WISCA works closely with our national association partner – the Ambulatory Surgery Center Association (ASCA) – on advocacy and other issues important to our members. In fact, the WISCA Government Affairs Team joins a national ASCA state chapter call twice a month for a federal regulatory and legislative briefing and closely follows their published Government Affairs Updates. Here is the latest federal government affairs news from ASCA:

• Final ACS Rule Update:  On November 1, the Centers for Medicare & Medicaid Services (CMS) released its 2025 final payment rule for ASCs and hospital outpatient departments (HOPD). Of note, CMS declined to add any of the surgical procedures requested by ASCA to the ASC Covered Procedures List (ASC-CPL) for 2025. CMS will continue to use the hospital market basket (HMB) as the ASC inflation update factor for 2025, although it is unclear whether that policy will continue further. This results in an effective update of 2.9 percent for ASCs—a combination of a 3.4 percent inflation update based on the HMB and a productivity reduction of 0.5 percentage points mandated by the Affordable Care Act. This is an increase of 0.3 percent from the proposed rule. Please note that this is an average and updates might vary significantly by code and specialty. CMS finalized the addition of 21 procedures to the ASC-CPL, including 19 dental codes that were included in the proposed rule. In addition, the agency finalized the addition of the following two adipose-derived regenerative cell (ADRC) therapy codes (short descriptor in parentheses):
• • 0717T (Adrc ther prtl rc tear)
  • 0718T (Adrc ther prtl rc tear njx)

Regarding the ASC Quality Reporting (ASCQR) Program, CMS is finalizing the adoption of the following measures:

• The Facility Commitment to Health Equity (FCHE) measure beginning with the CY 2025 reporting period/CY 2027 payment determination;
• The Screening for Social Drivers of Health (SDOH) measure beginning with voluntary reporting in the CY 2025 reporting period followed by mandatory reporting beginning with the CY 2026 reporting period/CY 2028 payment determination; and
• The Screen Positive Rate for Social Drivers of Health (SDOH) measure beginning with voluntary reporting in the CY 2025 reporting period followed by mandatory reporting beginning with the CY 2026 reporting period/CY 2028 payment determination.

ASCA will continue to analyze the 1,734-page final rule in detail and provide more information and resources soon, including its proprietary rate calculator, to help ASC operators understand the impact this rule will have on their centers.

• Medicare Physician Fee Schedule Final Rule: On November 1, the Centers for Medicare & Medicaid Services (CMS) released final policy updates for the 2025 Medicare Physician Fee Schedule (MPFS). The rule includes a 2.83 percent reduction to the physician conversion factor, which was expected due to the expiration of a one-year 1.68 percent increase passed as part of the Consolidated Appropriations Act, 2024 (CAA). Physicians have already organized in support of the recently introduced Medicare Patient Access and Practice Stabilization Act of 2024, which would eliminate the forthcoming cut and provide a small inflationary update to physician rates. Congress has had to intervene every year since 2021 to mitigate cuts in the MPFS. ASCA submitted formal comments in response to the MPFS proposed rule, primarily following the advocacy of the specialty societies that work in surgery centers.
• Election Update: Regarding congressional races, Republicans secured a majority in the Senate, winning 53 seats to the Democrats’ 47. The battle for control of the House, which requires 218, has been won by Republicans. Currently, Republicans have 218 seats, while Democrats have 212. Five house races have yet to be called.
• • ASCAPAC: ASCA’s Political Action Committee (ASCAPAC) contributed to 17 Representatives and Senators in the 118^th Congress. All ASCAPAC recipients eligible for reelection in the 118^th Congress have successfully won their races, as called by the Associated Press. No PAC-recipient Senators from the 118th Congress were up for reelection this year.
  • Federal Legislation: Regarding the cosponsors of H.R.972—Outpatient Surgery Quality and Access Act of 2023—100% of candidates seeking reelection have done so, with the exception of Rep. Miller-Meeks from Iowa’s 1^st District, whose race is still pending official results from the Associated Press.

Following election night, state lawmakers traditionally convene in partisan caucus – Assembly GOP Caucus, Assembly DEM Caucus; Senate GOP Caucus; and Senate DEM Caucus – to choose their respective leadership teams for the new legislative session. This election cycle was no exception, as all four partisan caucuses have or will meet to elect their leaders for the 2025-26 session.

There were no huge surprises, as most of the leadership team members from all four caucuses from the 2023-24 session retained their positions. However, there were some developments of note. Most prominently, Sen. Chris Kapenga (R-Pewaukee) decided not seek reelection for Senate President, and Sen. Mary Felzkowski (R-Tomahawk) was elected to the post. In addition, Rep. Scott Krug (R-Nekoosa) was selected as Assembly Assistant Majority Leader to replace a retiring colleague, and Sen. Mark Spreitzer (D-Beloit) was chosen as Senate Minority Caucus Chair, after serving in a lower leadership position last session. Please find the full legislative leadership results below:

Assembly Republicans

• Assembly Speaker – Rep. Robin Vos (R-Rochester)

• Assembly Majority Leader – Rep. Tyler August (R-Walworth)

• Assembly Assistant Majority Leader – Rep. Scott Krug (R-Nekoosa)

• Assembly Speaker Pro Tempore – Rep. Kevin Peterson (R-Waupaca)

• Assembly Majority Caucus Chair – Rep. Rob Summerfield (R-Bloomer)

• Assembly Majority Caucus Vice Chair – Rep. Cindi Duchow (R-Delafield)

• Assembly Majority Caucus Secretary – Rep. Nancy VanderMeer (R-Tomah)

• Assembly Majority Caucus Sergeant at Arms – Rep. Treig Pronschinske (R-Mondovi)

Senate Republicans

• Senate Majority Leader – Sen. Devin LeMahieu (R-Oostburg)

• Senate President – Sen. Mary Felzkowski (R-Tomahawk)

• Senate Assistance Majority Leader – Sen. Dan Feyen (R-Fond du Lac)

• Senate President Pro Tempore – Sen. Patrick Testin (R-Stevens Point)

• Senate Majority Caucus Char – Sen. Van Wanggaard (R-Racine)

• Senate Majority Caucus Vice-Chair – Sen. Rachel Cabral-Guevara (R-Appleton)

Senate Democrats

• Senate Minority Leader – Sen. Dianne Hesselbein (D-Middleton)

• Senate Assistant Minority Leader – Sen. Jeff Smith (D-Eau Claire)

• Senate Minority Caucus Chair – Sen. Mark Spreitzer (D-Beloit)

• Senate Minority Vice Caucus Chair – Sen.  Dora Drake (D-Milwaukee)

The Assembly Democratic Caucus will meet later this week to choose their leadership roster.

Wisconsin lived up to both its “Purple State” and its ticket-splitting reputation on election night (Nov. 5) as election results were razor thin across the ballot.  Former President Trump won the state by 30,000 votes, roughly 0.9% of the vote.  This is only the second time in the last 40 years the state has voted Republican for President, the first was also for Trump in 2016.  Conversely, Democrat US Senator Tammy Baldwin was re-elected by a very narrow margin, roughly 29,000 votes.   

There was also uncertainty with state legislative races heading into election night, mostly due to the election being held under new legislative maps. The State Assembly entered the night with a 64-35 Republican majority.  Most pundits expected the GOP to lose numerous seats, with some even predicting Democrats taking the majority.  However, once all the votes were counted, Assembly Republicans maintained 54-45 seat majority heading into the 2025-26 legislative session.

In the State Senate, Republicans lost all 4 contested seats and will enter the new session with a reduced 18-15 majority – down from their current 22-11 seat majority. Of note, Republican incumbent Senator Joan Ballweg (R-Markeson) lost her re-election battle after her 60% GOP seat was redistricted into a 45% GOP seat.  Similarly, Republican incumbent Senator Duey Stroebel (R-Saukville) lost his re-election race after he was redistricted out of his 70% GOP seat into a 49.5% seat.  The main take away from the election is that with their 4-seat pick-up, Democrats have put themselves into position to contest for the majority in 2026 election cycle.

The WISCA Government Affairs Team would like to thank every member who provided input on the development of WISCA’s 2025-26 Legislative Agenda – both at our monthly advocacy calls and through our member survey. With your valuable input, we were able to develop a broad legislative agenda that includes specific legislative goals. Please find below an overview of the 2025-26 WISCA Legislative Agenda:

• Exploration of Medicaid reimbursement increases.  We want to study MA as a payer to see if there are procedures that stand out for needing a higher reimbursement rate, as well as understanding what level of increase would be needed. 
• Every session we expect to see Workers Compensation bills. In the most recent sessions, some have argued on behalf of a health care fee schedule which would institute maximum payment amounts. In addition to opposing a fee schedule WISCA will monitor the Workers Compensation Council.
• We are expecting to see legislation from the Wisconsin Medical Society relating to prior authorization reform.  On a recent call ASCs voiced their frustrations with certain aspects of prior authorization. WISCA will have the opportunity to be part of a coalition that supports these reforms.
• Nationally ASCA has seen an uptick in bills imposing facility fees on ASCs.  We will monitor legislative activity to make sure such an effort doesn’t take hold in Wisconsin. 

Legislation to Watch:

• Advanced Practice Registered Nurse bill – Broader legislation that could impose a collaborative agreement requirement on nurse anesthetists that would be burdensome to certain ASCs.
• DSPS licensing – Any legislation that would improve the process to ensure health care professionals are licensed in a timelier manner.
• Video recording devices—Legislation that would require providers to record surgery at a patient’s request.

·     Transparency – Legislation targeting price transparency for hospitals, and potentially ASCs.

It is more important than ever for WISCA members to strengthen their relationships with their state lawmakers to educate them on the ASC model of care, the regulatory challenges we face, and the legislative solutions we need to increase access to affordable, quality care provided in the ASC setting. Remember, decisions state legislators make in the Capitol can have a significant impact on the ASC industry, your organization, and your profession.

One of the best ways you as a WISCA member can engage your local legislators is to invite them to tour your ASCs to illustrate firsthand the many benefits of surgery center care. These visits provide a tremendous advocacy opportunity, which is why WISCA members across the state have already hosted numerous successful legislative tours. But we need to maintain the enthusiasm for this critical grassroots advocacy program, and WISCA is excited and ready to set-up additional tours today.

If you would like to host a legislative tour at your site, please contact the WISCA office at WISCA@badgerbay.co. We will work with you and your legislators to coordinate the meetings and will provide participating members with full support, including legislator bios, advocacy tips, issue briefings, and supporting documents.   

WISCA works closely with our national association partner – the Ambulatory Surgery Center Association (ASCA) – on advocacy and other issues important to our members. In fact, the WISCA Government Affairs Team joins a national ASCA state chapter call twice a month for a federal regulatory and legislative briefing and closely follows their published Government Affairs Updates. Here is the latest federal government affairs news from ASCA:

·        IV Shortages: ASCA recently sent a brief letter to US Department of Health and Human Services (HHS) Secretary Xavier Becerra regarding intravenous (IV) solutions shortages arising in the aftermath of Hurricane Helene. Much of this is due to damage done to Baxter’s manufacturing site in North Cove, North Carolina, from the rain and storm surge that resulted in water permeating the facility.

o   This Baxter facility supplies approximately 60 percent of the IV solutions used every day in the US. Baxter’s website is being updated as new information is released. Baxter has stated, “Supporting our employees in the impacted communities, bringing the North Cove facility back online and helping to ensure ongoing supply to patients are our top priorities.”

o   As such, ASCA requests that a national public health emergency be declared to allow for waivers of the Centers for Medicare & Medicaid Services (CMS) rules and regulations that would help alleviate the growing problems associated with sterile IV shortages throughout the US. In addition to declaring a national public health emergency, HHS should continue to work with and encourage the US Food & Drug Administration (FDA) to declare a shortage of sterile IV solutions to allow certain flexibilities not otherwise available to healthcare providers.

o   ASCA has created a webpage with links to the most recent developments in Baxter’s hurricane response and additional resources. Contact Kara Newbury at knewbury@ascassociation.org with any questions.

·        CMS Final Rule: On September 9, ASCA submitted formal comments in response to the Centers for Medicare & Medicaid Services (CMS) 2025 proposed payment rule for ASCs and hospital outpatient departments (HOPD). ASCA expects the final rule to be released around November 1 and will provide more information to its members as soon as it becomes available. Contact Kara Newbury at knewbury@ascassociation.org with any questions.

·        OAS CAHPS: As a reminder, the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) Survey was finalized as a new measure, ASC-15a-e, in Medicare’s ASC Quality Reporting (ASCQR) Program in the CY 2022 OPPS/ASC final rule. Voluntary reporting for the measure began in 2024, with mandatory reporting beginning in 2025.

o   The survey has specific administration modes and requires ASCs to work with an approved OAS CAHPS Survey vendor to fulfill the reporting requirements. There are more than 6,300 Medicare-certified ASCs, but as of this week, only about a third of facilities (2,188) have authorized a vendor to submit data on their behalf.

o   In a recent episode of ASCA’s Advancing Surgical Care Podcast, “OAS CAHPS Keys to Success,” ASCA Immediate Past President Mandy Hawkins, RN, CASC, CAIP, leads a discussion with Press Ganey Emerging Markets President Bob McSweeney and Director of Health Policy Eme Augustine. The three talk about the challenges and opportunities confronting ASCs administering the OAS CAHPS Survey and provide practical advice that can help ASCs succeed with the new survey.

o   To ensure your facility is ready when the survey becomes mandatory, ASCA strongly encourages all ASCs to start the vendor selection process as soon as possible. Those with experience conducting the survey say setup alone can easily take three months or more. Surgery centers that fail to comply with the reporting requirement will be subject to a reduction in their Medicare reimbursement rates in 2027 and beyond. Learn more about the OAS CAHPS Survey. Contact Kara Newbury at knewbury@ascassociation.org with any questions.

With the November election only days away, most people are focused on the race for the White House, but there will be many interesting races to watch that will shape the future political make-up of the Wisconsin Legislature – especially after the implementation of new legislative maps. The implementation of new maps will perhaps have the most immediate impact to the State Assembly where Republicans have maintained large comfortable majorities for the past decade. That cushion will not be the case for the next several cycles and instead we will likely see tightening of the margins and potentially a flip from GOP to Dem.

Currently out of the 99 seats, the GOP holds 64 seats to the Dems 34 (with one vacancy). While elections almost always yield surprises, if Trump v Harris ends up as close as polling says it will, the below twelve seats will be the most impactful toward the new makeup of the Assembly. While Republicans are expected to return with a majority, the tighter margins will likely lead to a new dynamic in the Assembly and potentially a need for more bipartisan compromise on more issues than what has been the norm. 

We are starting with the assumption that safe and likely seats in both houses provide for a 46-41 Republican majority, leaving the below 12 seats to define the final margin.  Republicans can go 4-8 and still maintain the majority, democrats would have to go 9-3 to take it. 

Incumbents Face Challenges in New Districts

·        Assembly District 21

Incumbent Rep. and Joint Finance Committee member Jessie Rodriguez is running for re-election in south Milwaukee, where redistricting has shifted her seat to the left, making the race highly competitive. Her challenger, Democrat David Marstellar, a floriculturist and grassroots advocate, aims to capitalize on the district's new 54% Democratic lean in hopes of securing a win.

·        Assembly District 26

Freshman Republican Rep. Amy Binsfield is playing defense to maintain her new Assembly seat in what is now a 52% Democratic-lean Sheboygan area seat. Challenging Binsfield is Democratic Joe Sheehan, a former school superintendent and economic development executive.

·        Assembly District 30

Representative Shannon Zimmerman is seeking to maintain his Western Wisconsin district, which includes Hudson and River Falls. The new district moved 5 points to the left, and it now is just at 51% lean Republican in a fast-changing part of the state. Zimmerman, a seasoned Finance Committee member and businessman, is being challenged by Democratic Alison Page, a nurse and health care administrator.

·        Assembly District 51

Seasoned Republican Rep. Todd Novak has demonstrated in past races he can prevail in his southwestern Wisconsin left-leaning seat. However, his previously purple district shifted 5 points to the left now tracking at 55% Democratic. Facing off against Novak is Elizabeth Grabe, a farmer and realtor from Mount Horeb.

·        Assembly District 61

Freshman Republican Rep. Bob Donovan, who is former Milwaukee County Council member, moved into this district after seeing his current district turn solid blue. Donovan, who hails from Greenfield, is now running in the AD 61^st which includes Hales Corners and Greendale. Challenging Donovan in this 50/50 seat is LuAnn Bird, a caregiver, school board member and former Executive Director of the League of Women Voters of Wisconsin.

·        Assembly District 85

After redistricting, Republican Rep. Pat Snyder also faced a decision – stay or move into what is largely his former district that surrounds Wausau. Synder decided to take his chances in the new 85^th, which has shifted 2 points to the left, to a 51% lean GOP district. Snyder, who has outperformed in previous elections, is facing off against Democratic Yee Leng Xiong, a local official and non-profit executive. 

·        Assembly District 91

If there is a parallel Dem redistricting version to Rep. Moses and the 92^nd, current Democratic Rep. Jodi Emerson would be it. Emerson’s Eau Claire area seat now consists of 60% of new territory, which shifted her solid blue seat to a 54% lean Dem seat. Current Rep. Karen Hurd was drawn into this district but decided to take a pass and instead move to a solid red open seat in the 69^th. Challenging Emerson now is Michele Skinner, a member of the Eau Claire County Board of Supervisors and Altoona Lake District.

·        Assembly District 92

This is border-line lean 53% GOP district just makes it into the competitive category. Current Republican Rep. and practicing chiropractor, Clint Moses is hoping to hold onto his seat in a district where roughly sixty percent of the constituency is new to him. On the Democratic side, Joe Plouff, a former Assembly representative himself, is hoping his previous political experience gives him some leverage in the new 92^nd.

·        Assembly District 94

In all the changes with redistricting, some things never change- as is the case in AD 94. Rep. Steve Doyle is once again facing challenger Ryan Huebsch. Doyle has won his largely unchanged district six times since 2012, including winning in 2022 over Huebsch by 756 votes. This one will once again be a toss-up come November.

Open Seats (No Current Legislator Running)

·        Assembly District 53

Spanning from Neenah up to Menasha, the 53^rd is deemed highly competitive by most metrics. The district leans very slightly to the left – at about 53% lean Dem, but the GOP is running a candidate, Dean Kaufert with significant name ID which could help them in pick this up in November. Kaufert represented the area as an Assembly Rep from 1991 to 2015, followed by a stint as Neenah mayor from 2014 to 2022. Challenging Kaufert is Duane Shukoski, also a Neenah resident and longtime Kimberly Clark employee.

·        Assembly District 88

The new AD 88th is a 50/50 seat, with redistricting shifting the former red district around De Pere, Allouez, and Bellevue 5 points to the left. The district is now open, with two new candidates vying for the position. Republican small business owner Ben Franklin of De Pere emerged victorious in the primary against challenger Phil Collins. On the Democratic side, former business systems officer and Brown County Democratic Party chair Christy Welch, also of De Pere, did not face a primary challenge, potentially giving her a bit more runway than Franklin. However, in this 50/50 seat, it’s anyone’s guess what November will bring.

·        Assembly District 89

Like the 88th, AD 89th is also a 50/50 open seat that includes Ashwaubenon and eastern Green Bay. Democrat and Assistant District Attorney Ryan Spaude is running against Brown County Board Chairman and Republican Patrick Buckley. Both candidates are from Green Bay and have a background in local government, making this new seat an interesting one to follow.

The November general election, which will determine who controls the Wisconsin Legislature, is less than two weeks away. Before you know it, we will be rolling in to the new year – and the 2025-26 legislative session. And to align with state lawmakers reconvening in 2025, WISCA is in the process of developing and finalizing our legislative priorities and our advocacy roadmap for the next two years.

As you know, WISCA invites all members to attend a monthly state legislative update meeting led by our Advocacy Team, which reviews and discusses state legislative issues of importance to surgery centers, the latest political news, federal regulatory matters, and grassroots advocacy efforts and opportunities. However, it is extremely important for members to participate in next month’s meeting – which will be held on Thursday, November 7 at 12:00 PM. This one-hour meeting will focus on building WISCA’s 2025-26 Advocacy Plan and provide members with an opportunity to provide their input on what legislative and regulatory issues the Association should tackle over the next two years. Register online for the Update.

If you cannot attend next month’s meeting, please share your thoughts online on what state legislative issues you believe WISCA should prioritize during the 2025-26 Wisconsin Legislative Session.

The WISCA Leadership Summit held earlier this month in Wausau, WI, featured a tour of the Wausau Surgery Center. The tour provided Summit participants with a peek behind the curtain of WSC’s new, state-of-the-art facility, which opened in September 2022. WISCA invited and was thrilled to be joined by two state lawmakers from the Wausau area – Sen. Cory Tomczyk (R-Mosinee) and Rep. Pat Snyder (R-Schofield).

The tour allowed WISCA to show both legislators firsthand the benefits of the Ambulatory Surgery Center (ASC) model of care, how ASCs have transformed the outpatient experience, and how surgery centers offer patients a more convenient and safer alternative to hospital-based outpatient procedures at a lower cost. The tour also afforded WISCA members the opportunity to ask the lawmakers questions and to express their concerns over the regulatory challenges ASCs face and potential solutions to those challenges. 

August is National ASC Month, a time to raise awareness and celebrate the invaluable contributions of Ambulatory Surgery Centers (ASCs).

In 2022, 30 Medicare-certified ASCs in Wisconsin saved Medicare more than $52 million. If you need outpatient surgery or one of the many lifesaving health screenings that surgery centers provide, talk to your doctor about getting the care you need in an ASC.

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