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.

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:

• Extraordinary Circumstances Exceptions for ASCQR Program
  ASCA has heard from several of its members who were unable to submit their ASC Quality Reporting (ASCQR) Program data by the May 15 deadline. As a reminder, in the event that your ASC was unable to submit any required information due to an extraordinary circumstance, your ASC may request an exception. To request an exception, you must submit a completed Extraordinary Circumstances Exceptions form with any required information and supporting documentation within 90 calendar days of the missed deadline. These documents must be submitted to the ASC Support Contractor via one of the following:

Contact Kara Newbury with any questions.

• OPPS/ASC Proposed Rule
  ASCA expects the CY 2024 OPPS/ASC Proposed Rule to be released either the week of July 3 (following the July 4 holiday) or 10. ASCA will provide a quick review of the proposed rule on the next call on Tuesday, July 18.

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!

Although most of the activity the State Capitol is currently focused on the 2023-25 state budget bill – the state’s two-year spending plan – lawmakers are still working on stand-alone legislation, 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.

Earlier this month, the Wisconsin Legislature passed legislation (Assembly Bill 245), which was subsequently signed by Gov. Tony Evers, to eliminate the state’s personal property tax. WISCA considered elimination of the personal property tax a top legislative priority, as the antiquated tax was an unnecessary financial and administrative burden for surgery centers across Wisconsin.

The personal property tax was initially implemented in the 1830’s, before Wisconsin was a state, to fund the territorial government. At the time, Wisconsin did not have an income or sales tax. Lawmakers have been chipping away at the personal property tax for decades, and the passage of AB 245 – a sweeping bipartisan bill that also provides an increase in state funding to local governments – finally completes the job in abolishing the tax.

Senator Dan Knodl (R-Germantown), who spearheaded efforts to eliminate the tax, said, “With this legislation signed into law, the personal property tax has been finally eliminated. I have been working towards this moment throughout my time in the legislature and it is such a relief knowing this tax will no longer burden our small business owners.”

Previously, when a business purchased an item (i.e., personal property), not only did they have to pay sales tax on it, but they also had to pay personal property taxes on the item for as long as they owned it. Under the new law, Wisconsin businesses – including ASCs –  will receive long-overdue tax relief. 

Author: Andrew Engel – WISCA Lobbyist (Hamilton Consulting)

On June 15, JFC approved a motion on the Department of Health Services, including the following provisions:

• Funds Medicaid cost-to-continue ($113 million GPR in FY 24 and $240 million GPR in FY 25)
• Increases hospital reimbursement rates ($8.7 million GPR in FY 24 and $17.8 million GPR in FY 25)
• Increases primary care provider reimbursement rates for evaluation & management procedure codes to 70% of Medicare rates
• Increases the maximum Disproportionate Share Hospital (DSH) allocation from $47.5 million to $71.6 million
• Provides parity for chiropractic services to physician rates for all procedure codes for which both a chiropractor and physician are allowed to claim reimbursement
• Prohibits MA payment for puberty-blocking drugs or gender reassignment surgery
• Provides $15 million GPR to increase direct care and services portion of MCO cap rates for direct care & services

The DHS budget motion also included a requirement for Family Care, Partnership and PACE MCOs to report information on their executive leadership salaries and the amounts retrieved by the state under contractual risk corridors. It requires MCOs and DHS to track and annually report to the legislature the total authorized and provided care plan hours by service category and MCO.

The motion from Republican leaders did not include the 12-month Medicaid extension for postpartum women requested by Gov. Evers and many interest groups. Despite broad bipartisan support, Assembly Republican leadership remains opposed to this policy.

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:

• COVID-19 Public Health Emergency

The Biden administration allowed the official declaration of a public health emergency (PHE) due to the COVID-19 pandemic to expire on Thursday, May 11, 2023. Numerous waivers expired along with the PHE declaration, including the Hospitals Without Walls initiative that allowed ASCs to bill as hospitals. About 100 ASCs had enrolled in the program, and ASCA has yet to hear of any facilities that plan on formally enrolling as hospitals.

ASCA expects the Centers for Medicare & Medicaid Services (CMS) to release more guidance regarding removing survey requirements due to the expiration of the PHE, particularly in its 2024 OPPS/ASC Payment Rule.

• Medicare Enrollment

ASCA understands that many facilities are experiencing delays in receiving their initial CMS Certification Numbers (CCN) and Provider Transaction Account Numbers (PTAN). ASCA staff is scheduled to speak with CMS about this issue.

Author: By WI Senator Rachael Cabral-Guevara (R-Appleton)

As a healthcare provider myself, I’ve seen firsthand the dramatic changes the industry has gone through in the last two decades. Digitization, growth in specialty care, and diversification of service models have all helped advance how providers deliver care to patients.

Then a pandemic hit. This dramatically increased burnout, wore on the mental health of staff, and others simply left because of overburdensome restrictions. As a result, the entire healthcare system is still reeling from historic drops in staffing levels, with the pipeline of students entering the profession not keeping up with demand.

Hospitals are now relying on traveling nurses, who can come at a cost almost three times as much as nursing staff. Nursing homes, who were struggling to recruit before the pandemic, are now closing entire wings of their facilities. Meanwhile, the shortage of providers in rural areas remains an issue and the pace of attracting professionals to Wisconsin has been slow.

What can be done? As chair of the Senate Committee on Health this session, I’ve made it my mission to address these workforce issues head-on. There is no “silver bullet” solution–both investment and regulatory reform is necessary to improve Wisconsin’s nation-leading healthcare system.

I’m focused on three specific areas to achieve this:

• Boosting the attractiveness of healthcare professions to students. By highlighting healthcare professions and the rewarding nature of care, we can and should do a better job encouraging internships and other work-based learning programs for students to be exposed to healthcare. We also have opportunities to offer some loan forgiveness for our highest-need professions, reducing the financial burden on those who wish to pursue a career in the field.

• Streamlining the school-to-work pipeline. I’ve proposed letting students who have completed their education and training to enter the workforce without waiting on a bureaucratic process that–in some cases–can last months. This would keep students here after college, allow them to enter the workforce immediately, and so long as their employer consents, start treating patients.

• Allowing healthcare professionals to practice at the full extent of their scope. This includes our nurses, who are now operating in an environment that hinders their ability to practice independently. By unleashing this group of healthcare professionals, we can help solve two issues: attract more nurses to Wisconsin (which is desperately needed) and expand the pool of providers able to set up shop in areas that need it most.

Though we can and should do more than this, we need to start somewhere. This is our opportunity to break down barriers, build a robust patient-focused system, and deliver more accessible care to Wisconsinites.

Let’s keep moving forward!

Sen. Rachael Cabral-Guevara (R-Appleton) served one term in the state assembly and currently represents the 19th Senate District in the Wisconsin State Senate. She serves as chair for the Senate Committee on Health and Vice Chair for the Senate Committee on Mental Health, Substance Abuse Prevention, Children, and Families.

The 2023-24 legislative session is in full swing, and although the state budget bill is consuming most of the attention and activity in the State Capitol, numerous stand-alone bills are being introduced and considered by lawmakers. The WISCA Government Affairs Team – helmed by Andy Engel at Hamilton Consulting – is actively lobbying on legislation of interest to WISCA members.

Members can follow the activity in the Capitol with the WISCA Legislative Tracker that provides key information on the bills WISCA is working on under the Capitol dome. The Bill Tracker, which you can find below, includes the bill number, a description of the bill, its status, and WISCA’s position on the proposal:

·        Bill: Assembly Bill 144 / Senate Bill 158

• Description: This legislation, which aims to expedite occupational licensing in Wisconsin, would require the state to grant preliminary occupational credentials to health care professionals. More specifically, the bill requires the Department of Safety and Professional Services to grant a preliminary credential to an individual who has met all the requirements for a permanent credential, including having completed all education, training, and supervised experience requirements. In addition, an applicant for a preliminary license must also: 1.) Attest that they do not have a disqualifying arrest or conviction record; 2.) Verify that the position they have been hired for is within the scope of their practice; and 3.) Confirm that they have applied for a permanent credential. Finally, the health care employer that hired the applicant must verify that the individual has – to the best of the health care employer's knowledge – completed the required education, training, and supervised experience necessary for a permanent credential. 

·     Status: AB 144 was introduced and referred to the Assembly Regulatory Licensing Reform Committee. The committee held a public hearing on the bill on 04/12/23. SB 158 was introduced and referred to the Senate Committee on Licensing, Constitution, and Federalism.

·     WAO Position: SUPPORT

The WISCA Government Affairs Team  is also closely watching legislation (AB 245 / SB 301) to eliminate the personal property tax in Wisconsin. The proposal, which is supported by WISCA, was passed by the full Assembly and is under further consideration by the Senate.

WISCA will continue to monitor these proposals and report back to the membership on their status in future editions of the WISCA Advocacy Newsletter.