In a 6-0 decision, the Wisconsin Supreme Court reinstated a 2016 circuit court order prohibiting the Wisconsin Department of Health Services (DHS) from recouping Medicaid payments made to Medicaid providers “if the provider’s records verify that the services were provided and the provider was paid an appropriate amount for such services, notwithstanding that an audit identified other errors or noncompliance with [DHS] policies or rules.”

The Supreme Court labeled DHS’ recoupment policy for such services provided a “perfection policy” and held that such a policy was not consistent with Wisconsin’s Medicaid recoupment statute or administrative rules.

The case, Papa vs. Wisconsin Department of Health Services, involved the extent of DHS’ authority to require repayment from providers for previously paid claims based on failure to follow all documentation and other technical requirements contained in a confusing series of administrative rules in the Forward Wisconsin Provider Handbook, technical bulletins and other sources. In 2016, a Waukesha County Court found that DHS’ position that compliance with all technical and documentation requirements by providers as a prerequisite for payment amounted to a “Perfection Rule” that exceeded its authority to recoup payments otherwise properly made. However, the Wisconsin Court of Appeals overturned that decision in July 2019.

In today’s 6-0 decision, the Supreme Court reversed the Court of Appeals and restored the county court’s 2016 order limiting DHS’ authority to recoup payments, concluding that “so long as DHS can verify that a covered service was actually provided, the claim was appropriate, and the claim was accurate, DHS cannot recoup payments based on a record imperfection. A record imperfection alone is not an independent basis for recouping payments.” The decision provides clarity and greater certainty for physicians, who could otherwise face demands for repayment of thousands of dollars months or years after the fact based entirely on unintentional documentation errors.

Thursday, August 6, 2020
10:30 a.m. – 12:00 p.m. CST

Program Description:

Post-acute care is key for accelerating hospital throughput to ensure beds are available during potential Covid-19 surges and for providing critical rehabilitation services for patients with and without a Covid-19 diagnosis. But the epidemic has upended the role post-acute should play, particularly the transition patterns between acute and post-acute providers.

Learn how each post-acute setting fits into a hospital’s updated discharge strategy and find opportunities to optimize relationships and support post-discharge care.

Learning Objectives:

At the conclusion of the webinar, attendees will be able to:

• Describe how the COVID-19 pandemic has altered the role post-acute should play
• Describe how each post-acute setting fits into a hospital’s discharge strategy
• Identify the opportunities to optimize relationships and support post-discharge care

Intended Audience:

CMOs, CNOs, Quality Leaders, Skilled Nursing, and Home Health

Featured Presenters:

Jared Landis is the Executive Director over the Advisory Board’s post-acute research practice and a national spokesperson for the company—regularly presenting at industry conferences such as the American Health Care Association, National Association for Home Health and Hospice, and Leading Age. In 2010, he helped launch and continues to lead the Post-Acute Care Collaborative, which provides original research and dedicated resources to assist post-acute and long-term care providers, as well as hospital systems. Jared is a subject matter expert (SME) in post-acute market trends, post-discharge care management initiatives, and acute/post-acute alignment strategies. Jared is a 2005 graduate of Duke University with a Bachelor of Arts in Economics.

Questions:

For registration questions, contact Allison Taylor at ataylor@wha.org.

Fee:

There is no cost for this webinar.

Register Here!

On Monday, June 29, the Governor’s Task Force on Caregiving held a public listening session to gain input from stakeholders on the task force’s draft proposals. WiAHC members Leah Perras, , Executive Director of Transitions at Home, and Greg Von Arx, CEO of Recover Health testified at the listening session. Perras’ and Von Arx’s testimony was aimed at the task force’s failure to propose a Medicaid reimbursement rate increase for home health services despite previous testimony to the task force requesting such an increase.

“Wisconsin is lagging behind the nation in ensuring home health can adequately compete for staffing against other sectors of the healthcare industry despite growing demand for home health care services,” Perras said. “Due to Medicaid rates in Wisconsin, home health agencies pay below the state average for the same position across other sectors of the medical industry. As growth in the utilization of home health care services continue, today’s workforce challenges will only get worse.”

Perras explained that Wisconsin is well below the national average when it comes to RNs working in home health settings. RNs working in home health settings make up just 6% of the total nursing workforce in the state, according to the Wisconsin Center for Nursing. Nationally, RNs working in home health settings make up nearly 13% of the total nursing workforce, according to the Bureau of Labor Statistics. Unfortunately, home health agencies regularly lose highly skilled nurses to other sectors, mostly due to compensation potential.

According to CMS, patients’ homes are considered the ideal care setting, which is causing rapid growth in the industry, faster than most other health care categories since 2013. Increased utilization will also be necessary for the aging Baby Boomer generation.

“While healthcare inflation has grown 32.3% and Low Utilization Payment Adjustment (LUPA) rates, which are federally averaged Medicare rates, have increased by 26%, Wisconsin’s Medicaid reimbursement rate for home health services has increased 0% over the last ten years,” Von Arx told the task force.

During the 2019-20 legislative session, WiAHC worked with a large bipartisan group of lawmakers on legislation to increase the Medicaid home health visit rate by 10 percent. The bill, Senate Bill 416/Assembly Bill 447, received a public hearing in the Senate Health Committee and had considerable support in both the Senate and Assembly. WiAHC is hopeful a recommendation from the task force would assist in increasing awareness on the urgency of the issue facing Wisconsin’s home health agencies.

WiAHC lobbyists are also submitting a memo to the task force and will continue to advocate for including a rate increase in the task force’s final proposal.

June 1 marked the official start of state legislative campaign season in Wisconsin. Candidates for state office turned their nomination papers into the Wisconsin Elections Commission and will now campaign ahead of the August 11 partisan primary. Candidates who win in August will square off in the general election on November 3.

The 2020 election will produce both change and consistency in the state legislature. With 7 open Senate Seats and 13 open Assembly seats, there will be plenty of new faces. At the same time, it is likely that Republicans will maintain control of both houses, extending their ten-year majority another two years.

The following seats are open due to retirements whether leaving to pursue higher office or leaving public service:

•         SD-12: Tom Tiffany (R-Elected to Congress)
•         SD-14: Luther Olsen (R)
•         SD-16: Mark Miller (D)
•         SD-26: Fred Risser (D)
•         SD-28: Dave Craig (R)
•         SD-30: Dave Hansen (D)
•         SD-32: Jennifer Shilling (D)
•         AD-8: JoCasta Zamarripa (D)
•         AD-11: Jason Fields (D)
•         AD-17: David Crowley (D-Milwaukee County Exec)
•         AD-29: Rob Stafsholt (R-running for SD-10)
•         AD-35: Mary Felzkowski (R-running for SD-12)
•         AD-41: Joan Ballweg (R-running for SD-14)
•         AD-44: Deb Kolste (D)
•         AD-48: Melissa Sargent (D-running for SD-16)
•         AD-55: Mike Rohrkaste (R)
•         AD-57: Amanda Stuck (D-running for CD-8)
•         AD-69: Bob Kulp (R)
•         AD-75: Romaine Quinn (R)
•         AD-76: Chris Taylor (D)

The current political wisdom is that Assembly Republicans are in position to maintain control following the 2020 election due to their large majority. They currently have a 63-36 seat majority. Should the election be favorable for Democrats, there is a chance they could win nine competitive seats currently held by Democrats. However, they would still be short of obtaining the majority. The nine competitive seats currently held by Republicans include:

•         AD-21: Jessie Rodriguez
•         AD-49: Travis Tranel
•         AD-50: Tony Kurtz
•         AD-51: Todd Novak
•         AD-68: Jesse James
•         AD-85: Patrick Snyder
•         AD-88: John Macco
•         AD-92: Treig Pronschinske
•         AD-96: Loren Oldenburg

Likewise, it is expected Senate Republicans will also maintain control of that body. Until recently, Republicans had a 19-14 majority. However, following the resignations of Republican Tom Tiffany (elected to Congress in May) and Democrat Jennifer Shilling (resigned to take a job in the private sector), Republicans currently have an 18-13 majority.

Of the open seats, it is likely, Republicans will maintain control of the 12^th (Tiffany – Northern WI), 14^th (Olsen – Central WI) and 28^th (Craig – Southeast WI) Senate Districts. Likewise, it is certain Democrats will maintain control of the Madison-based 16^th and 26^th Senate Districts, which have both garnered large Democratic primaries.

Conversely, the open seats in the 30^th (Hansen – Green Bay) and 32^nd (Shilling – LaCrosse) Senate Districts could potentially go either way. Looking at the performance of Republican presidential candidates in the last two elections, Romney lost the Green Bay-based 30^th Senate District with 47.7% of the vote and Trump won it with 55.6%. If Trump performs well again, then it is conceivable a Republican State Senate candidate could win the district.

While the 32^nd Senate District in LaCrosse is typically a strong Democrat district, Trump did significantly better than Romney. Additionally, former 32^nd District Democratic Senator Jennifer Shilling narrowly defeated her opponent, Republican Dan Kapanke in 2016. Kapanke, a former Senator from the area, is running again this year. Should Trump increase support in the LaCrosse area, Kapanke may have a chance.

Political spectators are also keeping a close eye on the 10th Senate District in northwest Wisconsin, which is held by Democrat Patty Schachtner. Schachtner handily won the seat by 10-percentage points in special election in 2018. However, Republicans hold all three Assembly seats that comprise the Senate district, and Trump won the district with 55.6% of the vote in 2016. Again, a Republican candidate’s success may rely on the district’s support for Trump.

If Senate Democrats have the opportunity to flip a seat, it could be the 24th Senate District held by Republican Patrick Testin (Stevens Point). The central Wisconsin district, which includes the city of Stevens Point and surrounding areas, was once considered a Democratic district. Romney lost the district in 2012 and Trump won it with 53% in 2016. In 2018, Republicans running for statewide office lost the district. If the district continues its swing left and support for Trump decreases, Democrats could flip the seat.

The 2020 election in Wisconsin will be somewhat unique because there is no race for statewide office (Governor, U.S. Senate) for the first time in several cycles, which should mean that success for Democrats and Republicans in the state legislature will rely solely on attitudes in the presidential race. However, while Wisconsin is considered one of the foremost battle ground states this year and Biden leads Trump in recent polling, the vast majority of Democratic voters reside in Milwaukee County and Dane County (Madison). Democrats already hold the legislative seats in these two areas. The reality of how voters are distributed in the state lends itself to the possibility that the Democratic nominee for president wins the state and legislative Republicans return with large majorities again.

Starting June 5, the Wisconsin Department of Health Services (DHS) will be accepting applications from specific types of health care providers (listed below) for $110 million of funding provided to the state under the federal Coronavirus Aid, Relief, and Economic Security (CARES) Act. These funds will be used to make payments to offset lost revenues and expenditures facilities and services incurred during March, April, and May 2020, related to the COVID-19 pandemic.

Providers eligible to apply are:

Home and community-based service providers* that provide:

• 1-2 bed Adult Family Homes
• Day services
• Home health
• Personal care
• Pre-vocational and supported employment
• Respite care
• Supportive home care
• Daily living skills training for children

Assisted Living Facilities, including:

• 3-4 Bed Adult Family Homes
• Community-Based Resident Facilities (CBRFs)
• Resident Care Apartment Complexes (RCACs)

Nursing Homes, including:

• Skilled Nursing Facilities
• Intermediate Care Facilities

Emergency Medical Service Agencies

Clinics/Health Centers, including:

• Rural Health Clinics
• Federally Qualified Health Centers
• Tribal Health Clinics
• Free and Low Cost Clinics

* Only entities/organizations may apply for funding. Individuals such as those who are participant-hired workers or paid through a fiscal agent are not eligible.

The application for these funds will be available from June 5 to June 30. For more information on eligibility, the application, and the payment process, please visit the CARES Act Provider Payments page on the DHS website.

On May 13, the Wisconsin State Supreme Court struck down the Safer at Home extension ordered by Department of Health Services Secretary-designee Andrea Palm. While the Court did not rule on the legality of the Safer at Home policy, it did rule the process by which the policy was implemented was illegal.

The Court ruled that Secretary-designee Palm did not have the singular authority to extend the Safer at Home order to May 26 and stipulated the action required emergency rulemaking procedure, which was not executed by the Department.

At the heart of the issue was whether or not DHS can extend the Safer at Home order beyond May 11. Governor Tony Evers declared a public health emergency in March. By law, such declarations expire after 60 days. In this specific instance, the expiration date was May 11. 

Emergency Order #28, issued by Palm, extended the Safer at Home order two weeks beyond the expiration date. Palm and DHS cited statute 252.02 as providing the department the authority to take actions to combat outbreaks of communicable disease outside the confines of a 60 day public health emergency declaration. Republican legislative leaders disagreed with the interpretation of that statute and filed the challenge in the State Supreme Court.

The ruling was decided on a 4 to 3 vote. One conservative member, Justice Brian Hagedorn, disagreed with his conservative colleagues, stating in his dissent, “The legislature may have buyer's remorse for the breadth of discretion it gave to DHS in Wis. Stat. § 252.02. But those are the laws it drafted; we must read them faithfully whether we like them or not.”

In the wake of the ruling, Wisconsin is now without a statewide strategy to combat COVID-19. While the Department of Health Services took direction from the ruling and submitted proposed emergency rules to the legislature for approval, it rescinded that proposal on May 18, after comments from Republican legislative leaders who want to leave ongoing strategies to local public health departments.

Dane County, for instance, issued its own Safer at Home order shortly after the Court’s ruling on May 13. Other counties followed suit, but some later rescinded after confusion over their legal authority to do so became unclear. This confusion caused Attorney General Josh Kaul to issue an opinion that nothing in the Supreme Court’s ruling affects the authority of local public health officials to issue Safer at Home orders for their jurisdictions.

There is, however, some public opposition to local orders. On Wednesday, May 20, a group of Wisconsin citizens filed a challenge against local orders on Constitutional grounds in federal court in Milwaukee. The challenge states that safer at home orders infringe upon rights to freely assembly and freely practice religion. There has yet to be any developments in the challenge beyond the initial filing.

WiAHC’s lobbyists continue to closely monitor the situation and will provide updates as they’re available.

On Thursday, May 21, Governor Tony Evers announced $100 million in grants to home and community based services, long-term care, and emergency medical services. The funds are made available from federal dollars allocated by the CARES Act.

According to the linked press release, the program will be administered in two parts: an initial release of funds to support immediate needs, and a second, targeted release for additional needs of individual providers. Both rounds of funding will be allocated to support expenses directly related to COVID-19 as well as expenses associated with the interruption of typical operations, such as overtime pay, changes to sanitation procedures, and disruption to the standard delivery of care.

“We recognize the significant burden the COVID-19 response has placed on these providers,” says Governor Evers. “We also recognize the integral role they play in ensuring the health and safety of some of our most vulnerable Wisconsinites and we want to support their efforts during this pandemic.”

WiAHC’s lobbyists have been told by DHS that additional specifics for distributing the funds are forthcoming. They will update members as more details are made available.

The WiAHC Spring Conference has moved to virtual! This gives you and your entire agency the ability to watch all conference sessions for one price. This is the first time you do not need to choose who attends each breakout session or who attends the WiAHC Spring Conference from your agency. Everyone can benefit, firsthand!

There are experts presenting from Florida, Missouri, New Jersey, Pennsylvania, Texas and Wisconsin.  Five sessions are for new nurses presented by Teresa Northcutt, BSN RN COS-C HCS-D HCS-H, Senior Associate Consultant, Selman-Holman, A Briggs Healthcare Company. We have three sessions by Larry Prince, CEO and Managing Partner, Prince Health, LLC covering motivating employees and managing performance during times of change. Phil Ward, CHA, President of Hospice Operations, Community Hospice and Palliative Care presents on improving profitability of hospice GIP facilities and the evolution of business intelligence. Other topics include PDGM, infection control, revenue cycle management and many more.

Register today!

Wisconsin Health News, May 11, 2020

A decontamination system that will allow N95 respirators to be reused up to 20 times is now up and running, Gov. Tony Evers said Saturday. 

The system, developed by private nonprofit research firm Battelle Memorial Institute, will be able to decontaminate up to 80,000 respirators daily.

The services, including shipping, will be provided to Wisconsin healthcare organizations and professionals free of charge.

Caitlyn Farragher, Battelle’s Wisconsin site lead, said they plan 24-hour operations to ensure a "timely turnaround time."

Community COVID-19 testing sites are also set to open in Madison and Milwaukee this week. That builds on testing sites launched in communities in northern and central Wisconsin. 

“Anyone who goes to one of these community testing sites will receive their test for free,” Evers told reporters Friday. “If you need a test, we want you to get a test.” 

He said that the state is in “pretty good shape” for testing supplies, like swabs and reagents, but still needs help from the federal government. 

Evers unveiled a series of guidelines Friday on best practices and safety tips for businesses looking to keep workers, customers and families safe as they reopen.

The guidelines were developed by the Wisconsin Economic Development Corporation in consultation with other state agencies as well as industry associations and experts. 

There were 629 additional cases of COVID-19 and 16 more deaths reported over the weekend. As of Sunday, there were 10,219 positive cases and 400 deaths in total. 

Meanwhile, more health systems are restarting elective procedures. Ascension Wisconsin said Friday that it’ll start gradually reintroducing more services for non-urgent and medically necessary procedures as well as primary and specialty care clinic appointments. Bellin Health also said Friday it was resuming procedures and non-urgent appointments put on hold due to the pandemic.

And Marshfield Clinic Health System said Monday it has begun performing non-urgent surgeries at its hospitals in Marshfield and Eau Claire and anticipates increasing the number of procedures at its other hospitals and outpatient surgery centers in the next several weeks.

Advocate Aurora Health and other health systems throughout the state are pursuing similar efforts. 

Governor Tony Evers today announced Wisconsin’s new Battelle Memorial Institute Critical Care Decontamination System™ is now ready and available for use by the state’s health care workers and first responders to decontaminate their N95 respirators so they can be reused up to 20 times. The Battelle system decontaminates N95 respirators by killing viruses and bacteria using hydrogen peroxide gas, and will greatly extend the life of a vital piece of Personal Protective Equipment (PPE).

The Battelle system will be able to decontaminate up to 80,000 N95 respirators on a daily basis. It can decontaminate respirators up to 20 times without degrading filtration performance. The usual decontamination turnaround time for users is a maximum of 72 hours, plus shipping time, as long as the site is not over its capacity for use. The Battelle system can only decontaminate respirators, and not other items of PPE. It is also not authorized for use with respirators containing cellulose-based materials.

Battelle decontamination services, including shipping, will be provided to Wisconsin healthcare organizations and professionals free of charge. Eligible healthcare providers include, but are not limited to, hospitals, nursing homes, public health professionals, human and child protective services offices, emergency managers, first responders, coroners, medical examiners, law enforcement and correctional institutions, home health organizations, pharmacists, rural health services and dental offices.

The new Battelle system highlights decontamination efforts ongoing throughout Wisconsin to try to ensure that health care workers and first responders can be as safe as possible when performing their duties.

With all of the decontamination efforts underway in Wisconsin, health care workers and first responders are being asked to save their used PPE supplies for decontamination. Throughout the past couple of weeks, outreach efforts were conducted to inform health care workers and first responders on how to sign up for the Battelle system decontamination service, and ensure their masks are safely returned to them.

Through a partnership with the Federal Emergency Management Agency (FEMA) and Defense Logistics Agency (DLA), the State of Wisconsin received the Battelle system this week. Battelle developed the system in 2015 to help decontaminate PPE to prevent further spread of Ebola. The Columbus, Ohio company is currently deploying the system to 60 different sites across the nation.

Beyond the Battelle system, other decontamination efforts in Wisconsin include UV decontamination sites. These sites service N95 respirators as well as other types of PPE, such as face shields, gowns, and aprons. UV decontamination facilities are currently operating in much of Wisconsin, highlighted by sites in Brown, Dane, Kenosha, and Sawyer counties.

In addition to statewide decontamination efforts, Wisconsin continues to work on building up its stockpile of PPE supplies. Last week Wisconsin received a delivery of 230,000 N95 respirators from FEMA. Gov. Evers continues to request more of these supplies to meet Wisconsin’s pressing need.

The full press release from the Governor is available online (link).