As we look back over 2025, Tim and Nathan at Hoven Consulting are grateful to have the opportunity to work in Madison to advocate on behalf of Wisconsin’s home health agencies to improve patient safety and increase patient access to our state’s health care system.

With your help, WiAHC helped accomplish a number of important policy and budgetary priorities that benefit home health agencies and the patients you serve:

• Home Health Skilled Nursing Medicaid Rate Increase: Increase the Medicaid reimbursement rate from $96.96 per home visit to approximately $117.86 per home visit, which is 70 percent of the Medicare home health reimbursement rate. Due to funding levels, it appears that this rate increase will be fully implemented in the second year of the budget – in state Fiscal Year 2026-2027.
• Continued to advocate to eliminate outdated home health agency professional advisory bodies from state regulations, including drafting and submitting written and verbal testimony to the state Department of Health Services (DHS). We anticipate that this state regulatory change will likely be complete by mid-2026.

We look forward to 2026 and our continued efforts to advocate for policies that benefit both home health agencies and the patients you serve.

From all of us at Hoven Consulting, we would like to wish all of you and your families a very happy and healthy holiday season! 

For the last several years, WiAHC has been advocating to eliminate an outdated state regulation relating to professional advisory bodies for home health care agencies. WiAHC has been advocating for this change since professional advisory committees were removed from federal regulations in 2017, as home health agencies are already overseen by a governing body pursuant to federal regulations.  In addition, home health agencies are also overseen by governing bodies in Wisconsin regulations.  In 2017, the federal Centers for Medicare & Medicaid Services (CMS) also put in place federal regulations requiring home health agencies to implement ongoing quality assessment and performance improvement (QAPI) programs.  Essentially, CMS replaced professional advisory committees in federal regulations with the creation of the QAPI program.

In January 2023, WiAHC formally requested that the state Department of Health Services (DHS) eliminate professional advisory bodies for home health care agencies in the agency’s biennial rules review – a process by which DHS makes technical changes and updates to existing state regulations. As DHS included this change in their biennial rules review, WiAHC noted in a prior Madison update that we submitted formal testimony to DHS on September 26 in support of this change. In addition, one of WiAHC’s Madison lobbyists testified at the DHS September 26 virtual hearing in support of this change.

The next step in the state regulatory process is for the various legislative committees to review the broader biennial rules review proposal, which includes the provision removing home health agency professional advisory bodies. As this is written, several of those committees are reviewing this broader proposal. If this process remains on schedule, we anticipate that this state regulatory change will likely be complete by mid-2026.

In recent weeks, the state Department of Health Services’ Division of Quality Assurance (DQA) announced that it is launching a new online portal for health and residential care providers to use for licensure/certification, background checks, plan reviews, among other matters. As of December 15, 2025, various providers, including assisted living facilities, will be required to use this system. In the future, home health agencies, nursing homes, hospitals and other providers will also be required to use this online portal.

For more information, please visit the DHS website.

On December 2, former Democratic Lieutenant Governor Mandela Barnes announced his candidacy for governor. He was also the Democratic nominee for the 2022 U.S. Senate race against U.S. Senator Ron Johnson (R) and previously served as a state representative, representing an Assembly district in the City of Milwaukee. His entry into the governor’s race was widely expected. Based on statewide polling prior to his announcement, he appears to be the leading candidate for the Democratic nomination at this time.

A little over a week later, Greater Milwaukee Committee President Joel Brennan also announced his candidacy for the Democratic nomination for governor. In addition, he served as the secretary of the Wisconsin Department of Administration during Governor Tony Evers’ first term. With Brennan now in the race, there are now 10 candidates running for the Democratic nomination for governor.

CMS released the CY 2026 Home Health Final Rule November 28.  It includes significant modifications from the proposed rule released this summer.  The Alliance has prepared an initial high-level analysis of the Final Rule.  This analysis and press release are attached.  The Alliance will also be holding webinar covering the rule on December 4, from 2-3pm ET.

As you may be aware, the Veterans Affairs administration revisits its rates each year and releases the new fee schedule in November or December.

The 2026 rates have now been released. While in most states the rates are unchanged, substantial cuts were announced in parts of these states:

1.       Texas: 43% reduction in home care rates

2.       New Mexico: 19% reduction in home care rates

We're pleased to share that we've arranged access to a free interactive tool from Paradigm which you can use to check the updated rates in your service areas.

Check Your 2026 VA Rates Here

Important reminders about the new fee schedule:

1.       These rates take effect on January 1st, 2026.

2.       The rates will apply throughout the year, though the VA may adjust them at any time.

3.       Reimbursement rates are based on the care location (where the care is provided), not the referring VA Medical Center.

4.       If your agency serves clients across multiple counties or regions, applicable rates may vary.

We encourage all members to review these changes promptly to understand how they might affect your operations in the coming year.

On October 29, the Senate Committee on Insurance, Housing, Rural Issues and Forestry held a hearing on two bills limiting prior insurance authorization. WiAHC submitted written testimony on both bills.

Senate Bill 434 – Transparency and Regulation of Prior Authorization Requirements

This legislation makes the following changes to existing prior insurance authorization requirements:

• Limits prior authorization decision timelines to 72 hours for standard requests and 24 hours for urgent care requests.
• Requires a patient’s new insurer to honor a prior authorization decision made by a utilization review entity associated with the patient’s prior insurer for at least 90 days. 

WiAHC submitted written testimony in support of this legislation, bearing in mind that commercial insurers in Wisconsin often take as long as 10-15 days to respond to prior authorization requests from home health care agencies.

Senate Bill 373 – Addresses Prior Authorization for Coverage of Physical Therapy, Occupational Therapy, Speech Therapy, and Chiropractic Services

This legislation does the following:

• Allows 12 patient visits for physical therapy, occupational therapy, speech therapy, and chiropractic services – without requiring prior authorization.
• Limits the timeframe for subsequent insurance reauthorization to three business days.

WiAHC submitted written testimony noting that our organization appreciates this legislation, as home health agencies employ physical therapists, occupational therapists, and speech therapists. However, our organization’s testimony also requests the addition of home-based skilled nursing care to this legislation.

On November 6, the state Department of Health Services (DHS) announced that it recently submitted its application to the federal Centers for Medicare and Medicaid Services for $1 billion in Rural Health Transformation Program funding. This program was created by the Budget Reconciliation Act that was signed into law by the President earlier this year and allows each state to apply for rural health funding.

According to its press release, DHS divided its funding application into the following three areas:

“Strengthen the rural health care workforce - $337 million. Recruiting and retaining an adequate health care workforce is a challenge in rural areas, making access to quality, timely care for rural residents difficult. This funding will provide grants for innovative workforce projects in rural communities, support career pathways for rural health care providers, and fund services provided by community health workers.

Drive rural technology and innovation - $329 million. Rural Wisconsin needs the technology to support and reach residents, such as closed-loop referral systems and telehealth capabilities. This funding will invest in upgrades to rural provider systems, digital infrastructure, and develop a digital rural health care collaborative.

Transform rural care through partnerships - $279 million. Rural Wisconsinites experience fragmented coordination across primary care, specialty care, behavioral health, chronic disease prevention, and community social supports. This funding will stand up a competitive grant program for rural regions to create coordinated systems of care where multi-sector partnerships show a clear path to sustainability.”

Further details are included in the DHS press release.

On October 29, 2025, Marquette University Law School Poll released its most recent poll, which surveyed 846 registered Wisconsin voters between October 15-22, 2025. This poll is the first Wisconsin state-specific Marquette poll since June 2025. This new poll covers political approval ratings, candidates for certain 2026 elections, as well as various policy areas.

The following October 2025 poll findings may be of interest:

Elected Officials

President Trump Job Approval

• 46% approve of the job President Trump (R) is doing.
• 53% disapprove.

Governor Tony Evers Job Approval

• 50% approve of the job Governor Tony Evers (D) is doing.
• 45% disapprove.
• 5% don’t know.

Wisconsin Legislature Job Approval

• 39% approve of the state legislature’s job performance.
• 50% disapprove.
• 11% don’t know.

Wisconsin Gubernatorial Candidates – 2026 August Primary Election

The following are the results for polling of Wisconsin Republican primary voters:

• Congressman Tom Tiffany: 23%      
• Washington County Executive Josh Schoemann: 6%
• Medical Service Technician Andy Manske: Less than 0.5%

NOTE: 70 percent of Republican primary voters indicated that they have not made up their minds on a preferred candidate for governor.

The following are the results for polling of Wisconsin Democratic primary voters:

• State Rep. Francesca Hong (Madison): 6%
• Lieutenant Governor Sara Rodriguez:  4%
• Milwaukee County Executive David Crowley: 3%
• State Sen. Kelda Roys (Madison): 3%
• Former Wisconsin Economic Development Corp. CEO Missy Hughes: 2%
• American Family Field Beer Vendor Ryan Strnad: Less than 0.5%
• Former State Rep. Brett Hulsey (Madison Suburbs): 0.0%

NOTE: 81 percent of Democratic primary voters indicated that they have not made up their minds on a preferred candidate for governor.

General Issues

The most important issue among registered voters:

• Inflation and the cost of living: 27%
• Illegal immigration and border security: 16%
• Health insurance: 14%
• Jobs and the economy: 9%
• Gun violence: 9%
• Affordability of housing: 9%
• Taxes: 6%
• Abortion policy: 4%
• Public schools: 4%
• Crime in your community: 2%

State and Local Policy

Data Centers

• Costs of large data centers are greater than the benefits they provide:  55%
• Benefits of large data centers outweigh the costs: 44%

Paid Family Leave

• Support requiring businesses to provide paid family leave for parents of newborns:  77%
• Opposed to requiring businesses to provide paid family leave for parents of newborns: 22%

Handgun Concealed Carry

• Support state law allowing residents to obtain a license to carry concealed handguns: 77%
• Oppose this state law: 22%

• Support state legislative proposals to allow concealed carry without a license: 20%
•  Oppose such proposals: 78%

The House of Representatives passed the Senate Amendment to H.R. 5371, the Continuing Appropriations and Extensions Act, 2026, sending the measure to the President. President Trump subsequently signed this bill into law, formally ending the 43-day government shutdown. The bill provides a CR through January 30, 2026 at FY 2025 funding levels and provides full-year FY 2026 funding for the Agriculture Department, the Food and Drug Administration, the Legislative Branch, military construction projects, and the Veterans Affairs Department.  

Here are some highlights:

• The legislation retroactively restores the COVID-19 era Medicare telehealth flexibilities through January 30, 2026, as if they had never lapsed. For home health agencies, this reinstates the waiver of originating site and geographic requirements under section 1834(m), allowing face-to-face encounters to occur broadly via telehealth. For hospice providers, the required encounter prior to a third or subsequent benefit period may again be completed via telehealth by a hospice physician or nurse practitioner. These flexibilities previously expired on September 30, 2025.  
• The legislation renews $2 million in funding for Medicare hospice surveys, originally included in the IMPACT Act of 2014, to ensure hospices are surveyed at least every 36 months.
•  The legislation waives the Statutory PAYGO requirement through 2026, zeroing out PAYGO scorecard, which included $3.4 trillion in deficit spending resulting from the One Big Beautiful Bill (OBBA). Without this waiver, providers would have been subject to an additional sequestration cut of roughly 4% to Medicare payments. 
• The full-year appropriations for the Veterans Administration will provide more certainty regarding the ongoing stability of VA health services. Included in the CR through January 30, 2026, is the Department of Defense, which funds TriCare. During the shutdown, TriCare was unable to process and pay medical claims for services and this will allow reimbursement for services provided from October 1, 2025 through the end of the CR.

Additional details are published in the National Alliance for Care at Home Alliance Daily article.