Although the home health care industry recently received a reprieve from drastic Medicare cuts, the financial threat to the industry is far from over.

In June 2022, CMS issued their proposed 2023 Home Health Payment Rule, which carried with it a proposed cut to Medicare payments of 4.2% , or $810 million. Fortunately, the final rule issued by CMS wasn’t quite as devastating, as it ultimately provided a Medicare payment increase of 0.7%, or $125 million, for 2023.

But as was mentioned above, we are still not out of the woods. The final rule also authorizes CMS to claw back, starting in 2024, $2.1 billion in what they say are overpayments from 2020 and 2021.

To maintain access to home health care services and prevent harm to the Medicare patients across Wisconsin that depend on essential health care provided in their homes, it’s critical to urge Congress to fix the potential chaos created by CMS by passing the Preserving Access to Home Health Act of 2022 (H.R. 8581 and S. 4605) before the end of the year.

The bipartisan bill would delay the 2023 payment cut and the $2 billion claw back efforts, allowing time for home health care to  negotiate with CMS on a better outcome. With that in mind, WiAHC would urge you to contact your Members of Congress TODAY and ask them to support this highly important legislative proposal. 

Of course, when advocating for home health with your Members of Congress, it is important to ensure your message is both compelling and clearly presented. Thankfully, our national partner, the National Association for Home Care and Hospice (NAHC), has made connecting with your elected representatives as easy as a few clicks on your computer or mobile device.

Simply CLICK HERE to contact your federal lawmakers on the Preserving Access to Home Health Act of 2022. All you need to do is fill in your name and contact information and hit SEND.

By Hoven Consulting  – WiAHC’s lobbying firm

·         November General Election Results – State Legislature

o   State Assembly: In the 2023-2024 legislative session, Republicans will have 64 members and the Democrats will have 35 members.  Republicans gained a net of four Assembly seats.  One of these Assembly seats is located in the western Milwaukee suburbs, two are located in far northwest Wisconsin, and the other is a district that is between Milwaukee and Madison and also includes the southcentral Wisconsin city of Milton.

o   State Senate: During the next legislative session, Republicans will have 22 members and the Democrats will have 11 members.  Senate Republicans gained one Senate seat that was held by Democrats.  This seat is located in far northwest Wisconsin and includes the community of Superior. 

·         Assembly and Senate Elect Leadership

On November 10, both the Senate and Assembly Republican caucuses met to elect their respective leadership teams for the 2023-2024 legislative session. 

Senate Republicans re-elected their current senior leadership team:

o   Senate President – Chris Kapenga (Delafield)

o   Senate President Pro-Tempore – Patrick Testin (Stevens Point)

o   Majority Leader – Devin LeMahieu (Oostburg)

o   Assistant Majority Leader – Dan Feyen (Fond du Lac)

The Assembly Republican caucus elected several members to new senior leadership roles.  The new senior leadership members are:

o   Assembly Speaker – Robin Vos (Rochester)

o   Assembly Speaker Pro Tempore – Kevin Petersen (Waupaca)

o   Majority Leader – Tyler August (Lake Geneva)

o   Assistant Majority Leader – Jon Plumer (Lodi)

During the week of November 14, both the Assembly and Senate Democratic caucuses elected their respective leadership teams for the 2023-2024 legislative session.  Senate Democrats also elected new members to their leadership team.  Their new senior leadership team is:

o   Minority Leader – Melissa Agard (Madison)

o   Assistant Minority Leader – Jeff Smith (Brunswick)

Assembly Democrats re-elected the following members to their current leadership roles:

o   Minority Leader – Greta Neubauer (Racine)

o   Assistant Minority Leader – Kalan Haywood (Milwaukee)

·         Occupational License Study Committee Update

On Tuesday, November 15, the Legislative Council Study Committee on Occupational Licenses held its November public meeting.  Included in the agenda for this hearing was testimony from a number of individuals, including representatives from the state Department of Safety and Professional Services (DSPS) – which processes most occupational credentials in the state – as well as discussion on several draft bills intended to improve the ongoing occupational credential processing backlog.  Most of the testimony from the DSPS representatives focused on this backlog. 

During the hearing, DSPS representatives repeatedly underscored their need for more staff – particularly call center staff and occupational credential processing staff.  They also discussed the need to offer higher salaries in order to attract and retain employees.  Committee chair/Senator Rob Stafsholt (R-New Richmond) indicated that he is open to possibly providing more funding in the 2023-2024 state budget to DSPS to hire more staff.  However, he underscored the committee’s prior request for more data on the processing backlog, which would help him justify that funding request.  DSPS representatives stated a few times during the hearing that they would need to re-task credential processing employees to gather that data, which would likely increase the backlog.  Chair Stafsholt stated that he realized that but obtaining that data would be critical to help to possibly secure additional staff funding for the agency.  Committee Vice Chair/Representative Shae Sortwell (R-Two Rivers) also appeared to be open to providing funding for additional agency staff but also agreed that DSPS needed to provide them with more data on the backlog first.

DSPS representatives appeared to be supportive of committee draft legislation increasing credential renewal periods from two years to four years, as well as legislation that removes the requirement for the agency to review certain types of minor criminal offenses.  However, they also noted that several of the committee’s other draft bills would require additional staffing to accomplish. 

After hearing all of the testimony, the committee was scheduled to have a discussion among themselves regarding their various draft bills addressing this processing backlog.  However, as the DSPS testimony and questioning ran much longer than anticipated, the committee agreed to adjourn and postpone discussion on these draft bills to their next public meeting, which is scheduled for December 13. 

NOTE:  If your hospice/palliative care agency has employees who are experiencing delays in receiving their occupational licenses, please contact WiHPCA’s government affairs professionals – either Nathan Butzlaff at (608) 310-8833 or nathan@hovenconsulting.com or Tim Hoven at (414) 305-2011 or tim@hovenconsulting.com. 

·         Uniform Death Reporting Standards Study Committee Update

The Legislative Council Study Committee on Uniform Death Reporting Standards held a meeting on October 17 in Madison.  Senator Joan Ballweg (R-Markesan) and Representative Jesse James (R-Altoona) serve as chair and vice chair, respectively, and heard various presentations, which are summarized below.   

Representatives from the state Department of Health Services (DHS) were the first to present at this hearing.  They discussed the National Violent Death Reporting System (NVDRS) and the State Unintentional Drug Overdose Reporting System (SUDORS).  In response to questions from committee members, DHS representatives noted:  (1) DHS requests NVDRS data from all counties, and most participate, though such participation is not required and (2) a significant majority of physicians continue to use a “fax attestation form” when certifying the cause and manner of natural deaths, rather than submitting that information as an electronic user of the State Vital Records Information System (SVRIS).

The second presentation featured representatives from the state Department of Justice.  Much of this presentation covered the types of death investigation training offered in Wisconsin.  In particular, they discussed: (1) the death investigation training provided at police academies, (2) an annual 80-hour course for death investigators organized by DOJ and (3) an annual four-day death investigation symposium organized by the Wisconsin Association of Homicide Investigators. 

Following the presentations, committee members discussed various issues.  Committee members expressed interest/support for the following:

o   Expanding the death record to include different data points, including noting whether substance abuse contributed to the death.

o   Requiring physicians to receive training on how to properly certify cause and manner of death, including training how to address the types of death that must be reported to coroners or medical examiners.

o   Requiring all those who certify deaths (e.g., physicians) to submit the medical certification electronically using the State Vital Records Information System (SVRIS).

o   Creating a state statute governing fatality review teams in a manner codifying current practice (allowing counties to decide which types of teams, if any, are created).

·         Hard Launch of Electronic Visit Verification for Personal Care Services and Supportive Home Care Services

In November, the DHS announced that as of May 1, 2023, the agency will begin imposing penalties when personal care and home health care agencies do not collect the required electronic visit verification (EVV) for Medicaid-covered personal care and supportive home care services.  The included service codes are:  T1019, T1020, S5125 and S5126. 

For more information, please contact DHS at 1-833-931-2035 or VDXC.ContactEVV@wisconsin.gov.

• ·         DHS Medicaid Home and Community-Based Service Grant Program

On November 3, DHS awarded $12 million to over 40 organizations that provide home and community-based services to senior citizens or disabled individuals.  The intent is to support the direct care workforce in this field.  These grant funds are sourced from federal American Rescue Plan Act (ARPA) allocation of dollars to Wisconsin. 

DHS intends to open a second round of grants in February 2023.  According to the DHS website, applicants can be: 

o   A provider whose work supports HCBS participants

o   An MCO active with HCBS programs in Wisconsin

o   An IRIS consultant agency

o   A university whose work supports HCBS providers or participants

o   An advocacy agency whose work supports HCBS participants

o   An association whose membership comprises HCBS providers

o   A local government agency whose work supports HCBS providers or participants

Also, the DHS website states that grant funds must benefit at least one of the following:

o   Individuals receiving HCBS

o   Families of individuals receiving HCBS

o   HCBS providers

o   Direct care workers of HCBS providers

For more information, go to the HCBS grants page on the DHS website.

Last week, US Department of Health & Human Services (HHS) Secretary Xavier Becerra announced the renewal of the public health emergency (PHE) due to the ongoing COVID-19 pandemic. The PHE was originally declared on January 31, 2020 and has been renewed continuously since then. Renewal of the PHE keeps a number of important waivers and flexibilities active. The current PHE declaration will last 90 days from its effective date of October 13, 2022.

WiAHC Legislative Key Contact Program

If you were not yet aware, we would like to remined you about WiAHC’s Legislative Key Contact Program, which can be a highly effective grassroots advocacy tool to help build and nurture strong on-going relationships between WiAHC members and lawmakers in Wisconsin. Ultimately, the program can help us help shape new policies important to our members.

The program is now live on the WiAHC website and members can easily and quickly sign-up as a Key Contact. With the campaign season winding down, and the 2023-24 legislative session right around the corner, it’s more important than ever for WiAHC to have a robust Key Contact Program. It is essential to raising our profile in the State Capitol and beyond.

As a Key Contact, you can help influence the legislative process by cultivating relationships with elected officials. By taking advantage of existing relationships and making new contact with members of the Wisconsin Legislature (as well as the Wisconsin Congressional  Delegation), you can help us educate lawmakers on industry issues and influence legislation.

But the program will not succeed without strong member participation, so please take a few moments to read more about it – and learn how simple it is to “enlist” and participate as a Key Contact. The time commitment is minimal and your responsibility as a key contact depends on your level of comfort and willingness to engage.

Remember, lawmakers are often eager to hear input from their constituents, and as an expert in the home health care field, you can make a real difference in the policy process as a Key Contact. CLICK HERE to sign-up by filling out and submitting a brief online survey.

WiAHC Legislative Outreach Program

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. In effort to capitalize on our greatest advocacy resource – our membership – WiAHC has established our Coffee Conversations with Legislators advocacy program.

The initiative is designed  to help connect members with their local legislators. Under the program, the WiAHC Government Affairs Team will set-up in-district meetings between WiAHC members and state lawmakers who represent them in the Legislature. These meetings, which can be located at your facility, or a local coffee shop provide a tremendous opportunity for WiAHC members to build or strengthen their relationships with local legislators and to educate them on home health care and on policy issues important to home health care professionals and their patients.

WiAHC encourages all members to participate in this critical grassroots advocacy program. Please click here for more information on the program. If you’re interested in participating in the program, contact the WiAHC office at wiahc@badgerbay.co.

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:

·         ‘Most Intense Advocacy Effort Of My Lifetime’: Home Health Industry Braces For Rate Cuts

Home Health Care News - By Andrew Donlan | October 24, 2022

Any day now, the home health final payment rule will officially be released by the Centers for Medicare & Medicaid Services (CMS). As providers await its arrival, many of them are gathered in St. Louis at the National Association for Home Care and Hospice’s (NAHC) annual conference. If the final rule is as bad – or close to as bad – as the proposed rule, it will be a dark day for the industry. Read more…

·         Is CMS’ Proposed Home Health Rate Cut Legal? Other Court Decisions Suggest No

Home Health Care News - By Andrew Donlan | October 16, 2022

The entire home health industry is anxiously awaiting the release of the final payment rule for 2023, which should be released by the Centers for Medicare & Medicaid Services (CMS) at some point over the next two weeks. The anxiousness is due to the home health proposed payment rule, which included a 4.2% aggregate decrease in payments – or $810 million – and an avenue for future CMS clawbacks of perceived overpayments to providers. Read more…

·         As Labor Competition Heats Up In Health Care, Home Health Sector Left Behind

Home Health Care News - By Joyce Famakinwa | October 21, 2022

Home health providers are dealing with a number of headwinds — inflation-induced financial challenges, labor shortages, pandemic pressures and more — that will only worsen if the proposed payment adjustments for 2023 become finalized. That’s the major takeaway from a recent labor cost study from the Partnership for Quality Home Healthcare (PQHH). The study was conducted by Dobson DaVanzo & Associates and examines the changes in the home health labor costs. The study is based on the survey responses of six PQHH member organizations, and interviews from five industry leaders. Read More…

·         ‘Care Delayed Is Care Denied’: What Prior Authorization Changes Mean For Home Health Providers

Home Health Care News - By Patrick Filbin | October 10, 2022

Home health providers could potentially see a speedier prior authorization process thanks to legislation moving through Washington, D.C. While the changes in the Improving Seniors’ Timely Access to Care Act are welcomed, many experts in the space feel like more work needs to be done in order to have a more efficient care delivery process. 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.

As WiAHC members know well, grassroots advocacy is critical in our efforts to influence lawmakers and policy decisions that impact home health care in Wisconsin and across the country. And there is no issue more important today than the devastating CMS-proposed home health payment cuts that if implemented would significantly reduce access for vulnerable Medicare beneficiaries and their families.

As you certainly know by now, the CMS’s CY2023 proposed payment rule would cut rates for Medicare home health services in 2023 by an unprecedented, permanent -7.69% ($1.33 billion in 2023 alone). The net result of this cut along with inflation updates is -4.2% in 2023, equaling an $810 million cut starting next year.

In addition, CMS seeks to impose an additional $2 billion in cuts as soon as 2024, which is an unjustified clawback of payments for critical healthcare delivered to seniors and people with disabilities during the pandemic in 2020 and 2021. CMS also plans to add an additional $1 billion for alleged “overpayments” for 2022 services.

Fortunately, legislation was recently introduced in Congress – the Preserving Access to Home Health Act of 2022 – that would prevent proposed cuts to home health payment rates from taking effect prior to 2026. With that in mind, WiAHC would urge you to contact your Members of Congress TODAY and ask them to support this critical legislative proposal. 

Of course, when advocating for home health with your Members of Congress, it is important to ensure your message is both compelling and clearly presented. Thankfully, our national partner, the National Association for Home Care and Hospice (NAHC), has made connecting with your elected representatives as easy as a few clicks on your computer or mobile device. Visit NAHC’s Legislative Action Center or simply CLICK HERE to contact your federal lawmakers on the Preserving Access to Home Health Act of 2022. All you need to do is fill in your name and contact information and hit SEND.

Please act today to prevent CMS’s drastic cuts, which would carve billions of dollars out of the Medicare home health program, even as providers are facing numerous other challenges.

Last month, the WiAHC Advocacy Newsletter reported the association’s 2023-24 Policy Agenda was pending final WiAHC Legislative Committee approval before being sent to the full board. This month, we are pleased to announce the Legislative Committee has completed its work.

In addition to using member input to develop the association’s advocacy roadmap, the WiAHC Legislative Committee considered the following criteria when developing the Policy Agenda and individual issue priorities: 1.) The benefit to WiAHC members; 3.) The extent to which it will improve home health care in Wisconsin; and 3.) The likelihood of legislative/regulatory success.

The WiAHC Policy Agenda provides a broad policy vision for advancing home health care in Wisconsin and identifies the following specific legislative and regulatory goals for 2023-24:

• ·         Regulatory reform legislation to modernize DHS 133, including provisions to better align Wisconsin home care regulations with federal home care regulations.

• ·         Promote public awareness and increase policy influence of home health care, such as the creation of a Home Health Care Advisory Council at the Wisconsin Department of Health Services.

• ·         Grow/strengthen Wisconsin’s home health care workforce: Secure additional state funding to support    increasing the supply of nurse educators in Wisconsin.
• ·         Expand home health telehealth flexibility to leverage the effective delivery of virtual care, which ultimately benefits patients and helps to alleviate industry-wide workforce challenges.

CLICK HERE to review the full 2023-24 WiAHC Policy Agenda, which will be used to guide the association’s advocacy efforts over the next two years.

The WiAHC Government Affairs Team recently presented Sen. Mary Felzkowski (R-Irma) and Sen. Joan Ballweg (R-Markesan) with the organization’s 2022 Champion of Home Health Care legislative award for their leadership on policies to advance home health care in Wisconsin and improve the delivery of patient care provided by home health professionals.

“Both Sen. Felzkowski and Sen. Ballweg were fierce advocates for home health care during the 2021-22 legislative session, and their work was critical in efforts to strengthen the home health care workforce and increase patient access to skilled nursing provided in the comfort of their own homes,” said Jayne Thill, Chair of the WiAHC Board of Directors. “They both clearly understand the value of home health care for Wisconsin patients, and we are excited to thank them for their work on behalf of our members and the patients we serve every day.”

The Champion of Home Health Care award is presented at the end of each two-year legislative session to state lawmakers who exemplify WiAHC’s mission of promoting, protecting, and advancing the highest quality health care at home for Wisconsin patients. In 2022, WiAHC is presenting the award to only four legislators, including Felzkowski and Ballweg. These lawmakers exhibited an exceptional commitment to supporting home health care based on several factors, including voting record, sponsorship of legislation and responsiveness to critical home health issues during the 2021-22 session.

Ballweg and Felzkowsi earned the Champion of Home Health Care designation for their leadership on a successful legislative effort to increase the Medicaid reimbursement rate for skilled nursing provided in a home health setting, as well as their work on a bill to improve regulation of the home health care industry.

Ballweg, who was first elected to the Wisconsin Senate in 2020 after serving eight terms in the Assembly, represents the 14th Senate District, which includes numerous counties in central Wisconsin, stretching from Columbia County up to Waupaca County in the northern most part of the district. She is a member of the Legislature’s powerful Joint Finance Committee. 

Felzkowski was first elected to the Wisconsin Senate in 2019, after serving four terms in the Assembly, and represents the 12th Senate District, which covers the northeast portion of the state. She also serves on the Joint Finance Committee.

 

Under WiAHC’s legislative awards program, state and/or federal legislators who demonstrate support for policies that advance home health care in Wisconsin and are aligned with WiAHC’s mission are eligible to receive one of WiAHC’s legislative awards: 1) Champion of Home Health Care or 2)Friend of Home Health Care. These awards are given out every two years, following the end of each legislative session.

Lawmakers who display exceptional support of WiAHC and home health care in Wisconsin are eligible for recognition as a Champion of Home Health Care. Lawmakers who display general support of WiAHC and home health care in Wisconsin are eligible for recognition as a Friend of Home Health Care.

The following state legislators were recognized as Champions of Home Health Care:

• Rep. Amy Loudenbeck (Clinton)
• Rep. Donna Rozar (Marshfield)
• Sen. Mary Felzkowski (Irma)
• Sen. Joan Ballweg (Markesan)

WiAHC has recognized the following state lawmakers as Friends of Home Health Care:

• Rep. Robin Vos (Rochester)
• Rep. Mark Born (Beaver Dam)
• Rep. Rick Gundrum (Slinger)
• Sen. Devin LeMahieu (Oostburg)
• Senator Howard Marklein (Spring Green)

By Hoven Consulting  – WiHPCA’s lobbying firm

• ·         New Marquette Law School Poll Released on October 12

On October 12, Marquette Law School released a new statewide election poll, which was conducted between October 3-9.  The following poll findings may be of interest:

Gubernatorial Race

This poll asked likely Wisconsin voters about their preferred candidate for this year’s governor’s race.  The poll found the following:

·         Governor Tony Evers (Democrat): 47%

·         Tim Michels (Republicans): 46%

·         Joan Beglinger (Independent): 4%

o   NOTE:  Joan Beglinger ended her gubernatorial campaign in early September and endorsed Republican candidate Tim Michels.  However, her name will remain on the November general election ballot.

The October poll also asked respondents if they approved or disapproved of how Governor Evers is handling his job. The poll found the following:

Governor Tony Evers

·         Job Approval:  46%

·         Job Disapproval:  48%

·         No Opinion:  5%

U.S. Senate Race

This poll asked likely Wisconsin voters about their preferred candidate for this year’s U.S. Senate race.  The poll found the following:

·         Lt. Governor Mandela Barnes (Democrat): 46%

·         U.S. Senator Ron Johnson (Republican): 52%

The poll also asked respondents if they have a favorable or unfavorable opinion of Lt. Governor Mandela Barnes and U.S. Senator Ron Johnson.  The poll found the following:

Lt. Governor Mandela Barnes (Democrat)

·         Favorable: 39%

·         Unfavorable: 40%

·         Haven’t heard enough: 15%

·         Don’t know: 6%

U.S. Senator Ron Johnson (Republican)

·         Favorable: 41%

·         Unfavorable: 45%

·         Haven’t heard enough: 9%

·         Don’t know: 4%

• ·         Legislative Council Study Committee on Occupational Licenses - Update

This study committee’s most recent meeting occurred on Wednesday, October 12.  During the meeting, committee members expressed frustration with the state Department of Safety and Professional Services (DSPS) for their ongoing occupational license processing delays, as well as the limited amount of information the agency has provided to the study committee.  As such, there was discussion of potentially moving the responsibility of processing certain licenses to other state agencies (e.g., moving health care-related licenses to the state Department of Health Services). 

Other committee members stated their support to provide authority to DSPS to use more of their fee revenue to hire additional employees to assist with processing delays.  Interestingly, Committee Chair/Senator Rob Stafsholt noted that he does not oppose providing DSPS with the authority to hire more staff.  However, he would like the agency to provide the legislature with data to justify that.  Also, Chair Stafsholt and Vice Chair/Rep. Shae Sortwell noted their support for universal licensure recognition. 

A list of committee members, the full meeting agenda, as well as written presentations may be viewed on the legislature’s website.  This committee’s next public meeting will occur on Tuesday, November 15 in Madison.

WiAHC Legislative Key Contact Program

If you were not yet aware, we would like to remined you about WiAHC’s Legislative Key Contact Program, which can be a highly effective grassroots advocacy tool to help build and nurture strong on-going relationships between WiAHC members and lawmakers in Wisconsin. Ultimately, the program can help us help shape new policies important to our members.

The program is now live on the WiAHC website and members can easily and quickly sign-up as a Key Contact. With the campaign season winding down, and the 2023-24 legislative session right around the corner, it’s more important than ever for WiAHC to have a robust Key Contact Program. It is essential to raising our profile in the State Capitol and beyond.

As a Key Contact, you can help influence the legislative process by cultivating relationships with elected officials. By taking advantage of existing relationships and making new contact with members of the Wisconsin Legislature (as well as the Wisconsin Congressional  Delegation), you can help us educate lawmakers on industry issues and influence legislation.

But the program will not succeed without strong member participation, so please take a few moments to read more about it – and learn how simple it is to “enlist” and participate as a Key Contact. The time commitment is minimal and your responsibility as a key contact depends on your level of comfort and willingness to engage.

Remember, lawmakers are often eager to hear input from their constituents, and as an expert in the home health care field, you can make a real difference in the policy process as a Key Contact. CLICK HERE to sign-up by filling out and submitting a brief online survey.

WiAHC Legislative Outreach Program

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. In effort to capitalize on our greatest advocacy resource – our membership – WiAHC has established our Coffee Conversations with Legislators advocacy program.

The initiative is designed  to help connect members with their local legislators. Under the program, the WiAHC Government Affairs Team will set-up in-district meetings between WiAHC members and state lawmakers who represent them in the Legislature. These meetings, which can be located at your facility, or a local coffee shop provide a tremendous opportunity for WiAHC members to build or strengthen their relationships with local legislators and to educate them on home health care and on policy issues important to home health care professionals and their patients.

WiAHC encourages all members to participate in this critical grassroots advocacy program. Please click here for more information on the program. If you’re interested in participating in the program, contact the WiAHC office at wiahc@badgerbay.co.