Home Health Care News

By Andrew Donlan | November 19, 2021

The Biden administration’s Build Back Better plan – which includes an array of support for home-based care and senior services – took a significant step Friday.

A $1.9 trillion bill got the necessary number of votes to make it through the U.S. House of Representatives. The next stop will be the Senate.

“Today’s historic vote of support for home care comes at a time when the country needs it more than ever,” National Association for Home Care & Hospice (NAHC) President William A. Dombi said in a statement shared with Home Health Care News. “Health care at home is widely recognized as high value, high quality and highly preferred.”

Most notably, $150 billion will be dedicated to reducing waiting lists for in-home care services and improving pay for low-wage in-home care professionals.

But the Build Back Better plan will also include $150 billion to increase the supply of affordable housing, $130 billion to provide tax credits for uninsured people in states that have not expanded Medicaid benefits, $1 billion for direct care workforce competitive grants, and $20 million for hospice and palliative nursing programs.

“From pediatric nursing care to home care aide services for those with multiple chronic illnesses as they age, this legislation will provide improved access to home care,” Dombi said. “We now look to the Senate to complete the work to protect our families and friends who need this essential care.”

Originally, the plan included $400 billion for home- and community-based services (HCBS), but it was eventually trimmed as Democrats and Republicans bargained for their respective side’s wishes.

Even the lesser version won’t be a shoo-in to get through the Senate, though advocates are arguing relentlessly on its behalf. The Senate is expected to consider the bill in the coming weeks, with the hope that a decision will be made before Christmas.

“Today’s vote is a major step forward for millions of older Americans … stuck on waiting lists to rent a place they can afford, and unable to get the home health and other help they and their families need,” Katie Smith Sloan, the president and CEO of LeadingAge, said in a statement. “It’s also an overdue step toward alleviating workforce shortages that are denying critical services and support to millions of older adults.”

While the funding would help on the recruiting and retention front by improving wages, it would also likely give hundreds of thousands more Americans access to home-based care.

“Support for home- and community-based services and affordable senior housing programs in the Build Back Better legislation can fundamentally transform how people grow old in this country,” Sloan continued. “These are critically needed resources – especially the investments in the workforce – that will immediately help alleviate current shortages and scarcity across aging services.”

The investment in workers, particularly, has drawn praise from organizations across the country that represent caregivers and other home-based care professionals.

Ai-jen Poo, the executive director of the National Domestic Workers Alliance (NDWA) and Caring Across Generations, remarked that this was a step toward “the care and infrastructure our families and economy need.”

“Today’s vote brings us one step closer to realizing a future where America’s home care workers … receive a family-sustaining wage,” Poo said in a statement. “And those who need care … will be able to receive quality, affordable care services at home. The Senate’s quick passage of this historic legislation with all three pillars of the care economy – including home- and community-based services, child care and paid family medical leave – will enable us to start building the care infrastructure our families and economy need.”

The plan would be building on other legislative moves made to support in-home care since the onset of the COVID-19 pandemic. The passage of another $1.9 trillion stimulus bill, the American Rescue Plan set the stage for Build Back Better after it made a 10 percentage point increase to HCBS funding through the Federal Medicaid Assistance Percentage (FMAP) match.

An example of how those funds were used surfaced earlier this week in Florida, as the state used that hike to invest $1.1 billion to support HCBS for Floridians. Of that $1.1 billion, more than $669 million will go toward directly addressing HCBS providers’ ongoing workforce challenges and more than $128 million will go toward enhancing services for older adults.

As of Oct. 21, two dozen states had received approval to use increased FMAP funds to increase HCBS provider payment rates. Another 20 or so used it to offer special bonus payments to workers.

“Florida will invest the enhanced funding to allow Florida health care providers to recruit and retain staff to care for the most vulnerable and bolster the ability of Floridians to receive care in a community-based setting,” a statement from the state’s Agency Health Care Administration (AHCA) read. “HCBS programs serve the state’s aging population, as well as individuals with physical, intellectual and developmental disabilities.”

On November 3, Marquette Law School released a new poll that surveyed Wisconsin registered voters on their opinions of various national and statewide elected officials, as well as views related to the coronavirus pandemic.

In this poll, statewide elected officials had fairly low approval ratings. Among statewide elected officials, Governor Tony Evers has the highest favorable rating of 42%. However, he also had an unfavorable rating of 45%, while 13% didn’t know enough about him or don’t have an opinion. Notably, 53% approve of Governor Evers’ handling of the pandemic, while 40% disapprove.

U.S. Senator Tammy Baldwin (D) has the next-highest approval rating, with 38% of Wisconsin registered voters approving of her performance, 39% disapproving, and 22% did not have an opinion. Wisconsin’s other U.S. Senator – Republican Ron Johnson, had a 36% approval rating, a 42% disapproval rating, and 22% of surveyed voters didn’t know enough about him or didn’t not have an opinion.

The poll also asked several questions regarding the coronavirus pandemic. Here are the results:

• Overall, 55% support school mask mandates, while 40% oppose them.
• 48% support the federal mandate that require employees of larger businesses (100 or more employees) to either get vaccinated or face weekly testing. 48% of respondents opposed it.
• 74% of Wisconsin registered voters said they have received at least one dose of a vaccine, 23% said that they have not been vaccinated, and 3% declined to answer.
• 62% of respondents claimed they are fully vaccinated, although CDC data shows that 66% of Wisconsinites are fully vaccinated.
• Out of those surveyed who are unvaccinated, 56% said they will not get the vaccine and 18% said they will probably not get it.

DHS supports the FDA authorization, CDC recommendations

The Wisconsin Department of Health Services (DHS) supports the recommendation that anyone 18 and older receive a booster dose of COVID-19 vaccine at least six months after having received their second dose of the Pfizer-BioNTech (Pfizer) or Moderna vaccine. All adults are now eligible to receive booster doses, and booster doses are strongly recommended for everyone 50 and older, who are at the greatest risk for severe disease.

A recent decision by the CDC extends eligibility for a booster dose to everyone 18 and up at least 6 months after they received their second dose of Pfizer or Moderna. People who got the Johnson & Johnson COVID-19 vaccine are also eligible for a booster dose of any of the available COVID-19 vaccines. For the people who got the Johnson & Johnson COVID-19 vaccine, booster shots are recommended by the CDC for those who are 18 and older and who were vaccinated two or more months ago.

The CDC’s recommendations now also allow for mix-and-match dosing for booster doses. Some people may have a preference for the vaccine type that they originally received, and others may prefer to get a different booster.

“Getting everyone vaccinated continues to be our top priority for preventing serious illness and death from COVID-19,” said Dr. Ryan Westergaard, Chief Medical Officer and State Epidemiologist for DHS. “Too many of us remain unprotected going into the winter season. Getting a booster dose when it’s time to do so, and continuing to get our children 5 and older vaccinated will slow the spread of the virus and save lives.”

Getting vaccinated is about protection. Given that evidence suggests immunity is waning over time for some people who were initially well-protected by the vaccine, the booster dose can strengthen and extend their protection against infection, serious illness, hospitalization, and death from COVID-19.

With the high-level of disease transmission in Wisconsin, DHS continues to urge everyone who is not vaccinated to get the COVID-19 vaccine, and for all people to add additional layers of protection including masking up indoors, staying home when feeling sick, and avoiding large indoor gatherings.

DHS has also updated the COVID-19 vaccine administration dashboard on the COVID-19 vaccine data webpage. The expanded dashboard displays new data on additional and booster doses of COVID-19 vaccine. The administration tab now includes a section showing the cumulative number of additional and booster COVID-19 vaccine doses administered and reported to the Wisconsin Immunization Registry (WIR) by Wisconsin vaccine providers.

For up-to-date information about Wisconsin’s COVID-19 response, visit the DHS COVID-19 webpage.

The Wisconsin Department of Health Services (DHS) has released ForwardHealth Update 2021-40, “Electronic Visit Verification Soft Launch Has Been Extended.” This update communicates that DHS required hard launch consequences will not go into effect January 1, 2022.

ForwardHealth Update 2021-26, "Electronic Visit Verification Hard Launch Preparation" and ForwardHealth Update 2021-23, "Electronic Visit Verification Policy and Hard Launch Timeline" have been revised to reflect this extension.

With the soft launch extension:

• EVV is still required f or Medicaid-covered personal care and applicable supportive home care services and has been since November 2, 2020.
• Provider agencies that are not currently using EVV are out of compliance with current DHS policy.
• Fee-for-service claims without EVV data will be paid.
• DHS has encouraged health maintenance organizations (HMOs) and managed care organizations (MCOs) to continue to pay claims without EVV data until the new hard launch date. This will provide consistency and coordination f or provider agencies within the EVV program.
• Services without EVV data will be included in future capitation rate setting development for HMOs and MCOs.
• IRIS (Include, Respect, I Self -Direct) fiscal employer agencies will not deny payment for provider agency claims until the new hard launch date.
• The IRIS non-compliant participant disenrollment process will be delayed. Participants are out of compliance with current DHS policy if their participant-hired workers are not using an EVV system during the soft launch phase.
• Provider agencies choosing to use an alternate EVV system that is not certified should complete the certification process as soon as possible. They are out of compliance with current DHS policy if they are not using an EVV system during soft launch phase.
• In fee-for-service, the Sandata EVV system is not a replacement f or Record of Care timesheets until the new hard launch date.

DHS will continue to monitor the status of EVV and will be taking additional actions to further promote EVV usage and provider compliance during the extension.

Payers, provider agencies, and workers should use this extension to become more efficient with EVV, streamline processes, and take additional training as needed.

If you have questions or comments about EVV, please contact Wisconsin EVV Customer Care via phone at 833-931-2035. Customer Care hours are Monday–Friday, 7 a.m.–6 p.m. CT.

Earlier this month, the WI Department of Health Services’ Division of Quality Assurance (DQA) issued the following information to all DQA regulated providers regarding the Centers for Medicare & Medicaid Services (CMS) Interim Final Rule (released on Nov. 4, 2021), which requires COVID-19 vaccination for most healthcare workers at certain healthcare facilities certified by CMS:

On November 4, 2021, the Centers for Medicare & Medicaid Services (CMS) announced a new emergency rule related to COVID-19 vaccination requirements for Medicare and Medicaid-certified health care providers and suppliers. Specifically, it requires all health care providers and suppliers that participate in a federally certified Medicare and Medicaid program under Conditions of Participation (COP) to develop a plan/process to vaccinate all staff with a first dose or single dose of COVID-19 vaccine by December 6, 2021. All eligible staff must be fully vaccinated by January 4, 2022.

The Emergency regulations apply to the following Medicare and Medicaid-certified providers/suppliers:

• Ambulatory Surgery Centers
• Community Mental Health Centers
• Comprehensive Outpatient Rehabilitation Facilities
• Critical Access Hospitals
• End-Stage Renal 2 Dialysis Facilities
• Home Health Agencies
• Home Infusion Therapy Suppliers
• Hospices
• Hospitals
• Intermediate Care Facilities for Individuals with Intellectual Disabilities
• Clinics
• Rehabilitation Agencies, and Public Health Agencies as Providers of Outpatient Physical Therapy and Speech-Language Pathology Services
• Psychiatric Residential Treatment Facilities (PRTFs)
• Programs for All-Inclusive Care for the Elderly Organizations (PACE)
• Rural Health Clinics/Federally Qualified Health Centers
• Long Term Care Facilities

The regulation does not apply to:

• Assisted Living Facilities; however, the mandate would apply to large, assisted living facilities with more than 100 employees under the OSHA mandate.
• Home and Community-Based Services
• Physician’s offices

The vaccination requirement applies to eligible staff working at a facility that participates in the Medicare and Medicaid programs, regardless of clinical responsibility or patient contact. This includes:

• Facility employees
• Licensed practitioners
• Students
• Trainees
• Volunteers
• Individuals who provide care, treatment, or other services for the facility and/or its patients under contract or other arrangements

CMS has provided additional information about the COVID-19 Health Care Staff Vaccination Interim Final Rule in a FAQ document.

DQA Review:

CMS expects state survey agencies to conduct onsite compliance reviews of these requirements during recertification surveys and complaint surveys. Surveyors will check to determine if a facility has met the three basic requirements:

• Having a process or plan for vaccinating all eligible staff
• Having a process or plan for providing exemptions and accommodations for those who are exempt
• Having a process or plan for tracking and documenting staff vaccinations.
• Surveyors will review the facility’s vaccine policies, the number of resident and staff COVID-19 cases over the last 4 weeks and list of staff and their vaccination status. This information will be used to determine the compliance of the provider or supplier with these requirements.

Numerous states have files lawsuit against CMS and the Biden Administration challenging the COVID-19 vaccine mandate for healthcare workers. However, the Final Interim Rule currently remains in place.

By State Representative Tony Kurtz (R-Wonewoc)

Senator Alberta Darling and I recently introduced Koreen's Law (Assembly Bill 718) a critical legislative proposal to help ensure patients have access to life-saving medication. It is named after a patient, Koreen, who went through a traumatic experience while undergoing chemotherapy.

Seven months into her treatment, Koreen and her husband were told their insurance company would no longer cover the cost of her medication, which was vital to her treatment, because the company implemented a new “white bagging” policy that dictated where -- and from which provider – she could obtain her medication.

More specifically, white bagging is a practice by insurance companies that requires patients to obtain their clinician-administered drugs by a specialty pharmacy selected by the insurance company, rather than the patient’s local care provider. While their care provider and local pharmacy remain in-network for most things, an insurance company picks and chooses certain drugs that will then become out-of-network resulting in patients experiencing more confusion, cost, and disrupted care. For patients to keep their providers, they would be required to pay the costs associated with receiving out-of-network care.

On behalf of Koreen, her husband Nate, her family, and many other patients across Wisconsin, I am happy to author Koreen’s Law to prohibit health insurance companies from mandating the practice of white bagging. To better understand the impacts of white bagging on Wisconsin patients and providers, please visit www.PatientsFirstWI.com.

Hoven Consulting, Inc., WiAHC’s lobbying firm, recently announced the addition of Nathan Butzlaff to its government affairs team. Butzlaff, who joined the firm as lobbyist and government affairs specialist, brings over 19 years of valuable experience in state and federal public policy and advocacy to Hoven Consulting and WiAHC.

“We are pleased to have Nathan join the firm,” said Tim Hoven, president of Hoven Consulting.

“He’s a talented professional with a great understanding of the legislative process on both the state and federal levels. I’m confident his public policy experience will bring great value to WiAHC and its members.” 

Butzlaff most recently worked in the Wisconsin State Assembly as a legislative aide for State

Rep. Samantha Kerkman (R-Salem) and for State Rep. John Macco (R-Ledgeview). Prior to his service in Wisconsin, he worked in Washington, DC as a legislative staff member for U.S. Senators Ted Stevens and Lisa Murkowski, as well as a state-federal liaison in the Washington, DC office of the Alaska Governor. Butzlaff also has experience working as a lobbyist for a Washington, DC lobby firm. He graduated from Georgetown University with a bachelor’s degree in marketing.

“I am excited to join the team at Hoven Consulting,” said Butzlaff. “I look forward to putting my knowledge and experience into practice to help WiAHC meet its public policy goals.” 

By Hoven Consulting – WiAHC’s lobbying firm

With the holidays right around the corner, the halls of the State Capitol will be relatively quiet through December. But despite the fact there will not be much visible legislative activity until the new year, plenty is going on behind the scenes as lawmakers work to shape their remaining legislative priorities before the session ends in April.

Similarly, WiAHC continues to position itself for the rest of the current session and future legislative success. One significant step in that direction was our Virtual Legislative and Policy Forum held on Nov. 8 where members learned how they can be effective grassroots advocates and had an opportunity to hear from and ask questions of key policymakers, including WI Department of Health Services Deputy Secretary Debra Standridge, DQA Administrator Otis Woods, and two state lawmakers – Rep. Rick Gundrum (R-Slinger) and Rep. Donna Rozar (R-Marshfield).

While we are looking forward to holding an in-person WiAHC “Day at the Capitol” in the future – which will allow us to have a much bigger advocacy impact – the virtual legislative and policy forum provided great value and helped raise our profile and increase our influence in the Capitol and among state government officials.

Speaking of strengthening advocacy efforts, WiAHC’s legislative committee and lobbyists have spent a considerable amount of time over the last year refining legislation to make modest but impactful changes to DHS 133, the administrative rule chapter regulating home health agencies. We are pleased to report the bill has been officially introduced as Senate Bill 700.

The impetus for the changes began as an effort to bring Wisconsin’s administrative rules in line with the federal government’s elimination of requirements for professional advisory bodies. The final version of the legislation will eliminate DHS 133.05 (2) in its entirety regarding advisory board requirements, as they are no longer compatible with federal law.

The legislative committee also recommended several other changes to Chapter 133 which would have created additional efficiency to patient care. After sharing those recommendations with the Department of Health Services and previously receiving their support, the agency raised concerns regarding these proposed changes late in the legislative drafting process. With an eye on the legislative clock, we chose to move forward with the scaled-down version that DHS does support and not jeopardize a potential veto.

Our Government Affairs Team worked with Representative Donna Rozar (R-Marshfield) and Senator Joan Ballweg (R-Markesan) to introduce the legislation and will work to advance the proposals through the legislative process before the legislature adjourns in Spring 2022. Please watch for opportunities coordinated by WiAHC to engage your legislators and request their support for the bill.

Yesterday the WI Department of Health Services’ Division of Quality Assurance (DQA) issued the following information to all DQA regulated providers regarding the Centers for Medicare & Medicaid Services (CMS) Interim Final Rule (released on Nov. 4, 2021), which requires COVID-19 vaccination for most healthcare workers at certain healthcare facilities certified by CMS:

On November 4, 2021, the Centers for Medicare & Medicaid Services (CMS) announced a new emergency rule related to a COVID-19 vaccination requirements for Medicare and Medicaid-certified health care providers and suppliers. Specifically, it requires all health care providers and suppliers that participate in a federally certified Medicare and Medicaid program under Conditions of Participation (COP) to develop a plan/process to vaccinate all staff with a first dose or single dose of COVID-19 vaccine by December 6, 2021. All eligible staff must be fully vaccinated by January 4, 2022.

The Emergency regulations apply to the following Medicare and Medicaid-certified providers/suppliers:

• Ambulatory Surgery Centers
• Community Mental Health Centers
• Comprehensive Outpatient Rehabilitation Facilities
• Critical Access Hospitals
• End-Stage Renal 2 Dialysis Facilities
• Home Health Agencies
• Home Infusion Therapy Suppliers
• Hospices
• Hospitals
• Intermediate Care Facilities for Individuals with Intellectual Disabilities
• Clinics
• Rehabilitation Agencies, and Public Health Agencies as Providers of Outpatient Physical Therapy and Speech-Language Pathology Services
• Psychiatric Residential Treatment Facilities (PRTFs)
• Programs for All-Inclusive Care for the Elderly Organizations (PACE)
• Rural Health Clinics/Federally Qualified Health Centers
• Long Term Care Facilities

The regulation does not apply to:

• Assisted Living Facilities; however, the mandate would apply to large assisted living facilities with more than 100 employees under the OSHA mandate.
• Home and Community-Based Services
• Physician’s offices

The vaccination requirement applies to eligible staff working at a facility that participates in the Medicare and Medicaid programs, regardless of clinical responsibility or patient contact. This includes:

• Facility employees
• Licensed practitioners
• Students
• Trainees
• Volunteers
• Individuals who provide care, treatment, or other services for the facility and/or its patients under contract or other arrangements

CMS has provided additional information about the COVID-19 Health Care Staff Vaccination Interim Final Rule in a FAQ document.

DQA Review:

CMS expects state survey agencies to conduct onsite compliance reviews of these requirements during recertification surveys and complaint surveys. Surveyors will check to determine if a facility has met the three basic requirements:

• Having a process or plan for vaccinating all eligible staff
• Having a process or plan for providing exemptions and accommodations for those who are exempt
• Having a process or plan for tracking and documenting staff vaccinations.
• Surveyors will review the facility’s vaccine policies, the number of resident and staff COVID-19 cases over the last 4 weeks and list of staff and their vaccination status. This information will be used to determine the compliance of the provider or supplier with these requirements.

CMS will host a second stakeholder call TODAY, November 10, from 2:30 – 3:30 p.m. CST. To register in advance, visit the CMS Webinar Registration. After registering, you will receive a confirmation email containing information about joining the webinar. Please note that CMS can only accommodate 10,000 participants so register early to guarantee your participation.

During the month of November, the home care and hospice community honors the millions of nurses, home care aides, therapists, and social workers who make a remarkable difference for the patients and families they serve. These heroic caregivers play a central role in our health care system and in homes across the nation. To recognize their efforts, we call upon all Americans to commemorate the power of caring, both at the home and in their local communities, and ask them to join with the National Association for Home Care & Hospice (NAHC) by celebrating November as Home Care and Hospice Month.

In addition, Home Care Aide Week takes place the second full week of the month, November 8-14, 2020. Join us in honoring these compassionate, tireless workers who play an invaluable role for their clients as caregivers, companions, and friends.

“Home care and hospice nurses, therapists, aides, and other providers who choose to use their lives to serve our country’s aged, disabled, and dying. This noble work deserves our recognition and praise and we celebrate November as Home Care & Hospice Month for that very reason.”  – NAHC President William A. Dombi