Earlier this month, Janet Protasiewicz was sworn in as a new justice of the Wisconsin Supreme Court. Protasiewicz, who has positioned herself as a judicial liberal, defeated former Justice Dan Kelly in the April 4 spring general election, replacing two-term Justice Patience Roggensack, who did not seek reelection.

More notably, Protasiewicz’s addition to the state’s high court shifted it from a majority conservative court to a majority liberal one. With the ideological swing to a 4-3 advantage in favor of liberals for at least the next two years, the court is expected to issue several high-profile judicial decisions that could impact the political landscape in Wisconsin.

Among the hot-button  issues that may be determined by the court include voting and election rules, redrawing legislative district maps, the future of abortion and reproductive rights in Wisconsin, and overturning the law that eliminated bargaining rights for most state and local government employees.

By Hoven Consulting – WiAHC’s lobbying firm

• Fiscal Year 2023-2025 Finalized State Budget Highlights

The following are highlights of the finalized Fiscal Year 2023-2025 state budget, which was signed into law by Governor Tony Evers on July 5, 2023. 

Department of Health Services (DHS) – The approved DHS budget increased spending by $3.1 billion overall over the biennium. 

Higher Education Aids Board

Department of Safety and Professional Services

·       DHS Launches Independent Living Supports Pilot Program

In late June 2022, DHS announced the launch of their Independent Living Supports Pilot Program.  This program will allow eligible senior citizens and individuals with disabilities to access short-term, flexible services and supports to allow them to continue to live independently, instead of entering Medicaid long-term care.  This program will make available up to $7,200 in services and support to eligible individuals either on a one-time or continuing basis.  Such services and support include supportive home care, specialized medical equipment, home and vehicle modifications, among other items. 

For more information, including the list of counties in which the pilot program is taking place, go to the DHS pilot program website.  

• Improved Finances for State Medicaid Fund

DHS has projected that the state Medicaid fund ended state fiscal year 2023 with a $875.5 million surplus compared to the FY2021-2023 budgeted amount.  In addition, the surplus is $79.1 million more than what DHS projected this past spring.  This surplus was due to a number of factors, including lower costs for prescription drugs and long-term health care.  Once the surplus amount is finalized and confirmed at the end of July 2023, surplus funds will be transferred to the state’s general fund. 

• DHS Annual Adjustment to Patient Health Care Record Fees

Each year on July 1, DHS is required by state law to adjust the maximum fees (factoring in the change in the consumer price index) that health care providers may charge for patient medical records.  The updated fee schedule may be viewed on the Legislature’s website. 

Republican Paul Melotik (R-Grafton) defeated Democrat Bob Tatterson (D-Mequon) in a special election held on July 18 to fill the vacant 24th Assembly District –which includes portions of Ozaukee, Washington, and Waukesha Counties.

Melotik won the historically Republican-leaning district with 53.7% of the vote, compared to Tatterson’s 46.3% vote total. The Melotik victory gives the GOP a 64-35 majority in the 99-member Assembly.

Melotik, an accountant, small business owner, and former local official who has served on the Ozaukee County Board and Town of Grafton Board, will replace Dan Knodl (R-Germantown) in the Assembly. Knodl was elected to the state Senate (8th Senate District) in an April 4 special election.

Earlier this month, Gov. Tony Evers signed the $99 billion state budget bill sent to him by the GOP-controlled Legislature, but not before using his powerful veto pen to make 51 vetoes to the two-year spending plan for the state.

One of the Governor’s vetoes eliminated $3.3 billion in income tax cuts approved by lawmakers. Primarily because of this veto, the state of Wisconsin is projected to have a balance of more than $4 billion at the end of the 2024-25 fiscal year. Prior to Evers vetoes, the projected balance was $588 million.

Republican lawmakers are expected to send another tax cut to the Governor via a stand-alone bill prior to the end of the 2023-24 legislative session.

With work on the 2023-25 state budget bill – the state’s two-year spending plan – wrapped-up, state lawmakers have turned their attention to hundreds of pending stand-alone bills, some of which could impact WiAHC members and the home health care community in Wisconsin. Fortunately, the WiAHC Government Affairs Team – headed by Tim Hoven and Nathan Butzlaff from Hoven Consulting – closely monitor and lobby on legislative proposals important to WiAHC.

However, you can also track the bills WiAHC is lobbying on during the 2023-24 legislative session. Please CLICK HERE to review WiAHC’s legislative activity on the state of Wisconsin’s Eye on Lobbying website.

Medicare Home Health has endured a series of massive cuts to the reimbursement structure and providers are expecting additional cuts to be announced in this year’s rulemaking by the Centers for Medicare & Medicaid Services (CMS). These cuts will have devastating, long-term repercussions on access to care for patients, and it is estimated that more than half of Medicare-certified home health agencies will be operating with negative margins as a result of these cuts.

It is crucial for Congress to intervene and tell CMS to stop these additional cuts. The 7.85% permanent cut finalized in 2022 equates to more than $1 billion in cuts annually starting in 2024 and continuing in perpetuity. This will result in devastating, long-term repercussions for home health patients and their providers.

To maintain access to home health care services and prevent harm to the Medicare patients across Wisconsin that depend on essential health care provided in their homes, it’s critical for WiAHC members to urge Congress to fix the potential chaos created by CMS by passing the Preserving Access to Home Health Act of 2023 (S. 2137), which is being authored by Senators Debbie Stabenow (D-MI) and Susan Collins (R-ME).

The Preserving Access to Home Health Act of 2023 not only seeks to reverse these damaging Medicare home health cuts, but it also instructs the Medicare Payment Advisory Commission (MedPAC) to analyze the Medicare Home Health Program comprehensively. MedPAC's review would encompass aggregate trends under Medicare Advantage, Medicaid, and other payers.

We need you to tell your members of Congress to act NOW and require CMS to stop additional cuts to home healthcare in 2024. Remember, these cuts will threaten the ability of 3.2 million Medicare beneficiaries to receive life-saving clinical care in the home each year. It is time to prioritize the health and well-being of our elderly, disabled, and chronically ill patients and ensure that they have access to the care they need and deserve.

Of course, when advocating for home health with your members of Congress, it is important to ensure your message is both compelling and clearly presented. Thankfully, our national partner, the National Association for Home Care and Hospice (NAHC), has made connecting with your elected representatives as easy as a few clicks on your computer or mobile device.

Simply CLICK HEREto contact your federal lawmakers on the Preserving Access to Home Health Act of 2022. All you need to do is fill in your name and contact information and hit SEND.

July 18, 2023 – From the Desk of the National Association for Home Care & Hospice

On Monday, July 3, 2023, the National Association for Home Care & Hospice (NAHC) and Home Care Association of America (HCAOA) submitted a joint comment letter on the proposed Medicaid Access Rule. In our letter, we express support for many of the provisions in this proposed rulemaking. We specifically support and provide comments that we believe would strengthen and improve the following provisions:

• Access Reporting: 42 CFR §441.311(d);
• Payment Rate Transparency: 42 CFR §447.203(b)(1);
• Interested Parties Advisory Group: 42 CFR §447.203(b)(3)(ii)(6);
• State Analysis Required for Payment Restructuring and Access: 42 CFR §447.203(c);
• HCBS Quality Measure Set: 42 CFR §441.312;
• Strengthening Oversight of Person-Centered Plans:  §441.301(c)(3)(ii)(A);
• Incident Management System: 42 CFR §441.302;
• HCBS Grievance System: 42 CFR §441.301(c)(7); and
• Medicaid Advisory Committee and Beneficiary Advisory Group: 42 CFR §431.12.

We also provide recommendations that we believe would make the following provisions more effective and improve the ability to successfully implement:

• Definition of DCW: 42 CFR §441.302(k)(1)(ii);
• Reporting on Proportion of Payments to DCWs: 42 CFR §441.311(e); and
• Payment Rate Disclosure: 42 CFR §447.203(b)(3)(ii).

Unfortunately, the HCBS Payment Adequacy provision at 42 CFR §441.302(k)(3)(i) is the most impactful part of this rule and is untenable for our members. We provide significant analysis and detail to demonstrate why:

• The proposal lacks statutory authority;
• There is no data to support it;
• It contradicts CMS HCBS quality efforts;
• Existing policies do not support such a mandate;
• State rate models demonstrate inconsistency of the proposal with HCBS practices;
• Provider cost data also does not align with the proposal;
• Provider surveys indicate significant confusion and negative impacts for patients and caregivers;
• The mandate is administratively complex and would be extremely challenging to enforce;
• The proposal would create inequities within and across states;
• The proposed rule undermines state authority; and
• The proposed rule would disproportionately impact small and rural providers.

We believe that there are opportunities to implement regulations that improve the structure and outcomes of state HCBS reimbursements and offer an alternative proposal. We believe that our proposal would enhance HCBS payment methodologies in a way that:

• Provides more structure for state rate-setting processes;
• Creates a transparent approach that clearly delineates the components of a Medicaid reimbursement methodology;
• Supports and increases worker compensation;
• Maintains state flexibility and autonomy regarding provider rate setting;
• Preserves the ability to perform both required and supplementary administrative activities that are crucial to high-quality HCBS delivery; and
• Adheres to the statutory requirements regarding Medicaid payment adequacy found at Section 1902(a)(30)(A) of the Social Security Act.

NAHC and HCAOA look forward to ongoing discussions and collaboration with CMS, states, and other partners to strengthen and improve HCBS, increase wages for workers, and supports ongoing provider viability.

Each year,  National Association for Home Care & Hospice (NAHC) members and industry partners touch down in our nation’s capital to advocate with lawmakers for support of the care-in-the-home community. NAHC tracks critical legislative, regulatory, and policy issues that affect their members to ensure you’re prepared for the day.

Advocacy Day is where NAHC needs your help to advance policy by joining them for a day on Capitol Hill and participating in their grassroots efforts virtually through their online Action Center.

Advocacy Day participants will have the opportunity to meet with Members of Congress or their legislative staff to advance issues facing our growing and evolving industry. This is a chance to share your story with legislators and ask that they back policies to bolster your capacity to continue providing high-quality home-based care to patients and families. FREE REGISTRAION OPEN NOW!

Governor Tony Evers signed Senate Bill 70 – the Fiscal Year 2023-2025 budget bill – into law on July 5.  It is now 2023 Wisconsin Act 19.  This budget will spend nearly $99 billion over the next two fiscal years. 

In addition, Governor Evers issued a veto message that specifies 51 separate line-item vetoes he made to this budget bill.  The Governor’s budget and veto message may be viewed here: https://doa.wi.gov/budget/SBO/2023-25%20Veto%20Message%20FM.pdf

The following provision that Governor Evers fully vetoed will likely be of interest to WiAHC:  DHS and Managed Care Organization Reporting Requirements:  Require DHS to include information regarding (a) executive leadership salaries and (b) amounts retrieved by the state under the contractual risk corridors, in the publicly available financial summaries for Family Care, Family Care Partnership, and PACE managed care organization. Require DHS and Family Care, Family Care Partnership, and PACE managed care organization (MCO) to track and annually report to the Legislature’s Joint Finance Committee total authorized and total provided care plan hours by service category and MCO.

A summary of all the WiAHC budget highlights are included (HERE).

By Hoven Consulting – WiAHC’s lobbying firm

• Fiscal Year 2023-2025 State Budget Update – Department of Health Services

On June 15, the Legislature’s Joint Finance Committee (JFC) approved Fiscal Year 2023-2025 funding levels for the Department of Health Services (DHS).  The approved DHS budget increased spending by $3.1 billion overall during the biennium. The budget bill will still need to be approved by the JFC and the legislature and signed by the Governor before it becomes law.

In part due to WiAHC’s advocacy, JFC approved a continuation of the 5% Home and Community Based Services (HCBS) rate increase that was initially funded by federal American Rescue Plan Act (ARPA) funds.  

The following are highlights of the approved DHS budget:

Medicaid/Medical Assistance

Elder and Disability Services

Public Health

The DHS budget was adopted by the committee on a party line vote of 11-4. While these items will be included in the Legislature's budget proposal, they will only be enacted if the budget bill is passed by both the Assembly and Senate and the bill is signed by Governor Evers.

• Fiscal Year 2023-2025 State Budget Update – Department of Safety and Professional Services (Occupational Credentialing)

On June 8, the Legislature’s Joint Finance Committee (JFC) held a committee meeting and approved the Fiscal Year 2023-2025 budget for the state Department of Safety and Professional Services (DSPS).  This agency is responsible for occupational credential processing, the state’s electronic Prescription Drug Monitoring Program, as well as other matters.  In recent years, DSPS has struggled with processing a backlog of applications for new and renewed occupational credentials. 

During this meeting, committee Republicans proposed funding the following:

The committee approved this funding package and did not approve an alternate funding package advanced by committee Democrats.   

During this committee meeting, committee Democrats criticized GOP JFC members for not including funding for more credential processing staff, bearing in mind the ongoing credential processing backlog at DSPS.  JFC Republicans responded by noting that the agency will improve its output with fewer employees due to the increased use of technology. 

The DSPS budget was also adopted by the committee on a party line vote of 11-4. While these items will be included in the Legislature's budget proposal, they will only be enacted if the budget bill is passed by both the Assembly and Senate and the bill is signed by Governor Evers.

• Professional Advisory Bodies Rule Changes - Update

In January 2023, WiAHC Board Chair Jayne Thill wrote to Deb Standridge, the Department of Health Services’ (DHS) Deputy Secretary, requesting that the DHS eliminate an outdated administrative rule relating to professional advisory bodies for home health care agencies in their biennial rules review.  Specifically, this would bring Wisconsin’s regulations in line with federal regulations by eliminating professional advisory bodies but maintaining governing bodies along with regulatory oversight for ensuring the quality of care and patient safety. 

WiAHC made this request since federal regulations eliminated professional advisory committees in 2017, as home health agencies are already overseen by a governing body pursuant to federal regulations.  They are also overseen by governing bodies in Wisconsin administrative rules.  In 2017, the federal Centers for Medicare & Medicaid Services (CMS) also put in place federal regulations requiring home health agencies to implement ongoing quality assessment and performance improvement (QAPI) programs.  Essentially, CMS replaced professional advisory committees in federal regulations with the creation of the QAPI program.

On May 18, Governor Evers approved a document – a “statement of scope” – for a biennial review of administrative rules intended to repeal obsolete state administrative rules.  This document includes a provision that would effectively remove professional advisory bodies from the home health care portion of state administrative rules.  The approval of the “statement of scope” is the first step in the regulatory process.  WiAHC will provide future updates in this newsletter.

• WiAHC Spring Conference

WiAHC held its 2023 Spring Conference at the Best Western Premier Waterfront Hotel and Conference Center in Oshkosh from June 1-2.  This event featured a combination of general sessions and breakout sessions of interest to all those who work in Wisconsin’s home health care industry.  Leading subject matter experts from Wisconsin and throughout the nation presented at this event.  In addition, WiAHC was fortunate enough to host two state legislators at this conference – Representative Lori Palmeri (D-Oshkosh) and Senator Dan Feyen (R-Fond du Lac).  Rep. Palmeri serves on the Assembly Committee on Mental Health and Substance Abuse Prevention and Sen. Feyen is the Assistant Majority Leader in the state Senate.