Last week, the Centers for Medicare and Medicaid Services (CMS) published its FY 2025 home health proposed payment rule, which calls for additional cuts to home health payments. Please find below some key information on the proposed rule:

• Home Health Care News Article: CMS Proposes Over 4% Cut to Home Health Medicare Payments In 2025
• NAHC Webinar: 2025 Home Health Prospective Payment System Rate Update Proposed Rule (tomorrow, July 2, 2024). More information HERE.
• Copy of proposed CMS Rule: CLICK HERE

WiAHC will be working with our national partners to submit official comments on the rule to CMS. Stay tuned for more information on that front.

The 2023-2024 state legislative session, which began on January 3, 2023, has ended. The State Assembly held its final floor date for the regular session on February 22, 2024, and the State Senate held its final regular session day on March 12, 2024.  While the Senate reconvened on May 14, 2024, for a “Veto Review” session day, during which they voted to override the Governor’s vetoes of nine bills, it appears unlikely that the Assembly will also reconvene to vote to attempt to override these vetoes.  Furthermore, it does not appear likely at this time that either chamber will reconvene before the November general election.

The following are highlights from the current biennial budget law, as well as other relevant legislation introduced during the 2023-2024 legislative session.

·     2023-2025 State Budget:

o   Home and Community Based Services (HCBS) Rate Increase Continuation: Provided $43,707,300 in FY2023-24 and $181,951,800 in FY2024-25 to continue the federal American Rescue Plan Act (ARPA) HCBS 5.0 percent rate increase from April 1, 2024, through June 30, 2025.

o   Personal Care Reimbursement:  Increased Medicaid personal care reimbursement rates by $12.9 million in 2023-24 and $25.4 million in 2024-25.

o   Complex Patient Pilot Program:  Provided $5,000,000 in FY2023-24 on a one-time basis to help facilitate the transfer of complex patients from acute care settings, such as hospitals, to post-acute care facilities, such as nursing homes.

o   Allied Health Professional Training:  Provided $2,500,000 annually to expand allied health professional education and training grants.  Expanded eligibility for the program to include registered nurses.

o   Nurse Educators:  Maintained $5 million in annual funding for this program. 

·     Other 2023-2024 Legislative Highlights:

o   Support – Enactment of Senate Bill 476:  Codifies existing state regulations allowing health care providers that do not have a physical location in Wisconsin to be certified as a Medicaid provider in order to treat patients who are Medicaid beneficiaries via telehealth as long as the provider is licensed in the state and is in good standing with the relevant occupational licensing board.  Governor Evers signed this bill on March 22, 2024. 

o   Support – Assembly & Senate Passage of Senate Bill 158:  Grants preliminary occupational health care credentials to those who recently completed the requirements to obtain such a credential (e.g., recent graduates), submitted a license application, and have been engaged by a qualifying health care employer.  The intent behind this bill was to expedite the processing of health care occupational credentials.  Governor Tony Evers vetoed this bill on March 29, 2024. 

o   Support – Assembly Passage of Assembly Bill 204:  Increases the renewal period for health and business occupational credentials from two years to four years.  This legislation passed the Assembly, but the Senate did not vote on it before the end of the legislative session. 

o   Support – Assembly Bill 507:  Prevents an insurance policy from requiring prior authorization for certain health care services, including the first 12 visits for physical therapy, occupational therapy, speech therapy, or chiropractic services.  The Assembly Health Committee voted unanimously to recommend full Assembly approval of this bill.  However, neither the Assembly nor the Senate took any further action on this bill prior to the end of the legislative session.

·       Miscellaneous Policy Priorities

o   Amending Legislation Limiting Prior Insurance Authorization for Certain Health Care Services:  WiAHC’s government relations representatives will continue to work with the authors of such legislation (e.g., Assembly Bill 507 referenced above) and stakeholders to add “skilled home health nursing” to such legislation to exempt that type of service from prior insurance authorization in certain circumstances.

o   Updating Department of Health Services Regulations: 

§  Professional Advisory Bodies:  WiAHC will continue to work with DHS to remove outdated state regulations related to professional advisory bodies for home health agencies.  Our intent is that this change will be incorporated into a large package of regulatory updates that DHS works on every two years.

·       Governor Signs Bill Creating New State Legislative District Maps

o   On December 22, 2023, the State Supreme Court issued a ruling that Wisconsin’s state legislative district maps are unconstitutional and the maps for each such district must be redrawn before the 2024 elections.  State Supreme Court justices voted 4-3 in favor of this ruling.  The decision focused on specific state legislative districts that include non-contiguous portions of land, which the court found violated the state constitution. 

o   Specifically, the court ruled that the legislature must redraw the boundaries for each state Assembly and state Senate district in advance of the August 2024 primary election.  If the legislature and Governor Evers were not able to agree on legislation creating new district boundaries, the court noted that it would decide on the new boundaries.  As a practical matter, the state Elections Commission noted that new district boundaries needed to be finalized by March 15, 2024. 

o   In January 2024, the parties to the case submitted various proposed state legislative district maps to the court and the court-appointed consultants reviewed these maps and provided their analysis to the court on February 1.  However, in mid-February, the Legislature passed a bill with the version of state legislative district maps that Governor Evers previously submitted to the court.  This legislation passed both chambers of the Legislature with mostly Republican votes and was sent to the Governor.  On February 19, 2024, Governor Evers signed this legislation.  As such, these new legislative district maps have taken effect for legislative candidates who are elected in November 2024.  These new maps may be viewed on the Legislature’s website.

·     Governor Creates Task Force on the Healthcare Workforce

o   On January 29, 2024, Governor Tony Evers signed an executive order creating the Governor’s Task Force on Healthcare Workforce.  According to the Governor’s press release on this topic: “The task force will be charged with studying the workforce challenges facing the state’s healthcare system, including recruitment and retention, identifying ways to improve patient care and alleviate the burdens on the healthcare workforce, exploring educational and training pathways to grow a sustainable healthcare workforce, and creating an action plan with solutions related to workforce development, industry innovation, education, and training for consideration in the governor’s 2025-27 biennial budget.”

o   The task force is chaired by Lieutenant Governor Sara Rodriguez, a registered nurse with a master’s degree in public health, who has worked for both the U.S. Centers for Disease Control and Prevention and as a chronic disease director for the state of Colorado. 

o   The task force is co-chaired by state Department of Workforce Development Secretary Amy Pechacek and state Department of Health Services Secretary Kirsten Johnson.  Prior to being named DHS Secretary, Kirsten Johnson led the City of Milwaukee Health Department, as well as the Washington-Ozaukee Health Department.

o   Task Force members also include representatives from institutions of higher education, medical providers, patient advocacy organizations, among others. 

o   In March 2024, representatives from WiAHC and the Wisconsin Hospice and Palliative Care Association (WiHPCA) participated in a joint meeting with the task force chair, Lieutenant Governor Sara Rodriguez, to discuss health care workforce issues.  Various issues were discussed, including reimbursement from insurers and public sector payers, medical personnel wage levels, and the potential to expand an existing effort to concurrently train high school students to be licensed practical nurses (LPNs), so that they are able to graduate from high school and immediately enter the workforce. 

o   Please be assured that WiAHC’s government relations representatives will continue to monitor the work of this task force.  For more information about this task force, please visit the task force’s website. 

In late May, the state Department of Health Services (DHS) announced that the electronic visit verification (EVV) hard launch begins on October 1, 2024.  The following service codes are impacted:

• Home health care services (service codes 92507, 97139, 97799, 99504, 99600, S9123, S9124, T1001, T1021, T1502)

• Personal care nurse supervisory visits (service code 99509)

As you are likely aware, the federal government is requiring the hard launch of EVV in Wisconsin as a condition of the state receiving its full allocation of Medicaid funding. 

If your home health agency has not yet started to implement EVV, WiAHC strongly recommends that such agencies start the process immediately as the implementation process may take longer than expected.  Please note that DHS is able to provide assistance with implementation.  Wisconsin EVV customer service may be reached Monday through Friday, from 7:00AM – 6:00PM (Central Time) at 1-833-931-2035 or via email at vdxc.contactevv@wisconsin.gov.  Also, there is additional information regarding EVV implementation on the DHS website, including an online “Key Conversation” that DHS will hold on July 15 from 1:00PM – 2:00PM (Central Time) to answer questions. 

This task force’s most recent meeting was held on May 9 at the University of Wisconsin-La Crosse campus.  The initial portion of the agenda was a panel discussion on recruitment and retention that featured the following panelists:

• Dr. Hannah Maxey, Veritas Health Solutions (NOTE: She served as panel moderator.)
• Dr. Tom Kernozek, Professor and Chair, Department of Health Professions, UW – La Crosse (Task Force Member)
• Heather Schimmers, President, Gundersen Health System (Task Force Member)
• Ann Zenk, Senior Vice President of Workforce and Clinical Practice, Wisconsin Hospital Association (WHA)

Zenk discussed the annual workforce report that WHA publishes.  WHA is concerned about the “silver tsunami” – the increase of those Wisconsinites aging into retirement.  She also discussed that in 2022, the nursing shortage hit Wisconsin hard, as nurses comprise over half of a hospital’s workforce.  Kernozek discussed UW-La Crosse’s health education programs and how they partner with local school districts and health systems with a presence in the area.  With respect to challenges, he discussed their faculty recruitment and retention issues.  Schimmers discussed the hiring challenges that Gundersen faces and how they made changes to try to improve.  She noted that there is high turnover within the first 1-2 years of joining the health care profession and that the industry is not preparing the workforce enough for the hardships they will face in the workplace.

The three panelists proposed a number of solutions:  Medicaid reimbursement expansion, loosen restrictions on requirements for faculty, uniform licensing processes, tax incentives for nursing preceptors (mentors), loan repayment programs for faculty, among others.

The next portion of the meeting featured Dr. Maxey reviewing the themes discussed during the breakout sessions held during the task force’s April 4 meeting:  education, incentives, funding, and apprenticeships.  Please note that these issues were addressed in our summary of the task force’s April 4 meeting. 

The final portion of the agenda featured breakout groups, which came up with numerous proposed solutions to workforce challenges.  The groups came up with numerous suggestions, including encouraging worker usage of employee assistance programs, target funding based on geography and need, expanding Medicaid, invest in apprenticeship and related programs, marketing campaign to seek health care workers, removing the state “benefits cliff” for workers who are promoted, encouraging high school students to seek concurrent training for certain roles (LPNs, etc.), tax incentives for preceptors (mentors), among others.

The meeting closed with an announcement that the task force’s June meeting will review prior workforce improvement suggestions and transform them into draft task force recommendations that will be prioritized.

In early June, DHS issued a request for public comment on the Family Care and Family Care Partnership 1915(b) and 1915(c) waiver renewal applications.  The federal government requires that these waivers be renewed every five years.  These waivers comprise the rules for the Family Care program and allow this Medicaid-funded program to exist. 

The deadline to submit public comments to DHS is July 5, 2024.  Comments may be submitted to DHS via the following methods:

• Send an email to dhsltcpubliccomment@dhs.wisconsin.gov
• • Please include the subject line:  “Family Care 1915(b) Waiver Renewal or Family Care 1915(c) Waiver Renewal”

• Mail written comments to the following address:

Division of Medicaid Services

Bureau of Programs and Policy

Attn: Family Care 1915(b) Waiver Renewal or Family Care/Family Care Partnership 1915(c) Waiver Renewal

PO Box 309

Madison, WI 53701-0309

Additional details about this waiver renewals, including a summary of the proposed waiver changes may be viewed at the DHS website.

On June 10, Dane County Circuit Court Judge Susan Crawford announced her candidacy for the State Supreme Court seat that will be vacated next year by veteran Supreme Court Justice Ann Walsh Bradley, who is a member of the liberal court majority.  Prior to serving on the Dane County Circuit Court, Judge Crawford worked as an assistant attorney general in the state Department of Justice.  In addition, she served in the state Department of Corrections and the state Department of Natural Resources, as well as then-Governor Jim Doyle’s chief legal counsel.  She also worked as an attorney in private practice. 

As this is written, former Republican Attorney General Brad Schimel – who currently serves as a judge in Waukesha County – is the only other candidate who has announced a run for Justice Walsh Bradley’s seat on the State Supreme Court.  If additional candidates enter the race, a primary election will be held on February 18, 2025.  The general election will occur on April 1, 2025. 

The 2023-24 legislative has come to an end, and legislators have shifted their focus to the upcoming election season and the need to connect with voters. With that in mind, it is more important than ever for WiAHC members to strengthen their relationships with their state lawmakers (and new legislative candidates) to educate them on the value of skilled home health care, the regulatory challenges we face, and the legislative solutions we need to increase access to care for patients. Rember, decisions state legislators make in the Capitol can have a significant impact on the home health care industry, your organization, and your profession.

One of the best ways you as a WiAHC member can engage your local legislators is to invite them to tour your facilities to illustrate firsthand the many benefits of home health care. These visits provide a tremendous advocacy opportunity, which is why WiAHC members across the state have already hosted numerous successful legislative tours. But we need to maintain the enthusiasm for this critical grassroots advocacy program, and WiAHC is excited and ready to set-up additional tours today.  

If you would like to host a legislative tour at your site, please contact the WiAHC office at wiahc@badgerbay.co. We will work with you and your legislators to coordinate the meetings and will provide participating members with full support, including legislator bios, advocacy tips, issue briefings, and supporting documents.  

Now that the Legislature has adjourned their legislative session, the 2024 election cycle is in full campaign mode. Wisconsin’s state legislative and congressional district maps were finalized earlier this spring, which will create several very competitive races for control of the Wisconsin legislature. This, coupled with Milwaukee hosting the Republican National Convention in July and Wisconsin’s status as a key battleground state in the Presidential election and control of the U.S. Senate, will make for a very interesting 2024 election year. 

State Legislative Elections

Both houses of the Wisconsin Legislature currently have large Republican majorities (Assembly – 64-35; Senate 22 to 10 with 1 vacancy in a heavily Democratic district in Milwaukee). All 99 Assembly seats are up for election.  In the Senate, 16 of 33 seats are up – eight of these seats feature GOP incumbents and four of them are open seats. 

The current political wisdom is that Assembly Republicans are in position to maintain control following the 2024 election due to the number of Republican seats that are viewed as safe or strong for the GOP, in addition to the high number of GOP incumbents.  However, due to 2024 redistricting, the number of highly competitive seats has increased under the new district maps.  As such, it is possible that Assembly Republicans may lose a small number of seats, but not enough to lose the majority. 

Likewise, it is expected Senate Republicans will also maintain control of that body in 2024.  However, the GOP may also lose seats in this chamber due to the increase of competitive seats because of 2024 redistricting.  To take control of this chamber, 13 Democratic candidates would have to win Senate seats in November, which is unlikely.

To read the more detailed memo regarding the 2024 election, please click here.

In the coming months, WiAHC will send a legislative priority survey to all members.  This will help WiAHC leadership determine the policy priorities for the 2025-2026 state legislative session.  Please consider completing the survey once you receive it.  This will be a great opportunity to share your thoughts on the direction that WiAHC should take with respect to advocacy. 

In recent weeks, the Governor’s Task Force on the Healthcare Workforce launched its new website, which includes the following:

• An overview of the mission of the task force.
• A list of names and titles of the task force members.
• Schedule of future task force public meetings.
• Information related to prior meetings, including agendas and presentations.