By the National Association for Home Care and Hospice

On August 18, 2022, the Centers for Medicare & Medicaid Services (CMS) issued extensive materials providing guidance related to the planned phase-out of various waivers, regulations, enforcement discretion, and sub-regulatory guidance that were utilized to ensure access to care and give health care providers the flexibilities needed to respond to COVID-19 Public Health Emergency (PHE). According to the documents — issued under the rubric “Creating a Roadmap for the End of the COVID-19 Public Health Emergency” (Roadmap) — most of these waivers and broad flexibilities will terminate at the eventual end of the PHE, as they were intended to address the acute and extraordinary circumstances of a rapidly evolving pandemic and not replace existing requirements.

As previously indicated by Administration officials, to minimize any disruptions including potential coverage losses following the end of the PHE, the materials state that HHS Secretary Becerra will give states and the health care community writ large 60 days’ notice before ending the PHE. In the meantime, CMS is encouraging health care providers to prepare for the end of these flexibilities as soon as possible and to begin moving forward to reestablishing previous health and safety standards and billing practices.  Even though providers will receive 60 days’ notice before the ending of the PHE, they should begin preparing for the end of the waivers now.  In order to come into compliance with the conditions of participation at the end of the PHE, it may take some providers a significant amount of time. Therefore, NAHC recommends that providers utilizing any of the PHE waivers assess the need for continued use of the waiver(s) and begin transitioning away from utilization, as possible.  If it is not possible to stop utilizing the waivers, providers should develop a plan for tapering use, if possible.

While the COVID-19 PHE remains in effect CMS will use its Pandemic Plan as a guidebook for evaluating all existing flexibilities, while developing a comprehensive long-term approach for the health care system based on recovery and resiliency. Given the importance of this effort, CMS’ strategic plan includes a cross-cutting initiative to address the current PHE and ensure that CMS has a roadmap to support a health care system that is more resilient and better prepared to adapt to future disasters and emergencies. This work complements the work already underway to ensure as many eligible individuals as possible maintain a source of coverage, whether through Medicaid/CHIP, Marketplace, employer coverage, or Medicare.

As part of its Roadmap CMS has issued provider-specific guidance that details plans for the phase out of various waivers and flexibilities. NAHC previously posed questions to CMS regarding some of the waivers and flexibilities and had hoped answers to those questions would be found in this most recent Roadmap.  However, NAHC has continuing questions and concerns.  Below are links to two documents that address home health and hospice waivers and flexibilities:

• COVID-19 Emergency Declaration Blanket Waivers & Flexibilities for Health Care Providers (Updated 8/18/2022)

• Fact Sheet: Home Health

WiAHC Signs on as Supporting Organization

Earlier this month, the National Association for Home Care & Hospice (NAHC) submitted its formal comments on the CY 2023 Medicare home health services Proposed Rule, which includes 2023 payment rates, along with a variety of other changes affecting the value-based purchasing demonstration program and the collection of quality-of-care data. It’s estimated the proposal would slash aggregate home health payments by 4.2%, or $810 million, next year. The Wisconsin Association for Home Health Care (WiAHC) officially signed-on to the comments as a supporting organization. 

“The proposed rule is the most impacting of policy actions by CMS (Centers for Medicare & Medicaid Services) in years,” said William A. Dombi, President of NAHC.  “The proposed payment rate cut of 7.69 percent would send 51.5 percent of all home health agencies into financial deficit in 2023. That would place over three million of the most vulnerable Medicare patients and the five million of Medicaid, VA, and Medicare Advantage patients they serve in real jeopardy of losing care. Medicare would also lose the value that home health services brings to health care overall, likely increasing care costs through extended hospitalizations and higher use of institutional care to fill in the gaps,” added Dombi.

The comments submitted by NAHC argue that:

• More than 300,000 Medicare beneficiaries have lost access to home health services in recent years, with over 1000 HHAs have closing, and Medicare spending in 2020-2021 at its lowest point since 2010.
• Congress required that CMS institute a budget neutral payment model in 2020. That model underpaid home health agencies by 2.5-3.2% in contrast to the 6.9% overpayment alleged by CMS.
• CMS’s evaluation as to whether the new payment model was “budget neutral” is fatally flawed in its methodological approach and is inconsistent with comparable evaluations CMS applied in other sectors.
• CMS’s evaluation methodology is at odds with the clear mandates established by Congress in 2018 in all respects.
• CMS compounds the risks to patient care by adding new, unnecessary costs while failing to adequately recognize the significant labor and transportation cost inflation that has hit home health services.
• CMS is pulling resources from home health care at a time it is depending on that care to reduce Medicare spending on hospitalizations and other care.

CLICK HERE to review the full text of NAHC’s comments on the proposed rule.

Bipartisan legislation, the Preserving Access to Home Health Act of 2022 (S. 4605/H.R. 8581), is currently pending in the United States Senate and House of Representatives, would suspend any payment rate reductions, thereby allowing CMS additional time to reconsider its proposed actions. GO HERE to tell your members of Congress to support this critical legislation!

By Hoven Consulting – WiAHC’s lobbying firm

• Legislative Council Study Committee on Occupational Licenses - Update

The Legislative Council Study Committee on Occupational Licenses held its first hearing on August 2, 2022, at the Capitol building in Madison. The committee first received an overview from the Legislative Council Staff, then a briefing from the Legislative Fiscal Bureau, a briefing from the National Conference of State Legislatures (NCSL), and finally by the Wisconsin Department of Safety and Professional Services (DSPS).

Many of the questions for NCSL centered on the licensing process, interstate compacts, universal licensing, and reciprocal licensing. Questions for DSPS centered on staffing, the time required for licensure, issues with applications, legal reviews (crimes and ordinance violations) and additional barriers to timely and efficient license.

Following the testimony, study committee members discussed the following items:

• Duplication of background checks on applicants (credentials and hiring company)
• Insurance requirements for practice
• Number of applications being processed and approved (DSPS Stats)
• Reciprocal license, universal license and compacts

This committee’s next meeting will occur on September 27, 2022, in Madison.  For more information about this committee, please visit the committee’s website. 

• August 9 Primary Election Update

The following is a summary of the results of the August 9 primary election:

• As expected, Democratic Lt. Governor Mandela Barnes won his primary and will face incumbent Republican U.S. Senator Ron Johnson in November. 
• In the most contested race for the U.S. House of Representatives in Wisconsin, incumbent Democratic State Senator Brad Pfaff won the Democratic primary and will face Republican Derrick Van Orden in western Wisconsin’s Third Congressional District.  Retiring U.S. Rep. Ron Kind (D) currently represents this district.

• By a margin of 5 percent, Tim Michels prevailed in the Republican gubernatorial primary over former Lieutenant Governor Rebecca Kleefisch and will face incumbent Democratic Governor Tony Evers in November. 

• In the race for Lieutenant Governor, State Rep. Sarah Rodriguez of Brookfield won the Democratic primary and State Senator Roger Roth of Appleton prevailed in a crowded Republican primary. 
• In the State Assembly, all incumbent Republicans facing primary challengers won their respective races, including Assembly Speaker Robin Vos of Rochester, who faced Adam Steen.  Adam had received the endorsement of former President Donald Trump in the closing weeks of the primary campaign over concerns related to the 2020 election. 
• In the State Senate, incumbent Republican Senator – and Senate Majority Leader – Devin LeMahieu of the Sheboygan area prevailed against two opponents.  Also, incumbent Republican Senator Van Wanggaard of Racine won his race against a primary opponent. 

·       New Marquette Law School Poll Released on August 17

On August 17, Marquette Law School released a new statewide political poll.  The following poll findings may be of interest.

Gubernatorial Race

This poll, which was conducted from August 10-15 – after the August 9 primary election – asked Wisconsin voters their preference for governor:

• Governor Tony Evers (Democrat):  45%
• Tim Michels (Republicans):  43%
• Joan Beglinger (Independent):  7%

The August poll also asked respondents if they approved or disapproved of how Governor Evers is handling his job.  His approval rating was 47%, his disapproval rating is 45%, and 8% did not have an opinion. 

U.S. Senate Race

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

• Lt. Governor Mandela Barnes (Democrat):  51%
• U.S. Senator Ron Johnson (Republican):  44%

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:  37%
  • Unfavorable:  22%
  • Haven’t heard enough:  30%
  • Don’t know:  11%

• U.S. Senator Ron Johnson (Republican)
• • Favorable:  38%
  • Unfavorable:  47%
  • Haven’t heard enough:  9%
  • Don’t know:  6%

Issue Polling

The August poll also asked questions regarding various issues.  One of the questions asked whether the state is headed in the right direction or not.  The poll found the following: 

• Right direction:  35%
• Wrong track:  56%
• Don’t know:  9%

This poll also asked how Wisconsinites felt about certain topics.  Allowed responses:  very concerned, somewhat concerned, not too concerned, and don’t know.

• Inflation:  94% were either very concerned or somewhat concerned
• Crime:  88% were either very concerned or somewhat concerned
• Public Schools:  88% were either very concerned or somewhat concerned
• Gun Violence:  87% were either very concerned or somewhat concerned
• Taxes:  85% were either very concerned or somewhat concerned
• Abortion Policy:  80% were either very concerned or somewhat concerned
• Climate Change:  69% were either very concerned or somewhat concerned
• Illegal Immigration:  68% were either very concerned or somewhat concerned
• Coronavirus:  55% were either very concerned or somewhat concerned

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.

Jayne Thill (left), WiAHC Board of Directors and Legislative Committee member, presents WiAHC Champion of Home Health care Award to Rep. Donna Rozar (R-Marshfield).

The Wisconsin Association for Home Health Care (WiAHC) was thrilled to present Rep. Donna Rozar (R-Marshfield) with the organization’s 2022 Champion of Home Health Care legislative award for her leadership on policies to advance home health care in Wisconsin and strengthen the delivery of patient care provided by home health professionals. The award was recently presented to Rozar by WiACH member Jayne Thill at the COMPASSUS office in Marshfield, WI,

“Representative Rozar was an extraordinary advocate for home health care during the 2021-22 legislative session. As a nurse practitioner, she understands the value of home health care for patients who often recover faster and with fewer complications at home than in a hospital,“ said Thill, who serves on the WiAHC Board of Directors. “Her responsiveness to initiatives important to the home health care industry and her leadership on policies to strengthen Wisconsin’s health care workforce is highly commendable, and we were happy to present her with this award to thank her for her efforts.”

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 Rozar. 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.

Rozar, who was first elected to the Wisconsin Assembly in 2020, represents the 69th Assembly District, which includes portions of Clark, Marathon, and Wood Counties, including the City of Marshfield. She serves as the Vice-Chair of the Assembly Small Business Development Committee and sits on the Health Committee and the Aging and Long-Term Care Committee. 

Please find below the full list of state lawmakers who received recognition from WiAHC for their support of key initiatives during the 2021-22 legislative session to advance the state’s home health care industry. Legislators who displayed exceptional support of WiAHC were recognized as a Champion of Home Health Care. Legislators who displayed general support were recognized as a Friend of Home Health Care.

 Champion of Home Health Care:

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

Friend of Home Health Care:

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

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:

·       ‘We’re in the Fight’: The Preserving Access to Home Health Act Is Introduced in the Senate

Home Health Care News - By Andrew Nolan | July 25, 2022

A new bill that would prevent the U.S. Centers for Medicare & Medicaid Services (CMS) from reducing home health payments this year – and until 2026 – was introduced in the Senate Monday afternoon. Dubbed The Preserving Access to Home Health Act, the bill was introduced by Sens. Debbie Stabenow (D-MI) and Susan Collins (R-ME), both of which have been longtime advocates of at-home care. Read more…

·       CMS Announces Unprecedented Quality Measure Set for Home- and Community-Based Services

Home Health Care News - By Andrew Nolan | July 21, 2022

The Centers for Medicare & Medicaid Services (CMS) released its first ever home- and community-based services (HCBS) quality measures Thursday. The agency said the measures will promote “consistent quality measurement within and across state Medicaid HCBS programs” and are a “critical step to promoting health equity among the millions of older adults and people with disabilities who need LTSS.” Read more…

·       Home Health Care Gained a Greater Share of Post-Acute Admissions Post-COVID

Home Health Care News – By Andrew Nolan | July 19, 2022

The home health industry gained a more significant share of post-acute care admissions after the onset of the COVID-19 pandemic, new data shows. There was certainly a feeling at the time that home health agencies were gaining more patient admissions that may have previously gone to skilled nursing facilities (SNFs). And while some data has reflected that already, if there was any remaining doubt, the Medicare Payment Advisory Commission’s (MedPAC) July 2022 data book should cast that aside. Read more…

·       Home Health Providers, Staff In For ‘Rude Awakening’ Following Public Health Emergency Expiration

Home Health Care News - By Joyce Famakinwa | July 15, 2022

Though it sometimes may not feel like it, the expiration of the public health emergency (PHE) will, one day, come. And when it does, that will have ramifications on home health providers specifically, and home-based care more generally. With the declaration came a handful of waivers and flexibilities meant to alleviate the harsh impacts of the pandemic for home health providers. 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.

Join an informational webinar August 2 or 4

The Wisconsin Department of Health Services (DHS) is investing American Rescue Plan Act (ARPA) funds to create a statewide home and community-based services (HCBS) grant program. The ARPA HCBS Grants offer an exciting opportunity for entities active in the state's Medicaid HCBS system to apply for $25,000 to $2 million in grant funds.

The program goal is to disburse grants across all Medicaid HCBS programs, distribute funds geographically across the state in both rural and urban areas, and support diverse organizations and populations served. Grant funding will strengthen the HCBS system and support quality and innovation in the delivery of HCBS in Wisconsin.

For example, grants may be used to:

• Support organizations and providers as they recover from the impact of the COVID-19 pandemic.
• Develop and implement specialized training for direct care workers and managers.
• Help individuals with intellectual, developmental, and other significant disabilities find and retain work.
• Improve person-centered planning and implementation.
• Increase specialized care, services, and engagement for individuals with dementia, autism, children’s long-term care needs, or persons with other disabilities.  
• Expand the use of technology and telehealth by assisting HCBS providers with supplies and equipment.
• Reduce disparities and improve access to a diverse and culturally competent pool of HCBS providers.
• Develop other innovative ideas to improve HCBS services.
• Prepare information, including public health and educational materials, in accessible formats for people getting HCBS.
• Promote access to technology to facilitate human connection for people getting HCBS and their caregivers.
• Support quality initiatives that improve services and supports, and increase community engagement.
• Fund recruitment and retention activities for direct services workers of Medicaid HCBS providers.
• Purchase personal protective equipment and routine COVID-19 tests for direct services workers.

Applications will open August 11, 2022.

Visit the ARPA HCBS Grants webpage for details about the grant opportunity. You’ll find information about funding amounts, eligibility, timelines, and more. Please keep an eye on the grants webpage for more information as we draw closer to the release date.

In addition, DHS is hosting informational webinars to provide detailed information on the grant opportunity and application process. Use the links below to register for an upcoming session.

• Tuesday, August 2, 2022
  10-11 a.m. Central time
  Register Here

• Thursday, August 4, 2022
  1-2 p.m. Central time
  Register Here

By Hoven Consulting – WiAHC’s lobbying firm

• Uniform Death Reporting Standards Study Committee – First Meeting

The Legislative Council’s Study Committee on Uniform Death Reporting Standards held its first public hearing in Madison on Monday, July 18 at 10:00AM.  The meeting featured presentations by the state Department of Health Services, including from the State Registrar at the State Vital Records Office, a representative from a mental health organization and a children’s health organization, as well as the Chief Medical Examiner of Fond du Lac County.  A list of committee members, the full meeting agenda, as well as written presentations may be viewed on the legislature’s website.  

• DHS Announces Annual Adjustment of Health Care Provider Fees for Patient Health Care Records

Effective on the first day of each July, the Wisconsin Department of Health Services publishes an updated schedule of the maximum fees that health care providers may charge for producing patient medical records.  These fees are based on the consumer price indices for the prior two calendar years.  The fees vary based on the number of pages and the type of file provided (e.g., paper documents, microfiche, x-rays, etc.).  This fee schedule may be viewed on the Legislature’s website. 

• DSPS Secretary Dawn Crim Leaving Evers Administration

Earlier in July, Wisconsin Department of Safety and Professional Services (DSPS) Secretary Dawn Crim announced that she will be leaving the Evers Administration on August 1, 2022.  The State Medical Examining Board and the State Board of Nursing are housed within DSPS, which also processes nearly all occupational license applications in Wisconsin, including licenses for physicians, nurses and other health care professionals.  Earlier this year, DSPS implemented an online platform for health care occupational license applications.  The agency will transition the remaining occupational licenses that they handle to their online platform in the future. 

Governor Evers has announced that DSPS Assistant Deputy Secretary Dan Hereth will be the DSPS Secretary-designee upon Secretary Crim’s departure. 

• State Supreme Court Decision on Local Health Officer Authority

On July 8, the Wisconsin Supreme Court ruled that local health officials have the statutory power to issue public health orders without first getting permission from elected officials in their respective jurisdictions.  This case started out as a challenge from Dane County businesses against the authority of Public Health of Madison and Dane County (PHM&DC) related to COVID-19 emergency orders that PHM&DC Director Janel Heinrich issued.  These plaintiffs contended that the only way that these emergency orders could be enforced would be for the Dane County board to vote to approve them.  The Wisconsin Supreme Court ruled – with a 4-3 vote – that existing state statute includes the authority for local health officers to issue such emergency orders without the approval of elected officials in their respective jurisdiction.  The full decision may be viewed here. 

• Governor Announces Over $5 Million in Healthcare Workforce Grants

On June 23, Governor Evers announced the award of more than $5 million in Workforce Innovation Grant Program funds to assist with healthcare workforce challenges in Wisconsin.  Specifically, up to $4.9 million will be awarded to the Wisconsin Community Action Program Association (WISCAP), which is the statewide organization that represents 16 community action non-profit organizations throughout our state.  These organizations focus on assisting low-income households.  With these funds, WISCAP will assist in paying for low-income individuals to receive training and education to become healthcare workers.  Up to $376,000 will go to the University of Wisconsin at Green Bay to assist in expanding the nursing faculty in order to train up to 152 nursing students. 

As was reported in last month’s Advocacy Newsletter, the CMS recently proposed to cut Medicare rates for home health services in 2023 by an unprecedented, permanent -7.69%. The net result of this cut along with inflation updates is -4.2% in 2023, equaling an $810 million cut starting next year. These devastating cuts would be disastrous for the industry.

Fortunately, the Preserving Access to Home Health Act of 2022 was recently introduced in Congress to prevent these proposed cuts to home health payment rates from taking effect prior to 2026. Any adjustment needed to ensure budget neutrality under the new home health payment system would still be made within the budget window. If CMS determined that payment increases were needed to achieve budget neutrality, prior to 2028, upward adjustments would be made to support access to care.

Please utilize the extremely user-friendly NAHC Legislative Action Center, and with just ONE CLICK you can advocate for this important legislation with your Members of Congress!

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.