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:

·        The Last-Ditch Efforts Home Health Providers, Advocates Are Making To Nix Payment Cuts

Home Health Care News – By Joyce Famakinwa | Oct. 24, 2023

Any day now, the Centers for Medicare & Medicaid Services (CMS) will release the 2024 home health final payment rule. In anticipation, home health providers and advocates have been appealing to Congress, educating, calling to action on social media and more. Read more…

·        New Legislation Offers Hope For Expanding HCBS Across More States

Home Health Care News – By Patrick Filbin | Oct. 24, 2023

Over the past several years, many states have strengthened their home- and community-based services (HCBS) programs by covering more services and increasing rates. Now, over a dozen members of Congress are trying to give states additional funding to help expand those HCBS programs further.

Read More…

·       Medicare Advantage Plans Pulling Back On In-Home Care Supplemental Benefits

Home Health Care News – By Robert Holly | Oct. 23, 2023

Insurance companies selling Medicare Advantage (MA) plans have been facing increased scrutiny from members of Congress and regulators, with critics of the private version of Medicare claiming carriers are profiting far too much. Read More…

·       Intrepid USA CEO John Kunysz: We Can’t Keep Approaching Home Health ‘Like It’s 1965’

Home Health Care News – By Andrew Dolan | Oct., 2023

In home health care, there’s value in fighting for things to be a certain way. At the same time, there’s also value in accepting things for how they are right now. John Kunysz, the president and CEO of Intrepid USA, is looking for proactive strategies to address how things are right now. He’s found some of those already. 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.

By Hoven Consulting – WiAHC’s lobbying firm

• WiAHC Requests DHS to Appoint Home Health Provider to Possible Complex Patient Pilot Program Advisory Group

In the FY2023-2025 state budget bill that Governor Evers signed into law, the Legislature appropriated $5 million for a complex patient pilot program focused on successfully transferring patients with complex medical needs from acute care facilities to post-acute care facilities.  These are funds that are directed toward the state Department of Health Services (DHS). 

Governor Evers’ original FY2023-2025 budget request included a provision giving DHS authority to administer these funds, including the creation of an advisory group that would assist the department with developing and creating a complex patient pilot program.  Furthermore, members of such an advisory group would need to have “clinical, financial, or administrative expertise in government programs, acute care, or post-acute care.”  However, the final enacted version of the budget did not provide this authority. Despite that, the Evers Administration is working towards obtaining legislation that provides this authority. 

With this in mind, WiAHC sent a letter to state Department of Health Services Secretary-designee Kirsten Johnson in August requesting that DHS consider appointing a home health care provider to a complex patient pilot program advisory group, should separate legislation be enacted that authorizes this program, including the creation of an advisory group. 

• Governor Evers/DSPS Unveils New Occupational License Processing Dashboard

On August 31, Governor Tony Evers and the state Department of Safety and Professional Services (DSPS) unveiled a new online dashboard that provides high-level data on occupational license processing.  In addition to showing the average number of days to process all new applications, all health applications, and all business applications, users may also look up application review times by profession. 

• Governor Evers Creates Task Force on Workforce and Artificial Intelligence

On August 23, Governor Tony Evers signed an executive order creating the Governor’s Task Force on Workforce and Artificial Intelligence.  This task force will “produce an advisory action plan to identify the current state of generative artificial intelligence’s impact on Wisconsin’s labor market and develop informed predictions regarding its implication for the near term and future.”  In addition, it will “recommend solutions related to workforce development and educational systems.” 

This task force will be chaired by the state Department of Workforce Development Secretary Amy Pechacek and will include the Secretary of the state Department of Administration, the head of the Wisconsin Economic Development Corporation, representatives from the University of Wisconsin System, the Wisconsin Technical College System, as well as other public and private sector representatives. 

The Governor’s executive order did not include a timeline for the work of this task force.

• Assembly Speaker Robin Vos Creates Artificial Intelligence Task Force

On August 31, Assembly Speaker Robin Vos announced the creation of several speaker’s task forces, including one focused on artificial intelligence.  This task force, comprised entirely of Republican and Democratic state representatives, will hold public hearings at various locations across Wisconsin, starting in September.  The task force aims to complete its work by the end of 2023 and recommend legislation for introduction during the 2024-2025 legislative session.  This task force will be chaired by state Rep. Nate Gustafson (R-Neenah).

• State Rep. Deb Andraca Appointed to Legislature's Joint Finance Committee

On August 16, state Assembly Minority Leader Greta Neubauer (D-Racine) appointed Rep. Deb Andraca (D-Whitefish Bay) to serve on the Legislature’s budget-writing Joint Committee on Finance for the rest of the 2023-2024 legislative session.  Rep. Andraca, who represents portions of the north shore Milwaukee suburbs, will replace Rep. Evan Goyke (D-Milwaukee), who is departing the committee to focus on his campaign for the position of Milwaukee City Attorney.

On August 8, Governor Tony Evers called a special session of the Legislature, urging lawmakers to consider a $1 billion workforce development package the Governor said was needed to address the state’s workforce shortage crisis.

Republicans, who control both houses of the Legislature, convened the session as required by law, but quickly adjourned without acting. They called the special session a “political stunt” that was fiscally irresponsible and did not provide real solutions to Wisconsin’s workforce challenges.

The Governor’s proposed legislative package included $365 million to support childcare programs; the creation of a paid family and medical leave program that would cost $243 million; $66 million for the UW; $40 million for the state’s technical colleges; and nearly $60 million to help address the shortage of healthcare workers across the state. The funding to address the healthcare worker shortage included:

o   $10 million for the state’s nurse educators program, which incentivizes nursing professors to remain in Wisconsin.

o   $6 million for the WisCaregiver Careers program, which is intended to increase the number of certified nursing assistants employed at nursing homes.

o   $17 million for healthcare opportunity grants, which will go to local workforce development boards to help individuals obtain employment in the healthcare field.

o   $936,600 for the state Department of Workforce Development to work on healthcare apprenticeships.

o   $22.5 million for healthcare innovation grants, which will help the healthcare industry recruit and retain employees.

o   Over $1.2 million for graduate medical training support grants.

The Republican-controlled state Assembly recently passed a redistricting reform plan to completely overhaul how legislative district maps are drawn in Wisconsin. Under the proposal, which is based on the model used in Iowa, a nonpartisan committee would draw the legislative maps. The maps drawn by committee would be subject to approval by the state Legislature. 

Gov. Tony Evers roundly criticized the proposal, saying it was essentially election interference by the GOP and strongly inferred he would veto the measure if it made it to his desk. Assembly Republicans praised the legislation as not only the fairest approach to redistricting for citizens, but also a plan that would avoid costly political and legal battles.

Recent polling has shown that a large majority of Wisconsin residents would prefer legislative district maps be drawn by a nonpartisan commission rather than elected officials.

The proposal, which passed the Assembly on a largely partisan vote with one Democrat voting for the measure, is awaiting further action in the Senate.

Earlier this month, the GOP-controlled state Assembly passed a nearly $3 billion state income tax cut proposal that would drop income tax rates from 5.3% to 4.4% for individual filers with incomes between $27,630 and $304,170 and deliver the same tax relief for married couples with incomes between $18,420 and $405,550. The legislation would also exclude the first $150,000 of a couple’s retirement income from state income taxes. The provision would apply to residents over the age of 67.

Gov. Tony Evers has promised to veto the legislation, saying it would jeopardize priorities such as public schools, child care, and public safety. On the flip side of the debate, Assembly Republicans said the measure, which passed on a partisan vote, will help fight inflation, encourage retires to stay in Wisconsin, and give a large portion of the state’s $4 billion surplus back to taxpayers.

The bill is currently under further consideration in the Senate.

Jenny Malak, Vice President of Homecare Operations for Agrace, has been appointed by Governor Tony Evers to serve on the Wisconsin State Board of Nursing, which resides at the state Department of Safety and Professional Services (DSPS). The Board is comprised of eight members who were appointed to four-year terms.

The State Board of Nursing oversees issues related to the protection of the public from illegal and unauthorized nursing practices. It also enforces standardized training and certifications for all nurse assistants, registered nurses, and advanced medical professionals in Wisconsin.

Malak, a registered nurse who is also certified in hospice and palliative nursing, currently oversees Agrace’s in-home hospice operations, its chronic specialty care program, and the Agrace Grief Support program. She also serves on several other local and national committees, including the National Partnership for Healthcare and Hospice Innovation’s (NPHI) chief clinical officer/chief operations officer forum, the National Hospice and Palliative Care Organization (NHPCO) quality and standards committee, the Wisconsin Organization of Nurse Leaders’ new membership committee, and the Wisconsin Nurses Association Workforce Advocacy Council.

By Hoven Consulting – WiAHC’s lobbying firm

• DHS Announces Sept. 7 Electronic Visit Verification Public Hearing for Home Health Care Services

The Wisconsin Department of Health Services will hold a public hearing regarding Medical Assistance electronic visit verification (EVV) requirements on Thursday, September 7 at 11:00AM. This hearing will be held virtually (via Zoom).  The following is a link to a page with the Zoom meeting link:  https://docs.legis.wisconsin.gov/code/register/2023/812a3/register/rule_notices/cr_23_045_hearing_information/cr_23_045_hearing_information

Please note that this EVV hearing will address an administrative EVV rule for Medical Assistance personal care and home health care services.  To view the rule text (it is fairly short), please go to the following page (you will need to scroll to the bottom of the page to review the rule text):

https://docs.legis.wisconsin.gov/code/register/2023/812a3/register/rule_notices/cr_23_045_hearing_information/cr_23_045_rule_text

• Governor Requests Special Legislative Session to Provide Funding for the Healthcare Workforce Shortage

On August 8, Governor Tony Evers announced that he was calling the Legislature into session on Wednesday, September 20, 2023, to provide funding for several of his major budget priorities that were not included in the FY2023-2025 state budget, including over $300 million for childcare programs, the creation of a paid family and medical leave program, and almost $60 million to help address the shortage of healthcare workers.  The funding to address the healthcare worker shortage includes:

• o   $10 million for the nurse educators program, which incentivizes nursing professors to remain in Wisconsin.
• o   $6 million for the WisCaregiver Careers program, which is intended to increase the number of certified nursing assistants employed at nursing homes.
• o   $17 million for healthcare opportunity grants, which will go to local workforce development boards to assist individuals obtain employment in the healthcare field.
• o   $936,600 for the state Department of Workforce Development to work on healthcare apprenticeships.
• o   $22.5 million for healthcare innovation grants, which will help the healthcare industry recruit and retain employees.
• o   Over $1.2 million for graduate medical training support grants.

However, very soon after this announcement, Republican legislative leaders stated that they opposed this special session.  As such, they will very likely call the Legislature into session on September 20 and then quickly adjourn the session, as they have done in the past when Governor Evers has called for special sessions. 

• DHS Announces Free Online Program to Train 10,000 Caregivers

On August 8, the state Department of Health Services (DHS) announced an initiative to train 10,000 Wisconsinites as certified direct care professionals (CDCP).  These individuals provide personal/supportive home care to senior citizens and disabled people.

Wisconsinites interested in receiving the CDCP certification may sign up to receive free training and then will need to pass an online test in order to be certified.  Certified individuals who obtain employment with an eligible employer may earn up to $500 in combined hiring and retention bonuses. 

More information may be found on the DHS website.

• DHS Creates Webpage Detailing Statewide BadgerCare Plus & Medicaid Enrollment Data

During the COVID-19 pandemic, the federal government put in place a continuous coverage requirement for Medicaid enrollees.  Now that the pandemic-related federal public health emergency has ended, those Wisconsinites who benefit from BadgerCare Plus and Medicaid and want to continue to participate in these programs will need to renew their enrollment.  DHS has created a webpage that tracks this data, which will be updated on the third Thursday of each month. 

• DHS Launches "UpliftWI" Peer Support Phone Line

On July 31, the state Department of Health Services (DHS) unveiled “UpliftWI,” which is a new peer support phone line for individuals who are experiencing mental health and substance use challenges.  This phone line may be reached at 534-202-5438, seven days a week between the hours of noon and midnight.  There is no charge to use this service and those who call for assistance will not be required to disclose their name, address or other identifying information.  DHS intends to expand the phone line’s hours of operation to 24 hours a day by the end of 2024.  More information may be found at the UpliftWI website. 

All Copays Count” applies discounts and other assistance toward patients’ out-of-pocket costs 

Guest Column by WI Senator André Jacque

Patients would receive protections from rising health care costs by ensuring that health plans count copay assistance toward a patient’s maximum out-of-pocket cost or annual deductible, under bipartisan “All Copays Count” legislation (Senate Bill 100) I introduced with several of my colleagues earlier this session.

Amid nationwide inflation, health plans have increasingly shifted costs to patients and created barriers between individuals and the medications on which they rely.  For advocates of Wisconsin patients and the providers who care for them, this bill is a clear solution to help those individuals afford the critical medications their physicians prescribe to them to manage their health.

Copay assistance programs often act as a lifeline to help patients afford specialty medications they need to treat serious health conditions. Sixteen other states have already enacted such protections.

Just when patients think they’ve reached their out-of-pocket limit, insurers and benefit managers keep moving the goalposts, and folks wind up paying more.  For someone suffering from a complex disease, the financial hit is especially hard, leaving them to choose between groceries, utilities and mortgage payments - and the prescription medications that keep their condition under control.

In 2020, the average deductible for single coverage was $1,364, which is a 364% increase from 2006. Over the past five years, the percentage of covered workers with a general annual deductible of $1,000 or more for single coverage has grown from 23% to 57%.  Further, in 2020 more than one in four covered workers was enrolled in a plan with a deductible of $2,000 or more.

Many of these patients rely on copay coupons and vouchers to afford their prescribed treatments at the pharmacy counter.  Insurers should not have the power to prevent that copay assistance from counting toward their out-of-pocket expense or deductible.  If patients can’t afford their medications, they may choose to skip doses or stop treatment altogether, which can lead to increased costs in the overall healthcare system.  And worse.

The All Copays Count legislation would ensure that the copay assistance programs patients use to afford their medications count toward their out-of-pocket costs.  It would also close the loophole that allows insurers to define prescription drugs as non-essential and therefore not eligible to count toward their deductible.  At the same time, under this initiative Wisconsin insurers would retain flexibility with their plans, while making sure patients can continue to afford the medications they need.

If you have cancer, epilepsy or any other serious health condition, the last thing you should have to worry about is whether you’ve met your deductible.  “All Copays Count” is about giving patients peace of mind that they can pay for their prescriptions. 

Senator André Jacque represents Northeast Wisconsin’s First Senate District, consisting of Door and Kewaunee Counties and portions of Brown, Calumet, Manitowoc, and Outagamie counties.

Earlier this summer, the U.S. Centers for Medicare & Medicaid Services (CMS) released its 2024 home health proposed payment rule, which proposes to reduce home health payments by 2.2%, or an estimated $375 million less compared to 2023 levels.

While the home health care industry was not surprised by the proposed cuts, it is still discouraging considering the array of challenges home health care is facing – challenges that threaten patient access to care. In short, staffing shortages, inflation, increased operating costs, and reduced reimbursements are negatively impacting our ability to serve home health patients, and it is difficult to see where additional rate cuts can be absorbed without reducing access to care.

To prevent the proposed rate cuts, WiAHC, our national partners (NAHC / NHPCO), and other state chapters across the county have urged CMS to withhold the imposition of any of the proposed rate cuts in 2024, as doing so will further reduce care access in our communities.

CLICK HERE to review WiAHC’s comment letter to CMS on the proposed home health payment rule.

The Boards of Directors of the National Association for Home Care & Hospice (NAHC) and the National Hospice & Palliative Care Organization (NHPCO) signed a non-binding Letter of Intent earlier this week to jointly explore the formation of a new as-of-yet unnamed organization that combines the strengths of NAHC and NHPCO, creating a better and more powerful advocate for the entire home care, hospice, palliative care, and serious illness community.

The purpose of combining the two leading organizations serving providers of care to America’s elderly, disabled, and dying is simple: to better serve you. Both Boards voted for this course of action following the recommendations of a Steering Committee composed of member and staff leaders from both organizations. The Steering Committee’s recommendations were informed by consultation with members of both organizations. The Committee has been working, with the support of association consulting firm McKinley Advisors, since the March 8, 2023 joint announcement (NAHC website, NHPCO website) that NHPCO and NAHC would explore opportunities for deeper collaboration.

“The collaborative process of the NHPCO and NAHC Boards over the last five months has brought the two organizations closer together,” said Kenneth Albert, R.N., Esq., NAHC Board Chair, and President and CEO of Androscoggin Home Healthcare + Hospice. “In addition to the Board-level discussions, our organizations have been collaborating on multiple advocacy efforts, as well as projects such as the Value of Hospice research. Through these efforts, it has become crystal clear that we can do more on behalf of our members by working together. If the current discussions do not lead to a new, combined organization, the outcome will nevertheless be closer working relationships on behalf of community-based and home care providers.”

“The American healthcare system is shifting, and home and community-based care options are increasing in a multitude of forms across the country,” said Melinda Gruber, PhD, MBA, CNA, NHPCO Board Chair, and President of Caring Circle/Vice President, South Region, Medical Group and Continued Care of Corewell Health. “With decades of experience in hospice and home care, NHPCO and NAHC members are the long-standing experts, and they are evolving to meet patient needs in a shifting environment. As we look ahead, we see an opportunity for the organizations representing those providers to evolve. In this time of change, we are acting with intention and care to continue meeting the needs of providers, patients, families, and communities well into the future.”

To facilitate an effective process, both Boards have decided to suspend elections for new Directors this year.

We know our members may have many questions about this process and how a new combined organization will affect them. NAHC and NHPCO will be updating and consulting our members throughout this process to address your questions and concerns as quickly as possible.

Many details are still being determined and in the coming months, the NAHC and NHPCO Boards of Directors will work together, in consultation with member volunteers from both organizations, to determine how a consolidated organization could represent the best interests of the combined memberships. The organizations expect this process to take six to ten months, but getting it done right will be more important than getting it done quickly. McKinley will continue to support the process as an independent, third-party advisor.

In the meantime, you may be assured that staff of both organizations will continue to work as hard as possible to serve your needs, advocate for your interests, and strengthen the entire hospice, home care, and home health community.