Governor Evers released a 65-page draft piece of legislation and a draft joint resolution on Saturday night aimed at addressing COVID-19. The Governor also released a chart outlining the proposal.  The Legislative Fiscal Bureau also provided a Summary of provisions of Governor Evers’ proposed legislation and Joint Resolution indefinitely extending public health emergency to state legislators.

The bill includes several healthcare provisions, including language related to out-of-network bills that occur during the public health emergency. The language caps physician payment rates at 250% of the Medicare rate.

Insurance 

• Prohibits health plans from charging patients more for out-of-network services related to the diagnosis and treatment of the condition for which a public health emergency has been declared than they do for in-network services (if an in-network physician is not available).
• The bill requires the plan to reimburse the out-of-network provider at 250% of the Medicare rate. Providers and facilities are prohibited from charging patients more than what they are reimburse by the plan. 
• Creates a process for out-of-state physicians to have liability coverage in Wisconsin during a public health emergency. They would need to provide OCI with a certificate of insurance for a policy of health care liability insurance issued by an insurer that is authorized in a jurisdiction accredited by the National Association of Insurance Commissioners. 
• Requires health plans to cover without cost-sharing any testing, treatment or vaccines related to COVID-19.
• Requires health plans to cover any services provided via telehealth if they cover that service when it is provided in-person. 
• Prohibits health plans from canceling policies due to non-payment during the COVID-19 emergency 
• Prohibits health plans and pharmacy benefit managers from requiring prior authorization for any early refills of prescriptions or restricting the period of time in which a drug may be refilled. 
• Creates a process for pharmacists to extend prescription orders by up to 30 days during public health emergencies. 

Emergency Preparedness 

• Provides $300 million to the Department of Military Affairs to respond to the public health emergency. 
• Provides $200 million to the Department of Administration to respond to the public health emergency. 

Health 

• Creates a public health emergency fund for the Department of Health Services.
• Provides $100 million for a new health care provider grant program specific to planning, preparing for and responding to COVID-19. 
• Provides $17.4 million to local health departments. 
• Creates 64 positions within the Department of Health Services’ Division of Public Health.
• Allows DHS to suspend any premium or cost-sharing requirements for childless adults on BadgerCare in order to qualify for enhanced federal Medicaid matching funds related to COVID-19.  
• Exempts the Department of Health Services, during a public health emergency, from the current law legislative review requirements for submitting waiver requests to the federal government, amending the state Medicaid plan or raising Medicaid reimbursement rates.  
• Expands the definition of public health emergency to include toxins or other threats to health. 

Health Care Workforce 

• Allows former health care providers to receive a temporary license to provide services during a public health emergency. This would apply to physicians, nurses, PAs, dentists, pharmacists, phycologists, social workers and other health providers who have practiced within the last 5 years but do not currently have a license. The temporary license would be valid until 90 days following the conclusion of the health emergency. 
• Allows out-of-state health care providers to receive a temporary license to practice in Wisconsin. The temporary license would be valid until 90 days following the conclusion of the health emergency.
• Allows the state to waive licensure fees for physicians, physician assistants, nurses, dentists, pharmacists, psychologists, and certain behavioral health providers. 
• Exempts certain health care provider credentials issued by credentialing boards in DSPS from having to be renewed during the public health emergency. 

Unemployment Insurance

• Eliminates the one-week waiting period for Unemployment Insurance

Voting

The bill contains several provisions related to voting during public health emergencies. Specifically, for elections held during a declared public health emergency, it would: 

• Require elections held during public health emergencies to be held by mail. 
• Waive the state’s Photo ID requirement.
• Waive the requirement that mail-in absentee ballots need a witness signature.
• Allow mail-in ballots to be counted as long as they are postmarked by Election Day.
• Allow voters to register electronically until 5 days before the election.

 

Governor Evers and Wisconsin Department of Health Services (DHS) Secretary-designee Andrea Palm today exercised their authority under Article V, Section 4 of the Wisconsin Constitution and Sections 323.12(4) and 252.02(6) of the Wisconsin Statutes to simplify healthcare license renewals during the COVID-19 public health emergency and to encourage recently retired professionals with expired licenses to re-enter practice. This full order is available online (link).

The order includes the following policy changes:

Interstate Reciprocity: allows any out-of-state health can provider licensed and in good standing to practice in Wisconsin without a Wisconsin credential. The order requires the out-of-state physician to apply for a temporary or permanent Wisconsin license within 10 days of first working at a Wisconsin health care facility; and the health care facility must notify DSPS within 5 days. The order temporarily suspends the visiting physician practice limitations in Med 3.04. 

Temporary License: Any temporary licensed to an out-of-state provider during the emergency will be valid until 30 days after the conclusion of the emergency. 

Telemedicine: Allows physicians licensed and in good standing in Wisconsin, another U.S. state or Canada to provide telemedicine services to Wisconsin residents. 

Physician Assistants: Suspends several current rules regulating the practice of PAs in Wisconsin. This includes: the requirement of PAs to notify the MEB of changes to their supervising physician within 20 days (order changes it to 40 days); the requirement that PAs limit their scope of practice to that of their supervising physician (the order allows them to practice to the extent of their experience, education, training and abilities. It also allows them to delegate tasks to another health provider); the physician to PA ratio of 4:1 (the order allows a physician to oversee up to 8 on-duty PAs at a time, but there is no limit on how many PAs a physician may provide supervision to over time. It also allows a PA to be supervised by multiple physicians while on duty). 

Nurse Training and Practice: The order suspends many rules related to nursing. This includes suspending a rule that prohibits simulations from being utilized for more than 50% of the time designated for meeting clinical learning requirements. It also suspends the requirement for nurses to submit an official transcript in order to get a temporary license and allows a temporary license to remain valid for up to 6 months. In addition, it suspends the rule requiring license renewal within 5 years. 

Advanced Practice Nurse Prescribers: Temporarily suspends the requirement that Nurse Prescribers must facilitate collaboration with other health care professionals, at least 1 of whom shall be a physician or dentist.

Recently Expired Credentials: Requires the state to reach out to individuals with recently lapsed credentials about renewal options. The order also suspends many of the late renewal fees and continuing education requirements for most health professions. The order temporarily suspends MED 14.06(2)(a) to allow a physician whose license lapsed less than 5 years ago to renew without fulfilling the continuing education requirements. It also suspends RAD 5.01 (1) and (2) to allow radiographers or LXMO permit holders who have let their license lapse renew without completing continuing education. 

Fees: The order also gives DHS the ability to suspend fees or assessments related to health care provider credentialing. 

The order is effective immediately and will remain in effect through the duration of the public health emergency.

The full version of the Governor’s press release is available online (link).

For urgent prior authorization requests for fee‐for‐service members, contact ForwardHealth Provider Services at 800‐947‐9627 for assistance with expediting the prior authorization process. An urgent, medically necessary situation is one where a delay in authorization would result in undue hardship for the member or unnecessary costs for Wisconsin Medicaid as determined by the Division of Medicaid Services. In general, urgent requests will receive a response within five business days. Additional information regarding urgent services is available (link).

Note: Prior authorization is not required for emergency services, defined as services that are necessary to prevent the death or serious impairment of the health of the individual. Reimbursement is not guaranteed for services that normally require prior authorization that are provided in emergency situations; those services still must meet all ForwardHealth coverage requirements, including medical necessity.

This Action Alert 08 and others are available on the ForwardHealth website (link).

In response to the COVID‐19 pandemic, ForwardHealth is temporarily altering certain procedures in order to prevent further spread of the disease and effectively treat existing cases. These altered procedures will only be in effect during the public health emergency declared by Governor Tony Evers for the State of Wisconsin under Executive Order 72.

Temporary Phone Number Change for Urgent Prior Authorization Requests

For urgent prior authorization requests for fee‐for‐service members, contact ForwardHealth Provider Services at 800‐947‐9627 for assistance with expediting the prior authorization process. An urgent, medically necessary situation is one where a delay in authorization would result in undue hardship for the member or unnecessary costs for Wisconsin Medicaid as determined by the Division of Medicaid Services. In general, urgent requests will receive a response within five business days. Additional information regarding urgent services is available.

Note: Prior authorization is not required for emergency services, defined as services that are necessary to prevent the death or serious impairment of the health of the individual. Reimbursement is not guaranteed for services that normally require prior authorization that are provided in emergency situations; those services still must meet all ForwardHealth coverage requirements, including medical necessity.

Governor Evers directed the Wisconsin Department of Health Services (DHS) Secretary-designee Andrea Palm to temporarily order the suspension of evictions and foreclosures amid the COVID-19 public health emergency. The full order is available online (link).

The order prohibits landlords from evicting tenants for any reason unless failure to proceed with the eviction will result in an imminent threat of serious physical harm to another person and mortgagees from commencing civil action to foreclose on real estate for 60 days. Wisconsinites who are able to continue to meet their financial obligations are urged to do so. This order does not in any way relieve a person's obligation to pay their rent or mortgages.

The full press release is available on the Governor’s website (link).

Erik Kanter, Hoven Consulting

The Wisconsin Department of Health Services (DHS) has drafted an 1135 waiver to submit to CMS requesting the federal government make allowances for the state to comprehensively address COVID-19. While the contents of the full waiver can be found in the link above, Tim and I wanted to share the following highlights:

·  13.1 42 C.F.R. § 484.55(a). Allow home health agencies to perform certifications, initial assessments and determine patients’ homebound status remotely or by record review.

·  2.2  Waive pre-enrollment criminal background checks for Medicare-enrolled providers to temporarily enroll a provider for ninety (90) days or until the termination of the novel COVID-19 declaration of emergency, whichever is longer. (42 C.F.R. § 455.434); Following this temporary enrollment, DHS will complete the complete enrollment process, including conducting a criminal background check, within 90 days of this temporary enrollment.

·  2.3  Waive site visits to temporarily enroll a provider for ninety (90) days or until the termination of the novel COVID-19 declaration of emergency, whichever is longer. (42 C.F.R. § 455.432).

·  2.5  Waive the requirement that physicians and other health care professionals be licensed in the state in which they are providing services, so long as they have equivalent licensing in another state or are enrolled with Medicare (42 C.F.R.§ 455.412).

·  2.6  Allow providers to receive payments for services provided to affected beneficiaries in alternative physical settings, such as mobile testing sites, temporary shelters or other care facilities, including but not limited to, commandeered hotels, other places of temporary residence, and other facilities that are suitable for use as places of temporary residence or medical facilities as necessary for quarantining, isolating or treating individuals who test positive for COVID-19 or who have had a high-risk exposure and are thought to be in the incubation period or to expand overall capacity to meet high demand.

·  4.1  Suspend cost sharing for all Wisconsin Medicaid participants for the duration of the declared emergency.

·  4.2  Broadly waive any face-to-face requirements.

·  6.5  Waiver CMS Payment Error Rate Measurement (PERM) and Quality Control (QC) requirements to allow some flexibility regarding errors during the duration of the declared emergency.

·  6.6  Allow flexibility for the submission of electronic signatures on behalf of a member by application assistors if a signature cannot be captured in person. This would be in the case of individuals who are non-merit staff assisting individuals through the application process over the phone (who normally would be doing this assistance in-person).

·  8.8  Allow the State to waive requirements prohibiting the provision of home and community-based services to affected beneficiaries who are being served in an inpatient setting in order to enable direct care workers or other home and community-based providers to accompany individuals to any setting necessary (42 C.F.R. § 441(b)(1)(ii)).

·  8.13  Allow the State to restrict freedom of choice of provider (§ 1902(a)(23)(A)).

·  10.2.1.1 Approve the use of technology and physical barriers that limit exposure and potential spread of the virus, such as use of video and audio resources for limiting direct contact between physicians and other providers in the same clinical facility.

·  10.2.1.2 Permit treatment to occur in patient vehicles, assuming patient safety and comfort. Many facilities are standing up drive through specimen collection sites, we’d like to request basic evaluation and treatment be allowed in patient vehicles in order to prevent potential spread of the virus to the facility.

·  10.2.6  Medical Staff. 42 C.F.R. § 482.22(a); A-0341 So that physicians whose privileges will expire and new physicians can practice before full medical staff/governing body review and approval. This will keep clinicians on the front line and allow hospitals and health systems to prioritize patient care needs during the emergency.

·  10.3  Physician referral. Waive sanctions under section 1877(g) of the Social Security Act (relating to limitations on physician referral). This will allow hospitals to compensate physicians for unexpected or burdensome work demands (e.g., hazard pay), encourage multi-state systems to recruit additional practitioners from out-of- state, and eliminate a barrier to efficient placement of patients in care settings.

DHS has submitted the waiver to the legislature's Joint Committee on Finance for its approval, which is the normal process for submitting an 1135 waiver. We're trying to gain some information on the legislature's timeline. It is our understanding that due to certain requirements in statute, it may take a bill to actually allow DHS to submit the waiver, rather than just approval by the Joint Committee on Finance. We're doing our best to understand the full scope of the situation and will provide updates when we know more.

Any questions or follow-up on this or any other COVID-19 issues can be sent to wiahc@badgerbay.co.

Governor Tony Evers, March 26, 2020 

MADISON — Gov. Tony Evers today launched an initiative designed to get more personal protective equipment (PPE), such as gowns, gloves and masks, to those working on the frontlines of the response to the COVID-19 pandemic.

“It is absolutely imperative that our healthcare workers and first responders have the equipment they need to stay safe and healthy as they care for our communities. As we face a global shortage of PPE, and are competing with other states to acquire limited resources, I am calling on companies, schools, and other organizations that may have unused protective equipment sitting in their facilities to make those materials available to those who need it most,” Gov. Evers said. “The state appreciates any donations, but we are also prepared to pay a fair market value for large quantities of this equipment that are offered.”

Wisconsinites can now go to https://covid19supplies.wi.gov/Donations to either donate or sell large quantities of PPE to the State of Wisconsin. The State Emergency Operations Center (SEOC) will then work with distribute the PPE to communities that need it the most.

First responders and other non-medical organizations should communicate their PPE needs to their county or tribal emergency management office, which will then forward those requests to the SEOC for fulfillment. Medical facilities, including hospitals, nursing homes, assisted living facilities and clinics, should continue using the established process for requesting supplies from the Strategic National Stockpile (SNS).

“We are amazed at the outpouring of offers from businesses and other organizations who have already told us they want to help fill the critical need for this equipment across the state,” said Dr. Darrell L. Williams, Wisconsin Emergency Management administrator. “Our staff has already been working to review those offers of support, and our hope is this site will help to streamline that process going forward.”

“Wisconsin, like many other states, has a shortage of personal protective equipment due to the COVID-19 pandemic,” said DHS Secretary-designee Andrea Palm. “We are doing everything we can to get more protective equipment so our health care workers, first responders on the frontlines can protect themselves from COVID-19, and in turn, help keep all Wisconsinites safer.”

The state is currently seeking the following items:
• Surgical Gowns (S, L, XL, and XXL)
• Face/Surgical Masks (adult, pediatric)
• Gloves (Nitrile, Vinyl, or Butyl)
• N-95 Particulate Respirators
• Isolation Gowns
• Face Shields
• Tyvek Coveralls
• Thermometers
• Foot Coverings

If organizations or businesses have quantities of fewer than 50 of any of these items, they are encouraged to donate them to local health organizations instead of going through the buyback website.

The SEOC and Department of Health Services continue working to supply medical facilities with supplies requested from the SNS. So far, the state has received about 104,680 N95 respirators, 260,840 face/surgical masks, 48,168 face shields, 40,512 surgical gowns, 192 coveralls, and 70,375 pairs of gloves from the SNS. The state has also requested assistance from the Federal Emergency Management Agency (FEMA) with purchasing supplies for use by first responders.

Today Wisconsin Governor Tony Evers issued a shelter in place order to be in effect from Wednesday, March 25 at 8:00am until Friday, April 24 at 8:00am. This means all non-essential in-person services will stop and Wisconsinites are discouraged from leaving their homes except for essential activities and to conduct work at essential business and operations as defined below. Note: The following is a summary. For exact language, please refer to the linked order. 

Essential Activities

Individuals may leave homes or residences to perform any of the following:

·  Health and safety. 

·  Obtain Necessary supplies and services. 

·  Outdoor activity. 

·  Certain types of work at essential business and operations.

·  Take care of others.  

Essential Business and Operations

Individuals may leave their homes or residences to work at the following:

·  Healthcare and Public Health Operations - Includes, but is not limited to: home health agencies and providers; hospitals; medical facilities; clinics; ambulatory surgery centers for response to urgent health issues or related COVID-19 activities;manufacturers, technicians, logistics, and warehouse operators and distributors of medical equipment, personal protective equipment (PPE),medical gases, pharmaceuticals, blood and blood products, vaccines, testing materials, laboratory supplies, cleaning, sanitizing disinfecting or sterilization supplies, and tissue and paper towel products; dental offices; pharmacies; public health entities, pharmaceutical, pharmacy, medical device and equipment, and biotechnology companies; healthcare information technology companies; organizations collecting blood, platelets, plasma, and other necessary materials; obstetricians, gynecologists, and midwife practices; eye care centers, including those that sell glasses and contact lenses; mental health and substance abuse providers; detoxification and alcohol or drug treatment programs and facilities; syringe access programs, and naloxone distribution programs; other healthcare facilities and suppliers and providers of any related or any ancillary health care services; entities that transport and dispose of medical materials and remains; personal care agencies; hospices; allied health providers;acupuncturists; massage therapists; chiropractors; and adult family homes.

·  Essential Governmental Operations.

·  Human Service Operations

·  Essential Infrastructure

·  Many others to be found in the order language

 

All previous emergency executive orders also remain in effect. Those can be found here. 

We will continue to provide updates.

NAHC, March 23, 2020

Listen to NAHC President William A. Dombi discuss the impact of COVID-19 on the Disrupt podcast from Home Health Care News. Bill talks about what home health care workers need right now (PPE!) and what NAHC is doing to make sure our people are safe and quality care in the home remains at the center of the effort to slow and stop the spread of the coronavirus.

:: Listen now!

March 23, 2020

 

The Honorable Tony Evers

Governor, State of Wisconsin

115 East, State Capitol

Madison, WI 53702

 

Secretary-Designee Andrea Palm
Wisconsin Department of Health Services
1 West Wilson St, Room 650
Madison, WI 53703

 

Dear Governor Evers and Secretary-designee Palm, 

First, thank you for the measures you have taken so far to address the COVID-19 pandemic. Your actions have pragmatically addressed this growing problem in the best interest of Wisconsin.  

As you prepare to issue tomorrow's Safer at Home order, the Wisconsin Association for Home Health Care, Inc. (WiAHC) urges you to allow home health care agencies to continue to provide our essential, life-sustaining services throughout the public health emergency. Home health care agencies and the RNs and LPNs who deliver home health care services must be considered essential services under the order. The home health patients who rely on our services simply cannot afford to be without care during this time and our skilled nursing staff needs to continue to provide that needed care. 

While we request home health care services be considered essential services, we also request you allow for following two changes to DHS 133 administrative code that will allow our skilled nursing staff to conduct certain home health visits telephonically:

·         DHS 133.18 Supervisory visits.

o    Current rule language: (1) If a patient receives skilled nursing care, a registered nurse shall make a supervisory visit to each patient's residence at least every 2 weeks. The visit may be made when the home health aide is present or when the home health aide is absent. If the patient is not receiving skilled nursing care, but is receiving another skilled service, the supervisory visit may be provided by the appropriate therapist providing a skilled service.

o    Current rule language: (2) If home health aide services are provided to a patient who is not receiving skilled nursing care, or physical, occupational or speech-language therapy, the registered nurse shall make a supervisory visit to the patient's residence, when the home health aide is present or when the home health aide is absent, at least every 60 days to observe or assist, to assess relationships, and to determine whether goals are being met and whether home health services continue to be required.

o    Our request is to allow for a grace period of an additional 14 days to conduct supervisory visits for both the 14-day requirement under sub. sec. 1 and the 60-day requirement under sub. sec. 2 while the state is under a public health emergency. Additionally, we request DHS allow agencies to conduct supervisory visits via telephone or videoconferencing while the state is under a public health emergency.

·         DHS 133.20 Plan of care.

o    Current rule language: (3) Review of plan. The total plan of care shall be reviewed by the attending physician, advanced practice nurse prescriber, or physician assistant, and appropriate agency personnel as often as required by the patient's condition, but no less often than every 60 days. The agency shall promptly notify the physician, the advanced practice nurse prescriber, or the physician assistant of any changes in the patient's condition that suggest a need to modify the plan of care.  

o    We request DHS allow home health care agencies to conduct any necessary visits from RNs associated with the 60-day review process to be done via telephone or videoconferencing while the state is under a public health emergency.

Thank you for your attention to these matters. If you have any questions, please contact Tim Hoven ( tim@hovenconsulting.com) and me (erik@hovenconsulting.com).

 

Thank you,

--

Erik Kanter
Hoven Consulting, Inc.