In early March, the state Department of Health Services (DHS) opened registration for their annual Opioids, Stimulants, and Trauma Summit.  According to DHS, this summit “highlights prevention, harm reduction, treatment, and recovery strategies related to opioids, stimulants, and trauma.”  This event will be an in-person event (with a virtual option) held on May 7-9, 2024, at the Kalahari Resort in Wisconsin Dells. 

For more information, please visit the DHS website. 

WiAHC is happy to remind members about and provide links to the latest articles and information on the home health care industry from Home Health Care News and other publications:

·        MedPAC recommends 7% cut for home health

Home Health Line – By Greg Hambrick| March 19, 2024

For home health payments in 2025, MedPAC’s commission is again recommending a 7% reduction in the base payment rate. The commissions recommendations to Congress also included no payment update for hospice providers. MedPAC argues that Medicare fee-for-service payments are “substantially in excess of costs.” The industry has argued consistently that payment rates have not accounted for increased costs and noted Medicare payments are keeping some agencies afloat due to the insufficient payment rates from Medicaid and MA payors. Read more...

·        The Looming Home Care Disaster In New York State

Home Health Care News – By Joyce Famakinwa| March 18, 2024

There’s a potential storm brewing in New York state due to Gov. Kathy Hochul’s executive budget for 2025. The budget proposal includes over $1 billion in cuts to the states’ home care programs. The move is an effort to reduce Medicaid spending. The budget proposal cuts, which was released on Jan. 16, would directly impact New York’s Consumer Directed Personal Assistance Program (CDPAP). Read more...

·        New Bill Seeks To Reduce Challenges For Dual-Eligible Beneficiaries, Expand PACE Model Across US

Home Health Care News – By Robert Holly| March 14, 2024

Individuals who are dually eligible for both Medicare and Medicaid make up a sizable portion of the overall home-based care population. Too often, though, this dual status comes with frustrating challenges around care plans and coordination. Legislation introduced in the U.S. Senate on Thursday hopes to reduce some of those frustrations while also creating new opportunities for the Program of All-Inclusive Care for the Elderly (PACE) model. Read More…

·        President Biden’s State of The Union Address: ‘Imagine The Future Of Home Care’

Home Health Care News – By Andrew Dolan | March 8, 2024

In a State of the Union address that evoked Franklin Delano Roosevelt, Abraham Lincoln and Vladimir Putin within the first minute, President Joe Biden also made room for home-based care. After urging for higher taxes on the uber-wealthy, Biden challenged Americans to imagine a future with better access to home care. Read more…

Home Health Care News, which is part of the Aging Media Network, is a leading source for news and information covering the home health industry.

In recent weeks, the Legislature has approved several bills supported by WiAHC that will now be sent to Governor Evers:

• Senate Bill 476 – Codifies a DHS rule that allows health care providers who are not physically located in the state to apply for certification as a Medicaid provider to treat Medicaid recipients via telehealth. 

• Senate Bill 158 – Creates a preliminary health care occupational credential for those who have applied and are waiting for a decision from DSPS on a permanent or training credential.

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.

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 are not able to agree on legislation creating new district boundaries, the court noted that it will decide on the new boundaries.  As a practical matter, the state Elections Commission has noted that new district boundaries will need to be finalized by March 15, 2024. 

In January, 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 has been sent to Governor Evers, who signed the new maps into law on Feb. 19, 2024.

The new state legislative districts will take effect for legislative candidates who are elected in November 2024.

In Governor Tony Evers’ State of the State address, which was delivered before the Legislature on January 15, he announced that he would be forming a Task Force on the Health Care Workforce.  Soon thereafter, he signed an executive order formally creating this task force.  According to the Governor’s press release, “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.”

In early February, Governor Evers announced the various members of the task force, which includes several nurses.  Lieutenant Governor Sara Rodriguez, who is also a registered nurse, will chair the task force and Wisconsin Department of Workforce Development Secretary Amy Pechacek and Wisconsin Department of Health Services Secretary Kirsten Johnson will serve as co-chairs. 

This task force will likely hold multiple public meetings in various locations in the state.  That information will be shared in this newsletter, once it is available. 

In early February, the state Department of Health Services (DHS) announced a new online system that will allow Wisconsinites to report food and water related illnesses when individuals experience symptoms.  This new online questionnaire, which should take less than five minutes to complete, may be accessed here. This data will help local health departments determine the source of potential contamination and prevent others from getting sick. 

For more information on illnesses caused by food or water, please visit the DHS website. 

Final rule reduces patient and provider burden by streamlining the prior authorization process

The Centers for Medicare & Medicaid Services (CMS) recently finalized the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F), which sets requirements to improve the electronic exchange of health information and prior authorization processes for medical items and services. Together, these policies will improve prior authorization processes and reduce burdens on patients, providers, and payers, resulting in approximately $15 billion of estimated savings over ten years.

While prior authorization can help ensure medical care is necessary and appropriate, it can sometimes be an obstacle to necessary patient care when providers must navigate complex and widely varying payer requirements or face long waits for prior authorization decisions. This final rule establishes requirements for certain payers to streamline the prior authorization.

Beginning primarily in 2026, impacted payers, including Medicare Advantage (MA) organizations will be required to send prior authorization decisions within 72 hours for urgent requests and seven calendar days for standard requests for medical items and services. For some payers, this new timeframe for standard requests cuts current decision timeframes in half. The rule also requires all impacted payers to include a specific reason for denying a prior authorization request, which will help facilitate resubmission of the request or an appeal when needed. Finally, impacted payers will be required to publicly report prior authorization metrics.

The rule also requires impacted payers to implement an electronic prior authorization application interface, which can be used to facilitate a more efficient electronic prior authorization process between providers and payers by automating the end-to-end prior authorization process. These new requirements for the prior authorization process will reduce administrative burdens on the healthcare workforce, empower clinicians to spend more time providing direct care to their patients, and prevent avoidable delays in care for patients.

The final rule is available to review here: https://www.cms.gov/files/document/cms-0057-f.pdf - PDF.

The fact sheet for the final rule is available here: https://www.cms.gov/newsroom/fact-sheets/cms-interoperability-and-prior-authorization-final-rule-cms-0057-f.

WiAHC is happy to remind members about and provide links to the latest articles and information on the home health care industry from Home Health Care News and other publications:

·        The Path for Occupational Therapy To Lose Its ‘Second-Tier’ Status In Home Health Care

Home Health Care News – By Patrick Filbin | Feb. 20, 2023

If a senior or homebound patient is eligible for home health care, there are a number of caregiving professionals who can open a case and begin an assessment. Those include nurses, home health aides, physical therapists, and others. Read More…

·        The ‘Tipping Point Is Coming’ For Hospital-At-Home Care In The US

Home Health Care News – By Andrew Dolan | Feb. 16, 2024

Empirical evidence suggests that hospital-at-home care is safe and effective. Anecdotal evidence suggests that the model is still not nearly as widespread as it should be, however, with patients regularly asking their health care providers about the option. Read more…

·        Lawmakers Rubio, Carper Introduce Bill to Expand Hospital-At-Home Care In US

Home Health Care News – By Andrew Dolan | Feb. 9, 2024

Two senators introduced a bill Thursday that would create a pilot program aimed at expanding the scope of hospital-at-home care in the U.S. Dubbed the At Home Observation and Medical Evaluation (HOME) Services Act, the bill was introduced specifically by Sens. Marco Rubio (R-Fla.) and Tom Carper (D-Del.). Sen. Marsha Blackburn (R-Tenn.) was an original cosponsor of the legislation. Read More…

·        ‘A Monumental Shift’: Home Health Providers Believe Review Choice Demonstration Is Here To Stay

Home Health Care News – By Patrick Filbin | Feb. 1, 2024

The Centers for Medicare & Medicaid Services (CMS) has been tight-lipped about its Review Choice Demonstration (RCD) plans beyond May 2024. However, industry leaders believe RCD will be extended across the country on a more permanent basis — a development that agency leaders should recognize as a momentum shifting change. Read more…

Home Health Care News, which is part of the Aging Media Network, is a leading source for news and information covering the home health industry.

On January 16, the full Assembly approved several bills supported by WiAHC that attempt to streamline the state occupational licensing process:

• Assembly Bill 90:  A bill allowing a third-party contractor to process occupational credentialing applications for occupational therapists and occupational therapist assistants.  This will help expedite the processing of these applications, as many of them are stuck in a continuing backlog of credential processing at the state Department of Safety and Professional Services.   

• Assembly Bill 143:  This bill would help reduce processing delays for individuals applying for occupational credentials to be occupational therapists, occupational therapy assistants, advanced practice nurse prescribers, and certain other health care professions by no longer requiring such applicants to take a “statutes and rules” exam.  Instead, such applicants may need to affirm that they have read and understood the statutes and rules that apply to the applicants’ practice.

• Senate Bill 158:  In order to help expedite the occupational credentialing process for new college graduates in the health care field, this bill would require the state Department of Safety and Professional Services to grant preliminary occupational credentials to those who have recently completed the requirements to obtain a health care credential, submitted a license application, and have been engaged by a health care employer. 

On Friday, Jan. 26, Gov. Tony Evers appointed State Senator Lena Taylor (D-Milwaukee) to the Milwaukee County Circuit Court. Taylor immediately resigned from the Senate and will fill her new role starting on Jan. 30.

Taylor, 57, was first elected to the state Assembly in 2003 and has served in the Senate, representing the 4th Senate District, since 2005. Her departure from the Senate creates a vacancy, with Republicans now holding a 22-10 majority in the 33-seat legislative body. Evers said he will call a special election this spring to fill Taylor’s seat, which leans heavily Democratic.