March 23, 2020

 

The Honorable Tony Evers

Governor, State of Wisconsin

115 East, State Capitol

Madison, WI 53702

 

Secretary-Designee Andrea Palm
Wisconsin Department of Health Services
1 West Wilson St, Room 650
Madison, WI 53703

 

Dear Governor Evers and Secretary-designee Palm, 

First, thank you for the measures you have taken so far to address the COVID-19 pandemic. Your actions have pragmatically addressed this growing problem in the best interest of Wisconsin.  

As you prepare to issue tomorrow's Safer at Home order, the Wisconsin Association for Home Health Care, Inc. (WiAHC) urges you to allow home health care agencies to continue to provide our essential, life-sustaining services throughout the public health emergency. Home health care agencies and the RNs and LPNs who deliver home health care services must be considered essential services under the order. The home health patients who rely on our services simply cannot afford to be without care during this time and our skilled nursing staff needs to continue to provide that needed care. 

While we request home health care services be considered essential services, we also request you allow for following two changes to DHS 133 administrative code that will allow our skilled nursing staff to conduct certain home health visits telephonically:

·         DHS 133.18 Supervisory visits.

o    Current rule language: (1) If a patient receives skilled nursing care, a registered nurse shall make a supervisory visit to each patient's residence at least every 2 weeks. The visit may be made when the home health aide is present or when the home health aide is absent. If the patient is not receiving skilled nursing care, but is receiving another skilled service, the supervisory visit may be provided by the appropriate therapist providing a skilled service.

o    Current rule language: (2) If home health aide services are provided to a patient who is not receiving skilled nursing care, or physical, occupational or speech-language therapy, the registered nurse shall make a supervisory visit to the patient's residence, when the home health aide is present or when the home health aide is absent, at least every 60 days to observe or assist, to assess relationships, and to determine whether goals are being met and whether home health services continue to be required.

o    Our request is to allow for a grace period of an additional 14 days to conduct supervisory visits for both the 14-day requirement under sub. sec. 1 and the 60-day requirement under sub. sec. 2 while the state is under a public health emergency. Additionally, we request DHS allow agencies to conduct supervisory visits via telephone or videoconferencing while the state is under a public health emergency.

·         DHS 133.20 Plan of care.

o    Current rule language: (3) Review of plan. The total plan of care shall be reviewed by the attending physician, advanced practice nurse prescriber, or physician assistant, and appropriate agency personnel as often as required by the patient's condition, but no less often than every 60 days. The agency shall promptly notify the physician, the advanced practice nurse prescriber, or the physician assistant of any changes in the patient's condition that suggest a need to modify the plan of care.  

o    We request DHS allow home health care agencies to conduct any necessary visits from RNs associated with the 60-day review process to be done via telephone or videoconferencing while the state is under a public health emergency.

Thank you for your attention to these matters. If you have any questions, please contact Tim Hoven ( tim@hovenconsulting.com) and me (erik@hovenconsulting.com).

 

Thank you,

--

Erik Kanter
Hoven Consulting, Inc.

Governor Evers announced today that he be issuing a “Safer at Home” order effective Tuesday, March 24.  Organizations and individuals providing essential care and services will be allowed to continue travelling to and from work.  This includes healthcare professionals, grocers and family caregivers.  The full details of the order to be announced by the Governor’s office.  Everyone else is asked to not take any unnecessary trips, and to limit travel to essential needs such as getting medications and groceries. 

This order is based on the advice and counsel of public health experts, healthcare providers and first responders on the front line of our state’s response to the pandemic.  These unprecedented measures are necessary to reduce rate of spread in COVID-19 cases.  We must do everything we can to keep our healthcare systems from becoming overwhelmed, and protect both the public and essential healthcare workers who are taking care of the critically ill.

NACH, March 20, 2020 

On Friday, March 20, the Centers for Medicare & Medicaid Services (CMS) held a call with home health organizations to discuss recent developments related to the novel coronavirus COVID-19.  Even though the call was specific to home health agencies there hospice questions addressed, as well.

CMS indicated it plans to hold similar calls weekly, but these have not yet been scheduled.  Stay tuned to NAHC Report for additional information.

This was a short 30-minute call in which CMS briefly summarized recent activity related to the 1135 waivers and home health providers and then responded to questions from callers. The questions and answers are below. “We” in the answers is CMS.

Q: Do our agencies need to submit 1135 waiver requests or is a request submitted by a department of health or association on our behalf sufficient?

A:  If your concerns are listed on the waiver requests it is fine. No need to send another. When we look at specific provider requests, we do look at whether it would be good to have it applicable to all.

Q:  Does the 1135 waiver that allows telehealth for F2F visits include both home health and hospice, and if included will there be a code added for COVID19 to allow for billing?

A:  Telehealth for the F2F encounter for home health is allowed under the existing waiver. We are looking to update this on our website and FAQ pages and should see this later today. We are continuing to look at what additional flexibilities that we have in regard to hospice, but we are not able at this time to make additional waivers in regard to the 1135 process. We are looking closely and very seriously to these concerns . Also, by regulation, the cost of remote patient monitoring, if used to augment the patient care process, is allowed on the home health cost report.

Telehealth cannot be used to substitute for an in person visit – statute prohibits this, but we are still looking closely to see what flexibilities we have.

Q:  I think I can infer from your last statement that hospice is not part of the 1135 waiver and I am puzzled by this because it is inconsistent with social distancing guidance and I am curious if soon we can anticipate a waiver covering these F2F visits for certification, and if it does occur will it be retroactive?

A:  The statute under which we operate is very different between home health and hospice. It relates to section 1834(m) which does not include hospice telehealth. The 1135 waiver specifically references our ability to provide telehealth waivers specific to 1834(m). We are thinking as creatively as we can as to whether we have additional flexibility under this authority or other types of authorities.

Q: So in order for our medical directors to feel like we are providing care responsibly we feel it is mandatory that we forgo F2F visits to protect the health of our patients and our staff when we already have a staff person on site who can give the information to the physician for a hospice certification decision.

A:  This is along the lines of our thinking and we continue to look at this scenario.

Q:  Do you think hospices will be penalized for trying to protect the safety of their staff and their patients?

A:  We certainly understand the need for safety and we are making efforts to try to align the payment policies, processes and regulations with this need.

Q:  Please reiterate what you are saying about telehealth for F2F for home health and home health homebound status – will it be extended to cover  COVID-19?

A:  Homebound – in regard to individuals contraindicated to leave their home in this COVID emergency, we are looking to see what additional flexibilities we might be able to grant. With regard to the F2F visit, it can be performed by teleahtlh in accordance with the 1135 waiver. With regard to aspects of other telehealth visits – telehealth cannot be substituted for other in-person visits.

Q:  Providers are increasingly low on masks and other supplies. Will you change regulations as they get increasingly lower?

A:  We understand the concern across all settings about this shortage and we are working with the CDC to look at guidelines and see how they can be modified. We do encourage you to look at state and local systems as they have the ability to manage the stockpile.

Additional questions can be submitted to 1135waiver@cms.hhs.gov.

Posted in NAHC ReportTagged 1135 waiver, CMS, Coronavirus, Covid-19, Face-to-Face, waivers 

President Signs Coronavirus Response Act with Emergency Paid Sick Leave

On February 26, Wisconsin Governor Tony Evers vetoed Senate Bill 821, which passed both the State Senate and State Assembly on February 20. Just two Democratic lawmakers, Rep. Steve Doyle of Onalaska and Nick Milroy of South Range, voted for the bill. Every Republican lawmaker supported the legislation. 

The bill aimed to cut taxes by $250 million, which, according to estimates, would have reduced the average tax bill by over $100. The cut would have been funded by the positive revenue numbers reported earlier this year. 

On February 26, Governor Tony Evers vetoed the legislation on February 26 citing concerns that the tax cuts were made at the expense of further investment in public schools. 

In his veto message, Evers stated, “…[T]his bill fails to acknowledge or address the continued, inordinate burden that has been placed on our public schools, local governments, and Wisconsin families. Since 2011, nearly one million Wisconsinites have voted to raise their own taxes to support local schools. In 2018 alone, voters approved more than $2 billion in debt and revenue increases for local schools. This is not sustainable.” 

The statement went on to say, “We do not have to choose between funding for our kids and our schools and providing property tax relief—we can and should do both.” The move was expected and consistent with Evers’ prioritization of education funding. 

The Governor’s veto was met with criticism from Republican legislative leaders. “It seems that Governor Evers is obsessed with growing government more than addressing the needs of the middle class. This was a missed opportunity to do the right thing,” said Assembly Speaker Robin Vos. 

Senate Majority Leader Scott Fitzgerald also expressed discontent, saying, “While I’m disappointed in the governor’s actions, I’m not surprised – this is the second income tax cut he’s vetoed as governor.” 

The State Assembly planned to make its February 20 floor date its last of the 2019-2020 session. As of this writing, there has been no indication that will change. The State Senate is planning on holding its last floor session in March. It’s unclear if the State Senate will attempt to override the veto. A successful override would be extremely difficult. It would take 22 votes to successfully override a veto. The Republicans currently have 19 seats. It’s doubtful they could pick up three Democratic votes.

Since the start of the year, a number of legislators have stated they will not be seeking reelection to their current positions. As of this writing, twelve legislators have announced they will not seek reelection. Six of those are retiring. The other six are running for higher office.

The six retiring are as follows:

• Sen. Dave Hansen (D – Green Bay): 30th Senate District
• Sen. Mark Miller (D – Monona): 16th Senate District
• Sen. Luther Olsen (R – Ripon): 14th Senate District
• Rep. Deb Kolste (D – Janesville): 44th Assembly District
• Rep. Bob Kulp (R – Stratford): 69th Assembly District
• Rep. Mike Rohrkaste (R – Neenah): 55th Assembly District

The six seeking higher office are as follows:

• Sen. Scott Fitzgerald (R – Juneau): Running for Congress in the WI 5th Congressional District.
• Sen. Tom Tiffany (R – Minocqua): Running for Congress in the WI 7th Congressional District.
• Rep. Joan Ballweg (R – Markesan): Running for State Senate in 14th Senate District
• Rep. Melissa Sargent (D – Madison): Running for State Senate in 16th Senate District
• Rep. Rob Stafsholt (R – New Richmond): Running for State Senate in 10th Senate District
• Rep. Amanda Stuck (D – Appleton): Running for Congress in WI 8th Congressional District

These twelve announcements signal significant turnover in the next legislative session. More announcements are likely to come before legislators begin filing for candidacy in April. 

Putting Home Care First with the Power of One

Sign Up!

 

2020 is still in its infancy, but this year will be historic for policy advocacy here in our nation's capital and around the country. 

Big issues on the table concerning everything from immigration to health care and home health care and hospice services are an integral part of that debate. More and more Americans are choosing to receive care and services in the comfort of their own homes and to age in place. The home health care and hospice communities are struggling to meet the ever growing demand amidst nursing and caregiver shortages. For those of us in the Home Care and Hospice Party, our attention will be focused like a laser on solutions to the problems faced by the millions of Americans who provide and depend on quality health care in the home. 

Here at the National Association for Home Care & Hospice (NAHC), advocacy never sleeps AND never has it been more important for individuals to exercise their constitutional right to participate in the democratic process through advocacy; especially when it concerns the ability to receive quality health care and hospice services in the home. 

We need you to join us in our advocacy effort to put
"Home Care First" with the
Power of One! 

Forward this email today to ONE friend, or colleague, and ask them to sign up as an advocate by clicking:
HERE

If every person gets ONE other person to sign up, we will be more than 100K strong in just a week's time.

2020 is new and full of possibilities and you can play an integral role helping us to build our army, strengthen our voice and the heartbeat of the industry.

Is your agency interested in COS-C Certification for your staff? WiAHC is exploring this potential interest for our members. Please share your feedback by January 31. 

Take the Questionnaire Here 

 This potential workshop is designed to

·         Support the educational needs of home health clinicians in achieving comprehension and accuracy in OASIS data collection using guidelines established by the Centers for Medicare & Medicaid Services (CMS)

·         Provide a preparatory review for candidates for the COS-C (Certificate for OASIS Specialist-Clinical) examination. Please note that if you plan to take the COS-C Exam, it requires an additional fee.

·         Supply the knowledge and tools necessary to boost clinical confidence while building a foundation of data collection precision.

·         Provide relevant nursing Continuing Education credit required for license renewal

Marquette University Law School released a new poll yesterday. The new numbers illustrate trends in Wisconsin voters’ opinions on the impeachment proceedings, thoughts on the Democratic presidential primary candidates, and approval of state elected officials. 

The impeachment of President Donald Trump continues to be unpopular among Wisconsin voters. Fifty-two percent of respondents said the president should not be impeached. This is consistent with the November 20 Marquette University Law School Poll numbers. Despite weeks of impeachment proceedings, it seems Washington Democrats have not been able to move the needle on public opinion. Once again, however, fifty-two percent of respondents also said they do believe Trump asked Ukraine to investigate Trump’s political rivals, and forty-four percent believe he did something “seriously wrong” while only thirty-seven percent believe he did “nothing wrong.” 

The poll does indicate some positive trends for Democratic primary candidates. In November, Trump lead the top four potential Democratic contenders in the 2020 election by three points or more. Yesterday’s poll shows former Vice President Joe Biden leads Trump by one point, and Senator Bernie Sanders, Senator Elizabeth Warren, and South Bend Mayor Pete Buttigieg trail Trump by two points or less. 

The Democratic field also seems to be tightening in Wisconsin. In November, Biden lead Sanders by thirteen points, Warren by fifteen, and Buttigieg by seventeen points in the race for the Democratic nomination. Yesterday’s poll shows Biden now leads Sanders by four points, Warren by seven points, and Buttigieg by eight points. 

The new poll numbers also indicate Governor Tony Evers’ job approval rating is back at the fifty percent mark after dipping below that number last month for the first time. 

Other data includes:

President Donald Trump Approval Rating:

·         Approve: 47%

·         Disapprove: 50%

Democrat Senator Tammy Baldwin Favorability Rating:

·         Favorable: 42%

·         Unfavorable: 39%

Republican Senator Ron Johnson Favorability Rating:

·         Favorable: 36%

·         Unfavorable: 34%

The economy has:

·         Gotten Better: 44%

·         Gotten Worse: 21%

·         Stayed the Same: 37%

In 2020, the economy will:

·         Improve: 32%

·         Worsen: 25%

·         Stay the same: 37%

The poll, conducted among 80 registered Wisconsin voters, has a margin of error of +/- 4.2 percentage points.

The WiAHC education committee is busy making plans for 2020. Webinar topics that are being considered include telehealth, PDGM, medication diversion and various hospice topics. Conference topics may include PDGM, Medicare Advantage changes, care planning, profitability, back office structure, business intelligence, revenue cycle management and motivating employees. 

Save the dates!

WiAHC Spring Conference, June 4-5, 2020, Wilderness Resort, Wisconsin Dells

WiAHC Fall Conference, November 5-6, 2020, Holiday Inn, Stevens Point

Earlier this month, the State Senate and Assembly passed legislation to allow Medicaid providers to seek reimbursement for services provided via telehealth. Telehealth, sometimes called telemedicine, is a healthcare delivery model in which technology is utilized for healthcare providers to remotely speak to, treat, and monitor patients. 

The legislation passed both houses of the legislature earlier this month on unanimous voice votes. The bill was heavily bipartisan from its inception. 

WiAHC actively lobbied in support of the legislation. The bill innovatively assists in addressing nursing workforce issues. Utilizing telehealth could increase access and utilization of home health care, which means agencies could take on more patients. Additionally, due to the ability to deliver services remotely, nurses could see more patients daily without the burden of drive-time. 

On November 25, Governor Tony Evers signed the legislation into law at a bill signing ceremony in Richland Center. While the bill was signed into law, it will not go into effect until the Department of Health Services is able to begin making such reimbursements. The legislation provides DHS with a year to implement the reimbursements. However, DHS can begin payments as soon as it is logistically able to. Please stay tuned for updates. In the meantime, the legislative language can be found here.