On May 13, the Wisconsin State Supreme Court struck down the Safer at Home extension ordered by Department of Health Services Secretary-designee Andrea Palm. While the Court did not rule on the legality of the Safer at Home policy, it did rule the process by which the policy was implemented was illegal.

The Court ruled that Secretary-designee Palm did not have the singular authority to extend the Safer at Home order to May 26 and stipulated the action required emergency rulemaking procedure, which was not executed by the Department.

At the heart of the issue was whether or not DHS can extend the Safer at Home order beyond May 11. Governor Tony Evers declared a public health emergency in March. By law, such declarations expire after 60 days. In this specific instance, the expiration date was May 11. 

Emergency Order #28, issued by Palm, extended the Safer at Home order two weeks beyond the expiration date. Palm and DHS cited statute 252.02 as providing the department the authority to take actions to combat outbreaks of communicable disease outside the confines of a 60 day public health emergency declaration. Republican legislative leaders disagreed with the interpretation of that statute and filed the challenge in the State Supreme Court.

The ruling was decided on a 4 to 3 vote. One conservative member, Justice Brian Hagedorn, disagreed with his conservative colleagues, stating in his dissent, “The legislature may have buyer's remorse for the breadth of discretion it gave to DHS in Wis. Stat. § 252.02. But those are the laws it drafted; we must read them faithfully whether we like them or not.”

In the wake of the ruling, Wisconsin is now without a statewide strategy to combat COVID-19. While the Department of Health Services took direction from the ruling and submitted proposed emergency rules to the legislature for approval, it rescinded that proposal on May 18, after comments from Republican legislative leaders who want to leave ongoing strategies to local public health departments.

Dane County, for instance, issued its own Safer at Home order shortly after the Court’s ruling on May 13. Other counties followed suit, but some later rescinded after confusion over their legal authority to do so became unclear. This confusion caused Attorney General Josh Kaul to issue an opinion that nothing in the Supreme Court’s ruling affects the authority of local public health officials to issue Safer at Home orders for their jurisdictions.

There is, however, some public opposition to local orders. On Wednesday, May 20, a group of Wisconsin citizens filed a challenge against local orders on Constitutional grounds in federal court in Milwaukee. The challenge states that safer at home orders infringe upon rights to freely assembly and freely practice religion. There has yet to be any developments in the challenge beyond the initial filing.

WiAHC’s lobbyists continue to closely monitor the situation and will provide updates as they’re available.

On Thursday, May 21, Governor Tony Evers announced $100 million in grants to home and community based services, long-term care, and emergency medical services. The funds are made available from federal dollars allocated by the CARES Act.

According to the linked press release, the program will be administered in two parts: an initial release of funds to support immediate needs, and a second, targeted release for additional needs of individual providers. Both rounds of funding will be allocated to support expenses directly related to COVID-19 as well as expenses associated with the interruption of typical operations, such as overtime pay, changes to sanitation procedures, and disruption to the standard delivery of care.

“We recognize the significant burden the COVID-19 response has placed on these providers,” says Governor Evers. “We also recognize the integral role they play in ensuring the health and safety of some of our most vulnerable Wisconsinites and we want to support their efforts during this pandemic.”

WiAHC’s lobbyists have been told by DHS that additional specifics for distributing the funds are forthcoming. They will update members as more details are made available.

The WiAHC Spring Conference has moved to virtual! This gives you and your entire agency the ability to watch all conference sessions for one price. This is the first time you do not need to choose who attends each breakout session or who attends the WiAHC Spring Conference from your agency. Everyone can benefit, firsthand!

There are experts presenting from Florida, Missouri, New Jersey, Pennsylvania, Texas and Wisconsin.  Five sessions are for new nurses presented by Teresa Northcutt, BSN RN COS-C HCS-D HCS-H, Senior Associate Consultant, Selman-Holman, A Briggs Healthcare Company. We have three sessions by Larry Prince, CEO and Managing Partner, Prince Health, LLC covering motivating employees and managing performance during times of change. Phil Ward, CHA, President of Hospice Operations, Community Hospice and Palliative Care presents on improving profitability of hospice GIP facilities and the evolution of business intelligence. Other topics include PDGM, infection control, revenue cycle management and many more.

Register today!

Wisconsin Health News, May 11, 2020

A decontamination system that will allow N95 respirators to be reused up to 20 times is now up and running, Gov. Tony Evers said Saturday. 

The system, developed by private nonprofit research firm Battelle Memorial Institute, will be able to decontaminate up to 80,000 respirators daily.

The services, including shipping, will be provided to Wisconsin healthcare organizations and professionals free of charge.

Caitlyn Farragher, Battelle’s Wisconsin site lead, said they plan 24-hour operations to ensure a "timely turnaround time."

Community COVID-19 testing sites are also set to open in Madison and Milwaukee this week. That builds on testing sites launched in communities in northern and central Wisconsin. 

“Anyone who goes to one of these community testing sites will receive their test for free,” Evers told reporters Friday. “If you need a test, we want you to get a test.” 

He said that the state is in “pretty good shape” for testing supplies, like swabs and reagents, but still needs help from the federal government. 

Evers unveiled a series of guidelines Friday on best practices and safety tips for businesses looking to keep workers, customers and families safe as they reopen.

The guidelines were developed by the Wisconsin Economic Development Corporation in consultation with other state agencies as well as industry associations and experts. 

There were 629 additional cases of COVID-19 and 16 more deaths reported over the weekend. As of Sunday, there were 10,219 positive cases and 400 deaths in total. 

Meanwhile, more health systems are restarting elective procedures. Ascension Wisconsin said Friday that it’ll start gradually reintroducing more services for non-urgent and medically necessary procedures as well as primary and specialty care clinic appointments. Bellin Health also said Friday it was resuming procedures and non-urgent appointments put on hold due to the pandemic.

And Marshfield Clinic Health System said Monday it has begun performing non-urgent surgeries at its hospitals in Marshfield and Eau Claire and anticipates increasing the number of procedures at its other hospitals and outpatient surgery centers in the next several weeks.

Advocate Aurora Health and other health systems throughout the state are pursuing similar efforts. 

Governor Tony Evers today announced Wisconsin’s new Battelle Memorial Institute Critical Care Decontamination System™ is now ready and available for use by the state’s health care workers and first responders to decontaminate their N95 respirators so they can be reused up to 20 times. The Battelle system decontaminates N95 respirators by killing viruses and bacteria using hydrogen peroxide gas, and will greatly extend the life of a vital piece of Personal Protective Equipment (PPE).

The Battelle system will be able to decontaminate up to 80,000 N95 respirators on a daily basis. It can decontaminate respirators up to 20 times without degrading filtration performance. The usual decontamination turnaround time for users is a maximum of 72 hours, plus shipping time, as long as the site is not over its capacity for use. The Battelle system can only decontaminate respirators, and not other items of PPE. It is also not authorized for use with respirators containing cellulose-based materials.

Battelle decontamination services, including shipping, will be provided to Wisconsin healthcare organizations and professionals free of charge. Eligible healthcare providers include, but are not limited to, hospitals, nursing homes, public health professionals, human and child protective services offices, emergency managers, first responders, coroners, medical examiners, law enforcement and correctional institutions, home health organizations, pharmacists, rural health services and dental offices.

The new Battelle system highlights decontamination efforts ongoing throughout Wisconsin to try to ensure that health care workers and first responders can be as safe as possible when performing their duties.

With all of the decontamination efforts underway in Wisconsin, health care workers and first responders are being asked to save their used PPE supplies for decontamination. Throughout the past couple of weeks, outreach efforts were conducted to inform health care workers and first responders on how to sign up for the Battelle system decontamination service, and ensure their masks are safely returned to them.

Through a partnership with the Federal Emergency Management Agency (FEMA) and Defense Logistics Agency (DLA), the State of Wisconsin received the Battelle system this week. Battelle developed the system in 2015 to help decontaminate PPE to prevent further spread of Ebola. The Columbus, Ohio company is currently deploying the system to 60 different sites across the nation.

Beyond the Battelle system, other decontamination efforts in Wisconsin include UV decontamination sites. These sites service N95 respirators as well as other types of PPE, such as face shields, gowns, and aprons. UV decontamination facilities are currently operating in much of Wisconsin, highlighted by sites in Brown, Dane, Kenosha, and Sawyer counties.

In addition to statewide decontamination efforts, Wisconsin continues to work on building up its stockpile of PPE supplies. Last week Wisconsin received a delivery of 230,000 N95 respirators from FEMA. Gov. Evers continues to request more of these supplies to meet Wisconsin’s pressing need.

The full press release from the Governor is available online (link).

Governor Tony Evers today announced Wisconsin has received a delivery of 230,000 N95 respirator masks from the Federal Emergency Management Agency (FEMA), providing a needed boost to efforts to obtain personal protective equipment (PPE) for distribution in the state. FEMA has also informed the state that it will be receiving technology in the form of a Battelle Critical Care Decontamination System™ (CCDS) to help decontaminate N95 respirator masks, which will help extend the life of these important supplies.

The delivery of masks follows a request the state made to FEMA last month for assistance with purchasing PPE to help supply workers responding to the COVID-19 pandemic. The masks will be used to support state operations and be distributed to county and tribal emergency managers, who will allocate them to local direct care providers and first responders based on a review of their current needs.

Wisconsin’s response to COVID-19 has strained supplies of personal protective equipment (PPE) across the state, leading to some shortages of critical supplies including N95 respirator masks. In addition to sourcing additional N95 masks, the State of Wisconsin is exploring processes to decontaminate masks so they can be reused.

In partnership with the Federal Emergency Management Agency (FEMA) and Defense Logistics Agency (DLA), the State of Wisconsin will be receiving a Battelle CCDS Critical Care Decontamination System™, which can decontaminate tens of thousands of N95 masks daily. The Battelle CCDS Critical Care Decontamination System™ decontaminates masks by killing viruses and bacteria using hydrogen peroxide gas. Battelle advises masks can be decontaminated up to twenty times without degrading filtration performance.

In Wisconsin, it is our goal to have the Battelle Decontamination System in operation by mid-May. A process is currently being developed to collect, decontaminate, and swiftly return N95 masks for users throughout the state. In the meantime, we are asking Wisconsin health care providers interested in using the Battelle CCDS, to retain and not discard used N95 masks for future decontamination.

Please note:

• The Battelle Decontamination System is not authorized for use with respirators containing cellulose-based materials.
• All compatible N95 respirators must be free of any visual soiling or contamination (e.g., blood, bodily fluids, makeup).
• Compatible N95 respirators that are visually soiled or damaged should not be collected for decontamination and will be disposed of and not returned after decontamination.
• Masks should be marked with the name of the healthcare professional to whom the mask was issued.

Learn more about the Battelle CCDS Critical Care Decontamination System™

Final questions relative to the Battelle CCDS Critical Care Decontamination System™ installation will be answered in the coming weeks. More details will be provided in the coming days.

ForwardHealth recognizes that increased demand on the direct care services provided by physicians during the COVID-19 public health emergency could cause a delay in the availability of physicians to prescribe, refer, or order home health services in the normal timeframe. Therefore, during the COVID-19 public health emergency, ForwardHealth will allow Medicaid-enrolled nurse practitioners and physician assistants to prescribe, refer, or order the following:

• Home health nursing and aide services
• Medical supplies and equipment
• Physical therapy, occupational therapy, or speech pathology and audiology services

Billing policy and other requirements for these service areas as described in the Claims for Services Prescribed, Referred, or Ordered topic (#15737) of the ForwardHealth Online Handbook have not changed. Prescribers should note that they cannot have any affiliation, such as personal or financial affiliations, with the member or agency they are prescribing services for.

Governor Evers today announced Wisconsin's "Badger Bounce Back" plan which outlines important criteria for Wisconsin to be able to reopen its economy in phases and includes steps to make sure workers and businesses are prepared to reopen as soon as it is safe to do so. In coordination with this announcement, at the direction of the governor, Wisconsin Department of Health Services Secretary-designee Andrea Palm issued Emergency Order #31 establishing the process and outlining the phases of the plan. The emergency order is available here.

The Badger Bounce Back plan is informed in part by the President's Guidelines for Opening Up America Again that was issued by the White House on April 16, 2020. Currently, Wisconsin does not meet the criteria the White House established to start reopening our state. The Badger Bounce Back plan takes important steps to get the state of Wisconsin there. 

The goal of the Badger Bounce Back plan is to decrease cases and deaths to a low level, and increase capacity in our healthcare system so the phased reopening of businesses is possible. As part of that plan the state will be working to increase access to more testing and expand lab capacity. Under the Badger Bounce Back plan, everyone who needs a test should get a test. The state is setting a goal of 85,000 tests per week, averaging about 12,000 tests per day. More information on the state's testing efforts was released earlier today, and is available for review here.

Next, the state will be expanding contact tracing and more aggressively tracking the spread with the goal of every Wisconsinite who tests positive being interviewed within 24 hours of receiving their test results and their contacts being interviewed within 48 hours of test results.

Additionally, the state will continue to pursue every avenue to grow Wisconsin’s supply of personal protective equipment (PPE) for healthcare and public safety entities to conduct COVID-19 testing, patient care, and public safety work. Finally, the plan works to bolster healthcare system capacity where patients can be treated without crisis care and there are more robust testing programs in place for at-risk healthcare workers. 

The state will be looking for a downward trajectory of influenza-like illnesses and COVID-19 symptoms reported within a 14-day period, and a downward trajectory of positive tests as a percent of total tests within a 14-day period. When the state has seen these efforts be successful, Wisconsin can begin to turn the dial, re-open the state, and get businesses and workers back on their feet.

The Badger Bounce Back plan is available here. The Wisconsin Economic Development Corporation’s portion of the Badger Bounce Back plan aimed at helping to ensure workers and businesses are prepared and ready to bounce back is available here. The Badger Bounce Back plan in brief is also available here.

Governor Evers today directed Wisconsin Department of Health Services (DHS) Secretary-designee Andrea Palm to extend the Safer at Home order from April 24, 2020 to 8 a.m. Tuesday, May 26, 2020, or until a superseding order is issued. The order implements some new measures to ensure safety and support the progress we've made in containing COVID-19, but also allows certain activities to start up again.

The extension of the Safer at Home order includes a few changes. Some changes allow more businesses and activities to open back up, while other changes help make businesses safer for employees and customers.

The changes in this order go into effect on April 24, 2020. The order will remain in effect until 8 a.m. on May 26, 2020.

The order is available online (link).  The Governor’s full press release is also available online (link).