit of Selected, High-Risk Medicare Hospice General Inpatient Services,” according to OIG. The regulatory watchdog’s nationwide audit will concentrate on Medicare claims for hospice enrollees transferred to general inpatient care (GIP) settings following an acute hospitalization. Read more…

·       Hospices Seek Congressional Action on Staffing Constraints

• By Jim Parker | June 21, 2023
•  

Years after it was first introduced, hospice leaders are calling on Congress to move forward legislation that would bolster their dwindling workforce. The most significant bill in recent years is the Palliative Care and Hospice Education Training Act (PCHETA), which has come before Congress time and again but has not yet been passed. The bill’s most recent go around was last May, reintroduced by Sens. Tammy Baldwin (D-Wisc.) and Shelley Moore Capito (R-W.Va.). Read more…

 

·       Hospices, Lawmakers Target Medication Cost Reductions

• By Jim Parker | June 14, 2023

 

Medication costs are among hospice providers’ biggest expenses, and some are asking policymakers to take action on prices. High prices on drugs, as well as shortages, are problems that permeate the entire health care system. While recent industry-wide data are scarce on drug costs for hospice patients, providers often identify these as their second-highest expense, behind wages, salaries and employee benefits. Read more…

·       US Justice Department’s Spotlight on Hospice Sends ‘Powerful Message’ to Fraudulent Operators

• By Holly Vossel | June 13, 2023

 

The U.S. Department of Justice (DOJ) is prioritizing hospice as the agency cracks down on health care fraud. Increased reimbursement oversight could be on the horizon, lending to a potential rise in whistleblower cases. DOJ counts hospice claims among the root causes of rising Medicare costs in recent years, according to Lisa Miller, deputy assistant attorney general overseeing the department’s Crime Fraud Section. Read more…

·       Solutions That Make Sense: Why Hospice Benefit Reform Needs to Incorporate Concurrent Care

• By Jim Parker | June 9, 2023

 

Increasingly, both policymakers and providers are seeing potential opportunities to reform the Medicare Hospice Benefit, including the prospect of concurrent care. Driving these conversations is the need to lighten the nation’s heavy health care spend, which in 2021 reached $4.3 trillion, according to the U.S. Centers for Medicare & Medicaid Services (CMS). Read more…

·       New Senate Bill Would Create CMMI Palliative Care Demo

• By Jim Parker | June 8, 2023

 

Four U.S. senators have introduced a bipartisan bill that would direct the Center for Medicare & Medicaid Innovation (CMMI) to develop a palliative care-specific payment model demonstration. The bill’s sponsors include Sens. Jacky Rosen (D-Nev.), John Barrasso (R-Wy.), Tammy Baldwin (D-Wisc.), and Deb Fischer (R-Neb.). The four legislators in 2019 co-founded the Senate’s bipartisan Comprehensive Care Caucus to focus on legislation and policy to raise awareness of and improve access to palliative care. 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 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).

By Hoven Consulting – WiHPCA’s lobbying firm

• Update on the FY2023-2025 State Budget

On May 2, the Legislature’s Joint Committee on Finance voted to remove over 500 budget items included in Governor Evers’ Fiscal Year 2023-2025 budget request from further consideration by the committee.  However, it is important to note that even though certain budget items from the Governor’s budget request remain in the budget bill after this vote, a majority of committee members will still need to vote separately to approve including those budget items in the committee’s version of the budget bill.  Those votes will occur at committee meetings on various dates in the future, as the committee considers different state agency budgets.  In addition, the Joint Committee on Finance is able to offer their own budget amendments to different state agencies.   

However, on May 2, the Joint Committee on Finance did not vote to remove funding for the following budget items that may be of interest to WiHPCA:

On May 23, the Joint Committee on Finance voted on the budget for the Higher Educational Aids Board (HEAB), which includes funding for the nurse educators program.  While an amendment was offered to increase the nurse educators program by $5 million per year – for a total of $10 million per year –that amendment unfortunately failed.  It's important to note that demand for nurse educator program funds has been less than anticipated.  That could be the reason why this amendment failed.  However, the committee did not modify the existing annual $5 million for this program.  In addition, HEAB anticipates that there will be unspent funds – at least $1.5 million – from Fiscal Year 2022-2023 that will be carried over to FY2023-2024.  Therefore, if Governor Evers signs the budget bill, the nurse educator program will be funded at least at a $6.5 million level in FY2023-2024. 

• WiHPCA Supports Draft Bill Allowing Universal Occupational Licensure Recognition

WiHPCA recently decided to support a draft bill that would allow the state Department of Safety and Professional Services or the relevant state credentialing board to grant a reciprocal occupational credential to an individual who has the same credential in another state.  In order to qualify, the applicant could not be under investigation in the other state in which he/she is credentialed and could not have any limitations or restrictions on the credential in that state.  Once an out-of-state credentialed individual applies for a Wisconsin credential, a provisional credential is granted immediately and the applicant would be able to practice in Wisconsin immediately, subject to the ultimate decision on whether to grant or deny the reciprocal credential.  WiHPCA’s Madison lobbyists expect that this bill will be formally introduced in the coming weeks.

• Federal COVID-19 Public Health Emergency Ends

On May 11, 2023, the federal COVID-19 Public Health Emergency ended.  With the end of this emergency, there are changes in the response to COVID-19.  COVID-19 vaccines will continue to be provided free of charge to individuals until the government supply is depleted.  The state-funded Say Yes! COVID Test program will continue to provide free at-home antigen tests through May 2023, as supplies allow.  Eventually, however, all tests (antigen or PCR) will no longer be provided free of charge – individuals may have purchases reimbursed by insurance plans or may need to purchase them out-of-pocket.  COVID-19 antiviral treatments, such as Paxlovid, will continue to be free to patients until the federal stockpile has been depleted.  In addition, DHS will continue to operate its free-of-charge COVID-19 treatment telehealth service through December 31, 2023.

• Governor Calls Special State Assembly Election

On May 5, Governor Tony Evers called a special general election for the 24th Assembly District on July 18, 2023.  If a special primary election is needed, it will occur on June 20, 2023.  This vacancy was created by the election of then-state Representative Dan Knodl (R-Germantown) to the 8th Senate District, which was previously held by longtime state Senator Alberta Darling (R-River Hills).  The 24th Assembly District includes portions of Waukesha and Ozaukee Counties, including the communities of Germantown, Menomonee Falls, and Grafton.

By WI Senator Rachael Cabral-Guevara (R-Appleton)

As a healthcare provider myself, I’ve seen firsthand the dramatic changes the industry has gone through  in the last two decades. Digitization, growth in specialty care, and diversification of service models have all helped advance how providers deliver care to patients.

Then a pandemic hit. This dramatically increased burnout, wore on the mental health of staff, and others simply left because of overburdensome restrictions. As a result, the entire healthcare system is still reeling from historic drops in staffing levels, with the pipeline of students entering the profession not keeping up with demand.

Hospitals are now relying on traveling nurses, who can come at a cost almost three times as much as nursing staff. Nursing homes, who were struggling to recruit before the pandemic, are now closing entire wings of their facilities. Meanwhile, the shortage of providers in rural areas remains an issue and the pace of attracting professionals to Wisconsin has been slow.

What can be done? As chair of the Senate Committee on Health this session, I’ve made it my mission to address these workforce issues head-on. There is no “silver bullet” solution–both investment and regulatory reform is necessary to improve Wisconsin’s nation-leading healthcare system.

I’m focused on three specific areas to achieve this:

·        Boosting the attractiveness of healthcare professions to students. By highlighting healthcare professions and the rewarding nature of care, we can and should do a better job encouraging internships and other work-based learning programs for students to be exposed to healthcare. We also have opportunities to offer some loan forgiveness for our highest-need professions, reducing the financial burden on those who wish to pursue a career in the field.

·        Streamlining the school-to-work pipeline. I’ve proposed letting students who have completed their education and training to enter the workforce without waiting on a bureaucratic process that–in some cases–can last months. This would keep students here after college, allow them to enter the workforce immediately, and so long as their employer consents, start treating patients.

·        Allowing healthcare professionals to practice at the full extent of their scope. This includes our nurses, who are now operating in an environment that hinders their ability to practice independently. By unleashing this group of healthcare professionals, we can help solve two issues: attract more nurses to Wisconsin (which is desperately needed) and expand the pool of providers able to set up shop in areas that need it most.

Though we can and should do more than this, we need to start somewhere. This is our opportunity to break down barriers, build a robust patient-focused system, and deliver more accessible care to Wisconsinites.

Let’s keep moving forward!

Sen. Rachael Cabral-Guevara (R-Appleton) served one term in the state assembly and currently represents the 19^th Senate District in the Wisconsin State Senate. She serves as chair for the Senate Committee on Health and Vice Chair for the Senate Committee on Mental Health, Substance Abuse Prevention, Children, and Families.