The Wisconsin Department of Health Services (DHS) has released ForwardHealth Update 2021-40, “Electronic Visit Verification Soft Launch Has Been Extended.” This update communicates that DHS required hard launch consequences will not go into effect January 1, 2022.

ForwardHealth Update 2021-26, "Electronic Visit Verification Hard Launch Preparation" and ForwardHealth Update 2021-23, "Electronic Visit Verification Policy and Hard Launch Timeline" have been revised to reflect this extension.

With the soft launch extension:

• EVV is still required f or Medicaid-covered personal care and applicable supportive home care services and has been since November 2, 2020.
• Provider agencies that are not currently using EVV are out of compliance with current DHS policy.
• Fee-for-service claims without EVV data will be paid.
• DHS has encouraged health maintenance organizations (HMOs) and managed care organizations (MCOs) to continue to pay claims without EVV data until the new hard launch date. This will provide consistency and coordination f or provider agencies within the EVV program.
• Services without EVV data will be included in future capitation rate setting development for HMOs and MCOs.
• IRIS (Include, Respect, I Self -Direct) fiscal employer agencies will not deny payment for provider agency claims until the new hard launch date.
• The IRIS non-compliant participant disenrollment process will be delayed. Participants are out of compliance with current DHS policy if their participant-hired workers are not using an EVV system during the soft launch phase.
• Provider agencies choosing to use an alternate EVV system that is not certified should complete the certification process as soon as possible. They are out of compliance with current DHS policy if they are not using an EVV system during soft launch phase.
• In fee-for-service, the Sandata EVV system is not a replacement f or Record of Care timesheets until the new hard launch date.

DHS will continue to monitor the status of EVV and will be taking additional actions to further promote EVV usage and provider compliance during the extension.

Payers, provider agencies, and workers should use this extension to become more efficient with EVV, streamline processes, and take additional training as needed.

If you have questions or comments about EVV, please contact Wisconsin EVV Customer Care via phone at 833-931-2035. Customer Care hours are Monday–Friday, 7 a.m.–6 p.m. CT.

Earlier this month, the WI Department of Health Services’ Division of Quality Assurance (DQA) issued the following information to all DQA regulated providers regarding the Centers for Medicare & Medicaid Services (CMS) Interim Final Rule (released on Nov. 4, 2021), which requires COVID-19 vaccination for most healthcare workers at certain healthcare facilities certified by CMS:

On November 4, 2021, the Centers for Medicare & Medicaid Services (CMS) announced a new emergency rule related to COVID-19 vaccination requirements for Medicare and Medicaid-certified health care providers and suppliers. Specifically, it requires all health care providers and suppliers that participate in a federally certified Medicare and Medicaid program under Conditions of Participation (COP) to develop a plan/process to vaccinate all staff with a first dose or single dose of COVID-19 vaccine by December 6, 2021. All eligible staff must be fully vaccinated by January 4, 2022.

The Emergency regulations apply to the following Medicare and Medicaid-certified providers/suppliers:

• Ambulatory Surgery Centers
• Community Mental Health Centers
• Comprehensive Outpatient Rehabilitation Facilities
• Critical Access Hospitals
• End-Stage Renal 2 Dialysis Facilities
• Home Health Agencies
• Home Infusion Therapy Suppliers
• Hospices
• Hospitals
• Intermediate Care Facilities for Individuals with Intellectual Disabilities
• Clinics
• Rehabilitation Agencies, and Public Health Agencies as Providers of Outpatient Physical Therapy and Speech-Language Pathology Services
• Psychiatric Residential Treatment Facilities (PRTFs)
• Programs for All-Inclusive Care for the Elderly Organizations (PACE)
• Rural Health Clinics/Federally Qualified Health Centers
• Long Term Care Facilities

The regulation does not apply to:

• Assisted Living Facilities; however, the mandate would apply to large, assisted living facilities with more than 100 employees under the OSHA mandate.
• Home and Community-Based Services
• Physician’s offices

The vaccination requirement applies to eligible staff working at a facility that participates in the Medicare and Medicaid programs, regardless of clinical responsibility or patient contact. This includes:

• Facility employees
• Licensed practitioners
• Students
• Trainees
• Volunteers
• Individuals who provide care, treatment, or other services for the facility and/or its patients under contract or other arrangements

CMS has provided additional information about the COVID-19 Health Care Staff Vaccination Interim Final Rule in a FAQ document.

DQA Review:

CMS expects state survey agencies to conduct onsite compliance reviews of these requirements during recertification surveys and complaint surveys. Surveyors will check to determine if a facility has met the three basic requirements:

• Having a process or plan for vaccinating all eligible staff
• Having a process or plan for providing exemptions and accommodations for those who are exempt
• Having a process or plan for tracking and documenting staff vaccinations.
• Surveyors will review the facility’s vaccine policies, the number of resident and staff COVID-19 cases over the last 4 weeks and list of staff and their vaccination status. This information will be used to determine the compliance of the provider or supplier with these requirements.

Numerous states have files lawsuit against CMS and the Biden Administration challenging the COVID-19 vaccine mandate for healthcare workers. However, the Final Interim Rule currently remains in place.

By State Representative Tony Kurtz (R-Wonewoc)

Senator Alberta Darling and I recently introduced Koreen's Law (Assembly Bill 718) a critical legislative proposal to help ensure patients have access to life-saving medication. It is named after a patient, Koreen, who went through a traumatic experience while undergoing chemotherapy.

Seven months into her treatment, Koreen and her husband were told their insurance company would no longer cover the cost of her medication, which was vital to her treatment, because the company implemented a new “white bagging” policy that dictated where -- and from which provider – she could obtain her medication.

More specifically, white bagging is a practice by insurance companies that requires patients to obtain their clinician-administered drugs by a specialty pharmacy selected by the insurance company, rather than the patient’s local care provider. While their care provider and local pharmacy remain in-network for most things, an insurance company picks and chooses certain drugs that will then become out-of-network resulting in patients experiencing more confusion, cost, and disrupted care. For patients to keep their providers, they would be required to pay the costs associated with receiving out-of-network care.

On behalf of Koreen, her husband Nate, her family, and many other patients across Wisconsin, I am happy to author Koreen’s Law to prohibit health insurance companies from mandating the practice of white bagging. To better understand the impacts of white bagging on Wisconsin patients and providers, please visit www.PatientsFirstWI.com.

Hoven Consulting, Inc., WiAHC’s lobbying firm, recently announced the addition of Nathan Butzlaff to its government affairs team. Butzlaff, who joined the firm as lobbyist and government affairs specialist, brings over 19 years of valuable experience in state and federal public policy and advocacy to Hoven Consulting and WiAHC.

“We are pleased to have Nathan join the firm,” said Tim Hoven, president of Hoven Consulting.

“He’s a talented professional with a great understanding of the legislative process on both the state and federal levels. I’m confident his public policy experience will bring great value to WiAHC and its members.” 

Butzlaff most recently worked in the Wisconsin State Assembly as a legislative aide for State

Rep. Samantha Kerkman (R-Salem) and for State Rep. John Macco (R-Ledgeview). Prior to his service in Wisconsin, he worked in Washington, DC as a legislative staff member for U.S. Senators Ted Stevens and Lisa Murkowski, as well as a state-federal liaison in the Washington, DC office of the Alaska Governor. Butzlaff also has experience working as a lobbyist for a Washington, DC lobby firm. He graduated from Georgetown University with a bachelor’s degree in marketing.

“I am excited to join the team at Hoven Consulting,” said Butzlaff. “I look forward to putting my knowledge and experience into practice to help WiAHC meet its public policy goals.” 

By Hoven Consulting – WiAHC’s lobbying firm

With the holidays right around the corner, the halls of the State Capitol will be relatively quiet through December. But despite the fact there will not be much visible legislative activity until the new year, plenty is going on behind the scenes as lawmakers work to shape their remaining legislative priorities before the session ends in April.

Similarly, WiAHC continues to position itself for the rest of the current session and future legislative success. One significant step in that direction was our Virtual Legislative and Policy Forum held on Nov. 8 where members learned how they can be effective grassroots advocates and had an opportunity to hear from and ask questions of key policymakers, including WI Department of Health Services Deputy Secretary Debra Standridge, DQA Administrator Otis Woods, and two state lawmakers – Rep. Rick Gundrum (R-Slinger) and Rep. Donna Rozar (R-Marshfield).

While we are looking forward to holding an in-person WiAHC “Day at the Capitol” in the future – which will allow us to have a much bigger advocacy impact – the virtual legislative and policy forum provided great value and helped raise our profile and increase our influence in the Capitol and among state government officials.

Speaking of strengthening advocacy efforts, WiAHC’s legislative committee and lobbyists have spent a considerable amount of time over the last year refining legislation to make modest but impactful changes to DHS 133, the administrative rule chapter regulating home health agencies. We are pleased to report the bill has been officially introduced as Senate Bill 700.

The impetus for the changes began as an effort to bring Wisconsin’s administrative rules in line with the federal government’s elimination of requirements for professional advisory bodies. The final version of the legislation will eliminate DHS 133.05 (2) in its entirety regarding advisory board requirements, as they are no longer compatible with federal law.

The legislative committee also recommended several other changes to Chapter 133 which would have created additional efficiency to patient care. After sharing those recommendations with the Department of Health Services and previously receiving their support, the agency raised concerns regarding these proposed changes late in the legislative drafting process. With an eye on the legislative clock, we chose to move forward with the scaled-down version that DHS does support and not jeopardize a potential veto.

Our Government Affairs Team worked with Representative Donna Rozar (R-Marshfield) and Senator Joan Ballweg (R-Markesan) to introduce the legislation and will work to advance the proposals through the legislative process before the legislature adjourns in Spring 2022. Please watch for opportunities coordinated by WiAHC to engage your legislators and request their support for the bill.

Yesterday the WI Department of Health Services’ Division of Quality Assurance (DQA) issued the following information to all DQA regulated providers regarding the Centers for Medicare & Medicaid Services (CMS) Interim Final Rule (released on Nov. 4, 2021), which requires COVID-19 vaccination for most healthcare workers at certain healthcare facilities certified by CMS:

On November 4, 2021, the Centers for Medicare & Medicaid Services (CMS) announced a new emergency rule related to a COVID-19 vaccination requirements for Medicare and Medicaid-certified health care providers and suppliers. Specifically, it requires all health care providers and suppliers that participate in a federally certified Medicare and Medicaid program under Conditions of Participation (COP) to develop a plan/process to vaccinate all staff with a first dose or single dose of COVID-19 vaccine by December 6, 2021. All eligible staff must be fully vaccinated by January 4, 2022.

The Emergency regulations apply to the following Medicare and Medicaid-certified providers/suppliers:

• Ambulatory Surgery Centers
• Community Mental Health Centers
• Comprehensive Outpatient Rehabilitation Facilities
• Critical Access Hospitals
• End-Stage Renal 2 Dialysis Facilities
• Home Health Agencies
• Home Infusion Therapy Suppliers
• Hospices
• Hospitals
• Intermediate Care Facilities for Individuals with Intellectual Disabilities
• Clinics
• Rehabilitation Agencies, and Public Health Agencies as Providers of Outpatient Physical Therapy and Speech-Language Pathology Services
• Psychiatric Residential Treatment Facilities (PRTFs)
• Programs for All-Inclusive Care for the Elderly Organizations (PACE)
• Rural Health Clinics/Federally Qualified Health Centers
• Long Term Care Facilities

The regulation does not apply to:

• Assisted Living Facilities; however, the mandate would apply to large assisted living facilities with more than 100 employees under the OSHA mandate.
• Home and Community-Based Services
• Physician’s offices

The vaccination requirement applies to eligible staff working at a facility that participates in the Medicare and Medicaid programs, regardless of clinical responsibility or patient contact. This includes:

• Facility employees
• Licensed practitioners
• Students
• Trainees
• Volunteers
• Individuals who provide care, treatment, or other services for the facility and/or its patients under contract or other arrangements

CMS has provided additional information about the COVID-19 Health Care Staff Vaccination Interim Final Rule in a FAQ document.

DQA Review:

CMS expects state survey agencies to conduct onsite compliance reviews of these requirements during recertification surveys and complaint surveys. Surveyors will check to determine if a facility has met the three basic requirements:

• Having a process or plan for vaccinating all eligible staff
• Having a process or plan for providing exemptions and accommodations for those who are exempt
• Having a process or plan for tracking and documenting staff vaccinations.
• Surveyors will review the facility’s vaccine policies, the number of resident and staff COVID-19 cases over the last 4 weeks and list of staff and their vaccination status. This information will be used to determine the compliance of the provider or supplier with these requirements.

CMS will host a second stakeholder call TODAY, November 10, from 2:30 – 3:30 p.m. CST. To register in advance, visit the CMS Webinar Registration. After registering, you will receive a confirmation email containing information about joining the webinar. Please note that CMS can only accommodate 10,000 participants so register early to guarantee your participation.

During the month of November, the home care and hospice community honors the millions of nurses, home care aides, therapists, and social workers who make a remarkable difference for the patients and families they serve. These heroic caregivers play a central role in our health care system and in homes across the nation. To recognize their efforts, we call upon all Americans to commemorate the power of caring, both at the home and in their local communities, and ask them to join with the National Association for Home Care & Hospice (NAHC) by celebrating November as Home Care and Hospice Month.

In addition, Home Care Aide Week takes place the second full week of the month, November 8-14, 2020. Join us in honoring these compassionate, tireless workers who play an invaluable role for their clients as caregivers, companions, and friends.

“Home care and hospice nurses, therapists, aides, and other providers who choose to use their lives to serve our country’s aged, disabled, and dying. This noble work deserves our recognition and praise and we celebrate November as Home Care & Hospice Month for that very reason.”  – NAHC President William A. Dombi

Hospital & Healthcare Compensation Service

Oakland, NJ, October 2021--The average hourly rate for Registered Nurses (RNs) in home health agencies increased 2.98% in 2021, according to the 2021-2022 Home Care Salary & Benefits Report, just released by Hospital & Healthcare Compensation Service (HCS). The Report is published in cooperation with the National Association for Home Care & Hospice (NAHC).

In a comparison of rates by agency type, RNs in hospital-based home health agencies received the highest in pay with an average hourly rate of $40.10. The average hourly rate for RNs in VNS/VNAs was $37.67; for-profit agency RN hourly pay was $34.43; and not-for-profit agency pay was $36.17/hour. (All rates above represent the national average hourly rate.)

The national average hourly rate for RNs was $35.20. In a comparison of rates by state, RNs in Connecticut received $41.19/hour; RNs in Massachusetts received $41.98/hour; and California RNs ranked the highest in pay at $48.83/hour. On the lower spectrum, RNs in Mississippi received $28.53/hour; while RNs in Kentucky received $31.32/hour; and RNs in Alabama received $31.68/hour. (All rates above represent the national average hourly rate.)

The national average turnover rate for RNs has risen 11.70% since 2019. The average turnover rate for RNs in 2019 was 20.55%; 25.85% in 2020; and 32.25% in 2021. The average turnover rate for Home Care Aides rose from 36.53% in 2020 to 38.05% in this year’s study.

1,011 home health agencies participated in the study. The complete 190+ page Report contains 58 jobs and covers salaries, bonuses, and hourly & per visit rates. Data include the  10th, 25th, 50th, 75th, 90th average, total number of employees, and total number of agencies. Data are reported by state, CBSA, region, agency type and revenue size. Also included are 20 fringe benefits, planned percent increases, productivity, and personnel policies.

The Report price is $375. A separate Hospice Salary & Benefits Report will be published in late November. Both studies are published in cooperation with the National Association for Home Care & Hospice (NAHC).  To order, visit the HCS website at www.hhcsinc.comor call (201) 405‑0075.

With 50 years’ experience in national healthcare salary and benefits research, HCS is recognized for its comprehensive, responsible, and reliable ten specialized studies.  HCS provides the source for establishing and maintaining an effective compensation program. 

*National average hourly data from the 2020-2021 and 2021-2022 HCS Home Care Salary & Benefits Report

Back in August Representative Ron Kind (D-La Crosse) announced he would not seek reelection in 2022 to Wisconsin’s 3rd Congressional seat, which he has represented since 1997. Since his announcement, the field of candidates to replace him continues to grow.

On the Democratic side, current state Senator and former Wisconsin Agriculture Secretary Brad Pfaff was the first to throw his hat in the ring to replace Kind. Earlier this month, Kind endorsed Pfaff, who previously worked as a congressional aide for kind.

The following three Democrats have also joined the race and will face Pfaff in the Democratic primary:

• Rebecca Cooke, an Eau Claire small businesswoman and a member of the Wisconsin Economic Development Corporation Board of Directors (as an Evers appointee).
• Brett Knudsen, a U.S. Navy veteran, and political novice from Holmen; and
• Deb McGrath, an Army veteran, former CIA employee, and the daughter of Al Baldus, who represented the 3rd Congressional District for three terms in the late 70’s.

At this time there is only once declared candidate on the Republican side, Derrick Van Orden who narrowly lost to Kind in 2020. Van Orden, a retired Navy Seal and business consultant, has been endorsed by former President Donald Trump.

Wisconsin’s 3rd Congressional seat is a battleground district that could flip the balance of power in the U.S. House of Representative and is one of the most-watched congressional races nationally in the upcoming mid-term elections.

Earlier this month, Republican legislative leaders in the State Legislature unveiled their proposal to redraw new state legislative and congressional districts for the 2022 fall election. Every ten years, the U.S. Census Bureau publishes updated information reflecting changes in the population since the previous census, which is used by states to redraw local, legislative, and congressional districts so that each district has approximately the same number of people.

According to the nonpartisan Legislative Reference Bureau, the proposed GOP maps largely retain district boundaries as they are now, with some adjustments based on population changes. The new maps will likely pass the Legislature on a party-line vote next month, but Gov. Tony Evers (D) has vowed to veto the bills.