On June 6, the Governor’s Task Force on the Healthcare Workforce held a public meeting on the campus of Marquette University’s School of Dentistry.  The bulk of the livestreamed portion of the meeting was taken up by a panel discussion on education and training.  The following individuals participated in this discussion:

• Christina Patrin, Health Science Education Consultant, Wisconsin Department of Public Instruction (DPI)
• Danielle Cook, Education Director, Health Sciences, Wisconsin Technical College System (WTCS)
• • Note:  She is a task force member.
• Dr. Melissa Weege, Clinical Associate Professor, Radiation Therapy Program Director, UW-La Crosse
• Rebecca Larson, Executive Vice President for External Relations, Wisconsin Association of Independent Colleges and Universities

These panelists each gave some background information on their respective organizations, then discussed challenges, and possible solutions.  Patrin noted that while 60 percent of school districts in the state have a direct patient care training pathway (program) embedded in their schools, she noted that it is difficult to start such pathways at high schools.  Cook, Weege and Larson noted a number of similar challenges, including lack of classroom space, challenges in hiring faculty due to relatively low compensation levels, and continuing financial challenges for students. 

Next, the panelists proposed various solutions, including the following:

• Loan forgiveness for all health faculty, not just nursing faculty.
• Need incentives to help hire part-time health faculty.
• Need to do more to promote health care careers early on, even in elementary school.

The task force then moved on to the various breakout discussion groups and then adjournment, neither of which were covered in the livestream of this task force meeting. 

It is also worth noting that in preparation for the June meeting, a document listing draft task force recommendations was prepared.  The following is a high-level summary of these draft recommendations:

• Education and Training

• Recruitment and Retention

• Regulatory Policy

Help shape WiAHC’s Policy Agenda for the 2025-26 legislative session. The WiAHC Legislative Priorities Survey provides a tremendous opportunity to offer your input on what policy issues are most important to you and your organization. The purpose of surveying the full WiAHC membership is to help association leadership develop a policy agenda and determine what legislative and regulatory issues we should on focus during the 2025-2026 Wisconsin legislative session.

The survey takes only a few minutes to complete and will provide invaluable information used to help shape WiAHC’s advocacy priorities moving forward. The survey results will be presented to the WiAHC’s Legislative Committee and Board for further consideration. In addition to the member survey data, WiAHC leadership will consider the following criteria when finalizing the association’s policy agenda and issue priorities: 1.) The benefit to WiAHC members; 3.) The extent to which it will improve the delivery of home health care in Wisconsin; and 3.) The likelihood of legislative/regulatory success.

Once the WiAHC Board finalizes the policy agenda and legislative priorities for 2025-2026, it will be presented to the full membership and used by the WiAHC Government Affairs team to guide the association’s advocacy efforts over the next two years.

We value your input and encourage you to complete and submit the brief survey as soon as possible. Please CLICK HERE to take the survey.

After the state legislative session concludes in even-numbered years, the Legislative Council – the legislature's in-house, non-partisan group of attorney advisors – organizes study committees that perform in-depth reviews of various state policy matters facing Wisconsin.  Committees are comprised of both legislators and citizen members. 

Study committees hold hearings, during which they hear public testimony – including from subject-matter experts – on state policies that may need to be fixed or updated.  Once a committee has completed receiving public testimony, it generally drafts legislation for possible introduction and consideration by the legislature.  Recently, the scope of the Study Committee on the Regulation of Artificial Intelligence in Wisconsin was announced: 

“The Study Committee is directed to review current uses of artificial intelligence technology and make recommendations for legislation regarding the use and development of artificial intelligence technology. The committee may review the use of artificial intelligence in disinformation and artificial imagery and the feasibility of establishing a process to ensure continued state monitoring of high-risk use of artificial intelligence.”

State Senator Julian Bradley (R-Mukwonago), who will serve as chair, recently announced via press release the members of the committee.  Rep. David Armstrong (R-Rice Lake) will serve as vice chair.  Sen. Tim Carpenter (D-Milwaukee) and Rep. Clinton Anderson (D-Beloit) are the other legislator members.  Of the eight Wisconsin citizen members, there is one representative from the health care field – Jay Hill, who serves as vice president of advanced technologies for GE HealthCare.  The full committee membership list may be viewed on the Legislature’s website.

In his press release, Sen. Bradley also notes that this study committee “…will travel throughout the state to consider how the new technology will impact workforce, healthcare, law enforcement, government, and consumer protection.” 

The committee’s first meeting was held at the Waukesha County Technical College in Pewaukee on Wednesday, July 24. 

Each year on July 1, DHS is required by state law to adjust the maximum fees (factoring in the change in the consumer price index) that health care clinicians may charge for patient medical records.  The updated fee schedule may be viewed on the Legislature’s website. 

The 2023-24 legislative has come to an end, and legislators have shifted their focus to the upcoming election season and the need to connect with voters. With that in mind, it is more important than ever for WiAHC members to strengthen their relationships with their state lawmakers (and new legislative candidates) to educate them on the value of skilled home health care, the regulatory challenges we face, and the legislative solutions we need to increase access to care for patients. Rember, decisions state legislators make in the Capitol can have a significant impact on the home health care industry, your organization, and your profession.

One of the best ways you as a WiAHC member can engage your local legislators is to invite them to tour your facilities to illustrate firsthand the many benefits of home health care. These visits provide a tremendous advocacy opportunity, which is why WiAHC members across the state have already hosted numerous successful legislative tours. But we need to maintain the enthusiasm for this critical grassroots advocacy program, and WiAHC is excited and ready to set-up additional tours today.  

By Joyce Famakinwa | July 22, 2024

As home health providers continue to digest the proposed payment rule for 2025, National Association for Home Care & Hospice (NAHC) President William A. Dombi believes that the industry will ultimately see a comparatively toned down final rule.

“We believe we will not end up with this proposed rule as a final rule,” he said during the opening presentation at NAHC’s Financial Management Conference in Las Vegas on Sunday. “We will end up with something less draconian. The cuts will be reduced because, No. 1, that’s what they’ve done for the last several years, and, No. 2, it’s an election year.”

Even with a prediction of a “less draconian” final payment rule, NAHC is still gearing up to fight against home health cuts and the Centers for Medicare & Medicaid Services’ (CMS) payment-setting methodologies.

“Our focus more than anything else is remedy coming by way of Congress,” Dombi said. “If we run the clock back 365 days, we had a Congress that was telling us, very overtly, ‘We will not help you.’ They were telling us that because they believed [providers] were making too much profit in the Medicare program. They were not understanding how the business runs. They weren’t understanding how any margin [providers] got was subsidizing other government programs like Medicaid and Medicare Advantage. They now understand it.”

Dombi credits a meeting the organization had with Sen. Ron Wyden (D-Ore.), which took place in Portland, Oregon and included five home health agency representatives from the state.

“Senator Wyden asked the question: ‘MedPAC says your margins average 22%, are those numbers wrong or has something changed?’” Dombi said. “One agency representative immediately spoke up and said, ‘the numbers are wrong and things have changed for the worse.’ He started explaining what happened within his home health agency. Now Senator Wyden is working with us to help us bring about some positive legislative changes.”

Dombi noted that there is already pending legislation.

Still, working with Congress isn’t the only way NAHC plans to address the issue. The organization is still moving forward on its plan to sue the Department of Health and Human Services.

“The action plan continues with this litigation,” Dombi said. “This litigation does not give us quick remedies. My estimate is if we succeed in the first round, we will be facing an appeal by the government. If we lose, they’ll be facing an appeal. Then there’s still the step above that — the U.S. Supreme Court. This kind of litigation may take many years to get through.”

However, Dombi believes that last month’s Supreme Court decision, which struck down the Chevron doctrine, may help NAHC’s lawsuit.

The proposed payment rule wasn’t the only issue highlighted during Dombi’s rundown of legislative and regulatory updates, however.

80-20 silver lining

The “Ensuring Access to Medicaid Services” rule also came under fire, specifically its 80-20 provision, which is controversial among providers.

Dombi pointed out that caregivers should receive higher compensation for their work, but NAHC doesn’t believe that the 80-20 provision is the right method to achieve this.

“We’re in agreement that the direct care workforce is underpaid and underappreciated,” he said. “We don’t agree that the solution is to say, ‘You have to pay 80% of your payment rate as compensation to that workforce,’ when the states are paying you at such an abysmal level for the service. There’s nothing in this rule that increases payment rates for the providers of services.”

There is, however, a silver lining to the provision. It doesn’t require compliance for the first six years.

“In Washington circles, giving that much of a glide path for something to take effect is almost a death sentence, so we expect that there’ll be a number of changes or it will be abandoned along the way,” Dombi said.

Despite the 80-20 provision, Dombi explained that the rule had other aspects that would be beneficial to providers, including more accountability for the states regarding payment rates.

Dombi warned private-duty personal care providers not to fall into the trap of viewing the industry as being free of regulation.

“They may not be getting paid by federal or state governments, but they’re subject to a lot of rules and regulations, particularly under the Department of Labor,” he said.

Specifically, personal care is an industry that the department has its eye on when it comes to compliance with the Fair Labor Standards Act.

Aside from the DOL’s personal care focus, The Federal Trade Commission (FTC) also finalized a rule that effectively banned non-competes. Though this impacts all industries, Dombi noted that home care companies often rely on non-competes.

More recently, a federal court in Texas temporarily blocked the FTC’s non-compete ban. Dombi advised providers to follow these updates closely.

Last week, the Centers for Medicare and Medicaid Services (CMS) published its FY 2025 home health proposed payment rule, which calls for additional cuts to home health payments. Please find below some key information on the proposed rule:

• Home Health Care News Article: CMS Proposes Over 4% Cut to Home Health Medicare Payments In 2025
• NAHC Webinar: 2025 Home Health Prospective Payment System Rate Update Proposed Rule (tomorrow, July 2, 2024). More information HERE.
• Copy of proposed CMS Rule: CLICK HERE

WiAHC will be working with our national partners to submit official comments on the rule to CMS. Stay tuned for more information on that front.

The 2023-2024 state legislative session, which began on January 3, 2023, has ended. The State Assembly held its final floor date for the regular session on February 22, 2024, and the State Senate held its final regular session day on March 12, 2024.  While the Senate reconvened on May 14, 2024, for a “Veto Review” session day, during which they voted to override the Governor’s vetoes of nine bills, it appears unlikely that the Assembly will also reconvene to vote to attempt to override these vetoes.  Furthermore, it does not appear likely at this time that either chamber will reconvene before the November general election.

The following are highlights from the current biennial budget law, as well as other relevant legislation introduced during the 2023-2024 legislative session.

·     2023-2025 State Budget:

o   Home and Community Based Services (HCBS) Rate Increase Continuation: Provided $43,707,300 in FY2023-24 and $181,951,800 in FY2024-25 to continue the federal American Rescue Plan Act (ARPA) HCBS 5.0 percent rate increase from April 1, 2024, through June 30, 2025.

o   Personal Care Reimbursement:  Increased Medicaid personal care reimbursement rates by $12.9 million in 2023-24 and $25.4 million in 2024-25.

o   Complex Patient Pilot Program:  Provided $5,000,000 in FY2023-24 on a one-time basis to help facilitate the transfer of complex patients from acute care settings, such as hospitals, to post-acute care facilities, such as nursing homes.

o   Allied Health Professional Training:  Provided $2,500,000 annually to expand allied health professional education and training grants.  Expanded eligibility for the program to include registered nurses.

o   Nurse Educators:  Maintained $5 million in annual funding for this program. 

·     Other 2023-2024 Legislative Highlights:

o   Support – Enactment of Senate Bill 476:  Codifies existing state regulations allowing health care providers that do not have a physical location in Wisconsin to be certified as a Medicaid provider in order to treat patients who are Medicaid beneficiaries via telehealth as long as the provider is licensed in the state and is in good standing with the relevant occupational licensing board.  Governor Evers signed this bill on March 22, 2024. 

o   Support – Assembly & Senate Passage of Senate Bill 158:  Grants preliminary occupational health care credentials to those who recently completed the requirements to obtain such a credential (e.g., recent graduates), submitted a license application, and have been engaged by a qualifying health care employer.  The intent behind this bill was to expedite the processing of health care occupational credentials.  Governor Tony Evers vetoed this bill on March 29, 2024. 

o   Support – Assembly Passage of Assembly Bill 204:  Increases the renewal period for health and business occupational credentials from two years to four years.  This legislation passed the Assembly, but the Senate did not vote on it before the end of the legislative session. 

o   Support – Assembly Bill 507:  Prevents an insurance policy from requiring prior authorization for certain health care services, including the first 12 visits for physical therapy, occupational therapy, speech therapy, or chiropractic services.  The Assembly Health Committee voted unanimously to recommend full Assembly approval of this bill.  However, neither the Assembly nor the Senate took any further action on this bill prior to the end of the legislative session.

·       Miscellaneous Policy Priorities

o   Amending Legislation Limiting Prior Insurance Authorization for Certain Health Care Services:  WiAHC’s government relations representatives will continue to work with the authors of such legislation (e.g., Assembly Bill 507 referenced above) and stakeholders to add “skilled home health nursing” to such legislation to exempt that type of service from prior insurance authorization in certain circumstances.

o   Updating Department of Health Services Regulations: 

§  Professional Advisory Bodies:  WiAHC will continue to work with DHS to remove outdated state regulations related to professional advisory bodies for home health agencies.  Our intent is that this change will be incorporated into a large package of regulatory updates that DHS works on every two years.

·       Governor Signs Bill Creating New State Legislative District Maps

o   On December 22, 2023, the State Supreme Court issued a ruling that Wisconsin’s state legislative district maps are unconstitutional and the maps for each such district must be redrawn before the 2024 elections.  State Supreme Court justices voted 4-3 in favor of this ruling.  The decision focused on specific state legislative districts that include non-contiguous portions of land, which the court found violated the state constitution. 

o   Specifically, the court ruled that the legislature must redraw the boundaries for each state Assembly and state Senate district in advance of the August 2024 primary election.  If the legislature and Governor Evers were not able to agree on legislation creating new district boundaries, the court noted that it would decide on the new boundaries.  As a practical matter, the state Elections Commission noted that new district boundaries needed to be finalized by March 15, 2024. 

o   In January 2024, the parties to the case submitted various proposed state legislative district maps to the court and the court-appointed consultants reviewed these maps and provided their analysis to the court on February 1.  However, in mid-February, the Legislature passed a bill with the version of state legislative district maps that Governor Evers previously submitted to the court.  This legislation passed both chambers of the Legislature with mostly Republican votes and was sent to the Governor.  On February 19, 2024, Governor Evers signed this legislation.  As such, these new legislative district maps have taken effect for legislative candidates who are elected in November 2024.  These new maps may be viewed on the Legislature’s website.

·     Governor Creates Task Force on the Healthcare Workforce

o   On January 29, 2024, Governor Tony Evers signed an executive order creating the Governor’s Task Force on Healthcare Workforce.  According to the Governor’s press release on this topic: “The task force will be charged with studying the workforce challenges facing the state’s healthcare system, including recruitment and retention, identifying ways to improve patient care and alleviate the burdens on the healthcare workforce, exploring educational and training pathways to grow a sustainable healthcare workforce, and creating an action plan with solutions related to workforce development, industry innovation, education, and training for consideration in the governor’s 2025-27 biennial budget.”

o   The task force is chaired by Lieutenant Governor Sara Rodriguez, a registered nurse with a master’s degree in public health, who has worked for both the U.S. Centers for Disease Control and Prevention and as a chronic disease director for the state of Colorado. 

o   The task force is co-chaired by state Department of Workforce Development Secretary Amy Pechacek and state Department of Health Services Secretary Kirsten Johnson.  Prior to being named DHS Secretary, Kirsten Johnson led the City of Milwaukee Health Department, as well as the Washington-Ozaukee Health Department.

o   Task Force members also include representatives from institutions of higher education, medical providers, patient advocacy organizations, among others. 

o   In March 2024, representatives from WiAHC and the Wisconsin Hospice and Palliative Care Association (WiHPCA) participated in a joint meeting with the task force chair, Lieutenant Governor Sara Rodriguez, to discuss health care workforce issues.  Various issues were discussed, including reimbursement from insurers and public sector payers, medical personnel wage levels, and the potential to expand an existing effort to concurrently train high school students to be licensed practical nurses (LPNs), so that they are able to graduate from high school and immediately enter the workforce. 

o   Please be assured that WiAHC’s government relations representatives will continue to monitor the work of this task force.  For more information about this task force, please visit the task force’s website. 

In late May, the state Department of Health Services (DHS) announced that the electronic visit verification (EVV) hard launch begins on October 1, 2024.  The following service codes are impacted:

• Home health care services (service codes 92507, 97139, 97799, 99504, 99600, S9123, S9124, T1001, T1021, T1502)

• Personal care nurse supervisory visits (service code 99509)

As you are likely aware, the federal government is requiring the hard launch of EVV in Wisconsin as a condition of the state receiving its full allocation of Medicaid funding. 

If your home health agency has not yet started to implement EVV, WiAHC strongly recommends that such agencies start the process immediately as the implementation process may take longer than expected.  Please note that DHS is able to provide assistance with implementation.  Wisconsin EVV customer service may be reached Monday through Friday, from 7:00AM – 6:00PM (Central Time) at 1-833-931-2035 or via email at vdxc.contactevv@wisconsin.gov.  Also, there is additional information regarding EVV implementation on the DHS website, including an online “Key Conversation” that DHS will hold on July 15 from 1:00PM – 2:00PM (Central Time) to answer questions. 

This task force’s most recent meeting was held on May 9 at the University of Wisconsin-La Crosse campus.  The initial portion of the agenda was a panel discussion on recruitment and retention that featured the following panelists:

• Dr. Hannah Maxey, Veritas Health Solutions (NOTE: She served as panel moderator.)
• Dr. Tom Kernozek, Professor and Chair, Department of Health Professions, UW – La Crosse (Task Force Member)
• Heather Schimmers, President, Gundersen Health System (Task Force Member)
• Ann Zenk, Senior Vice President of Workforce and Clinical Practice, Wisconsin Hospital Association (WHA)

Zenk discussed the annual workforce report that WHA publishes.  WHA is concerned about the “silver tsunami” – the increase of those Wisconsinites aging into retirement.  She also discussed that in 2022, the nursing shortage hit Wisconsin hard, as nurses comprise over half of a hospital’s workforce.  Kernozek discussed UW-La Crosse’s health education programs and how they partner with local school districts and health systems with a presence in the area.  With respect to challenges, he discussed their faculty recruitment and retention issues.  Schimmers discussed the hiring challenges that Gundersen faces and how they made changes to try to improve.  She noted that there is high turnover within the first 1-2 years of joining the health care profession and that the industry is not preparing the workforce enough for the hardships they will face in the workplace.

The three panelists proposed a number of solutions:  Medicaid reimbursement expansion, loosen restrictions on requirements for faculty, uniform licensing processes, tax incentives for nursing preceptors (mentors), loan repayment programs for faculty, among others.

The next portion of the meeting featured Dr. Maxey reviewing the themes discussed during the breakout sessions held during the task force’s April 4 meeting:  education, incentives, funding, and apprenticeships.  Please note that these issues were addressed in our summary of the task force’s April 4 meeting. 

The final portion of the agenda featured breakout groups, which came up with numerous proposed solutions to workforce challenges.  The groups came up with numerous suggestions, including encouraging worker usage of employee assistance programs, target funding based on geography and need, expanding Medicaid, invest in apprenticeship and related programs, marketing campaign to seek health care workers, removing the state “benefits cliff” for workers who are promoted, encouraging high school students to seek concurrent training for certain roles (LPNs, etc.), tax incentives for preceptors (mentors), among others.

The meeting closed with an announcement that the task force’s June meeting will review prior workforce improvement suggestions and transform them into draft task force recommendations that will be prioritized.