As is well known throughout the industry, skilled home health care in Wisconsin is facing a workforce shortage crisis, which is threatening patient access to care. The growing problem has been sparked by stagnant Medicaid reimbursement rates for skilled nursing care in a home health setting. To draw long-overdue attention to the matter and encourage lawmakers to address the issue in the state budget bill, WiAHC members have written an opinion article to effectively capture the situation. The article, “Limited Workforce Leads to Limited Care Capacity”, has been published in news outlets across the state, including The Capital Times. CLICK HERE to read the article.

The 2021-23 Wisconsin state budget bill was unveiled by Governor Tony Evers (D) in February and now resides in the hands of the Republican-controlled Legislature. Unfortunately, the $91 billion, two-year spending plan for the state as proposed by the governor DID NOT include a long-overdue Medicaid rate increase for skilled nursing provided in a home health care setting. However, lawmakers, who are currently holding public hearings on the Governor’s proposal, are expected to significantly rewrite the budget bill and can include a Medicaid rate increase for skilled home health care.

With that in mind, WiAHC is asking you to please contact your state lawmakers TODAY and urge them to support a Medicaid rate increase for home health care skilled nursing in the state budget bill.

BACKGROUND:

Operating in communities through the state, home health care agencies provide a variety of health care services provided in the homes of patients and are integral to comprehensive post-acute medical care in Wisconsin. In addition to offering quality, convenient care to patients in the comfort of their own homes, home health care agencies provide cost effective care that reduces the financial burden for patients as well as public and private payers.

Unfortunately, current Medicaid reimbursement levels make it difficult to operate home health care agencies due to the problems it creates, including workforce retention and patient access challenges. In fact, the Medicaid reimbursement rate for Wisconsin home health care skilled nursing has not been increased in over a decade and has created a crisis in the industry. In short, the state’s home health care agencies must receive an increase to sustain their skilled nursing services in Wisconsin.

During the 2019-20 legislative session, WiAHC advocated for legislation to increase reimbursement rates to $94.10. The non-partisan Legislative Fiscal Bureau found the increase would only cost the state $300,000 per year – or just 0.009% of the state’s $6.7 billion biennial Medicaid budget.

Even that modest additional investment will have a significant impact on home health care in Wisconsin. It will serve to strengthen the home health care workforce, increase patient access to care in their own homes, and ultimately reduce state spending by shifting certain patients away from expensive institutional-care facilities for post-acute care.

WHAT YOU CAN DO TO HELP:

E-mail your state legislators today and urge them to support a Medicaid rate increase for home health care skilled nursing services. Please feel free to use WiAHC’s sample e-mail when contacting your lawmakers. All you need to do is cut-and-paste it into an e-mail, but please consider personalizing your e-mail to include examples of your experiences that capture the workforce and patient access challenges created by stagnant Medicaid compensation.

If you don’t know who your state legislators are, or do not have their contact information, simply CLICK HERE and type your home address in the upper right corner text box. Remember to contact both your state senator and state representative.

If you have any questions on this WiAHC Advocacy Action Alert request or would like additional information on the issue, please contact WiAHC at erik@hovenconsulting.com or tim@hovenconsulting.com.

ACTION ALERT RESOURCES:

• Sample e-mail to legislators
• WiAHC Medicaid Issue Overview
• Op-Ed: “Limited workforce leads to limited care capacity”

As Wisconsin continues to ramp-up vaccination distribution, home health care agencies have and can continue to play a role in the COVID-19 vaccination rollout. In fact, organizations can still sign-up to be become vaccinators. For more information and to enroll as a vaccinator, please click on the following link: https://www.dhs.wisconsin.gov/covid-19/vaccine-program.htm (look for the drop down box labeled “COVID-19 Vaccinator Enrollment”). If you sign-up your organization as a vaccinator, vaccines may not be immediately available. However, you would be approved and ready to provide vaccines when they become accessible.

In addition to the vaccinator sign-up information referenced above, the following Department of Health Services web page provided tools, resources, and information to protect your communities and promote COVID-19 vaccine confidence: https://www.dhs.wisconsin.gov/covid-19/vaccine-resources.htm.  This information is geared towards employers and vaccinators.

Wisconsin DHS

(Updated 03/01/2021 to highlight the provider registration scenarios that help while filling out required Form B and Redistribution Forms.)

Background

The Wisconsin COVID-19 Vaccine program is enrolling entities that wish to vaccinate. By enrolling in the program, entities and their vaccinators will be approved to administer COVID-19 vaccine in Wisconsin. To become a COVID-19 Vaccinator, all organizations must have an approved Form A and Form B. To redistribute vaccine, all enrolled COVID-19 vaccinators must also have an approved Redistribution Form.

Steps to complete enrollment and redistribution forms

It is important that you complete every step in the enrollment process in order to ensure your submission is processed as quickly as possible. Please use Google Chrome when navigating the enrollment tool. Email(link sends e-mail) us if you have any questions!

Step 1: Log in to the COVID-19 Vaccine Enrollment Tool(link is external) using your Department of Administration (DOA)/Wisconsin Logon Management System username and password.

• If you do not have a DOA/Wisconsin Logon, please register here(link is external).
  • Select Self-Registration. After you accept the user agreement and fill in your personal profile information, select “DHS Health Reports” under “Systems You Will Access.”
  • After your registration is complete, proceed to the enrollment tool(link is external).
• If you have a DOA/Wisconsin Logon, then proceed to the enrollment tool(link is external) and logon using your DOA/Wisconsin Logon username and password.

Step 2: Generate your forms.

USE CAUTION: Once information is entered and site type is chosen, you may NOT go back to change them.

• Enter information into the COVID-19 Vaccine Enrollment Tool.
• Scroll to the bottom of the page and select “Generate Forms”, which will generate forms specifically for your organization.
  • Your organization name and a reference number will be pre-populated on the forms (located at the bottom of each generated form).
  • You can have your vaccine sites use this information to ensure they are using your organization-specific forms.

Step 3: Complete and sign your forms. (Updated 03/01/21)

Note: All signatures must be present on a form before submission. Instruction is provided within the forms by hovering over the blue bars in the form.

• Each unique legal organization must complete a Form A.
• If your organization may need to move vaccine to another organization, or to another Form B location within your own organization, you must complete a Redistribution Form. This form should match your organization’s Form A in the following fields:
  • Organization Name
  • Medical Director/Chief Medical Officer
  • Chief Executive Officer (CEO) or Chief Financial Officer (CFO)
• Complete a Form B for each physical address where you will store or administer COVID-19 vaccine, with certain exceptions. Please see these provider registration scenarios to see what forms are required for different vaccination clinics. If you have questions about whether your organization requires additional Form B submissions, please email us(link sends e-mail).

Step 4: Submit all your forms.

Note: You may submit your organization's forms from any DOA/Wisconsin Logon Management System login. Only submit the completed forms that were specifically generated for your organization with the reference number in step 2 above (this is listed at the bottom right of your generated forms).

• Find “Submit Forms” at the top left of your web browser.
• Upload your completed and signed forms to their corresponding fields. DON’T FORGET TO HAVE YOUR FORMS SIGNED AND DATED!
• Scroll to the bottom of the page and select the “Upload Files” button.
• If you need to change your information after submitting do so via the Wisconsin Immunization Registry. Any information that needs to be changed outside of WIR can be done by contacting dhscovidvaccinator@wi.gov(link sends e-mail).

Step 5: At various different stages of registration, staff may contact you to ask questions about your submission, correct errors, or provide instructions on next steps. Please respond to this outreach immediately so that we can continue processing your registration. This step may occur after your organization has been approved to receive vaccine.

Step 6: Once your information is verified and your WIR account is configured, the primary contact listed on the Form B will receive an email from DHS with next steps for your organization.

 Your vaccine coordinator, back-up coordinator, and other relevant staff must complete the required Wisconsin Immunization Registry (WIR) and vaccine storage and handling trainings. These training videos do not use Adobe Flash Player. You will be emailed a survey to attest that your staff have completed the WIR and the Storage and Handling trainings. Your organization will not be able to order COVID-19 vaccine unless these trainings are completed and acknowledged within 5 days of receipt of the email with the attestation survey.

 We also highly recommend your staff takes the CDC's Just in Time trainings for Pfizer-BioNTech(link is external) and Moderna(link is external) vaccines! See the Trainings section below for additional trainings.

Wisconsin’s home health care agencies provide high quality, cost effective skilled nursing care for individuals recently discharged from a hospital or skilled nursing facilities. Operating in rural and urban communities throughout the state, home health care agencies provide health care services including skilled nursing, physical therapy, occupational therapy, speech therapy and home health aide in a patient’s home. Home health care services address a variety of health issues, from pulmonary care and neurological rehabilitation to intravenous therapy, wound care, and chronic disease management.

This convenient quality healthcare is also cost effective and reduces the financial burden for patients, private insurance, and public payers. In fact, when home health is the first option utilized after discharge from a hospital, studies found a cost savings of $5,411 per person among the Medicare population. Additional data shows home health care services lead to 26% fewer acute care hospital admissions and 19-30% in total medical cost savings.

Unfortunately, the skilled home health care industry is facing a workforce shortage crisis, which is threatening patient access to care.

Wisconsin’s home health care agencies are reimbursed by private pay insurance, Medicare, and Medicaid. However, Wisconsin’s Medicaid reimbursement rate for home health services has been stagnant for over a decade, without a single increase. Yet over that same time, healthcare inflation has grown 32.3%, and the average Medicare reimbursement rates have increased by 26%. Medicare rates average $145.00 and Medicaid reimbursement for home health services remain at $85.54 per visit.

Such low Medicaid reimbursement levels create a critical workforce crisis for home health care agencies to retain essential skilled nursing staff and adequately serve Wisconsin’s home health care patients. Wisconsin home health agencies regularly lose highly skilled nurses to other sectors of the healthcare industry, mostly due to inequitable compensation potential.

According to the Wisconsin Center for Nursing, Wisconsin is well below the national average when it comes to RNs working in home health settings. RNs working in home health settings make up just 6% of the total nursing workforce in the state, while nationally that statistic is 13% of the total nursing workforce.

Wisconsin’s lagging Medicaid reimbursement rates not only create workforce challenges, they also negatively impact access to home health care services among the Medicaid population.

In short, Wisconsin’s home health care agencies have earned and deserve a Medicaid rate increase. Most importantly, Medicaid patients should be able to access home health services which increase quality of life and decrease medical costs.

By incentivizing home health care agencies to accept new Medicaid patients and increase capacity for home health care to attract new workforce, the state could reduce dependency on expensive institutional-care facilities for post-acute care. 

On behalf of the patients we serve, the Wisconsin Association for Home Health Care urges the Legislature to include a modest increase in the 2021-23 biennial budget. It is time to raise Medicaid reimbursement rates for home health care services. The downstream cost savings far exceed the investment and most importantly it will benefit all patients.

Lisa Kirker, RN, MSN, MBA
President
Wisconsin Association for Home Health Care

As was reported in previous editions of the WiAHC Advocacy Newsletter, the Association has launched a Legislative Key Contact Program, which can be a highly effective grassroots advocacy tool to help build and nurture strong on-going relationships between WiAHC members and lawmakers in Wisconsin. Ultimately, the program can help us help shape new policies important to our members.

We are happy to report the program is now live on the WiAHC website and members can easily and quickly sign-up as a Key Contact.

As a Key Contact, you can help influence the legislative process at both state and federal levels by cultivating relationships with elected officials. By taking advantage of existing relationships and making new contact with members of the Wisconsin Legislature and the Wisconsin Congressional  Delegation, you can help us educate lawmakers on industry issues and influence legislation.

But the program will not succeed without strong member participation, so please take a few moments to read more about it – and learn how simple it is to “enlist” and participate as a Key Contact. The time commitment is minimal and your responsibility as a key contact depends on your level of comfort and willingness to engage.

Remember, lawmakers are often eager to hear input from their constituents, and as an expert in your field, you can make a real difference in the policy process as a Key Contact. CLICK HERE to sign-up by filling out and submitting a brief online survey.

All too often, citizens believe they cannot influence the political and policymaking process. Fortunately, that perception is NOT ACCURATE, as lawmakers are eager to hear input from their constituents. In fact, they have a duty to listen to and address the concerns of their constituents, including those working in the home health care industry.

One of the most important steps WiAHC members can take to promote our industry and advance beneficial policies and legislation is to develop a relationship with their state legislators. With that in mind, the WiAHC Government Affairs Team is encouraging you to contact your state lawmakers TODAY, introduce yourself and educate them on the importance of the home health care industry in Wisconsin.

With the 2021-23 Wisconsin state budget bill currently under consideration, it is also an ideal time to remind your legislators the Medicaid reimbursement rate for Wisconsin home health care skilled nursing has not been increased in over a decade and their support for such increase is essential for the viability of home health care services in Wisconsin. 

Again, please contact your state lawmakers TODAY to introduce yourself and WiAHC, as well as to educate them on the home health care industry.

BACKGROUND:

Operating in communities through the state, home health care agencies offer a variety of health care services provided in the homes of patients and are integral to comprehensive post-acute medical care. In addition to offering quality, convenient care to patients in the comfort of their own homes, home health care agencies provide cost effective care that reduces the financial burden for patients as well as public and private payers.

However, home health care can mean different things to different people – including legislators. There is a great need to educate policymakers on what home health care means to WiAHC and our members. In short, skilled home health care includes a wide range of services to treat an illness or injury that are provided by skilled non-physician practitioners – including nurses and physical therapists – in a patient’s home.

It is also important for lawmakers to understand the benefits of home health care. Not only does it improve patient recovery time, convenience and quality of life, skilled home health care is typically less expensive then care a patient would receive in a hospital or other facility.

Unfortunately, current Medicaid reimbursement levels make it difficult to operate home health care agencies due to the problems it creates, including workforce retention and patient access challenges. Even a modest Medicaid rate increase would significantly improve home health care in Wisconsin.

WHAT YOU CAN DO TO HELP:

E-mail your state legislators today to introduce yourself and educate them about the importance of the home health care industry in Wisconsin. Please feel free to use WiAHC’s sample e-mail when contacting your lawmakers. All you need to do is cut-and-paste it into an e-mail, but please consider personalizing your e-mail to include examples of your personal experiences that capture the benefits of home health care. Also, please attach the WiAHC 101 document – which is linked below – to your e-mail to lawmakers.

If you don’t know who your state legislators are, or do not have their contact information, simply CLICK HERE and type your home address in the upper right corner text box. Remember to contact both your state senator and state representative.

If you have any questions on this WiAHC Advocacy Action Alert request or would like additional information on the issue, please contact WiAHC at erik@hovenconsulting.com or tim@hovenconsulting.com.

ACTION ALERT RESOURCES:

• Sample e-mail to legislators
• WiAHC 101 Document

Earlier this month, Congress passed, and President Joe Biden signed into law the American Rescue Plan Act of 2021. The sweeping $1.9 trillion legislative package includes a wide range of funding programs and policies to aid individuals, businesses, and communities across the county with additional COVID-19 relief. In addition to direct $1,400 stimulus payments to individuals, extended unemployment benefits, housing assistance and funding for states, large cities, and schools, the American Rescue Plan also includes funding for the COVID-19 public health response and numerous health care-related initiatives, including:

• $8.5 billion to track, administer and distribute COVID-19 vaccines.
• $47 billion for diagnosing and tracing COVID-19 infections.
• 10% increase to Federal Medicaid Assistance Percentage for home and community-based services (HCBS), which equates to a $12.67 billion payment increase for HCBS from April 1 of 2021 through March 31, 2022.
• $8.5 billion in payments for rural Medicare and Medicaid providers – including hospitals, clinics, home health, and hospice – for COVID-19-related expenses and lost revenue.
• $200 million for infection control and vaccination uptake in skilled nursing facilities.
• Requires COVID-19 vaccine coverage without cost-sharing for Medicaid beneficiaries.
• Increases health insurance premium assistance for individual coverage on the Affordable Care Act Marketplace for 2021 and 2022

For more information on the American Rescue Plan, please review a comprehensive overview of the new law provided by the National Conference of State Legislatures (see page five for health and human services provisions).

The Wisconsin Legislature's powerful budget-writing committee – the Joint Finance Committee – will  hold four public hearings next month on Governor Tony Evers' proposed $91 billion state budget bill. The committee has scheduled three in-person hearings and one virtual hearing for the following dates and locations: April 9 – University of Wisconsin-Whitewater April 21 – Rhinelander, WI (Hodag Dome) April 22 – University of Wisconsin-Stout (Menomonie, WI) April 28 – Virtual hearing The public hearings will begin at 10:00 AM and conclude at 5:00 PM. Due to COVID-19, capacity at each hearing site will be closely monitored. Individuals wishing to testify at the virtual hearing will be required to register in advance. The hearings will provide the public with an opportunity to comment on the state’s two-year spending plan and suggest modifications to the proposal before the Finance Committee votes to make what is anticipated to be extensive changes to Evers' budget bill. Once the committee finishes its work, the budget bill will be considered by the full Legislature. For individuals who cannot attend the public hearings, but wish to comment on the budget proposal, the following online portal is available for the public to provide input on the bill: www.legis.wisconsin.gov/topics/budgetcomments. If you have any questions on the state budget bill, would like more information, or need assistance on how to engage in the budget process, please contact WiAHC’s government affairs team at Hoven Consulting.

The Department of Health Services (DHS) announced today that individuals age 16 and older with certain medical conditions will be eligible for the COVID-19 vaccine beginning March 22, which is earlier than previously expected. This eligibility group includes individuals with medical conditions associated with an increased risk of severe illness from COVID-19.

The next eligibility group, which again will begin March 22, 2021, includes individuals age 16 and over with the following medical conditions:

• Asthma
• Cancer
• Cerebrovascular disease
• Chronic kidney disease
• COPD
• Cystic fibrosis
• Down syndrome
• Heart conditions
• Hypertension or high blood pressure
• Immunocompromised state
• Liver disease
• Neurologic conditions
• Obesity or overweight
• Pregnancy
• Pulmonary fibrosis
• Sickle cell disease
• Type 1 or 2 diabetes mellitus
• Thalassemia

Individuals with the outlined medical conditions can access vaccine through a variety of options, including community-based clinics, health care providers, Local and Tribal Health Departments, and pharmacies. Wisconsinites with a primary care provider may hear directly from their provider. Visit the Wisconsin COVID-19 vaccine options page or call the vaccine hotline at 1-844-684-1064 to learn more.

Additionally, DHS clarified current eligibility to include all clergy (as part of health care personnel who provide spiritual care to the sick), restaurant workers (as part of the food supply eligibility group) and further expanded public safety to include judges, prosecutors, and other essential criminal court personnel, in addition to public defenders.

Depending on vaccine supply, DHS still anticipates that Wisconsin will be able to expand eligibility May 1 to include all individuals age 16 and older. DHS will continue to monitor vaccination coverage statewide and partner with vaccine providers in order to provide an updated vaccination timeline for the general public.

For information, resources, and data related to Wisconsin’s COVID-19 vaccination program, visit the COVID-19 vaccine webpage.