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Earlier this month, the State Senate and Assembly passed legislation to allow Medicaid providers to seek reimbursement for services provided via telehealth. Telehealth, sometimes called telemedicine, is a healthcare delivery model in which technology is utilized for healthcare providers to remotely speak to, treat, and monitor patients.
The legislation passed both houses of the legislature earlier this month on unanimous voice votes. The bill was heavily bipartisan from its inception.
WiAHC actively lobbied in support of the legislation. The bill innovatively assists in addressing nursing workforce issues. Utilizing telehealth could increase access and utilization of home health care, which means agencies could take on more patients. Additionally, due to the ability to deliver services remotely, nurses could see more patients daily without the burden of drive-time.
On November 20, Marquette University Law School released its newest poll numbers forecasting the 2020 elections and gauging the state’s attitudes on a variety of issues and public figures.
The most significant numbers provide a glimpse into Wisconsin voters’ opinions on the impeachment proceedings. The new poll numbers found 40 percent of respondents favor impeachment of President Donald Trump while 53 percent do not. However, 52 percent of respondents said they do believe Trump asked Ukraine to investigate Trump’s political rivals.
Additionally, the poll indicates 42 percent of respondents say Trump did “something seriously wrong” while 38 percent say he “did nothing wrong.”
While the numbers indicate a majority of respondents believe Trump asked Ukraine to investigate political rivals and a plurality believe he did “something seriously wrong”, a majority of respondents still do not support impeachment.
In other presidential data, Trump now leads the top four potential Democratic contenders in the 2020 election. Previously polls showed him trailing former Vice President Joe Biden, Vermont Senator Bernie Sanders, and Massachusetts Senator Elizabeth Warren. However, Trump now leads Biden by 3 points, Sanders by 3 points, and Warren by 5 points.
According to the poll, 28 percent of respondents indicated they usually think of themselves as Republicans, 28 percent said they think of themselves as Democrats, and 38 percent said they consider themselves Independent. Given the breakdown, this week’s poll numbers could indicate Trump seems to be polling better amongst self-described independents.
While Trump’s numbers are rising, Biden still remains the first choice for many Democratic Primary voters in Wisconsin. He leads Sanders by 13 points and Warren by 15 in the race for the Democratic nomination.
The new poll numbers also indicate Governor Tony Evers’ approval rating has dipped below 50 percent for the first time. The November data shows 47 percent of poll respondents approve of Evers’ job performance.
Other data includes:
The economy, over the last year, has:
· Improved: 42 percent
· Worsened: 18 percent
· Stayed the Same: 37 percent
In 2020, the economy will:
· Improve: 35 percent
· Worsen: 24 percent
· Stay the same: 37 percent
Chronic wasting diseases is a threat to the future of deer hunting:
· Deer Hunters Responding: Agree – 65%, Disagree – 31%
· Non-Deer Hunters Responding: Agree – 62%, Disagree – 18%
The poll, conducted among 801 registered Wisconsin voters, has a margin of error of +/- 4.1 percentage points.
Gov. Tony Evers vetoed a bipartisan plan Wednesday that would have reduced the number of required training hours to become a certified nursing assistant in Wisconsin.
Wisconsin requires 120 hours of training to become a CNA, including 32 hours of clinical training. The bill would have reduced that to the federally required minimum of 75 hours of training, including 16 hours of clinical experience.
Evers said he objected to providing less training for those caring for the state's most vulnerable.
“Research has shown that higher training standards result in better outcomes for patients, lower staff turnover and higher job satisfaction," Evers said in his veto message. "There are better ways to address the shortage of nurse aides than reducing the quality of training programs.”
Evers noted that he directed the Governor’s Task Force on Caregivers to develop strategies to attract and retain a strong direct care workforce.
Bill author Sen. Rob Cowles, R-Green Bay, said he doesn't believe that reducing training hours to the federal minimum would diminish quality.
"The governor disagrees with that, so we move on," he said in an interview Thursday. "That's the way it is."
He said he believes the nursing homes that told him the federally required minimum would be sufficient and help recruit more young people into the field.
"Having been in numerous homes, I believe the people around those facilities have credibility and they have passion and they're not trying to skirt anything," Cowles said. "They care about elderly, frail people."
Cowles also said that a bigger issue in addressing the workforce shortage is pay, noting that Republican lawmakers pushed for higher Medicaid rate increases that were included in the current budget.
"Hopefully that's enough to stem the loss and generate more people in the field," Cowles said.
A coalition of long-term care providers said in a statement that the state is facing a critical caregiver workforce shortage.
"This policy would have helped facilities have the staff to maintain and advance care quality," they said in a statement.
Mindy Meehean, director of nursing at Wausau Manor, said the bill would have made the CNA profession "more financially available for potential applicants."
"The current CNA hourly training requirement creates a financial obstacle that leads many interested candidates to look for jobs elsewhere," Meehean said in a statement. "It is disappointing that this bill was vetoed, as it was a needed change to help providers maintain quality care for our residents."
LeadingAge Wisconsin CEO John Sauer said having a higher required amount of training "stings a bit" for nursing homes along the Minnesota, Iowa and Michigan borders. Those states are at the federal minimum, making recruitment efforts more difficult for Wisconsin facilities, he said.
"We're facing unprecedented times in competing for workforce," Sauer said. "What we were hoping is that if we went to the national standard for training, that we might be able to attract and compete with other non-healthcare employers."
The bill faced opposition from advocates for seniors and those with disabilities, who warned it could hurt the quality of care.
"We think that a reduction in hours leads to a reduction in quality of care," said Helen Marks Dicks, state issues advocacy director for AARP Wisconsin. "This is not a solution to the problem of the workforce crisis."
She said that the Governor's Task Force on Caregiving is charged with addressing the workforce crisis and will probably discuss training.
Disability Rights Wisconsin warned the bill could have led to “unintended long-term consequences" that would diminish quality care.
The task force may recommend a reduction in training requirements, but at that point “it will be part of a carefully considered comprehensive plan to address the larger issue," the statement noted.
While the task force could take up the training requirements, pay is the number one thing, Cowles said.
"I think this whole field is going to be going through a lot of trauma in the years ahead," Cowles said. "There's going to be more closures, there's going to be more pain and more difficulty for families trying to figure out where grandma and grandpa are going to go. And that's something we have to pay attention to."
Sauer said the task force should consider innovative ways to address the caregiver shortage, including allowing people with prior experience as a caregiver count some of their hours served toward the required training.
"We need a lot of innovation," he said. "This is going to be a multi-faceted solution."
On Wednesday, October 23, Marquette University Law School released its most recent poll results. The poll, which was conducted between October 13 and October 17 among 799 Wisconsin voters, sought public opinion on a range of state and federal topics. The poll indicated good news for Democratic Governor Tony Evers and less optimistic results for Republican President Donald Trump.
Evers’ job approval remains at relatively high at 52% with 34% disapproval. This number is down slightly from August, which indicated a 54% job approval rating. However, the new number is within the margin of error. Additionally, 53% of respondents said the state is headed in the right direction.
Meanwhile, public support in Wisconsin for impeaching Trump continues to rise. In April, 29% of respondents said there was enough cause to impeach. Wednesday’s poll indicates 46% now believe there is enough cause. The number is certainly trending in a direction unfavorable to the President.
Additionally, the poll found Trump loses in head-to-head matchups with Democratic primary candidates former Vice President Joe Biden (Biden 50% - Trump 44%), Senator Bernie Sanders (Sanders 48% - Trump 46%), and Senator Elizabeth Warren (Warren 47% - Trump 46%).
However, Trump’s job approval ratings has held relatively stagnant at 46% approval and 51% disapprove.
Other poll findings include:
Q: Do you support or oppose having a national health plan, sometimes called Medicare-for-all, in which all Americans would get their insurance from a single government plan?
· Support: 51%
· Oppose: 42%
Q: In 2018, Wisconsin lost nearly 700 dairy farms. Do you think the federal government should financially support small farms that are struggling to stay in business, or is this not the job of the federal government?
· Support small farms: 63%
· Not the job of the federal government: 30%
Q: Would you support or oppose a mandatory buy back program in which the federal government would require assault weapon owners to turn in those weapons in exchange for payment?
· Support: 42%
· Oppose: 54%
Earlier this month, both the State Senate and State Assembly were on the floor voting on a wide range of legislation. The activity marked the first floor days after the summer break. In total, the two houses took up over eighty bills and resolutions.
Both houses worked diligently throughout August and September in the committee process to prepare much of the legislation voted on this week.
The State Senate was in session on Tuesday, October 8. Debate was generally uneventful with much of the legislation passing on bipartisan voice votes or unanimously. Among the highlights was a bill from Republican Senator Patrick Testin regarding industrial farming of hemp. Specifically, the bill, Senate Bill 188, aims to take the state’s current hemp cultivation pilot program to a permanent program. The bill’s authors cited the 2019 numbers that show over 1,400 growers and 700 hemp processors applied for permits from the Department of Agriculture Trade and Consumer Protection. The bill passed 30-2 with Republicans Steve Nass and Duey Stroebel voting in opposition.
The Senate also took up a piece of legislation known as the Lemonade Stand Bill, which seeks to legalize minors being able to sell certain non-hazardous foods. The legislation was introduced following some stories in Wisconsin and other states about children being cited by local law enforcement for operating food stands without permits. The bill, Senate Bill 170, passed on a unanimous voice vote.
The State Assembly convened on Thursday, October 10. Like much of the Senate calendar, many bills passed on simple bipartisan voice votes. However, the calendar included a somewhat controversial resolution that sought to change Assembly rules. The controversy stemmed from events last year in which Representative Jimmy Anderson (D – Fitchburg) sought changes to Assembly rules which would allow him to call into committee meetings. Anderson, a paraplegic, sought the rule change in order to participate in committee meetings while also tending issues related to his disability.
Assembly Republican port forth the bill, Assembly Resolution 12, to change the rules to allow an accommodation for Anderson. However, the resolution also included other substantive rule changes which Assembly Democrats called a “power grab.” For instance, the resolution included a provision which would allow the Assembly unlimited veto override attempts.
In comments to the media, Anderson said, “We’re on the cusp of providing these accommodations and what does [Speaker Robin Vos] do? A political stunt that’s going to force me to vote against my own accommodations, I think that’s ridiculous.”
Following hours of debate on the resolution and an impassioned speech by Anderson, Assembly Republican leadership introduced an amendment to remove most the language not regarding accommodations for Anderson. Anderson said in another floor speech he would extend an “olive branch” and vote in favor of the amendment. The amendment was adopted and the resolution passed.
The Senate and Assembly will meet again in November.
This month, two bills aimed at helping home health agencies saw significant process in the legislative process. Senate Bill 416, which raises skilled nursing home health rates by 10%, received a public hearing in the Senate Committee on Health. Senate Bill 380 its companion bill Assembly Bill 410 both passed their respective committees this month. WiAHC actively engaged in lobbying and advocating for both initiatives.
On Wednesday, October 23, the Senate Committee on Health and Human Services heard testimony on Senate Bill 416, which seeks to raise Medicaid reimbursement for home health skilled nursing visits by 10%. Medicaid rates for home health care have not been raised in over a decade, which has ultimately led to a workforce shortage crisis. Proponents argue the rates must be raised to attract more nurses to work in home health care. Additional workforce will be vital as home health utilization rates continue to increase.
WiAHC members Lisa Kirker and Colleen Shade testified before the committee in support of the bill. Kirker and Shade provided integral testimony on the financial strain placed on Wisconsin’s home health agencies due, in part, to insufficient Medicaid rates. They explained the intricacies of how Wisconsin’s rates are contributing to a nursing workforce shortage for agencies.
Committee members greatly appreciated their testimony and asked inciteful questions to gain additional information and clarification. By the end of their testimony, it was clear committee members understood the workforce shortage is real and the Medicaid rates are antiquated. WiAHC leaders are hopeful it will receive a vote in the coming weeks.
The Senate Committee on Health also unanimously passed Senate Bill 380, authored by Senator Dale Kooyenga (R-Brookfield) and Representative Amy Loudenbeck (R-Clinton), allows any Medicaid provider to seek and receive reimbursement for services provided via telehealth technology. The Assembly Committee on Medicaid Reform and Oversight passed the Assembly version, Assembly Bill 410, on October 30. WiAHC’s lobbyist advocated for the bills before the committee members throughout October.
The next step for Senate Bill 380 and Assembly Bill 410 would be to receive votes in their respective houses. WiAHC’s lobbying team is working with legislative leaders to try to schedule those bills.
On Wednesday, October 23, the State Senate Committee on Health and Human Services held a public hearing on Senate Bill 416, which seeks to increase Medicaid rates for home health care services by 10%. Members of the Wisconsin Association for Home Health Care (WiAHC) provided crucial testimony on the need for high Medicaid rates to address the home health care workforce shortage.
WiAHC members Lisa Kirker and Colleen Shade testified before the committee. Both Kirker and Shade are home health care agency administrators with backgrounds in nursing. Their crucial testimony illustrated the workforce crisis Wisconsin’s home health care agencies face.
In Wisconsin, Registered Nurses (RNs) are disproportionately represented in nearly all other areas within the healthcare industry. RNs working in home health settings make up just 6% of the total nursing workforce in the state, according to the Wisconsin Center for Nursing. Nationally, RNs working in home health settings make up nearly 13% of the total nursing workforce, according to the Bureau of Labor Statistics.
This is caused, in part, by outdated Medicaid reimbursement rates. Home health agencies have not received a Medicaid reimbursement increase for skilled nursing visits in ten years. When home health agencies do not receive adequate reimbursement, they cannot provide staff with competitive reimbursement. “It is hard to recruit a nurse and be comparable in wages to a hospital,” Kirker told legislators. “When we don’t have staff, we can’t take new patients.”
Home health agencies need Medicaid rates to keep up with healthcare costs in order to staff agencies and provide low-cost, high-quality healthcare to patients in need. The demand for home health services is only going to increase.
“We know in 2025, 1.3 million people will be in need of homecare services,” Shade said. “Without an increase, [providing access to services] will continue to be a challenge.”
Kirker and Shade were grateful for the opportunity to testify and WiAHC hopes the bill will continue through the legislative process.
The Wisconsin Association for Home Health Care is a membership-based association that represents home health care agencies and their staff across the state. Wisconsin’s home care agencies provide care to Wisconsin residents throughout the year, and the more than 14,000 garners more than $386 million in wages. WiAHC members are committed to make sure home health care remains a high-quality, cost-effective health care option in our state.
Nominate a yourself or a colleague to serve on the WiAHC Board of Directors today!
WiAHC is run by a volunteer Board of Directors. Board members are elected annually to staggered three-year terms. Board members develop and manage the affairs of the Association and are supported by Committee Chairs and staff. Positions include Chair, Vice-Chair, Secretary/Treasurer, and Regional and At-Large Representatives.
Positions serve a three-year term, starting January 2020. Those elected will also be invited to attend the final Board meeting of 2019.
To be eligible, a nominee's home health agency must be a current member of WiAHC.
How to Nominate
Nominating is easy, quick and simple!
Submit a nomination by completing the call for nominations form on the WiAHC website.
The deadline to submit nominations is October 25, 2019.
On September 20, Senator Patrick Testin (R – Stevens Point), Senator Jon Erpenbach (D – West Point), and Representative Chris Taylor (D – Madison) introduced a bipartisan medical marijuana bill.
The legislation would legalize medicinal use of cannabis for specified diseases laid out in the bill. The legislation direct the Department of Health Services to develop a medical cannabis registry. In order for an individual to obtain cannabis, they must have a registry identification card and a recommendation from a physician.
Furthermore, the bill requires the Department of Agriculture, Trade, and Consumer Protection to develop a licensing system for growers, producers, and sellers in order to ensure quality and safety in medical cannabis products.
If passed, Wisconsin would join in Minnesota, Illinois, and Michigan in legalizing medical cannabis. However, passage appears to be a bit of a longshot. Senate Majority Leader Scott Fitzgerald (R – Juneau) told the media, “I don’t support this plan and I think it’s going to be a tough sell to a majority of my caucus.”
While there have been attempts in recent legislative sessions to legalize medical cannabis, this effort is somewhat different due to Republican Senator Patrick Testin being a coauthor of the bill. This is the first bipartisan attempt in recent legislative sessions.
Last month, the legislative update included an article regarding two important pieces of legislation introduced in the State Legislature. The first provides Medicaid reimbursement for services provided via telehealth. The second seeks to raise Medicaid reimbursement rates for home health agencies by 10 percent. In September, both bills had some promising movement in the legislative process.
First, the Assembly version telehealth bill, Assembly Bill 410, received a public hearing in the Assembly Committee on Medicaid Reform and Oversight on September 24. WiAHC submitted written testimony to the committee in favor of the bill. In general, the hearing went very well with no testimony in opposition to the bill. The next step is for the committee to vote the bill out of committee. Doing so would allow the bill to receive a vote on the Assembly floor.
The Senate version, Senate Bill 380, was referred to the Senate Committee on Health and Human Services.
The home health Medicaid reimbursement bill, Assembly Bill 447 and Senate Bill 416, were both referred to standing committees. Assembly Bill 447 was sent to the Assembly Committee on Medicaid Reform and Oversight, of which bill author Rep. Rob Brooks is the vice chairman of the committee. Senate Bill 416 was referred to the Senate Committee on Health and Human Services.
Upon official introduction, Assembly Bill 447 and Senate 416 had a bipartisan list of forty cosponsors, which, in general terms, shows significant support for the bills.
Both bills are awaiting public hearings and WiAHC’s lobbyists are working with the respective committee chairs to schedule those hearings. The lobbying team will continue to provide updates as they advocate for both bills.
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