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.

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.