Author: Andrew Engel - WISCA Lobbyist (Hamilton Consulting)
Gov. Evers gave his third biennial budget address on February 15, unveiling his 2023-25 executive budget. He proposes an operating budget of $103.8 billion over the next two fiscal years. For comparison, the 2021-23 state budget spent $87.5 billion.
The complete budget bill, budget in brief, and other executive budget documents are available here. The governor has also published his prepared remarks and a recording of his address, as well as selected excerpts.
For an overview of the provisions in Gov. Evers’ budget, separated by issue area follow Hamilton Consulting’s 2023-25 State Budget page.
A couple items of note for ASCs, the Governor’s budget did include a full repeal of the personal property tax. A provision we believe will result in savings for many ASC’s should the legislature approve the change.
Additionally, the Governor included additional spending and position authority for the Department of Safety and Professional Services’ (DSPS) in an effort to improve the processing time of occupational license applications.
By law, Gov. Evers’ budget will be introduced as a bill in the Wisconsin Legislature. The Joint Committee on Finance (usually Joint Finance Committee, JFC) will spend several months reviewing and altering the proposal. Based on past experience, we expect the following to happen:
Tony Evers Sworn in for Second Term as Governor
Inauguration Day in Wisconsin took place on January 3. Democratic incumbents Gov. Tony Evers and Attorney General Josh Kaul began their second terms in office, while Sara Rodriguez was sworn in as the state’s new lieutenant governor. Gov. Evers spent the majority of his second inaugural address laying out his administration’s goals and policy priorities for the next four years, including the following statements:
2023-24 Legislature Begins with 31 New Members
Inauguration Day also marked the beginning of the 2023-24 Session of the Wisconsin Legislature, and 31 new members were sworn in, nearly 25 percent of the Legislature’s total membership. Republicans continue to control both chambers of the Wisconsin Legislature with strong majorities. Caucus leadership from both parties has remained mostly the same, while the budget-writing Joint Finance Committee will have five new members.
In the 33-member Senate, there will be seven new members, five Republicans and two Democrats. Sen. Cory Tomczyk (R-Mosinee) will be brand new to the Legislature; the other new members of the Senate previously served in the Assembly. In the 99-member Assembly, there will be 24 new members, 16 Republicans and eight Democrats.
This turnover was almost entirely due to legislators retiring or seeking other offices. Only Rep. Don Vruwink (D-Milton), who was moved into a differently numbered district due to redistricting, lost his bid for reelection. Shortly after the election, Sen. Alberta Darling (R-River Hills) retired, setting up a special election to select her replacement.
Key Issues: State Budget and Tax Reform
With another legislative session comes another biennial state budget bill, and Wisconsin is expected to have a surplus of $6.6 billion when the current biennium ends on July 1.
Late last year, Assembly Speaker Robin Vos said a top priority for him will be for the 2023-25 budget to cut taxes by at least $3.4 billion and possibly “significantly” more. The 2021-23 budget cut income and property taxes by that amount.
During the 2022 election, Gov. Evers said that his upcoming budget proposal will include additional funding for K-12 education and an increase in shared revenue for municipalities. He also proposed an income tax cut of 10 percent for single filers at $100,000 or less and joint filers at $150,000 or less. Gov. Evers will present his executive budget proposal to a joint session of the Legislature on February 15.
Recently, Senate Majority Leader Devin LeMahieu proposed changing the state income tax to a flat rate of 3.25 percent for all taxpayers by 2026. Currently, Wisconsin’s income tax rates start at 3.54 percent and rise to a high of 7.65 percent. Speaker Vos has also indicated he would support a flat tax. Last month, Gov. Evers called a flat tax a “non-starter,” saying “we prefer a progressive tax system that we have now.”
Sign-up to host a legislative tour of your ASC
With the 2023-24 legislative now upon us – and legislators busy at work on critical health care policy – it is more important than ever for WISCA members to strengthen their relationships with their state lawmakers 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. Remeber, decisions state legislators make in the Capitol building 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.
· Legislative Session
Both the State Senate and the State Assembly were on the floor this month, but only dealt with limited calendars. Both houses adopted an amendment to the constitution relating to bail imposed on defendants awaiting trial, as well as a resolution to create an advisory referendum to be held at the April non-partisan election on the issue of whether individuals receiving public assistance should be subject to a work requirement. The proposed constitutional amendment will also go before voters (to approve or deny) in April.
· Protasiewicz with Early Supreme Court Fundraising Lead
The first campaign finance reports for WI Supreme Court candidates were due earlier this month, and Milwaukee County Circuit Court Judge Janet Protasiewicz reported raising $756,000 in the last 6 months of last year, more than doubling her next closest competitors. Waukesha County Circuit Court Judge Jennifer Dorow raised $306,000, former Supreme Court Justice Dan Kelly raised $312,000 and Dane County Circuit Court Judge Everett Mitchell raised $115,000. The four face off in a primary in February, with the top two vote getters moving on to the April General Election. While the Supreme Court is nonpartisan, its members do loosely line up along ideological lines, with Conservatives holding a 4-3 advantage. For Conservatives to maintain their majority, either Dorow or Kelly would need to win the April Election.
· Legislative Republicans circulate Tax Proposals
Legislative Republicans have proposed two bills early this session focusing on tax cuts, fulfilling campaign promises from last fall. Earlier this month, Senate Majority Leader Devin LeMahieu circulated a bill that would phase in a flat tax over the next four years. The State currently has four income tax brackets, and if this bill were to pass, everyone in Wisconsin would be paying a rate of 3.25%, down from 7.65%, which is what taxpayers in the upper bracket are currently paying. Governor Evers has said he does not support this proposal, although he is likely to introduce his own income tax relief proposal in his budget bill.
Republicans have also re-introduced legislation to eliminate the personal property tax in Wisconsin. While Evers vetoed a bill to repeal the personal property tax last session, Republicans hope a compromise on the issue can be reached this session.
· Medicaid Budget Surplus
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.
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:
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.
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.
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.
Association of Wisconsin Surgery Centers
563 Carter Court, Suite B Kimberly WI 54136
920-560-5627 I WISCA@badgerbay.co