All Copays Count” applies discounts and other assistance toward patients’ out-of-pocket costs 

Guest Column by WI Senator André Jacque

Patients would receive protections from rising health care costs by ensuring that health plans count copay assistance toward a patient’s maximum out-of-pocket cost or annual deductible, under bipartisan “All Copays Count” legislation (Senate Bill 100) I introduced with several of my colleagues earlier this session.

Amid nationwide inflation, health plans have increasingly shifted costs to patients and created barriers between individuals and the medications on which they rely.  For advocates of Wisconsin patients and the providers who care for them, this bill is a clear solution to help those individuals afford the critical medications their physicians prescribe to them to manage their health.

Copay assistance programs often act as a lifeline to help patients afford specialty medications they need to treat serious health conditions. Sixteen other states have already enacted such protections.

Just when patients think they’ve reached their out-of-pocket limit, insurers and benefit managers keep moving the goalposts, and folks wind up paying more.  For someone suffering from a complex disease, the financial hit is especially hard, leaving them to choose between groceries, utilities and mortgage payments - and the prescription medications that keep their condition under control.

In 2020, the average deductible for single coverage was $1,364, which is a 364% increase from 2006. Over the past five years, the percentage of covered workers with a general annual deductible of $1,000 or more for single coverage has grown from 23% to 57%.  Further, in 2020 more than one in four covered workers was enrolled in a plan with a deductible of $2,000 or more.

Many of these patients rely on copay coupons and vouchers to afford their prescribed treatments at the pharmacy counter.  Insurers should not have the power to prevent that copay assistance from counting toward their out-of-pocket expense or deductible.  If patients can’t afford their medications, they may choose to skip doses or stop treatment altogether, which can lead to increased costs in the overall healthcare system.  And worse.

The All Copays Count legislation would ensure that the copay assistance programs patients use to afford their medications count toward their out-of-pocket costs.  It would also close the loophole that allows insurers to define prescription drugs as non-essential and therefore not eligible to count toward their deductible.  At the same time, under this initiative Wisconsin insurers would retain flexibility with their plans, while making sure patients can continue to afford the medications they need.

If you have cancer, epilepsy or any other serious health condition, the last thing you should have to worry about is whether you’ve met your deductible.  “All Copays Count” is about giving patients peace of mind that they can pay for their prescriptions. 

Senator André Jacque represents Northeast Wisconsin’s First Senate District, consisting of Door and Kewaunee Counties and portions of Brown, Calumet, Manitowoc, and Outagamie counties.

Earlier this summer, the U.S. Centers for Medicare & Medicaid Services (CMS) released its 2024 home health proposed payment rule, which proposes to reduce home health payments by 2.2%, or an estimated $375 million less compared to 2023 levels.

While the home health care industry was not surprised by the proposed cuts, it is still discouraging considering the array of challenges home health care is facing – challenges that threaten patient access to care. In short, staffing shortages, inflation, increased operating costs, and reduced reimbursements are negatively impacting our ability to serve home health patients, and it is difficult to see where additional rate cuts can be absorbed without reducing access to care.

To prevent the proposed rate cuts, WiAHC, our national partners (NAHC / NHPCO), and other state chapters across the county have urged CMS to withhold the imposition of any of the proposed rate cuts in 2024, as doing so will further reduce care access in our communities.

CLICK HERE to review WiAHC’s comment letter to CMS on the proposed home health payment rule.

The Boards of Directors of the National Association for Home Care & Hospice (NAHC) and the National Hospice & Palliative Care Organization (NHPCO) signed a non-binding Letter of Intent earlier this week to jointly explore the formation of a new as-of-yet unnamed organization that combines the strengths of NAHC and NHPCO, creating a better and more powerful advocate for the entire home care, hospice, palliative care, and serious illness community.

The purpose of combining the two leading organizations serving providers of care to America’s elderly, disabled, and dying is simple: to better serve you. Both Boards voted for this course of action following the recommendations of a Steering Committee composed of member and staff leaders from both organizations. The Steering Committee’s recommendations were informed by consultation with members of both organizations. The Committee has been working, with the support of association consulting firm McKinley Advisors, since the March 8, 2023 joint announcement (NAHC website, NHPCO website) that NHPCO and NAHC would explore opportunities for deeper collaboration.

“The collaborative process of the NHPCO and NAHC Boards over the last five months has brought the two organizations closer together,” said Kenneth Albert, R.N., Esq., NAHC Board Chair, and President and CEO of Androscoggin Home Healthcare + Hospice. “In addition to the Board-level discussions, our organizations have been collaborating on multiple advocacy efforts, as well as projects such as the Value of Hospice research. Through these efforts, it has become crystal clear that we can do more on behalf of our members by working together. If the current discussions do not lead to a new, combined organization, the outcome will nevertheless be closer working relationships on behalf of community-based and home care providers.”

“The American healthcare system is shifting, and home and community-based care options are increasing in a multitude of forms across the country,” said Melinda Gruber, PhD, MBA, CNA, NHPCO Board Chair, and President of Caring Circle/Vice President, South Region, Medical Group and Continued Care of Corewell Health. “With decades of experience in hospice and home care, NHPCO and NAHC members are the long-standing experts, and they are evolving to meet patient needs in a shifting environment. As we look ahead, we see an opportunity for the organizations representing those providers to evolve. In this time of change, we are acting with intention and care to continue meeting the needs of providers, patients, families, and communities well into the future.”

To facilitate an effective process, both Boards have decided to suspend elections for new Directors this year.

We know our members may have many questions about this process and how a new combined organization will affect them. NAHC and NHPCO will be updating and consulting our members throughout this process to address your questions and concerns as quickly as possible.

Many details are still being determined and in the coming months, the NAHC and NHPCO Boards of Directors will work together, in consultation with member volunteers from both organizations, to determine how a consolidated organization could represent the best interests of the combined memberships. The organizations expect this process to take six to ten months, but getting it done right will be more important than getting it done quickly. McKinley will continue to support the process as an independent, third-party advisor.

In the meantime, you may be assured that staff of both organizations will continue to work as hard as possible to serve your needs, advocate for your interests, and strengthen the entire hospice, home care, and home health community.

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:

·         Cigna To Shed Certain Prior Authorization Requirements, May Benefit Home-Based Care Providers

Home Health Care News – By Patrick Filbin |Aug. 24, 2023

In an attempt to lower administrative burden, Cigna Healthcare — the health insurance arm of The Cigna Group (NYSE: CI) — announced that it is removing nearly 25% of medical services from its prior authorization requirements. Broadly, prior authorization is the process that occurs when a health care provider requests a patient to receive a specific service, medication or procedure. The health insurance company then has to give the go-ahead. Read more…

·         New Home-Based Care Worker Recruitment Program Includes Incentives, Plans For Nationwide Expansion

Home Health Care News – By Patrick Filbin |Aug. 22, 2023

Over the next few years, hundreds of thousands of home care workers will be needed to meet demand. In order to meet that demand in the Badger State, the University of Wisconsin-Green Bay and state health officials are hoping to certify 10,000 new home care aides through a new online certification program. The program includes a $500 bonus for individuals who become certified and remain employed for six months. Read more…

·         Report: HCBS Utilization Remains High, But Varies Drastically By State

Home Health Care News – By Andrew Dolan |Aug. 15, 2023

A new report from the Kaiser Family Foundation shines further light on how popular home- and community-based services (HCBS) are in the U.S. It also makes clear how much cheaper HCBS delivery is for states in comparison to institutional-based care. Read more…

·         Home-Based Care Providers Break Down ‘Unintended Consequences’ Of CMS’ Proposed Medicaid Rule

Home Health Care News – By Patrick Filbin |Aug. 14, 2023

A proposed rule from the U.S. Centers for Medicare & Medicaid Services (CMS) – which would require at least 80% of Medicaid reimbursement for home- and community-based services go toward worker compensation – received over 2,100 submissions during its public comment period. Many of the comments included gratitude and appreciation for CMS regarding its efforts to enhance the HCBS workforce. But concerns persist over how the rule would affect HCBS providers across the country. Read More…

·         CMS Allows States To Extend PHE-Era Flexibilities For HCBS

Home Health Care News – By Patrick Filbin |Aug. 3, 2023

The U.S. Centers for Medicare & Medicaid Services (CMS) has extended a COVID-19 pandemic-era waiver that will allow home- and community-based service (HCBS) providers to take advantage of flexibilities in their state programs. The Appendix K waiver allowed HCBS providers more wiggle room during emergencies, such as the COVID-19 pandemic. CMS introduced the waiver to support states in responding to the unique challenges brought on by the public health emergency. 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 care industry.

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.