On August 11, Wisconsin held its partisan primaries for state legislative offices. These elections determined which two major party candidates will square off against each other in November. 

While most sitting legislators were either unchallenged or were expected to handily win their primaries, political spectators had their eyes on the following races: 

·  60th Assembly District GOP Primary - Ozaukee County: Rep. Brooks v Chris Reimer

·  82nd Assembly District GOP Primary - Franklin: Rep. Skowronski  v Theodore Kafkas

·  90th Assembly District Dem Primary - Green Bay: Rep. Staush Gruszynski v Kristina Shelton

·  6th Senate District Dem Primary - Milwaukee: Sen. LaTonya Johnson v Michelle Bryant

·  10th Senate District GOP Primary - Northwest Wisconsin: Rep. Stafsholt v Cherie Link

After votes were totaled, the only incumbent to lose was Democrat Representative Staush Gruszynski, who faced a tough reelection bid following sexual harassment allegations from a legislative staffer earlier this year.

Also of note, State Senator and Senate Majority Leader Scott Fitzgerald won the Republican Primary in the 5th Congressional District. Fitzgerald is seeking to replace longtime Congressman Jim Sensenbrenner, who is not seeking reelection. Fitzgerald's primary victory essentially guarantees his seat in Congress as the 5th District is overwhelmingly conservative. With Fitzgerald officially leaving the Senate, the Republican caucus are in search of a new Majority Leader, the most powerful position in the State Senate.

The state is now set for the November 3 general election. All 99 Assembly seats are up for election as well as 16 of the 33 Senate seats. For complete primary results, please see here.

Wisconsin Department of Health Services

What is Electronic Visit Verification?

The federal 21st Century Cures Act requires all states to put Electronic Visit Verification (EVV) into effect. This applies to all Medicaid-covered personal care and some supportive home care services.

EVV uses technology to make sure members and participants get their personal care or supportive home care services. EVV will not change your care. You will continue to receive the care you need.

Starting in November 2020, workers must use EVV for each visit. During each visit, six pieces of information will be recorded. 

Read more here

Electronic Visit Verification (EVV) training is being offered for personal care provider agencies, supportive home care agencies, and program payers. The intended audience for these trainings is provider agency and program payer administrative staff. The goal is for these staff to be trained on EVV so that they in turn can train other agency staff, including workers. DHS will provide an EVV system free of charge. However, provider agencies may choose to purchase an alternate system that meets DHS requirements. DHS will offer EVV-system trainings for administrative staff, specific to the EVV system being used:

• DHS EVV training (for the Sandata system provided by DHS) will include general EVV functionality, Sandata technology, and Wisconsin-specific information.
• Sandata Aggregator training (for EVV systems not provided by DHS) will cover Sandata’s aggregator, the technology that integrates information from alternate or third-party EVV systems with the DHS EVV solution.

The trainings are offered to assist with agency compliance before DHS’ scheduled implementation of the electronic visit verification (EVV) on November 2.  EVV will be required for Medicaid-covered personal care and supportive home care services that include personal care. EVV uses technology to verify that billed services were provided. Refer to the July 2020 ForwardHealth Update (2020-31), titled “Implementation of Electronic Visit Verification for Personal Care and Supportive Home Care Services,” for detailed information on EVV policy, technology, and validation. 

Additional information is available on the Wisconsin Department of Health Service’s website (link) for updates and information.  This site includes an informational video on the program, and summary of key policy decisions.

National Association for Home Care & Hospice

The Certified Home Care & Hospice Executive (CHCE) certification is available to eligible individuals in home care/hospice leadership positions. This includes executives and managers in provider organizations and those serving in related organizations such as consultants, accreditation and regulatory surveyors, and state home care associations.

Certification is a sign of commitment to your profession as a home care or hospice executive. It communicates pride in your work and dedication to being fully versed in all of the areas of executive management required to effectively run a home care or hospice agency.

In order to receive your CHCE certification you must complete a few steps.

Step 1. Submit your application. The application fee for NAHC members is $20, for nonmembers it is $50

Step 2. Once approved you may register to take the CHCE Exam and will receive access to the CHCE Study Guide. The certification exam for NAHC members is $200, and $500 for nonmembers. The timed exam consists of 223 questions covering the following topics Legal Requirements, Financial Operations, Payment Source, Regulatory Compliance, Strategic Planning and Operations, Human Resources, Quality and Performance Improvement, Risk Management, Marketing and Public Relations, Training and Continuing Education, Ethics, Technology Application, and Policy and Advocacy. You will have one year to prepare for the exam.

Step 3. Once you pass the exam, you will receive your certification materials. Your CHCE certification will be valid for 4 years.

Ready to become a Certified Home Care & Hospice Executive. Get started today!

Helpful Links

• Candidate Information
• Examination Registration and Testing Procedures
• Code of Ethics

This month, the Wisconsin State Supreme Court issued an opinion in the case of Papa v Wisconsin Department of Health Services. The case, brought by Professional Homecare Providers, Inc., sought to resolve an issue in which the Department of Health Services was recouping Medicaid payments made to private-duty nurses after auditing their records.

DHS recouped between $15,000 and $48,000 each from four separate private-duty nurses after audits found errors in notes and medical records. In other, DHS recouped costs for the way records were written, not because of fraudulent claims. Professional Homecare Providers, Inc. sued the state because of this documentation “perfection policy” created by DHS.

The State Supreme Court sided with the nurses, stating in the ruling, “There is no legal basis for the perfection policy.”

Writing the unanimous opinion, Justice Annette Ziegler said, “We conclude that…DHS may recoup Medicaid payments from service providers only in cases where DHS cannot verify one of the following: (1) the actual provision of covered services; (2) that the reimbursement claim is appropriate for the service provided; and (3) that the reimbursement claim is accurate for the service provided.”

While the case was brought by private-duty nurses, the ruling applies across the board to all Medicaid providers and clarifies the only justifications for DHS to recoup payments as stated by Justice Ziegler.

The following article was originally published this month by NBC-affiliate WTMJ4 in Milwaukee:

MILWAUKEE — As nursing homes have become hot spots for COVID-19 outbreaks, home health care may become a more popular avenue for those who are able to receive it, but the industry is currently facing a shortage of registered nurses in Wisconsin, according to a state agency.

"When it comes point to make a decision for our loved ones we're going to want to keep them in their homes," said Leah Perras, the executive director of Transitions at Home.

Perras is also a member of the Wisconsin Association for Home Health Care, or WiAHC. She says home health care was already growing in popularity and anticipates additional clients because of the COVID-19 pandemic.

"The pleasing factors of home health is that you have [fewer] people coming into your home," Perras said. "So, you have a decreased risk factor of getting that virus."

Making the transition could be tough based on the number of registered nurses in the field in Wisconsin.

Citing state and federal data, the WiAHC said 6 percent of Wisconsin RNs are working in home health care, compared to the national average of 13 percent.

We asked fellow WiAHC member Greg Von Arx why there's such a gap, and he said it's because of the way the state pays providers for Medicaid patients.

"The Medicaid rates for home care for seniors in Wisconsin haven't changed since we've been in business for 11 years and we've never had a rate increase in Wisconsin," Von Arx said.

The state reimburses providers for caring for Medicaid users based on a fixed rate. Because that rate hasn't changed, Von Arx said it's hurting their bottom line, making it more difficult to recruit, hire and retain nurses.

"The Medicare rates have continued to increase in the Medicaid rates just haven't, haven't kept up," he said. "So we've had to do one of two things. And that is either do more Medicare or turn away some Medicaid business."

"We need that money in order to hire retain recruit those you know great qualified nurses and other caregivers," Perras said.

Without it, the shortage of nurses could grow.

"It's hard to find nurses that want to be in the home health industry," Perras said. "So once you find a good one that you truly want to retain and have represented your company, you don't want to overwork them. You don't want to do anything to run them out the door."

Lawmakers proposed a plan to increase the Medicaid rate last September. The proposal never made it out of committee.

NAHC Report for July 30, 2020

Hospice PEPPER Available

The Hospice PEPPER, a data report that contains a single hospice’s claims data statistics (obtained from the UB-04 claims submitted to the Medicare Administrative Contractor (MAC)) for areas targeted by CMS as being at risk for improper Medicare payment, is now available.

Each Medicare certified hospice has access to a PEPPER (Program for Evaluating Payment Patterns Electronic Report), which contains statistics for these target areas, regardless of whether the hospice’s data are of concern. The report shows how a hospice’s data compares to national, MAC jurisdiction and state statistics for the three most recent years. Hospices must download their PEPPER via the PEPPER Portal.  

Hospices can also access a User’s Guide and other PEPPER resources from the PEPPER Resources webpage.

NAHC is planning for a Hospice PEPPER webinar to be held in the near future.

***

Key CMS Updates for Hospice & Home Care in New Open Door Forum

The Centers for Medicare & Medicaid Services (CMS) held a Home Health, Hospice, & DME Open Door Forum (ODF) on July 29. This is the first ODF held since the current Public Health Emergency (PHE) began. A summary of this ODF is below.

Read Full Article

NAHC Report for July 29, 2020

Home care and hospice workers are on the front line of the fight against the spread of the COVID-19 pandemic and they face more risks to their own health than almost anyone. These heroes deserve more than our thanks – they deserve our support and protection. As Congress crafts additional legislative responses to the pandemic, it is imperative that a set of core principles be considered for an equitable, effective, and efficient deployment of programs. Tell Congress to give our front line workers in the home the protection and compensation they deserve. Take action now!

ForwardHealth Updates

The Wisconsin Department of Health Services (DHS) has released two new ForwardHealth Updates that explain Electronic Visit Verification (EVV) policy and training:

• ForwardHealth Update 2020-31, “Implementation of Electronic Visit Verification for Personal Care and Supportive Home Care Services”
• ForwardHealth Update 2020-32,“Electronic Visit Verification Training for Personal Care Services and Supportive Home Care Services”

Next Steps

Non-Medicaid-Enrolled Providers

The EVV soft launch starts November 2, 2020, in Wisconsin. To prepare, provider agencies that do not have a Medicaid ID will need to obtain a unique provider agency ID. This includes provider agencies that plan to use an alternate EVV system and those who operate a self-employed business.

• Learn how to obtain a unique provider agency ID.
• Start the process to obtain a unique provider agency ID.

The provider agency ID is generated in real time and will display once you have finished submitting your information.

Medicaid-Enrolled Providers

Review the email listed on the Mailing Address panel in the demographic maintenance tool in your secure ForwardHealth Portal account, and update the email address if necessary. DHS will use this provider agency email address for EVV communication with providers. DHS must have the correct email on file for the individual in your organization that is responsible for the administration of EVV.

Please complete the email verification by July 31, 2020, to ensure receipt of needed EVV information.

Training

For information about and to register for EVV training, go to the EVV Training webpage. Training begins mid-August and is required to access the DHS-provided EVV system.

The Wisconsin Association for Home Health Care joined a coalition of medical societies in Wisconsin that created an open letter to the people of Wisconsin on the importance of wearing masks and social distancing to help curb further spread of COVID-19. 

Read letter.