By Hoven Consulting – WiAHC’s Government Affairs Firm

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, 2021.

“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 tele-dentistry 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 to treat telehealth the same as in-person care and mandates that Medicaid reimburse the same telehealth 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. 

The Long Term Care Advisory Council (LTCAC) is tasked with providing advice to the Wisconsin Department of Health Services (DHS), as outlined in the council charter. DHS aims to have a diverse council, consisting of individuals from rural and urban areas, varied ethnicities, and different experiences with the various long term care programs in Wisconsin. Members of the LTCAC are appointed by DHS Secretary-designee Karen Timberlake. LTCAC members serve three-year terms that begin in January and run through the end of December.

At the end of 2021, there will be one seat up for renewal and we are also looking to fill the current vacancies. Current membership and vacancies are listed on the LTCAC webpage. The Department is specifically looking for individuals that represent either consumer or advocate groups.

Individuals interested in being considered for LTCAC membership should send a letter of interest describing a little bit about themselves, their background, and why they are interested in serving on the council. It is encouraged that applicants include information in their letter of interest describing how they will provide diversity to the council. Letters can be emailed to Suzanne Ziehr.

To ensure consideration for membership beginning 2022, please submit a letter of interest by October 15, 2021.

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 advocacy. In effort to capitalize on our greatest advocacy resource – our membership – WiAHC has unveiled 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 provides 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.

Please click here for more information on the program.

Wisconsin Governor Tony Evers and the Wisconsin Department of Health Services (DHS) earlier this month announced $58.4 million in funding for local and tribal health departments to continue their work responding to the COVID-19 pandemic and build a strong recovery. The funding comes from the Coronavirus State Fiscal Recovery Funding and Coronavirus Local Fiscal Recovery Fund established by the American Rescue Plan Act (ARPA) and adds to the $106.5 million the Evers Administration has already allocated to local and tribal health departments for COVID-19 response activities in 2021.

“We’ve worked hard this past year to put our state in the best position to recover from this pandemic, and this funding will help support our local partners in this effort to help build a robust and equitable state and ensure our continued economic recovery,” said Gov. Evers.

The funding will provide resources to meet the public health needs that continue to emerge from the COVID-19 pandemic, or to address those needs that have been exacerbated by the pandemic and the associated economic downturn. Potential uses for the funding include: measures to stop the spread of COVID-19 such as testing, contact tracing, and vaccination programs; staffing for public health and safety; enhancing public health programs through improvements like technology infrastructure or data analysis; addressing disparities in health outcomes, including services that connect residents with resources; and supporting healthy living environments and healthy childhood environments.

“As vital partners in our COVID-19 response, local and tribal health departments have gone above and beyond, and this funding from ARPA will help them continue to respond to the pandemic while also improving systems and building capacity in their communities,” said DHS Secretary-designee Karen Timberlake. “Activities and resources like the ones funded by this investment are the building blocks of Wisconsin’s recovery, and we look forward to continuing to partner with our local and tribal health departments in this effort.”

The $58.4 million in ARPA funding is applicable to expenses that local and tribal health departments incurred from March 3, 2021 through December 31, 2024, and has been allocated to departments based on a formula that includes a base amount of funding with additional funding based on population size.

Earlier this month, former DHS Deputy Secretary Julie Willems Van Dijk, who was a highly visible part of the Evers’ Administration’s COVID-19 response efforts, announced her retirement. Van Dijk, whose last day in her role at DHS was Sept. 10, was replaced by Deb Standridge as the new DHS Deputy Secretary.

“Having spent 40 years dedicated to public good and the health and safety of folks in this state, Julie is the embodiment of public service. It has been a privilege to work alongside her on a near-daily basis over the past year and a half. I want to thank Julie for her career in public service and her family for their many years of support as well. Julie will be greatly missed, and I wish her all of the best in her retirement,” said Gov. Tony Evers.

Standridge previously served as executive director of the state’s alternate care facility at State Fair Park. She has spent her career working in healthcare systems, most recently serving as Regional President of the North Region of Ascension Wisconsin. Her professional focus has been on the strategic direction and operational management of hospitals in a diversity of communities, including her work at Wheaton Franciscan Healthcare’s North Market. She has also served on the Board of Directors for the Wisconsin Hospital Association.

“I want to thank Governor Evers and Secretary-designee Timberlake for this opportunity to serve our state. I know we have both challenges and opportunities ahead of us, and I am ready to get to work serving the people of Wisconsin in this new role,” said Deb Standridge. “I would also like to add my gratitude to the outgoing deputy secretary. Having worked closely with Julie when I ran the Alternate Care Facility, I’ve seen her dedication in action.”

Earlier this month, the National Association for Home Care & Hospice (NAHC) filed comments with the Centers for Medicare & Medicaid Services (CMS) on the proposed 2022 home health rule (CMS -1747-P), calling for no major changes to the Patient-Driven Groupings Model (PDGM) payment system, while also calling attention to the fact hospitals and skilled nursing facilities received payment boosts during the COVID-19 pandemic, while home health agencies did not.

More specifically, NAHC recommended the following modifications to the proposed rule in their comments to CMS:

• The structure and design of PDGM should be maintained for 2022.
• Withdraw the proposal to recalibrate PDGM case mix weights based on 2020 care utilization data, given the fact it’s unreasonable to assume health care utilization in 2020 is an appropriate basis for 2022.
• Replace the suggested methodology for assessing whether behavioral changes of home health agencies resulted in PDGM achieved budget neutrality in comparison to the HHPPS HHRG payment model with a methodology that focuses on behavioral changes, not change in average case mix weight. 
• Reconsider the decision to apply the new OMB geographic designations for core-based statistical areas (CBSAs) in the annual wage index. Instead, CMS should treat all provider types equally in the transition to an updated wage index as it has done for inpatient hospitals.
• Establish a process and methodology to modify HHA payment systems and rates during a Public Health Emergency.

CLICK HERE to read the full text of NAHC’s comments to CMS.

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 serve a three-year term, starting January 2022.

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 here.

The deadline to submit nominations is October 1, 2021.

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 advocacy. In effort to capitalize on our greatest advocacy resource – our membership – WiAHC has unveiled 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 provides 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.

Please click here for more information on the program.

Gov. Tony Evers and the Wisconsin Department of Health Services (DHS) announced today that six million doses of COVID-19 vaccine have been administered in the state of Wisconsin. Over half of all Wisconsinites have already completed their COVID-19 vaccine series.

“Wisconsin’s vaccine providers have worked tirelessly to get shots in arms,” said Gov. Evers. “This is a tremendous milestone, and we couldn’t have gotten here without the hard work and dedication of everyone involved. Whether you’re administering shots, scheduling appointments, answering phones, or sanitizing workstations, thank you. I encourage every eligible Wisconsinite who has not done so already to roll up their sleeves and get vaccinated to help protect themselves and their loved ones.”

Since Wisconsin began administering COVID-19 vaccine in mid-December of last year, over 3.1 million Wisconsinites have received at least one dose. The state continues to make deliberate choices to reduce barriers to accessing the COVID-19 vaccine and provide much-needed relief to communities that have withstood the worst of the pandemic. Since the start of the COVID-19 Vaccination Program in Wisconsin and thanks to countless partners, the state has launched a number of successful vaccine initiatives. Through the Vaccine Equity and Outreach grant program, DHS has helped support 100 organizations to serve as trusted vaccine messengers, increase vaccine confidence, and promote vaccine equity in racially and geographically diverse communities across Wisconsin.

Earlier this month, over 600 people got their COVID-19 vaccine at the Wisconsin State Fair, and in the process, a voucher for a free cream puff. Wisconsin also recently announced its $100 COVID-19 Vaccine Reward Program, which offers a $100 Visa gift card to anyone who receives their first dose of COVID-19 vaccine between August 20 and September 6.

Data continue to show that COVID-19 vaccines do their job by preventing severe illness, hospitalization, and death. In July, people who were not fully vaccinated were nearly three times more likely to test positive for COVID-19, and 3.7 times more likely to be hospitalized for COVID-19-related illnesses. The COVID-19 vaccines remain one of the best ways to protect yourself, your family, and your community from COVID-19 and the highly infectious Delta variant.

“It is important that we continue to vaccinate everyone who is eligible for the COVID-19 vaccine, especially as cases continue to rise, driven by the Delta variant,” said DHS Secretary-designee Karen Timberlake. “Layering protection by getting vaccinated and wearing masks in schools and in public, indoor settings is critical to stopping the spread of the Delta variant.”

First elected to the state Assembly in 2014, Representative Nancy VanderMeer (R-Tomah) represents the 70th Assembly District, which includes portions of Monroe, Jackson, Wood, and Portage Counties. The district also includes the cities of Tomah and Sparta.

Before running for office, Rep VanderMeer owned an auto dealership, and her family continues to operate a dairy farm. In her many volunteer roles, Nancy has served on the Tomah Memorial Hospital board of directors and is a former president of the American Business Women’s Association. In addition to drawing on her experience as a small businessowner to champion pro-growth policies for rural Wisconsin, she has also focused on legislation to boost Wisconsin’s healthcare workforce.

She currently chairs the Assembly Rural Development Committee and serves on the Assembly Health Committee.

Rep. VanderMeer took a few minutes to talk with us about a handful of topical health care-related issues and what the Legislature may focus on during the remainder of the 2021-22 legislative session:

Question:

As a member of the Assembly Health Committee and a legislator who has worked on numerous health care-related polices, including Interstate Medical Licensure Compacts, what do you believe are the biggest health care-related challenges currently facing the state? What policy solutions do you believe are needed to address those challenges? Are you currently working on any health care-related legislation?

Rep. VanderMeer:

I think that there are always things that can be improved, and the mark of any successful organization is constantly trying to identify areas of strength and weakness – and adjusting accordingly to better serve the individuals and stakeholders they work with.

One thing that can get overlooked in the minutia of things is that here in Wisconsin, we’re consistently ranked high and commended for the quality of care that providers deliver. There are a variety of metrics one can utilize in that regard. For example, toward the end of 2018, the federal Agency for Healthcare Research and Quality (AHRQ) issued a State Snapshots ranking naming Wisconsin fourth in the nation for highest overall health care quality among all 50 states and first in the Midwest. I believe that part of my role as a legislator on the health committee especially, is to do what I can to help ensure health care providers, both specialty and primary care, have the tools they need to provide quality care to patients, and that whenever possible, state government is working with providers and not standing in their way. Trying to limit bureaucratic hurdles is an example of that and deciding how to allocate limited taxpayer resources is another.

One of the reasons I’ve been so pleased with the work that went into both the initial Interstate Medical Licensure Compact in 2015 and the Enhanced Nurse Licensure Compact in 2019, is that I believe that those compacts are examples of the Legislature responding to defined needs brought forth by health care providers – and ultimately allowing our state to participate in those compacts that provide direct benefits to patients and providers. It will probably come as no surprise that I’m currently working with the Wisconsin Occupational Therapy Association on an Occupational Therapy Compact with Senator Ballweg of Markesan. I’m also looking at some licensing efficiency reforms for Speech Language Pathologists with Senator Kooyenga of Brookfield. I believe the compact model, if done correctly, has been proven successful in improving access to quality care. Another important benefit of the compacts is that they can be especially beneficial for military families and their spouses relocating to our state. That’s something that’s particularly important me in part because my district includes Fort McCoy and borders Volk Field in Monroe County. I was pleased to author and pass legislation last session that creates a licensure reciprocity process for military spouses.

Question:

Given your past policy work on workforce and rural development issues, you are certainly familiar with the growing health care workforce shortage in Wisconsin and the stress it is putting on the delivery of patient care. Aside from your extensive work on health care licensure compact legislation, are there any potential programs or policies you are considering or willing to support that you believe would help address our health care workforce shortage?

Rep. VanderMeer:

During the 2017-2018 Legislative Session, the Rural Development Committee was able to include a grant program in the state budget that allocated $500,000 annually for training and retaining allied health professionals and $500,000 annually for training and retaining advance practice clinicians. I think that’s a decent model to look at. I recently was able to participate in an update call on that program with a health care provider, and they were very pleased with what they’ve been able to do with the resources provided under the program. That said, I might think about the overarching issues a bit differently than some of my colleagues, in part because of what you shared above pertaining to my background, my close ties to the military community, and my experience as a board member of a rural, critical care access hospital.

Unfortunately, I don’t believe there is a silver bullet. However, I think we can make significant strides if stakeholders continue to think about things more comprehensively. For example, when the military makes decisions on whether to create, maintain, grow, shrink, or eliminate installations, they consider a variety of factors that affect their operations and personnel in a local community and geographic region, and how those factors support their overall mission. What are those factors? Those are things like the quality of workforce opportunities and educational opportunities for families - both at the K-12 and higher ed level. Additional considerations, for example, could include quality broadband access and housing available for the civilian workforce. Anyone who has followed the Assembly Committee on Rural Development since I took over as chairperson in the 2017-2018 session, knows that we’ve proactively tried to bring together stakeholders to look at some of these key issue areas. I’m always interested to learn about and would consider new ideas to address the workforce shortage, especially as it pertains to the health care workforce.

Question:

What key health care-related initiatives, if any do you believe the Assembly Republican majority will make a priority during the remainder of the current legislative session?

Rep. VanderMeer:

That is a great question, and if anyone has any specific ideas, I encourage them to contact my office. With that said, given the nature of the legislative process, I’ve learned not to over-speculate on what might move forward, or make it across the legislative “finish line” outside of what I’m directly working on. I can share that I’m cautiously optimistic about the prospects of some of the proposals I’ve authored and mentioned previously on the Assembly side of things this session. Outside of that, I can share that there’s generally broad agreement in both houses as it pertains to professional licensing reform. With that in mind, I think most of the significant policy items that we’ll see this session were already enacted via the state budget bill. There were numerous items in the budget that reflect the priorities of the Assembly Republican Caucus and aim to increase access to care, provide additional support for of our most vulnerable citizens, and limit bureaucratic hurdles for patients and providers. Things like adequately and continually funding Medicaid Disproportionate Share Hospital (DSH) Payments for rural, critical care providers was a significant achievement in this session’s budget.

Question:

Different approaches and new innovations in health care can lead to higher quality, greater convenience, and lower costs across the health care system. Examples include price transparency, increased use of telemedicine, and direct primary care. In addition, the delivery of certain health care services in non-hospital settings, such as ambulatory surgery centers, can be less expensive and more convenient for the patient. What type of innovative ideas and policies do you support or are you interested in exploring to expand health care access and increase affordability?

Rep. VanderMeer:

I agree that different approaches and new innovations in health care can lead to higher quality, greater convenience, and lower costs across the health care system. There is certainly a greater demand for the increased use of telemedicine. That’s something I hear about quite a bit from the health care providers in my district, and the constituents I represent. If you were to look at a map of my district, you would see that in some cases, a trip to a provider can take an hour or more each way. That is a challenge for most people, especially those in need of regular care. In short, I will continue to support policies that knock down barriers to expand use of telemedicine. I will also continue to listen to patients and providers on what is the most effective and efficient delivery of care.

One question I try to ask myself when evaluating these types of approaches and innovations is, how does this create access for patients? It is a very important consideration for me that the vast majority of those I represent reside in more sparsely populated areas of the state. Obviously, as a patient, one either goes to receive care, or care comes to them. I think some of the different models of care outside of telehealth, like ambulatory surgery centers and home health care, are examples of care coming to an individual or to their community. I commend the hospital at home model that some of the larger providers in and around my district have had success with. I also co-sponsored the direct primary care bill in the 2019 session (vetoed by the governor), and I think it’s a worthwhile concept to consider again in the future.

The views and opinions expressed in this interview are those of the individual interviewed and do not reflect the position of WiAHC.