Earlier today (Nov. 14), WHA’s Public Policy Council met with full attendance for a discussion with staff leadership from Governor Tony Evers’ administration and to have a robust conversation focusing on state and federal regulatory reforms related to professional licensure, value-based purchasing arrangements and promptpay discounts for patient cost-sharing obligations.
WHA President/CEO Eric Borgerding welcomed Maggie Gau, Chief of Staff to Gov. Evers, and Wisconsin Department of Health Services Deputy Secretary Julie Willems Van Dijk as guest speakers to the Council. Gau discussed the first year of Gov. Evers’ first term in office, including the work it took post-election to get the Governor’s office established and create a state budget.
“We all have a health care story,” Gau said. “It’s what makes the work you [hospitals] do so important. We have built the finest team to support the work you all are doing.”
Gau thanked WHA for being a real champion for health care and for the regular communication during the biennial budget process. She specifically praised WHA’s work on telehealth improvement legislation, which is currently awaiting the Governor’s signature. “This bill is exactly what the Governor has asked for from the Legislature,” Gau said, praising the bipartisan nature of the bill.
Willems Van Dijk, who appeared before both the WHA Public Policy Council and the WHA Board of Directors earlier this year, provided the Council with an update regarding implementation of the state budget – including significant funding for key WHA priorities like the Medicaid Disproportionate Share Hospital program, behavioral health reimbursement increases, addressing needs related to post-acute care for patients and establishing a “hub and spoke” system to provide more comprehensive care for those trying to escape drug dependency.
Willems Van Dijk also discussed the Department’s work coordinating with CMS to implement a Sec. 1115 demonstration waiver scheduled to take effect. Elements of this waiver include a monthly premium payment requirement for childless adults in Wisconsin’s Medicaid program, as well as a co-pay if a Medicaid patient presents to an emergency department with utilization that may be deemed inappropriate emergency care. Willems Van Dijk said the Department expects to implement these provisions by Feb. 1, 2020.
WHA Sees Rapid Progress on Several Key Legislative Priorities
As reported by Willems Van Dijk, Borgerding further updated the Council on recent news from Gov. Evers’ administration related to reimbursement improvements on key WHA priorities. While the Department has laid out its framework for these reimbursement priorities, DHS plans to work with WHA to further flesh out details.
WHA Senior Vice President of Government Relations Kyle O’Brien also briefed the Council on recent activity occurring quickly in the Legislature, including WHA-led legislation to reauthorize Wisconsin’s participation in the Interstate Medical Licensure Compact, significant reforms to Medicaid’s telehealth policies and new legislation enabling advanced practice clinicians to make certain determinations and diagnoses alongside physicians to effectuate an individual’s advance directive.
Jon Hoelter, WHA director of federal and state relations, provided even more details regarding WHA’s work on telehealth, discussing the process to move legislation from its origins in WHA’s Telehealth workgroup to a product that finally passed the Assembly and Senate last week. The bill now awaits the signature of Gov. Evers, who is expected to sign the bill into law. Hoelter also commented about the new ways WHA deployed its grassroots advocacy network HEAT (Hospital Education & Advocacy Team) on this telehealth legislation.
“Considering we are in a new era of significant political divisiveness and disagreement, we have worked hard to keep WHA’s priority issues above the political fray,” Borgerding commented. “We are grateful to our legislative partners, both Republican and Democratic lawmakers, for working together to move forward on impactful health care policy.
“I’ve always said that in health care, good policy makes good politics. Never has that been more true than it is today,” Borgerding said.
O’Brien and Borgerding also briefed the Council on legislation circulated earlier this fall creating new state-level regulations related to post-discharge care for patients. O’Brien called the legislation an unnecessary burden on hospitals and their health care workforce, as Wisconsin hospitals lead the country in patient satisfaction scores related to discharge planning. WHA lobbied aggressively against the legislation, correcting misinformation being spread by the bill’s advocates and making sure legislators understood how hospitals are strong partners in ensuring discharged patients succeed in their care plan.
WHA Focus on Improving Physician, Provider Licensure Processing Gaining Momentum
WHA Vice President of Workforce & Clinical Practice Ann Zenk presented to the Council on WHA’s efforts to work with the state’s Department of Safety and Professional Services and the Wisconsin Medical Examining Board to develop metrics that identify and proactively address delays in physician licensure processing. Zenk said that WHA has proposed rethinking the way the licensure board or staff determine which actions by an applicant require further legal or liaison review. In addition, Zenk encouraged Council members to provide feedback on other areas of focus or alternative changes WHA’s government relations team might present to the state for consideration.
Council members supported the approach of targeted improvement. Council members also emphasized the critical nature of licensure as only the initial step in a physician being added to the health care workforce. Until a Wisconsin license is granted, the physician cannot be issued a DEA number or be credentialed by payers.
CMS Seeks Comment on Significant Changes Related to Federal Stark Law, Anti-Kickback Statute
Hoelter also discussed recently proposed rules from the Centers for Medicare & Medicaid Services (CMS) to reform regulations related to the Stark Law and Anti-Kickback Statute (AKS), both cited as barriers to enable providers who want to enter into contracts that take on financial risk or patient incentives to receive appropriate care.
In its proposed regulations, CMS has identified new exceptions and “safe harbors” for providers to consider as they look at becoming part of a value-based enterprise or value-based purchasing arrangement. These safe harbors depend on, among other things, the level and type of financial risk assumed by a health care provider.
Hoelter solicited feedback from the Council in preparation for WHA’s comments to CMS, due by the end of 2019, focusing on whether the proposed changes would help hospitals – regardless of their decision to join a valued-based payment arrangement. Hoelter also requested feedback from Council members regarding areas that CMS may have missed in their proposed changes.
All WHA members are encouraged to contact Jon Hoelter
with any additional feedback or questions regarding to Stark/AKS proposed changes.
Council Supports Aligning State Law with Federal Law Regarding Prompt-Pay Discounts
WHA’s Laura Leitch led a conversation with Council members regarding the complex interplay between federal and state statutes and regulations that have caused some confusion regarding a health care provider’s ability to offer patients a discount for cost-sharing obligations paid timely.
Leitch provided Council members with background regarding a relevant Wisconsin statutory provision and the original intent of that provision. Leitch also discussed letters exchanged between a Legislator and the WI Attorney General in 2004. In his letter, the Legislator made the point that a prompt-pay discount would not be the health care provider offering an inappropriate inducement for the patient to receive health care services, but rather an inducement for the patient to pay the bill in a timely manner, thereby reducing collection costs.
In addition, Leitch discussed the federal Anti-Kickback Statute, an AKS safe harbor, and an Office of the Inspector General Advisory Opinion from 2008 that laid-out the safe harbor conditions and other features that would allow the requesting health care provider to implement a prompt pay discount program for the purpose of more successful bill collection.
Leitch then described proposed legislation that would clarify state law to help health care providers trying to navigate the potential inconsistencies between state and federal law and other guidance and asked for comments from Council members.
For questions or comments, contact Laura Leitch