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By Hoven Consulting – WiAHC’s Government Affairs Firm
The Wisconsin State Legislature will be back in session in September. After passing the biennial state budget bill in late June, lawmakers did not hold floor sessions in July and August. Typically, legislators utilize the summer months to engage with constituents in their districts and prepare bills for the fall and winter sessions.
However, legislative committees have been quite active in the past eight weeks as they held public hearings on bills likely to come to the floor during the fall session days.
The Assembly Committee on Health held a marathon public hearing in late July lasting nearly 6 hours on eleven separate pieces of legislation. These bills touched on a number of topics from newborn screenings to Medicaid reimbursement for pharmacist services to scope of practice for advanced practice registered nurses. The Senate Health Committee also heard a public hearing in July on similar bills.
While there will surely be a fair share of health care legislation that makes its way to the floors of both the Assembly and Senate, the big story of the fall will be legislative redistricting.
Wisconsin received its final census data numbers in August, triggering the beginning of the redistricting process. The Republican legislature will look to pass a bill this fall defining legislative district boundaries for the next ten years. However, the bill will almost surely be vetoed by Democratic Governor Tony Evers, which will then put the bill in the in hands of the Courts.
Census data showed significant population growth in Democratic-stronghold Dane County with some analysts predicting the county could pick up an entirely new Assembly seat. Conversely, Milwaukee County, another solid stronghold for Democrats, lost population. This means longtime Democratic districts will need to grow in geographic size out into more conservative Milwaukee suburbs.
Stay tuned for more updates on relevant health care legislation and the redistricting fight throughout the fall.
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.
As was reported in previous editions of the WiAHC Advocacy Newsletter, WiAHC has launched a Legislative Key Contact Program, which can be a highly effective grassroots advocacy tool to help build and nurture strong on-going relationships between WiAHC members and lawmakers in Wisconsin. Ultimately, the program can help us help shape new policies important to our members.
The program is now live on the WiAHC website and members can easily and quickly sign-up as a Key Contact.
As a Key Contact, you can help influence the legislative process at both state and federal levels by cultivating relationships with elected officials. By taking advantage of existing relationships and making new contact with members of the Wisconsin Legislature and the Wisconsin Congressional Delegation, you can help us educate lawmakers on industry issues and influence legislation.
But the program will not succeed without strong member participation, so please take a few moments to read more about it – and learn how simple it is to “enlist” and participate as a Key Contact. The time commitment is minimal and your responsibility as a key contact depends on your level of comfort and willingness to engage.
The Wisconsin Department of Health Services (DHS) has submitted a plan to the federal Centers for Medicare and Medicaid Services (CMS) to use American Rescue Plan Act (ARPA) funds to improve and enhance Wisconsin’s home and community-based services under Medicaid. DHS estimates it will receive approximately $350 million under this part of ARPA. Key components of the plan that support Wisconsin’s caregiving workforce include increasing rates for home and community-based services and expanding the professional advancement opportunities for the workers who provide these services.
“Strengthening our caregiver workforce and making investments in the services that many seniors and people with disabilities rely on across our state are critical steps we must take to support our economic recovery from the pandemic,” said Governor Tony Evers. “We are fortunate to have access to these federal funds to move these efforts forward since many of the proposals to support and strengthen our caregiving workforce included in my proposed state budget were removed by the legislature and not included in the budget that was recently passed.”
In consultation with key stakeholders and partners, DHS assembled a plan that will continue to advance Wisconsin’s successful record of implementing innovative programs that enable older adults and people with disabilities to live independently in their homes and communities. In Wisconsin, these efforts include the Family Care, Family Care Partnership, IRIS, PACE and the Children’s Long-Term Support programs, as well as personal care, private duty nursing, home health, and rehabilitative services provided to eligible Medicaid members.
“Wisconsin has long been a national leader in developing and implementing programs that allow the elderly and people with disabilities to live their best lives in their homes and communities. In 2021, we achieved a major milestone by fully eliminating the adult waiting list for home and community-based services,” said DHS Secretary-designee Karen Timberlake. “The ARPA funds designated by Congress and President Biden to support state home and community-based services will help us continue to build on that success and help stabilize and the services people depend upon as well as the workforce needed to provide them.”
Foundational to Wisconsin’s plan is a commitment to ensuring all eligible people in Wisconsin have access to home and community-based services by addressing health disparities and focusing on equity in program design and access. In addition to working with the Governor’s Health Equity Council to support implementation of the approved plan, DHS will work alongside community-based organizations that share our commitment to addressing disparities within the home and community-based service system for Black, Indigenous, and people of color, people with varying abilities, people living in extremely rural areas, and other historically underserved and disadvantaged communities. Wisconsin is also engaging in individual conversations with each of the 11 federally recognized tribes to identify ways to enhance HCBS services for tribal members under the proposals in the submitted plan.
CMS is currently reviewing Wisconsin’s plan, along with those plans submitted by other states. Implementation efforts will begin once CMS approval is received.
Learn more by visiting the Proposed Funding for Home and Community-Based Services.
Gov. Tony Evers (D) earlier this month signed the 2021-2023 state budget bill into law. Before signing the bill, Evers used his broad veto authority to make 50, mostly minor changes to the state’s two-year spending plan, which was largely reshaped by the Republican-controlled Legislature over the past few months. Click here to review the Governor’s full veto message.
Most importantly to WiAHC members, we are thrilled to report the Governor maintained our home healthcare Medicaid reimbursement rate increase that was added by the Legislature – and the provision is now state law!
This is obviously great news that illustrates the power of effective advocacy. Thank you to all WiAHC members that contacted their legislators on this important issue or helped in other significant ways to achieve this major legislative win.
The final $87.5 billion budget bill contains more than $2 billion in individual income tax cuts, $650 million in property tax relief, and provides $129 million in broadband funding. In addition, the budget includes a number of health care-related items that may be of interest to WiAHC members, including:
By Representative Amy Loudenbeck (R-Clinton)
Vice Co-Chair of the Joint Committee on Finance
Wisconsin’s 2021-23 biennial budget makes significant investments across a wide spectrum of health care priorities, including raising Medicaid reimbursement rates for numerous providers who hadn’t seen increases in over a decade and targeted investments to increase access to care and improve health care outcomes.
Over the last year, long-term care facilities and their staff have been strained by the COVID-19 pandemic. In addition, for the past several years many of these facilities have been experiencing a critical workforce shortage and were also struggling with low Medicaid reimbursement rates that didn’t even cover the cost of care. The budget invests nearly $440 million in long-term care facilities and the workforce that staffs them.
Ambulance Service Providers (EMS) will see an increase in reimbursement rates of over $16 million. This additional funding will help to sustain many of our EMS providers across the state and will help avoid service deserts.
To ensure residents have access to high-quality dental care when they need it, this budget invests over $46 million to expand dental access across Wisconsin.
The budget increases Medicaid reimbursement for autism services by over $14 million. These services are intended to teach children with autism spectrum disorders the skills that children would usually learn by imitating others around them, such as social interaction and language skills, and there is a significant waiting list for services.
Nearly two-thirds of hospitals will continue to receive state funding in the form of Disproportionate Share Hospital payments to hospitals that serve low-income patients. This funding helps reduce cost-shifting to individuals with private insurance to cover losses.
The budget also boosts Medicaid reimbursement rates for Skilled Home Health Care Services, Emergency Room Physicians, Speech-Language Pathologists, Audiology Services, Chiropractic Services, Physical Therapy Services, and the Child Psychiatry Consultation Program. These investments are intended to increase access and to ensure providers are compensated appropriately for their work.
Federally-Qualified Health Centers and Free and Charitable Clinics, non-profit organizations that provide comprehensive primary health care to underserved areas and populations, also receive a boost. These providers will receive an additional $4 million over the biennium (each category will share $1 million/year in financial support).
In addition, the budget includes an increase of $6 million to expand the Dementia Care Specialist Program statewide by funding 18 dementia care specialist positions at Aging and Disability Resources Centers around the state, as well as seven tribal dementia care specialist positions.
Finally, this budget increases funding for psychological testing, diagnosis, psychotherapy, and counseling for individuals, groups, and families, as well as mental health day treatment services for children. The budget also includes over $3 million for medication-assisted treatment (including patient evaluation as well as methadone and other opioid abuse treatment medications) for individuals with substance abuse disorders.
Overall, the 2021-23 biennial budget will ensure that health care service providers and their employees will be well positioned to continue providing quality care across the health care continuum so all residents across Wisconsin can access a wide range of health care settings and services.
The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of WiAHC.
Gov. Tony Evers (D) yesterday signed the 2021-2023 state budget bill into law. Before signing the bill, Evers used his broad veto authority to make 50, mostly minor changes to the state’s two-year spending plan, which was largely reshaped by the Republican-controlled Legislature over the past few months. Click here to review the Governor’s full veto message.
The final $87.5 billion budget bill contains more than $2 billion in individual income tax cuts, $650 million property tax relief, and provides $129 million in broadband funding. In addition, the budget includes a number of health care-related items that may be of interest to WiAHC members, including:
William Penterman, a legislative aide in the State Capitol and a member of the U.S. Army reserve narrowly won an eight-way Republican special primary in the 37th Assembly District. The district includes portions of Dane, Dodge, Jefferson, and Columbia counties as well as parts of the cities of Columbus, Waterloo, and Watertown.
Peterman received 758 votes, gaining a slim 16-vote victory of local university professor Jennifer Meinhardt. A recount remains a possibility.
If officially declared the winner, Penterman will face Democratic candidate Peter Adams and Independent candidate Stephen Ratzlaff Jr. in the July 13 special general election.
The seat became vacant when then state Representative John Jagler (R-Watertown) was elected to represent the 13th Senate District that was previously held by former Senate Majority Leader Scott Fitzgerald, who was elected to Congress last November.
Republicans currently hold a 60-38 seat majority in the Assembly, with the one vacancy in the 37th Assembly District.
For the past eight years, I have worked as an Advanced Practice Nurse Practitioner (APRN) in the State of Wisconsin and have operated my own independent clinic. My passion for affordable, accessible healthcare has permeated nearly every aspect of my hectic life, including my new role as a state legislator.
Over the course of my time as a nurse, the healthcare industry has changed drastically. I have worked for large health systems, small ones, clinics, and everything in between. At the end of the day, I got in to nursing so that I can care for my patients, not feed a massive healthcare system. That is why I started my own business: so that I can provide healthcare to those who may not fit into the large systems, if they have astronomical deductibles, or if they do not have insurance at all.
I believe this model of small clinics, operated by nurses, can be replicated across the state and dramatically cut healthcare costs for folks who need it the most. For example, all of the prices for procedures and appointments are posted directly on my clinic’s website – there is not some mystical formula that only the system can understand. The logic is simple: you would never go through a McDonald’s drive-thru for them to only tell you at the end your burger costs $25. You would go down the road to Burger King or Wendy’s, where the prices you know are more competitive. This is how we can bring some sanity back to the healthcare field – the more competitive it is, the market will do its job to cut costs. Just imagine having dozens of these clinics in our area.
One obstacle in the way of this, however, is the fact that nurses in the State of Wisconsin have their hands tied. They are required to pay astronomical prices for collaborating physicians to even have their doors open – and if that physician dies or disappears, they need to immediately shut down. Collaboration is not the issue. I collaborate every day with specialists in nearly every aspect of healthcare for the good of my patients. The issue is the price and risk of having to close my doors because of someone who I may not even talk to on an annual basis somehow vanishes. This has turned off many fellow APRNs from replicating clinics like mine throughout our cities and rural areas.
Currently, 24 states and 2 territories have full practice authority (FPA) for Nurse Practitioners (NPs). Wisconsin made steps towards this goal when Governor Evers issued his COVID-19 emergency order, which eliminated the restrictions placed on NPs to practice without that collaboration requirement. Unfortunately, after the emergency orders were overturned by the Wisconsin Supreme Court, all restrictions were re-instated on the profession. During the COVID-19 pandemic, we learned NPs can have FPA without the negative consequences that some feared. In fact, studies have shown that an NPs outcomes for management of acute and chronic disease are equivalent if not better than a physicians.
Assembly Bill (AB) 396/Senate Bill (SB) 394 brings Wisconsin up-to-date with 24 other states to give Nurse Practitioners FPA. Passing these bills will allow NPs to continue to prioritize patient care and allow NPs to continue excellence in their nursing practice without unnecessary and undue restrictions.
Those opposing these bills have raised concerns about the unlikely event an NP goes “rogue” and attempts to practice outside of the scope of their training. As nurses, this is not how reality works. I have collaborated with physicians and other professionals in every instance that is deemed necessary. To do
otherwise would open me up to severe liability issues and lawsuits, just as it would for a physician who practices outside of their scope.
At the end of the day, all nurses are asking for is a level playing field. We want the freedom to do what we do best: care for our patients.
State Representative Rachael Cabral-Guevara (R-Appleton) represents the 55th Assembly District in the Wisconsin Legislature. Her Assembly district is in Winnebago County and includes the City of Neenah and parts of Appleton.
NOTE: The views and opinions expressed in this article are those of the author and do not reflect the official policy or position of WiAHC. Furthermore, the opinion piece allows WiAHC to gain a better understanding of a health care-related bill from the author’s perspective, but in no way indicates support for or opposition to the proposal.
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