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.

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.