Author: Andrew Engel – WISCA Lobbyist (Hamilton Consulting)
On August 1st, 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 RuleOn 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 RuleCMS 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.
With work on the 2023-25 state budget bill – the state’s two-year spending plan – wrapped-up, state lawmakers have turned their attention to hundreds of pending stand-alone 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.
According to a recent report from the Wisconsin Department of Health Services, the state’s Medicaid program finished the 2021-23 budget biennium, which ended on June 30, with a projected $875.5 million surplus. The projected surplus is $79.1 million more than what DHS projected earlier this year and is due to numerous factors, including lower costs for prescription drugs and long-term health care. After the exact amount of the surplus is confirmed at the of this month, the additional funds will be transferred to the state’s general fund.
Earlier this month, Gov. Tony Evers signed the $99 billion state budget bill sent to him by the GOP-controlled Legislature, but not before using his powerful veto pen to make 51 vetoes to the two-year spending plan for the state.
One of the Governor’s vetoes eliminated $3.3 billion in income tax cuts approved by lawmakers. Primarily because of this veto, the state of Wisconsin is projected to have a balance of more than $4 billion at the end of the 2024-25 fiscal year. Prior to Evers vetoes, the projected balance was $588 million.
Republican lawmakers are expected to send another tax cut to the Governor via a stand-alone bill prior to the end of the 2023-24 legislative session.
Republican Paul Melotik (R-Grafton) defeated Democrat Bob Tatterson (D-Mequon) in a special election held on July 18 to fill the vacant 24th Assembly District –which includes portions of Ozaukee, Washington, and Waukesha Counties.
Melotik won the historically Republican-leaning district with 53.7% of the vote, compared to Tatterson’s 46.3% vote total. The Melotik victory gives the GOP a 64-35 majority in the 99-member Assembly.
Melotik, an accountant, small business owner, and former local official who has served on the Ozaukee County Board and Town of Grafton Board, will replace Dan Knodl (R-Germantown) in the Assembly. Knodl was elected to the state Senate (8th Senate District) in an April 4 special election.
Contact Kara Newbury with any questions.
As usual, summer is going by fast. Before we know it, it will be August. And of course, August is National ASC Month, which gives surgery centers a special opportunity to highlight their achievements and the value they offer to patients, businesses, and communities throughout Wisconsin and across the country.
For 2023 National ASC Month, WISCA is urging members to help celebrate by hosting tours of their facilities for their local state lawmakers. Hosting a facility tour offers a chance for state legislators to learn about the impact and benefits of ASCs directly from their constituents and businesses in their districts. They allow lawmakers to see firsthand the value of patient care provided in an ASC setting.
Numerous WISCA members have already hosted successful legislative tours over the last few years, but we would urge you to seize the opportunity provided by National ASC Month to maintain the momentum for this critical grassroots advocacy program and invite your local lawmakers to your facility.
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 full support, including legislator bios, advocacy tips, issue briefings, and supporting documents. In other words, the work will be minimal on your end. Please SIGN-UP TODAY!
Association of Wisconsin Surgery Centers 563 Carter Court, Suite B Kimberly WI 54136 920-560-5627 I WISCA@badgerbay.co
