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:

Price Transparency Legislation

On July 26, the US House Ways & Means Committee voted to send H.R. 4822, the Health Care Price Transparency Act of 2023, to the House floor. The legislation, which was introduced on July 24, impacts various healthcare providers and would require ASCs to compile and make public, including:

·         Standard charges for each item and service furnished by the ASC.

·         Information on the facility’s prices for as many of the CMS-specified shoppable services that are furnished by the ASC, and additional ASC-selected shoppable services, as may be necessary for a combined total of at least 300 shoppable services.

·         An indication that a service is not furnished by the ASC for each CMS-specified shoppable service that is not furnished.

This legislation allows CMS to issue penalties of $300 per day for noncompliance. ASCA has been working closely with Ways & Means and Energy and Commerce committee staff to improve the legislation and has already successfully pushed back the effective date in the bill to 2028 from 2026, as originally proposed. In addition, ASCA got language removed that would have provided the secretary of the US Department of Health & Human Services broad discretion to require ASCs to submit “any additional information specified by the Secretary.” ASCA staff and lobbyists will continue to work with members of Congress over the August recess to reduce burdens on facilities and try to ensure that any price transparency legislation enacted would benefit patients and the general public.

As was reported in last month’s edition of the WISCA Advocacy Newsletter, the Centers for Medicare & Medicaid Services (CMS) released the 2024 proposed payment rule for ASCs and hospital outpatient departments (HOPD) on July 13.

Of note, CMS concurred with ASCA’s request and proposed to continue to align the ASC update factor with the one used to update HOPD payments, extending the five-year interim period an additional two calendar years (CY) through 2025. In addition, if the proposed rule were to be finalized as drafted, ASCs would see, on average over all covered procedures, an effective update of 2.8 percent—a combination of a 3.0 percent inflation update based on the hospital market basket and a productivity reduction mandated by the Affordable Care Act of 0.2 percentage points. It is important to note that CMS does not consider sequestration in its proposed rule. This statutory 2.0 percent reduction remains in effect unless Congress acts.

The Ambulatory Surgery Center Association (ASCA) – our national partner organization – has been keeping WISCA fully briefed on the proposed rule and has developed a national stakeholder letter outlining the ASC industry’s concerns and general thoughts on the rule. WISCA has signed onto the comment letter, which will be submitted to CMS prior to the September 11, 2023, deadline.

Earlier this month, Assembly Minority Leader Greta Neubauer (D-Racine) appointed Rep. Deb Andraca (D-Whitefish Bay) to serve on the Legislature’s powerful budget-writing committee – the Joint Finance Committee – for the remainder of the 2023-2024 legislative session.  Andraca replaces Rep. Evan Goyke (D-Milwaukee) on the committee. Goyke stepped down from the post to focus on his campaign for the position of Milwaukee City Attorney.  The 16-members Joint Finance Committee is comprised of lawmakers from both the Assembly and Senate, with 12 Republicans and four Democrats.

Earlier this month, Gov. Tony Evers called the legislature into special session for Wednesday, Sept.20, 2023, to consider a number of workforce-related initiatives originally included in his state budget bill but rejected by the legislature. Among the proposals Evers is asking lawmakers to act on include the creation of a paid family and medical leave program, financial support (over $300 million) for the state’s childcare industry, and funding ($60 million) to help address Wisconsin’s shortage of health care workers. The $60 million for health care workforce development would fund the following programs under Evers’ plan:

·         $22.5 million for healthcare innovation grants, which will help the healthcare industry recruit and retain employees.

·         $17 million for healthcare opportunity grants, which will go to local workforce development boards to assist individuals obtain employment in the healthcare field.

·         $10 million to increase the number of nurse educators program in Wisconsin.

·         $6 million for the WisCaregiver Careers program, which aims to increase the number of certified nursing assistants employed at nursing homes.

·         $1.2 million for graduate medical training support grants.

·         $936,600 for the state Department of Workforce Development to advance healthcare apprenticeships opportunities.

Despite the governor’s call for a special session, the Republican-controlled legislature is opposed to the Evers initiatives, and they are expected to quickly adjourn the Sept. 20 special session without acting on any of the proposals. 

“All Copays Count” applies discounts and other assistance toward patients’ out-of-pocket costs
Guest Column by WI Senator André Jacque

Patients would receive protections from rising health care costs by ensuring that health plans count copay assistance toward a patient’s maximum out-of-pocket cost or annual deductible, under bipartisan “All Copays Count” legislation (Senate Bill 100) I introduced with several of my colleagues earlier this session.

Amid nationwide inflation, health plans have increasingly shifted costs to patients and created barriers between individuals and the medications on which they rely.  For advocates of Wisconsin patients and the providers who care for them, this bill is a clear solution to help those individuals afford the critical medications their physicians prescribe to them to manage their health.

Copay assistance programs often act as a lifeline to help patients afford specialty medications they need to treat serious health conditions. Sixteen other states have already enacted such protections.

Just when patients think they’ve reached their out-of-pocket limit, insurers and benefit managers keep moving the goalposts, and folks wind up paying more.  For someone suffering from a complex disease, the financial hit is especially hard, leaving them to choose between groceries, utilities and mortgage payments - and the prescription medications that keep their condition under control.

In 2020, the average deductible for single coverage was $1,364, which is a 364% increase from 2006. Over the past five years, the percentage of covered workers with a general annual deductible of $1,000 or more for single coverage has grown from 23% to 57%.  Further, in 2020 more than one in four covered workers was enrolled in a plan with a deductible of $2,000 or more.

Many of these patients rely on copay coupons and vouchers to afford their prescribed treatments at the pharmacy counter.  Insurers should not have the power to prevent that copay assistance from counting toward their out-of-pocket expense or deductible.  If patients can’t afford their medications, they may choose to skip doses or stop treatment altogether, which can lead to increased costs in the overall healthcare system.  And worse.

The All Copays Count legislation would ensure that the copay assistance programs patients use to afford their medications count toward their out-of-pocket costs.  It would also close the loophole that allows insurers to define prescription drugs as non-essential and therefore not eligible to count toward their deductible.  At the same time, under this initiative Wisconsin insurers would retain flexibility with their plans, while making sure patients can continue to afford the medications they need.

If you have cancer, epilepsy or any other serious health condition, the last thing you should have to worry about is whether you’ve met your deductible.  “All Copays Count” is about giving patients peace of mind that they can pay for their prescriptions. 

Senator André Jacque represents Northeast Wisconsin’s First Senate District, consisting of Door and Kewaunee Counties and portions of Brown, Calumet, Manitowoc, and Outagamie counties.

With the WI Legislature’s summer recess coming to an end, state lawmakers are ready to get back to work, which includes consideration of hundreds of bills, some of which could impact WISCA members and the surgery center industry in Wisconsin. Fortunately, the WISCA Government Affairs Team – headed by Andy Engel and Caty McDermott from Hamilton Consulting – closely monitor and lobby on legislative proposals important to WISCA.  

However, you can also track the bills and issues WISCA is lobbying on during the 2023-24 legislative session. Please CLICK HERE to review WISCA’s legislative activity on the state of Wisconsin’s Eye on Lobbying website.

Author: Andrew Engel – WISCA Lobbyist (Hamilton Consulting)

On August 1^st, new Supreme Court Justice Janet Protecewicz was sworn into her new role on the Court switching the 4-3 conservative majority to a 4-3 liberal majority.  While this could impact numerous issues in the coming years, many legislators are focusing on an immediate one:  redistricting.  A successful redistricting challenge could upend Wisconsin’s current legislative district changing the maps and putting every legislator at least at risk for a more competitive district or in some cases a brand new district.  While that won’t be the case for most legislators, it will impact some and could impact the heavy majorities in both houses.  Senate republicans currently have a 22-11 edge over Senate democrats, a 2/3 majority that can override Governor Evers veto.  Assembly republicans aren’t quite at 2/3s, but they do have a 64-35 majority that has continuously expanded over the years.  If the redistricting challenge is successful and new maps are drawn, it is expected those majorities would shrink, potentially significantly. 

With the redistricting challenge currently in front of the Court, legislators may look to expedite legislative action allowing them more time in 2024 to adjust to new districts.  That should mean a fast-paced Fall session that starts in a couple of weeks.  Issues that they will be addressing could include a tax relief package to finish the goal that wasn’t achieved in the budget process, a Milwaukee Brewers stadium bill, a long awaited and somewhat controversial alcohol enforcement bill, and some response to Wisconsin’s childcare concerns.  On the health care front, we expect to see activity on the bill creating licensure for Advanced Practice Nurses move, hearings on Senator Felzkowski’s health care transparency legislation and discussion on contraception prescribing authority.

The Fall session is just beginning to unfold as is how legislators who may be in more competitive districts next year may approach it.  For more information on the session as it unfolds you could subscribe to Hamilton Tidbits to follow along. 

Initial June data shows renewals initiated by members

The Wisconsin Department of Health Services (DHS) recently launched a new webpage showing statewide data in BadgerCare Plus and Wisconsin Medicaid enrollment following the end of the federal continuous coverage requirement that had kept members enrolled during the COVID-19 pandemic. Between June 2023 and May 2024, more than 1.6 million, or about 1 in 4, Wisconsinites will need to renew to see if they can stay covered under their current state program.

“We want to be transparent about the unprecedented changes happening with Medicaid this year, and the data we post each month will always be a snapshot in time as we will see the numbers change over time,” said DHS Secretary-designee Kirsten Johnson. “Our preliminary figures begin to paint a picture of what we’re seeing so far. We've seen at least 60% of Medicaid members who were scheduled to renew their coverage in June take action to start the process.”

The data on the new webpage show that in June 2023, 99,037 members of Wisconsin’s health care programs were due to renew their coverage and 61,057 members took some action to initiate the renewal process (this figure does not reflect current processing status or outcome). Some of those who did not initiate the renewal process may already have other coverage or may have known they were above the income limit for their program. Members who missed their renewal window can still submit their information up to three months past their renewal month to see if they are still eligible for coverage and get it reinstated.

“We are committed, as are our local and tribal agencies, health plans, and partner organizations, to continue to help people through this process, even after their renewal month has passed,” said Wisconsin Medicaid Director Jamie Kuhn. “Our priority is ensuring Wisconsinites continue to have health care coverage – whether through our state programs, an employer, or a plan purchased through HealthCare.gov.”

Additional data on the webpage show enrollment in BadgerCare Plus, Medicaid, and other state-funded programs and subprograms that provide health insurance coverage. These data help illustrate the impact of Medicaid in Wisconsin. DHS plans to update this page by the third Thursday of each month to reflect renewal activity in the previous month. DHS will be reviewing the data snapshot each month to learn and to improve our processes and messaging.

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:

·         OPPS/ASC Proposed Payment Rule
On Thursday, July 13, the Centers for Medicare & Medicaid Services (CMS) released the 2024 proposed payment rule for ASCs and hospital outpatient departments. Please find the highlights below:

·         MPFS Proposed Rule
CMS also released proposed 2024 updates to the Medicare Physician Fee Schedule (MPFS). Although this rule doesn't affect ASC reimbursement, ASCA does comment as PFS policy updates affect the clinicians that work in ASCs. In the proposed rule, clinicians would see a 3.36% decrease to the physician conversion factor.

The Centers for Medicare & Medicaid Services (CMS) released the 2024 proposed payment rule for ASCs and hospital outpatient departments (HOPD) on July 13. Of note, CMS concurred with ASCA’s request and proposed to continue to align the ASC update factor with the one used to update HOPD payments, extending the five-year interim period an additional two calendar years (CY) through 2025.

If the proposed rule were to be finalized as drafted, ASCs would see, on average over all covered procedures, an effective update of 2.8 percent—a combination of a 3.0 percent inflation update based on the hospital market basket and a productivity reduction mandated by the Affordable Care Act of 0.2 percentage points. Please note that this is an average and that updates might vary significantly by code and specialty. It is also important to note that CMS does not consider sequestration in its proposed rule. This statutory 2.0 percent reduction remains in effect unless Congress acts.

Although ASCA provided a list of 63 codes for procedures that are being performed safely in ASCs on non-Medicare populations to be added to the ASC Covered Procedures List (ASC-CPL), CMS added only one of the requested codes—G0330 (Facility svs dental rehab)—as part of a larger policy change that includes the proposed addition of 26 dental surgical codes. CMS provided no comment on the lack of inclusion of the other surgical codes ASCA proposed for addition to the ASC-CPL, which included total shoulder arthroplasty.

Regarding the ASC Quality Reporting (ASCQR) Program, CMS proposed to readopt, with modification, ASC-7: ASC Facility Volume Data on Selected ASC Surgical Procedures, with voluntary reporting in the CY 2025 reporting period followed by mandatory reporting beginning with the CY 2026 reporting period. CMS also proposed to adopt ASC-21: Risk-Standardized Patient Reported Outcome-Based Performance Measure (PRO-PM) Following Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA) in the ASC Setting (THA/TKA PRO-PM), with voluntary reporting beginning with the CY 2025 and 2026 reporting periods followed by mandatory reporting beginning with the CY 2027 reporting period. In addition, CMS proposed modifications to ASC-11: Cataracts Visual Function (previously referred to as Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery), but the measure remains voluntary at this time.

Unfortunately, ASC-20: COVID-19 Vaccination Coverage Among Health Care Personnel was proposed to remain in the ASCQR Program, with some modification. ASCA will continue to oppose this burdensome measure.

ASCA will provide additional resources soon, including a rate calculator that allows users to determine what ASCs will be paid locally if the proposal is adopted as well as template letters to assist facilities when commenting on the rule. Comments can be submitted through September 11, 2023. WISCA will be working with ASCA to develop and submit comments that reflect the concerns of Wisconsin surgery centers.