By Hoven Consulting – WiAHC’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 Tony 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 likely of interest to WiAHC:

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.

• WiAHC Supports Bills Addressing Occupational Credentialing

WiAHC has decided to support the following bills that attempt to streamline the occupational credentialing process:

• Assembly Bill 144/Senate Bill 158:  In order to help expedite the occupational credentialing process for new college graduates in the health care field, these bills would require the state Department of Safety and Professional Services to grant preliminary occupational credentials to those who have recently completed the requirements to obtain a health care credential, submitted a license application, and have been engaged by a health care employer. 
• Assembly Bill 143/Senate Bill 160:  These bills would help reduce processing delays for individuals applying for occupational credentials to be occupational therapists, occupational therapy assistants, advanced practice nurse prescribers, and certain other health care professions by no longer requiring such applicants to take a “statutes and rules” exam.  Instead, such applicants may need to affirm that they have read and understood the statutes and rules that apply to the applicants’ practice.
• Senate Bill 193/Assembly Bill 204:  This bill changes the two-year renewal period for health and business occupational credentials to four-year renewal periods. 

·       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.

WiAHC is happy to remind members about and provide links to the latest articles and information on the home health care industry from Home Health Care News and other publications:

· Home Health Stakeholders Call on CMS To Rectify ‘Significant’ Forecast Errors From 2021, 2022

Home Health Care News – By Joyce Famakinwa | May 17, 2023

Home health stakeholders are urging the Centers for Medicare & Medicaid Services (CMS) to address an alleged forecast error in the home health market basket for 2021 and 2022. Broadly, CMS calculates the expected impact of cost inflation for home health agencies annually. In order to do this, CMS relies on a forecasting methodology from a private entity that is applied to the most recent cost data available for home health care. Read More…

·  ‘Sky is falling’ under weight of home health cuts, NAHC’s Dombi says

McKnights Home Care – By C. Max Bachmann | May 16, 2023

The healthcare industry is nearing a breaking point due to the Centers for Medicare & Medicaid Services’ 3.925% behavioral rate cut enacted in January, home care leaders said recently. “Hospitals are saying, ‘we can’t find a place to send out patients,’ and patients are saying the same thing,” William Dombi, president of the National Association for Home Care & Hospice said during a McKnight’s Home Care Newsmakers podcast. “We’re starting to see home health agencies reject care for Medicare Advantage patients because they are paying less than cost. Those are signs and symptoms that the sky is starting to fall.” Read more…

·       The Public Health Emergency’s End Will Mark ‘Significant’ Change for Home Health Providers

Home Health Care News – By Joyce Famakinwa | May 10, 2023

Now that the public health emergency (PHE) is ending, home health stakeholders are taking stock of what ripple effects will impact the industry most. The Trump Administration first declared the PHE in March of 2020, retroactive to Jan. 27, 2020. In January, the Biden administration announced that the PHE would end on May 11. Read More…

·       2024 Hospice Proposed Rule Offers Hints on What’s to Come For Home Health Agencies

Home Health Care News – By Joyce Famakinwa | May 3, 2023

Many home-based care providers tend to offer both home health and hospice services. Thus, home health leaders pay close attention to proposed rules in hospice.  Home health providers are still weeks away from getting a glimpse at their proposed rule for 2024. Read more…

Home Health Care News, which is part of the Aging Media Network, is a leading source for news and information covering the home health industry.

Recognizing potential big changes on the legislative and regulatory front this year in Washington, D.C., the National Association for Home Care and Hospice (NAHC) has once again planned ahead with strategies to protect the continued viability of home care and hospice across the country.

In fact, NAHC recently posted its finalized 2023 Regulatory and Legislative Blueprints, which entail a comprehensive review of all NAHC policy positions on matters impacting the home care and hospice community.

In addition, the NAHC Board of Directors has identified a list of specific legislative and regulatory priorities for 2023. These priorities, selected from the larger Blueprints, address issues related to workforce, home health, hospice, home care, and innovation. The priorities highlight the areas needed for Congressional and regulatory action to support and expand care in the home. The proposed priorities aim to improve access to high-quality care, reduce costs, and address workforce shortages to better meet the needs of patients and their families.

The full Legislative and Regulatory Priority Reports are linked below for your review:

·        NAHC 2023 Legislative Priorities

·        NAHC 2023 Regulatory Priorities

By Hoven Consulting – WiAHC’s lobbying firm

• Electronic Visit Verification (EVV) Will Be Implemented on May 1, 2023

As of May 1, 2023, the state Department of Health Services (DHS) will begin imposing penalties when personal care and home health agencies do not collect the required electronic visit verification for Medicaid-covered personal care and supportive home care services.  This is otherwise known as the “EVV hard launch.”  The included service codes are:  T1019, T1020, S5125 and S5126. 

DHS is imposing these penalties to ensure that the state receives its full allocation of federal Medicaid funding. 

If you would like additional information, please review the April 2023 ForwardHealth Update.  If you have any questions, please feel free to contact DHS EVV Customer Care at 1-833-931-2035 between 7:00AM – 6:00PM (Central Time), Monday through Friday or via email at vdxc.contactevv@wisconsin.gov.

• Temporary Health Care “Act 10” Occupational Licenses Will Continue to Be Available

During the COVID-19 pandemic, Governor Tony Evers signed into law legislation that became 2021 Wisconsin Act 10.  This legislation allowed health care professionals who are licensed in good standing in other states to work in Wisconsin immediately, without obtaining a permanent occupational credential.  This was to ensure that Wisconsin had enough health care professionals to treat Wisconsinites during the pandemic.  These temporary licenses are known as “Act 10 licenses.”

This state law was tied to the end of the pandemic-related Presidential Emergency Declaration.  On April 10, 2023, President Biden signed federal legislation that ended this emergency declaration.  According to state law, the “Act 10 licenses” expire 30 days after the Presidential Emergency Declaration ends – which is May 10, 2023 – unless the license holder applies for a permanent license by that date.  If a license holder applies for a permanent license by that date, that individual will still be allowed to practice in Wisconsin.

In addition, there is a provision in 2021 Wisconsin Act 10 that could benefit out-of-state health care professionals who seek Wisconsin licensure after May 10, 2023, and wish to practice immediately in the state.  If an individual’s out-of-state license is in good standing, that professional could apply simultaneously in Wisconsin for an “Act 10 license” and a permanent license and would be able to practice immediately in Wisconsin. 

For more information on “Act 10 licenses,” please go to the state Department of Safety and Professional Services’ FAQ page. 

The WiAHC Legislative Committee is charged with developing the association’s legislative priorities and providing direction and support on public policy that impacts Wisconsin’s home health care industry. The committee, which meets once a month, also evaluates legislative and regulatory issues of importance as they arise and leads WiAHC’s lobbying and grassroots advocacy efforts. The committee recently acted on the following items:

·         State Funding for Nurse Educators

WiAHC’s 2023-24 Legislative Agenda includes a priority to strengthen Wisconsin’s home health care workforce. More specifically, WiAHC is working to secure additional state funding to increase the supply of nurse educators in Wisconsin. As such, the WiAHC Legislative Committee recently approved a member-driven grassroots advocacy campaign to encourage the WI Legislature to provide $10 million in additional funding to boost the state’s Nurse Educators program.

The Nurse Educators program was established two years ago to support nursing education and increase the number of nurses in Wisconsin by providing grants to nurses enrolled full-time in doctor of nursing or mater of nursing programs. Grant recipients must commit to teaching at an approved Wisconsin nursing school for at least three years post-graduation. Providing additional funding for this program is more important than ever, as nursing education programs across the state are struggling to turn out enough graduates to meet the growing demand for nurses in Wisconsin.

Please be on the lookout for a WiAHC Advocacy Action Alert asking you to contact your state lawmakers and urge them to support $10 million in funding for the Wisconsin Nurse Educators program as part of the state budget bill.

• Legislation to Expedites Health Care Occupational Licensing in Wisconsin
• Speaking of workforce challenges in the home health care industry, many of our members have had trouble and experienced delays securing occupational licenses from the Wisconsin Department of Safety and Professional Services (DSPS). The licensing backlog at DSPS is exacerbating the state’s health care workforce shortage crisis, and WiAHC has been encouraging policymakers to address the problem. In fact, the WiAHC Legislative Committee recently voted to support Assembly Bill 144, legislation to expedite occupational licensing in Wisconsin.

This bill requires the state to grant preliminary occupational credentials to health care professionals. More specifically, the bill requires DSPS to grant a preliminary credential to an individual who has met all the requirements for a permanent credential, including having completed all education, training, supervised experience requirements. In addition, an applicant for a preliminary license must also: 1.) Attest that they do not have a disqualifying arrest or conviction record; 2.) Verify that the position they have been hired for is within the scope of their practice; and 3.) Confirm that they have applied for a permanent credential. Finally, the health care employer that hired the applicant must verify that the individual has – to the best of the health care employer's knowledge – completed the required education, training, and supervised experience necessary for a permanent credential. 

WiAHC is happy to remind members about and provide links to the latest articles and information on the home health care industry from Home Health Care News and other publications:

·         CMS To Publicly Release All Ownership Info of Home Health, Hospice Agencies

Home Health Care News – By Andrew Dolan | April 20, 2023

The U.S. Department of Health and Human Services (HHS) is making ownership data for all Medicare-certified home health and hospice agencies publicly available. The Centers for Medicare & Medicaid Services (CMS) announced the news early Thursday. Read more…

·         Providers On Biden’s Executive Order, Home-Based Care ‘Drumbeat That Won’t Be Ignored’

Home Health Care News – By Andrew Dolan | April 19, 2023

The Biden administration has made mention of home-based care regularly and intentionally during its tenure in the White House. It did so again Wednesday, this time through 50-plus directives for government agencies, many of which were home care-related. Though still just directives, the sitting president making this sweeping of an executive order focused on senior care – in part – is worth plenty of weight. Read More…

·         As States Negotiate Budgets, Biden’s Executive Order Puts Home-Based Care at The Forefront

Home Health Care News – By Andrew Dolan | April 18, 2023

In tandem with an executive order, the White House announced a bevy of directives for government agencies on Tuesday, many of which were centered around bettering home-based care. Perhaps most notable is the timing, however. As states work through their budgets and potential Medicaid spending, the Biden administration has put home care at the forefront of their minds. Read More…

·         Nearly 800,000 More Nurses Are Expected to Leave Field Within 5 Years

Home Health Care News – By Andrew Dolan | April 17, 2023

Nearly 100,000 registered nurses left the field during the COVID-19 pandemic, according to an analysis conducted by the National Council of State Boards of Nursing (NCSBN). Worse yet, the analysis suggested that nearly 800,000 more nurses could leave the field by 2027. For home health providers already short on staffing, that could mean significant headwinds over the next five to ten years. Read more…

Home Health Care News, which is part of the Aging Media Network, is a leading source for news and information covering the home health industry.

WiAHC’s grassroots advocacy program is critical to the success of the association’s overall government affairs program. It allows our members to have a voice and influence in shaping public policy that impacts home health care in Wisconsin.

With that in mind, we are pleased to report about WiAHC’s latest legislative advocacy outreach effort.  WiAHC Board member Nicole Naidl recently hosted state lawmaker Rep. Paul Tittl (R-Manitowoc) at Holy Family Memorial Home Care (Manitowoc Medical Center) to discuss WiAHC and home health care in the Badger State.

The meeting, which also included WiAHC Advocacy Director Micheal Welsh, provided a tremendous opportunity to have a conversation about the importance of home health care for Wisconsin patients. Nicole did a great job briefing Rep. Tittl on the value of home health care and WiAHC’s legislative priorities, which focused primarily on the industry’s workforce challenges.  WiAHC would like to thank Nicole for making time to host the meeting. She did a wonderful job leading the discussion and was a fantastic representative of WiAHC. Her passion for home health care was evident and appeared to have a big impact on Rep. Tittl.

As mentioned above, grassroots advocacy is the most powerful tool WiAHC has at its disposal to shape public policy – and building relationships with lawmakers is the most important aspect of grassroots advocacy. The meeting with Rep. Tittl was just the latest endeavor in WiAHC’s goal to connect members with their local legislators. WiAHC encourages all members to participate in this critical grassroots advocacy program. If you or your organization is interested in hosting a state lawmaker, please contact the WiAHC office at wiahc@badgerbay.co.

By Hoven Consulting – WiAHC’s lobbying firm

• WiAHC Advocacy on State Budget Bill

One of WiAHC’s top legislative priorities for the 2023-24 legislative session is to strengthen Wisconsin’s home health care workforce. More specifically, WiAHC will be working to secure additional state funding to support efforts to increase the supply of nurse educators in Wisconsin.

Fortunately, Gov. Tony Evers has included a provision in his state budget bill proposal to allocate an additional $5,000,000 annually for the state’s nurse educators program. The program provides the following to boost the state’s nursing workforce:

While WiAHC will be implementing numerous advocacy tactics to support the proposal and win legislative approval – including direct lobbying and member grassroots advocacy engagement – one of the first steps we can take is to “enlist” members to testify on the initiative before the Joint Finance Committee’s public hearings on the budget bill.

In fact, the Co-Chairs of the GOP-controlled Joint Finance Committee – the Legislature’s powerful budget-writing committee – recently announced they will hold the following four public hearings across the state to give Wisconsin residents the opportunity to testify on issues related to the Fiscal Year 2023-2025 State Budget bill, which lays out the state’s spending plan for the next two years:

If you are interested in attending one of the public hearings and testifying in favor of the nurse educators funding proposal on behalf of WiAHC, please contact WiAHC Advocacy Director Michael Welsh for coordination purposes.  You may reach Mike at mwelsh@weda.org. 

Please keep in mind the public hearings on the budget bill are very well attended and generally take all day. Individuals who testify typically have two minutes to speak and could wait several hours for their brief appearance before the committee. With that said, there is still significant value in testifying before the committee and signaling to lawmakers that the nurse educators funding proposal is important to home health care and the overall health care workforce in Wisconsin.

• State Legislative Committee Suspends Certain DHS Immunization Requirements for Children

Earlier this year, the state Department of Health Services (DHS) announced updates to the required immunizations for children attending school, as well as those placed in child-care facilities. The changes to chapter DHS 144 of state administrative rules include requiring:  (1) children to receive the Tdap (tetanus, diphtheria, and acellular pertussis) vaccine at the start of the seventh grade (instead of the sixth grade), (2) students starting seventh grade to receive a meningococcal vaccine (MenACWY-containing vaccine), (3) high school seniors to also receive a booster of the meningococcal vaccine, (4), parents/guardians to obtain proof from a medical clinician that their child in child care or school has had chickenpox if they want their child to be exempted from the chickenpox vaccine, and (5) updating the definitions of “substantial outbreak” for both child care centers and schools so that they are aligned with Centers for Disease Control and Prevention (CDC) definitions and to add chickenpox and meningococcal disease to the definitions.

As originally released, these requirements took effect at child-care centers on February 1, 2023, and were to take effect for school-age children at the start of the 2023-2024 school year. 

On Tuesday, March 7, the Legislature’s Joint Committee for Review of Administrative Rules (JCRAR) held a public hearing in Madison to consider suspending these updated state administrative rules.  Two days later, JCRAR voted 6-4 to suspend portions of chapter DHS 144 of state administrative rules addressing student immunizations.  The following items were suspended: 

As a result of this March 9 vote in JCRAR, this will likely suspend implementation/enforcement of the three portions of chapter DHS 144 referenced immediately above until at least spring 2024. 

• WiAHC Supports Occupational Licensing Legislation

At its March meeting, the WiAHC Legislative Committee agreed to support the following legislation:

• Governor Evers Appoints New Secretary of State

Effective on Friday, March 17, longtime Wisconsin Secretary of State Doug La Follette resigned his position.  He had held that position for more than 40 years and was re-elected to a four-year term in November 2022.  Also, on Friday, March 17, Governor Evers appointed former State Treasurer Sarah Godlewski as the new Secretary of State.  Godlewski will serve out the remainder of La Follette’s term, which will end in January 2027. 

Earlier this month, the WiAHC had the opportunity to ask State Representative Clint Moses (R-Menomonie), Chair of the Assembly Health, Aging and Long-Term Care Committee, what his health care-related policy goals are for the 2023-24 legislative session. Here is what he had to say:

“My health priorities this session is to address the healthcare workforce shortage and to help make healthcare more affordable and accessible for Wisconsin citizens. Throughout Wisconsin, the health care workforce shortage has reduced accessibility to quality care. We have seen reduced service options and closures of clinics. In many cases, people are driving over an hour plus for a routine checkup. This creates a challenging situation for patients, especially for our aging population who face increasingly difficult decisions when it comes to their healthcare. I have been spending time learning about regulations surrounding Senior Care, IRIS, Nursing Homes, and Hospitals services across the state. I have also been on numerous tours in health care facilities and have met with many health care providers. I look forward to working with all the stakeholders to make Wisconsin a healthy state for all ages.”

Representative Clint Moses (R-Menomonie) represents the 29^th Assembly District in northwestern Wisconsin, which includes portions of Dunn and St. Croix Counties. He was first elected to the Assembly in 2020 and was reelected in 2022. He currently serves at the Chair of the Assembly Health, Aging and Long-Term Care Committee. Rep. Moses, who resides in Menomonie with his wife and four daughters, is a chiropractor by trade. He operates Red Cedar Chiropractic with his wife, Dr. Nora Moses, and has been caring for residents of Dunn County for 20 years. He is a member of the Chiropractic Society of Wisconsin, Community Foundation of Dunn County, lifetime alumni member of Northwestern Health Sciences University, and has served on the Colfax Health & Rehabilitation Board.