By Hoven Consulting – WiAHC’s lobbying firm

With the holidays right around the corner, the halls of the State Capitol will be relatively quiet through December. But despite the fact there will not be much visible legislative activity until the new year, plenty is going on behind the scenes as lawmakers work to shape their remaining legislative priorities before the session ends in April.

Similarly, WiAHC continues to position itself for the rest of the current session and future legislative success. One significant step in that direction was our Virtual Legislative and Policy Forum held on Nov. 8 where members learned how they can be effective grassroots advocates and had an opportunity to hear from and ask questions of key policymakers, including WI Department of Health Services Deputy Secretary Debra Standridge, DQA Administrator Otis Woods, and two state lawmakers – Rep. Rick Gundrum (R-Slinger) and Rep. Donna Rozar (R-Marshfield).

While we are looking forward to holding an in-person WiAHC “Day at the Capitol” in the future – which will allow us to have a much bigger advocacy impact – the virtual legislative and policy forum provided great value and helped raise our profile and increase our influence in the Capitol and among state government officials.

Speaking of strengthening advocacy efforts, WiAHC’s legislative committee and lobbyists have spent a considerable amount of time over the last year refining legislation to make modest but impactful changes to DHS 133, the administrative rule chapter regulating home health agencies. We are pleased to report the bill has been officially introduced as Senate Bill 700.

The impetus for the changes began as an effort to bring Wisconsin’s administrative rules in line with the federal government’s elimination of requirements for professional advisory bodies. The final version of the legislation will eliminate DHS 133.05 (2) in its entirety regarding advisory board requirements, as they are no longer compatible with federal law.

The legislative committee also recommended several other changes to Chapter 133 which would have created additional efficiency to patient care. After sharing those recommendations with the Department of Health Services and previously receiving their support, the agency raised concerns regarding these proposed changes late in the legislative drafting process. With an eye on the legislative clock, we chose to move forward with the scaled-down version that DHS does support and not jeopardize a potential veto.

Our Government Affairs Team worked with Representative Donna Rozar (R-Marshfield) and Senator Joan Ballweg (R-Markesan) to introduce the legislation and will work to advance the proposals through the legislative process before the legislature adjourns in Spring 2022. Please watch for opportunities coordinated by WiAHC to engage your legislators and request their support for the bill.

Yesterday the WI Department of Health Services’ Division of Quality Assurance (DQA) issued the following information to all DQA regulated providers regarding the Centers for Medicare & Medicaid Services (CMS) Interim Final Rule (released on Nov. 4, 2021), which requires COVID-19 vaccination for most healthcare workers at certain healthcare facilities certified by CMS:

On November 4, 2021, the Centers for Medicare & Medicaid Services (CMS) announced a new emergency rule related to a COVID-19 vaccination requirements for Medicare and Medicaid-certified health care providers and suppliers. Specifically, it requires all health care providers and suppliers that participate in a federally certified Medicare and Medicaid program under Conditions of Participation (COP) to develop a plan/process to vaccinate all staff with a first dose or single dose of COVID-19 vaccine by December 6, 2021. All eligible staff must be fully vaccinated by January 4, 2022.

The Emergency regulations apply to the following Medicare and Medicaid-certified providers/suppliers:

• Ambulatory Surgery Centers
• Community Mental Health Centers
• Comprehensive Outpatient Rehabilitation Facilities
• Critical Access Hospitals
• End-Stage Renal 2 Dialysis Facilities
• Home Health Agencies
• Home Infusion Therapy Suppliers
• Hospices
• Hospitals
• Intermediate Care Facilities for Individuals with Intellectual Disabilities
• Clinics
• Rehabilitation Agencies, and Public Health Agencies as Providers of Outpatient Physical Therapy and Speech-Language Pathology Services
• Psychiatric Residential Treatment Facilities (PRTFs)
• Programs for All-Inclusive Care for the Elderly Organizations (PACE)
• Rural Health Clinics/Federally Qualified Health Centers
• Long Term Care Facilities

The regulation does not apply to:

• Assisted Living Facilities; however, the mandate would apply to large assisted living facilities with more than 100 employees under the OSHA mandate.
• Home and Community-Based Services
• Physician’s offices

The vaccination requirement applies to eligible staff working at a facility that participates in the Medicare and Medicaid programs, regardless of clinical responsibility or patient contact. This includes:

• Facility employees
• Licensed practitioners
• Students
• Trainees
• Volunteers
• Individuals who provide care, treatment, or other services for the facility and/or its patients under contract or other arrangements

CMS has provided additional information about the COVID-19 Health Care Staff Vaccination Interim Final Rule in a FAQ document.

DQA Review:

CMS expects state survey agencies to conduct onsite compliance reviews of these requirements during recertification surveys and complaint surveys. Surveyors will check to determine if a facility has met the three basic requirements:

• Having a process or plan for vaccinating all eligible staff
• Having a process or plan for providing exemptions and accommodations for those who are exempt
• Having a process or plan for tracking and documenting staff vaccinations.
• Surveyors will review the facility’s vaccine policies, the number of resident and staff COVID-19 cases over the last 4 weeks and list of staff and their vaccination status. This information will be used to determine the compliance of the provider or supplier with these requirements.

CMS will host a second stakeholder call TODAY, November 10, from 2:30 – 3:30 p.m. CST. To register in advance, visit the CMS Webinar Registration. After registering, you will receive a confirmation email containing information about joining the webinar. Please note that CMS can only accommodate 10,000 participants so register early to guarantee your participation.

During the month of November, the home care and hospice community honors the millions of nurses, home care aides, therapists, and social workers who make a remarkable difference for the patients and families they serve. These heroic caregivers play a central role in our health care system and in homes across the nation. To recognize their efforts, we call upon all Americans to commemorate the power of caring, both at the home and in their local communities, and ask them to join with the National Association for Home Care & Hospice (NAHC) by celebrating November as Home Care and Hospice Month.

In addition, Home Care Aide Week takes place the second full week of the month, November 8-14, 2020. Join us in honoring these compassionate, tireless workers who play an invaluable role for their clients as caregivers, companions, and friends.

“Home care and hospice nurses, therapists, aides, and other providers who choose to use their lives to serve our country’s aged, disabled, and dying. This noble work deserves our recognition and praise and we celebrate November as Home Care & Hospice Month for that very reason.”  – NAHC President William A. Dombi

Hospital & Healthcare Compensation Service

Oakland, NJ, October 2021--The average hourly rate for Registered Nurses (RNs) in home health agencies increased 2.98% in 2021, according to the 2021-2022 Home Care Salary & Benefits Report, just released by Hospital & Healthcare Compensation Service (HCS). The Report is published in cooperation with the National Association for Home Care & Hospice (NAHC).

In a comparison of rates by agency type, RNs in hospital-based home health agencies received the highest in pay with an average hourly rate of $40.10. The average hourly rate for RNs in VNS/VNAs was $37.67; for-profit agency RN hourly pay was $34.43; and not-for-profit agency pay was $36.17/hour. (All rates above represent the national average hourly rate.)

The national average hourly rate for RNs was $35.20. In a comparison of rates by state, RNs in Connecticut received $41.19/hour; RNs in Massachusetts received $41.98/hour; and California RNs ranked the highest in pay at $48.83/hour. On the lower spectrum, RNs in Mississippi received $28.53/hour; while RNs in Kentucky received $31.32/hour; and RNs in Alabama received $31.68/hour. (All rates above represent the national average hourly rate.)

The national average turnover rate for RNs has risen 11.70% since 2019. The average turnover rate for RNs in 2019 was 20.55%; 25.85% in 2020; and 32.25% in 2021. The average turnover rate for Home Care Aides rose from 36.53% in 2020 to 38.05% in this year’s study.

1,011 home health agencies participated in the study. The complete 190+ page Report contains 58 jobs and covers salaries, bonuses, and hourly & per visit rates. Data include the  10th, 25th, 50th, 75th, 90th average, total number of employees, and total number of agencies. Data are reported by state, CBSA, region, agency type and revenue size. Also included are 20 fringe benefits, planned percent increases, productivity, and personnel policies.

The Report price is $375. A separate Hospice Salary & Benefits Report will be published in late November. Both studies are published in cooperation with the National Association for Home Care & Hospice (NAHC).  To order, visit the HCS website at www.hhcsinc.comor call (201) 405‑0075.

With 50 years’ experience in national healthcare salary and benefits research, HCS is recognized for its comprehensive, responsible, and reliable ten specialized studies.  HCS provides the source for establishing and maintaining an effective compensation program. 

Hourly Data by Agency	VNA / VNS	Not-for-profit	For-profit	Hospital-based	Combined
Registered Nurse	$37.67	$36.17	$34.43	$40.10	$35.20

*National average hourly data from the 2020-2021 and 2021-2022 HCS Home Care Salary & Benefits Report

Back in August Representative Ron Kind (D-La Crosse) announced he would not seek reelection in 2022 to Wisconsin’s 3rd Congressional seat, which he has represented since 1997. Since his announcement, the field of candidates to replace him continues to grow.

On the Democratic side, current state Senator and former Wisconsin Agriculture Secretary Brad Pfaff was the first to throw his hat in the ring to replace Kind. Earlier this month, Kind endorsed Pfaff, who previously worked as a congressional aide for kind.

The following three Democrats have also joined the race and will face Pfaff in the Democratic primary:

• Rebecca Cooke, an Eau Claire small businesswoman and a member of the Wisconsin Economic Development Corporation Board of Directors (as an Evers appointee).
• Brett Knudsen, a U.S. Navy veteran, and political novice from Holmen; and
• Deb McGrath, an Army veteran, former CIA employee, and the daughter of Al Baldus, who represented the 3rd Congressional District for three terms in the late 70’s.

At this time there is only once declared candidate on the Republican side, Derrick Van Orden who narrowly lost to Kind in 2020. Van Orden, a retired Navy Seal and business consultant, has been endorsed by former President Donald Trump.

Wisconsin’s 3rd Congressional seat is a battleground district that could flip the balance of power in the U.S. House of Representative and is one of the most-watched congressional races nationally in the upcoming mid-term elections.

Earlier this month, Republican legislative leaders in the State Legislature unveiled their proposal to redraw new state legislative and congressional districts for the 2022 fall election. Every ten years, the U.S. Census Bureau publishes updated information reflecting changes in the population since the previous census, which is used by states to redraw local, legislative, and congressional districts so that each district has approximately the same number of people.

According to the nonpartisan Legislative Reference Bureau, the proposed GOP maps largely retain district boundaries as they are now, with some adjustments based on population changes. The new maps will likely pass the Legislature on a party-line vote next month, but Gov. Tony Evers (D) has vowed to veto the bills.

Policy decisions made at the State Capitol and throughout Wisconsin government can have a significant impact on the home health care industry, the professionals that work in the field, and the patients and families they serve. That’s why it’s increasingly important for WiAHC members to engage in the policymaking process at the state level. But the first step in raising our profile and increasing our influence under the Capitol dome is educating members on the importance of advocacy and building relationships with key policymakers.

With that on mind, we strongly encourage you to REGISTER TODAY for the FREE Wisconsin Association for Home Health care Virtual Legislative Forum, which will provide participants with effective grassroots advocacy training, help them understand how they can make a difference in the legislative process, and allow them to hear from key state lawmakers and Wisconsin Department of Health Services (DHS) officials. They will also have an opportunity to engage with invited policymakers and discuss issues that impact Wisconsin’s home health care industry.

The virtual event will take place on Monday, Nov. 8 from 10:30 A.M. to 12:00 P.M.

Participating state officials include newly appointed WI DHS Deputy Secretary Debra Standridge and State Representative Amy Loudenbeck (R-Clinton), Co-Chair of the Legislature’s powerful Joint Finance Committee.

LEGISLATIVE FORUM AGENDA: 

• ​10:30-10:35 a.m. - Welcome and Overview
• 10:35-10:50 a.m. – Grassroots Advocacy 101
• 10:50-11:15 a.m. – Featured Speaker
• • DHS Deputy Secretary Debra Standridge
  • DHS Division of Quality Assurance staff
• 11:15-12:00 p.m. – Legislative Panel and Interactive Discussion
• • CONFIRMED – Rep. Amy Loudenbeck (R-Clinton), Co-Chair of the Legislature’s Joint Finance Committee
  • INVITED – Rep. Donna Rozar (R-Marshfield), member of the Assembly Health Committee

Please do not wait to register for this exciting event. We look forward to “seeing you” on November 8.

By Hoven Consulting – WiAHC’s lobbying firm

According to the Wisconsin Health News, the state’s Medicaid program will carry forward many of the temporary telehealth provisions it put in place at the start of the COVID-19 pandemic in a permanent policy that will take effect January 1, 2022.

“What you see right now is in many cases the same rule that you’re going to see in the future, with I think some improvements actually,” Medicaid Director Jim Jones said at a Wisconsin Health News virtual panel in September.

Jones said improvements include paying originating sites, like a pharmacy or medical office, to provide a place for Medicaid members to receive telehealth. They’re also looking at expanding teledentistry and doctor-to-doctor teleconsultation.

Other changes like covering asynchronous telehealth, where patients, for instance, send a photo to their provider, are still being developed.

A state law enacted in November 2019 requires that the Department of Health Services treat telehealth the same as in-person care and mandates that Medicaid reimburse the same telehelath services that Medicare covers. The Department of Health Services initially anticipated taking six to nine months to roll out the law.

But when the pandemic struck in March 2020, DHS “ripped the Band-Aid off” and moved quickly to set up a temporary policy to ensure members could still get access to services, Jones said. They've spent the time since working on a permanent rule.

Rep. Amy Loudenbeck, R-Clinton, who wrote the law, said it helped plant “the seed of what telehealth could be,” particularly in how it could boost access to mental healthcare.

“This test period that we’re in has been really helpful and will inform rule-making,” she said.

She’s now working on legislation that would apply the Medicaid definition for telehealth to the state occupational licensing law.

Jim Castellano, telehealth and virtual care manager at Marshfield Clinic Health System, said state and federal flexibilities boosted their ability to provide telehealth.

“In some ways, I think this was a unique opportunity for everybody to just really get down and dirty with the technology and see what it’s capable of,” said Dr. John Schneider, chief medical officer at the Milwaukee County Behavioral Health Division.

He said telehealth has helped them reach more people, including easing the pivot from at-home visits to telecalls. He said there could be challenges with reimbursement in the future.

John Nygren, Wisconsin Association of Health Plans executive director, said their members have embraced the use of telehealth, calling it the “one of the best things” that has come out of the pandemic.  

Over the last year, WiAHC’s legislative committee and government affairs team have been refining a critical legislative proposal to make modest but impactful changes to DHS 133, the administrative rule chapter regulating home health agencies. The bill, which will be introduced by Senator Joan Ballweg (R-Markesan) and Representative Donna Rozar (R-Marshfield), is currently being circulated co-sponsorship, which gives other lawmakers an opportunity to co-sign the bill.

The impetus for the changes began as an effort to bring Wisconsin’s administrative rules in line with the federal government’s elimination of requirements for professional advisory bodies. A working group made up of members of WiAHC’s legislative committee identified additional changes to make permanent following emergency regulatory allowances during the COVID-19 pandemic. The proposal includes the following provisions:

Updates to Match Federal Code

• Eliminate DHS 133.05 (2) regarding Professional Advisory Bodies in its entirety.
• • LRB-5046 and LRB-2570 brings Wisconsin in line with recent federal updates to eliminate the Professional Advisory Body but maintain the Governing Body.
  • Current administrative rule requires each home health agency to establish a Professional Advisory Body, which is required to annually review and make recommendations concerning an agency’s operations.
  • Home health agencies also have a Governing Body, as required in DHS 133.05 (1), which governs operations.
  • Professional Advisory Bodies are redundant and unnecessary, which is why there were eliminated at the federal level.

• Allow for 120 hours to develop a plan of care under DHS 133.20 (1)
• • LRB-5046 and LRB-2570 allows Wisconsin’s home health agencies to streamline the administrative work needed for home health agencies to admit new patients by adhering to one timeline of 120 hours.
  • Federal law allows 120 hours for home health agencies to develop a plan of care for agencies to meet additional federal admittance requirements.
  • State rules require agencies to develop plans of care in 72 hours.
  • 120 hours provides home health agencies and other health care providers necessary time to develop comprehensive plans of care.

Maintain regulatory allowance made for COVID-19

• Allow supervisory visits required under DHS 133.18 to be done in person or via telehealth.
• • LRB-5046 and LRB-2570 allows supervisory to continue to be provided in person or by telehealth, as first allowed by DHS during the pandemic.
  • Supervisory visits are required no less than every two weeks during a patient’s term of care to ensure a plan of care being properly administered.
  • Registered nurses are able to perform more supervisory visits in a day by cutting down on travel time between homes. This is especially helpful in rural areas.
  • Supervisory visits are not the same as routine plan of care visits, which are provided in person. LRB-5046 and LRB-2570 does not change that.

As mentioned above, the bill is currently being circulated for co-sponsorship. The more co-sponsors on a bill, the better chance it may have to make it to the governor’s desk. Click here to find out how you can contact your legislators to encourage them to co-sponsor this important legislation.

By State Representative Patrick Snyder (R-Schofield)

One of the most pressing concerns facing families across Wisconsin is the cost of health care. Undergoing treatment for a medical condition can already be a very stressful time for patients and their families. Unfortunately, hat stress can skyrocket once the bill comes due.

Most health insurance plans include cost-sharing arrangements such as copayments, coinsurance, and deductibles. These out-of-pocket costs, which have increased in recent years, are not only a financial burden on patients, but also an administrative burden on the providers who must collect them.

Guidance from the US Department of Health and Human Services’ Office of Inspector General allows providers across the country to provide “prompt-pay” discounts for copayments and deductibles under certain circumstances if the bill is paid promptly. These discounts offer relief to patient’s wallets and simplify the collections process for providers.

However, due to differing interpretations of Wisconsin state law, providers that offer these discounts in other states are hesitant to give these same discounts to patients in Wisconsin. That’s why Senator Dan Feyen and I introduced Assembly Bill 571. This bill clarifies that prompt-pay discounts are permissible in Wisconsin allowing patients and providers to take advantage of this practice that is common elsewhere in the country.

A similar bill was passed unanimously by the state Assembly last session, but unfortunately “died” in the Senate after senators abruptly ended the session due to the COVID-19 pandemic. The proposal was re-introduced this fall, I look forward to it moving through the legislative process so Wisconsinites can finally take advantage on a nationwide industry norm that helps lower health care costs.