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 government affairs news from ASCA:
According to reporting by Politico, the Biden administration is considering ending the federal government’s formal declaration of a public health emergency (PHE) due to the COVID-19 pandemic at the end of the most recent renewal on January 11, 2023. The PHE was originally declared on January 31, 2020, by former US Department of Health & Human Services (HHS) Secretary Alex Azar, and has been renewed continuously since then. If the Biden administration chooses not to renew the PHE again, it is set to expire mid-April 2023. Numerous waivers that were introduced to ease administration of health services during the pandemic, including the Hospitals Without Walls initiative that allowed ASCs to bill as hospital outpatient departments (HOPD), would expire along with the PHE declaration.
Help ASCA advocate for the expansion of the Centers for Medicare & Medicaid Services’ (CMS) ASC Covered Procedures List by completing a brief survey. The ASC-CPL contains codes that CMS considers clinically appropriate for ASCs to provide to Medicare beneficiaries. Participants must complete one survey for each procedure they would like added. For example, if you would like to see three procedures added, you would need to complete three surveys. Per 42 CFR §416.166 - Covered surgical procedures, unlisted codes (generally ending in 99) are not payable in ASCs. In addition, codes that are currently on the inpatient-only list may be recommended, but please note that it is generally a multiyear process for those codes to be considered for the ASC-payable list. Take the survey by Friday, February 10, 2023. Contact Kara Newbury with any questions.
CMS decided in 2022 rulemaking to resume data collection and reporting beginning in 2023 for ASC-1: Patient Burn; ASC-2: Patient Fall; ASC-3: Wrong Site, Wrong Side, Wrong Patient, Wrong Procedure, Wrong Implant; and ASC-4: All-Cause Hospital Transfer/Admission. These measures were previously suspended as of January 1, 2019. Facilities do not report these measures on claims as was previously required. Instead, ASCs must collect data for these measures for all patients, not just fee-for-service (FFS) Medicare beneficiaries, and will submit the data in calendar year (CY) 2024 via the Hospital Quality Reporting (HQR) secure portal (also known as QualityNet). Data collected in 2023 must be reported through the HQR secure portal by May 15, 2024. For more information, read last week’s Digital Debut.
Sign-up to host a legislative tour of your ASC
With the 2023-24 legislative session right around the corner, it is increasingly important for WISCA members to strengthen their relationships with key state lawmakers and candidates for state legislative office and 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.
One of the best ways to do that is for members to invite their local legislators to tour their 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/candidate bios, advocacy tips, issue briefings, and supporting documents.
State Senator Alberta Darling has announced her resignation from the Wisconsin Legislature. After a career that spanned 32 in the State Capitol, she will step down from her seat on Dec. 1. Darling was initially elected to the Assembly in 1990, but only served a single two-year term. She was elected to the Senate in 1992.
Following the Nov. 8 elections, and heading into the 2023-24 Legislative Session, the GOP was set to hold a 22-11 veto proof majority in the senate. With Darling’s retirement, Senate Republicans will be one seat short of a two-thirds supermajority, at least until Gov. Tony Evers calls a special election to fill the seat.
The 8th Senate District, which Darling is vacating, covers portions of Waukesha, Ozaukee, and Washington Counties, including the municipalities of Mequon, Cedarburg, Germantown, and Menomonee Falls. The district leans Republican, but the special election could be competitive, especially if it is held in conjunction with the April general election that has a WI Supreme Court race on the ballot.
Darling, who was the first woman lawmaker to co-chair the Legislature’s powerful Joint Finance Committee, helped to shape the state’s finances and budget policies for over two decades. She served on the committee for 22 years, including 12 years as the co-chair.
The Wisconsin Department of Administration recently reported the state anticipates a record-high budget surplus of nearly $6.6 billion for the current fiscal year, which ends on June 30, 2023. Previous estimates set the surplus at just over $5 billion. In addition to the expected $6.6 billion surplus, the state also has $1.7 billion in its rainy-day fund.
“Exceptional fiscal management, a positive GAAP balance, and a record high surplus are good news for Wisconsin as we get ready to close out 2022 and put the pandemic in the rear view,” said DOA Secretary-designee Kathy Blumenfeld. “Our financial outlook is strong, as is our Administration’s leadership and commitment to ensure a prosperous and resilient Wisconsin that works for all.”
The record surplus will have a significant impact on the upcoming state budget process, which will begin next year after the Legislature reconvenes. Gov. Tony Evers will submit his two-year budget proposal in February, and the Republican-controlled Legislature will take the next several months to rewrite the spending plan before sending it back to Evers by June 30 for his signature and/or veto.
Gov. Tony Evers said Wisconsin is in a strong financial position and, “This unprecedented surplus presents an unprecedented opportunity to make critical investments in Wisconsinites and the future of our state.”
The GOP Co-Chairs of the Legislature’s powerful budget-writing committee – Sen. Howard Marklein and Rep. Mark Born – also applauded the historic surplus, saying “It gives us flexibility to fund the programs and agencies that are necessary for prosperity in Wisconsin while cutting taxes to benefit all Wisconsin taxpayers."
CLICK HERE to read the full DOA budget report.
In the weeks following the Nov. 8 general election, which saw Republicans increase their majorities in both the state Senate and Assembly, all four partisan caucuses met to elect their leadership teams for the 2023-24 legislative session. Please find below an overview of leadership elections:
Senate GOP:
There were not many changes in the Senate GOP Caucus. There entire leadership team stayed intact, except Sen. Joan Ballweg replaced retiring Sen. Kathy Bernier as Majority Caucus Vice-Chair.
Assembly GOP:
There was more of a shakeup in the Assembly Republican Caucus, as the retirement of former Assembly Majority Leader Jim Steinke caused a chain reaction, with Rep. Tyler August moving up from Speaker Pro Tempore to Majority Leader, and Rep. Keven Petersen moving up from Assistant Majority Leader to Speaker Pro Tempore. New leadership members filled the positions of Assistant Majority Leader, Caucus Chair, and Caucus Sergeant at Arms.
Senate DEM:
Assembly DEM:
CMS also finalized a policy to provide complexity adjustments for combinations of certain service codes and add-on procedure codes that are eligible for a complexity adjustment under the hospital OPPS. While add-on codes (N1) do not receive additional reimbursement when packaged into primary codes, the addition of the add-on codes to a primary procedure code often changes the complexity of the procedure, making it more costly to perform. As finalized in this rule, Medicare will now provide a “complexity adjustment” to adjust the payment rate for certain primary procedures to account for the cost of also performing certain add-on procedures. There are 55 new C-codes that represent these procedure combinations.
Although ASCA provided a list of dozens of procedures that are performed safely on non-Medicare populations in the ASC setting for consideration to be added to the ASC Covered Procedures List (ASC-CPL), CMS added only four of the requested codes:
· 19307 (Mast mod rad)
· 37193 (Rem endovas vena cava filter)
· 38531 (Open bx/exc inguinofem nodes)
· 43774 (Lap rmvl gastr adj all parts)
With regards to the Ambulatory Surgical Center Quality Reporting (ASCQR) Program, CMS finalized its proposal to suspend the mandatory adoption of ASC-11: Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery in the ASCQR Program. ASCA has been strongly advocating for this measure to remain voluntary.
The final rule rate calculator is already available to members on our Medicare Payment Resources page, and we will continue to add to these resources in the coming weeks.
ASCA’s National Advocacy Day returns February 27-March 1, 2023, at the Washington Marriott Capitol Hill. National Advocacy Day gathers engaged members of the ASC community from across the country to advocate for their facilities and the high-quality care they deliver. It is an excellent opportunity to meet face-to-face with your members of Congress and their staff to educate them about the many benefits ASCs provide. CLICK HERE for more information and to register for this important event.
By Andrew Engel – WISCA Lobbyist (Hamilton Consulting)
Governor, Legislators Prepare for New Session
After all the ballots were cast and counted, not much changed in the Wisconsin legislature. Governor Tony Evers will return for four more years after beating Tim Michels by over 90,000 votes.
State Senate republicans picked up a seat to move their majority to a 22-11 advantage. This gives them a veto-proof majority. Senator Devin LeMahieu was re-elected by his caucus as the Majority Leader and he is in the process of forming committees and naming Chairs.
Republicans in the State Assembly also picked up seats moving their majority to a 64-35 advantage, just two seats away from having a veto-proof majority. Speaker Vos was re-elected by his caucus as well and remains the longest serving Speaker in Wisconsin history.
In other Wisconsin state races Attorney General Kaul was re-elected by about 35,000 votes, Secretary of State Doug LaFollette was re-elected by less than 7,500 votes, and John Leiber (R) defeated Aaron Richardson (D) by nearly 40,000 votes to become the new State Treasurer
Chaperone Rule Still in Flux at Latest Medical Examining Board Meeting
Representatives of the Wisconsin Medical Society and Wisconsin Hospital Association spoke to the board during the hearing. Mark Grapentine (Medical Society) commented that his organization supports the revised rule, understands the board’s intent, and appreciates MEB’s willingness to compromise. He noted that WMS received an “inordinate” level of feedback from members concerning the original draft of the rule.
Ann Zenk (Hospital Association) asked MEB Chair Dr. Wasserman to meet with the WHA Physician Leaders Council before the board votes on the latest version of the rule. She said that WHA members still have concerns with the rulemaking and want to discuss potential alternatives. She noted that her organization is also submitting written comments.
Following the public hearing, MEB reviewed the Legislative Clearinghouse report, which identifies potential legal and technical issues in a rulemaking. Notably, the report indicated that MEB did not adequately explain its intent regarding the responsibility of hospitals and other employers of physicians and to explain the source of its authority to impose a requirement on anyone other than physicians. The report asked what MEB expects to happen if a hospital does not post a chaperone policy.
The board agreed to add an explicit statement to the rule to the effect of, “Nothing under this rule is intended to impose a requirement on any person or entity that the board does not have jurisdiction over.” MEB member Dr. Goel commented that he was “disappointed” that some organizations responded to the board’s rulemaking in a “get off our turf” manner.
The board also agreed to some minor language changes suggested by the Clearinghouse Report, but the overall language and effect of the rule will remain the same. Meanwhile, MEB Chair Wasserman said he would meet with WHA to discuss the organization’s concerns. The board will review a revised rule at its next meeting in December.
Voting is a cornerstone of American democracy and gives citizens a voice in choosing the elected officials whose decisions impact us, not only personally, but often professionally for those who work in highly regulated industries. With that in mind, take a few minutes to educate yourself on what you need to know to cast your vote on Election Day – Tuesday, November 8th.
WISCA Legislative Affairs Report:
2022 Election Preview
Environment
Historically, mid-term elections in the first term of a Presidency are rather textbook in nature. Whichever party has recently won the Presidency tends to face an unfavorable electoral environment. On average the party in power loses 36 seats in the House and faces challenges in races from the top to the bottom of tickets in all kinds of states.
In 2018, two years after President Trump was elected, Wisconsin democrats swept every race at the top of the ticket including US Senate, Governor, Attorney General, State Treasurer, etc. Democrats picked up 40 seats in Congress and flipped seven Governors from red to blue.
Will 2022 yield the same results? Early indications were an emphatic “yes”. The question wasn’t whether or not there was going to be a “red wave”, it was what was going to be the size of it. With the economy teetering on recession status, gas prices higher than they’ve been in years, inflation that refuses to cool, mortgage rates nearly doubling, and the stock market hovering in bear territory for the last quarter, economic angst has more than set in. Factor in a sitting President who has approval numbers hovering around 40 for the last year and the environment would appear to have republicans positioned for epic victories at every level.
Enter the Dobbs decision. The Supreme Court overturning Roe v. Wade in June has certainly added an element of doubt into the election forecasts. Right after the June 24th decision the environment shifted. Whether this was a temporary shift or one that will have an impact on November races remains to be seen. The generic ballot shifted from consistently showing preference for republican candidates to voters narrowly choosing a democratic candidate. While there weren’t many non-primary elections that took place after June 24 there were a couple notable races wherein the Dobbs decision played a role. In Kansas an amendment to prohibit abortion was on the ballot. It failed by a sizeable 59-41% significantly outperforming where the polls expected the margin to be. In addition to Kansas there were a couple special elections that took place where the democrat performed substantially better than where the polls had their races pre-Dobbs.
So where does that leave us with less than two weeks before Election Day? Republicans appear to be positioned to easily win the house, and the cascade of recent polls show them having regained the lead in generic ballot tests. Dobbs was four months ago, but economic concerns are omnipresent in every district. All things considered, the environment should still favor Republicans both nationally and in Wisconsin. As the early voting numbers continue to come in, we’ll start to glean a little bit more as to what will happen on Election Day.
Senator Ron Johnson vs. Lieutenant Governor Barnes
To fully understand this race you first have to put it in the context of how it fits into the national landscape. Democrats hold the majority in the Senate by virtue of holding the Presidency and having Vice President Harris accounting for the 51st vote in an otherwise 50-50 split. The Republicans will control the Senate if they net one seat this cycle. The democrats need to break even to hold control but in a perfect world would pick up two seats to avoid having to go through Senators Manchin and Sinema on every vote. Additionally, dems will be on the defensive in 2024 and need to protect as many seats now given likely losses in two years.
Early on many predicted this to be possibly the top US Senate race in the country for both sides but as time has passed that calculus has changed. Toss-ups in Georgia, Pennsylvania, Nevada, Arizona, and potentially close races in a number of other states broadens the playing field and lessens the on Wisconsin. From available polling there are still up to 9 seats in play heading down the stretch, and in an environment where the democrats need to protect the seats they have, the Wisconsin seat is receiving slightly less attention from national democratic players.
Does this mean those national players have given up on Barnes? Not necessarily, but it does strengthen Johnson’s position. Coming into this race Senator Johnson’s favorability was among the worst in the country and he was considered the most vulnerable republican incumbent, but shortly after a Marquette Law School post-primary poll showed Barnes with a 7-point lead Johnson and allies went on the attack. Significantly outspending Barnes and allies defining him with a relentless barrage of negative ads and taking over control of the race. Since that early Marquette poll Johnson has led in every poll since. By aggregating polls, Real Clear Politics has Johnson with a 2.7 point lead and 538, another polling aggregator shows Johnson with a 2.6 point lead and states that Johnson is “favored to win” (76 times out of 100 according to their forecast).
While Barnes and allies will match and perhaps even outspend Johnson in the final weeks, the dye may have been cast early on when Johnson was able to define Barnes with little counter message from allies. At the same time Johnson has also improved his favorability numbers and is rock solid with republican voters. Even if Barnes and allies had perfectly run his campaign the environment as it relates to the economy is likely too much to overcome. Still, with two weeks to go, Barnes is close enough in recent polling to pull it off if the Wisconsin turnout hits the sweet spot of increased vote total in Milwaukee, increased vote totals from new women voters voting on Roe and increased turnout on campus. All realistic goals when you factor in an Obama visit to Milwaukee, evidence of more young women registering to vote in Wisconsin post-Dobbs and rumors of increased turnout efforts on campuses. That said, going into Election Day you would much rather be Johnson than Barnes.
Governor Evers vs. Tim Michels
This race has turned out to be a true toss-up to this point. Neither candidate has been able to establish much of a lead in any of the polling and while the environment certainly favors the challenger, most of the October polling we’ve seen or heard about shows Evers tied or with a narrow lead.
Michels entered the race for Governor months after his established primary opponent, Rebecca Kleefisch had been raising money, building her team and barnstorming the state. Michels was able to use personal wealth combined with a Trump endorsement to quickly close any advantage Kleefisch had, beating her handily on Primary Election Day. Michels runs as an outsider, successful businessman with a blue-collar vibe who wants to put Wisconsin on the right track (as an aside, polling shows the vast majority of Wisconsin voters believe the state is on the “wrong track”). Despite his primary win and previous run for the US Senate, Michels still was largely unknown to voters. Similar to Johnson’s strategy, Evers and allies were aggressive out of the gate running negative ads on Michels. The ads focused predominantly on abortion and Michel’s position on it. Michels advertising in the first few weeks after the primary lagged Evers and this allowed Evers to blunt his post-primary momentum.
The race remains one of the tightest in the country. 538 shows Evers with a .6 lead in their polling and forecast Evers winning 55 out of 100 times. Real Clear Politics has Evers with a 1-point lead using what appears to be an average from the three October polls we’ve seen so far.
Three things I like if I’m Team Evers:
1. Turnout models that show polling under increased turnout scenarios seem to benefit me. If in fact there is an increase of young women voting due to Dobbs (and there is some evidence of this), I should be in a stronger position than where current polls show me.
2. Even with Michels being able to spend millions of his own dollars, I’ve raised record amounts for a Wisconsin democratic gubernatorial candidate and have spent it effectively. The negative attacks on Michels have blunted his momentum and increased his unfavorables.
Three things I like if I’m Team Michels:
1. The current environment is poison for democrats. The two biggest concerns for Wisconsin voters this year are the economy and crime and I have a better story to tell on both. Evers only won by 30,000 votes in a very favorable environment, hard to imagine he can hold on here.
2. Our negative ads are working. Since September Evers’ favorability and job performance numbers are upside down. Factor in Biden’s approval and overall it’s a bad year to be a democrat. Messages on crime that dovetail with Johnson’s attacks on Barnes help us win back some of the suburban women we might have lost because of Dobbs or Trump.
3. Polling shows both in Wisconsin and nationally that republicans are more enthusiastic about voting. If there is higher turnout it could very well be in places that benefit republicans.
Want to Be More Involved in WISCA Advocacy? Join the WISCA Legislative Committee
We are pleased to announce that Jackie McLaughlin – administrator of the Northwoods Surgery Center in Woodruff, WI – has joined the WISCA Legislative Committee. WISCA is thrilled to have her onboard and excited about the knowledge and experience she will bring to the committee as they tackle the ASC community’s biggest legislative and regulatory challenges in Wisconsin.
Despite the exciting addition of Jackie, the Legislative Committee still has a few vacancies, and WISCA is actively recruiting members to serve on this important committee.
The WISCA Legislative committee is responsible for setting and communicating legislative priorities and policy positions that are representative of WISCA’s membership. The committee also works closely with WISCA’s professional lobbying/advocacy team to ensure that state and federal issues important to members are effectively communicated to policymakers.
If you are interested in serving on the WISCA Legislative Committee, please contact he WISCA office at WISCA@badgerbay.co.
Association of Wisconsin Surgery Centers 563 Carter Court, Suite B Kimberly WI 54136 920-560-5627 I WISCA@badgerbay.co
