For urgent prior authorization requests for fee‐for‐service members, contact ForwardHealth Provider Services at 800‐947‐9627 for assistance with expediting the prior authorization process. An urgent, medically necessary situation is one where a delay in authorization would result in undue hardship for the member or unnecessary costs for Wisconsin Medicaid as determined by the Division of Medicaid Services. In general, urgent requests will receive a response within five business days. Additional information regarding urgent services is available (link).

Note: Prior authorization is not required for emergency services, defined as services that are necessary to prevent the death or serious impairment of the health of the individual. Reimbursement is not guaranteed for services that normally require prior authorization that are provided in emergency situations; those services still must meet all ForwardHealth coverage requirements, including medical necessity.

This Action Alert 08 and others are available on the ForwardHealth website (link).

In response to the COVID‐19 pandemic, ForwardHealth is temporarily altering certain procedures in order to prevent further spread of the disease and effectively treat existing cases. These altered procedures will only be in effect during the public health emergency declared by Governor Tony Evers for the State of Wisconsin under Executive Order 72.

Temporary Phone Number Change for Urgent Prior Authorization Requests

For urgent prior authorization requests for fee‐for‐service members, contact ForwardHealth Provider Services at 800‐947‐9627 for assistance with expediting the prior authorization process. An urgent, medically necessary situation is one where a delay in authorization would result in undue hardship for the member or unnecessary costs for Wisconsin Medicaid as determined by the Division of Medicaid Services. In general, urgent requests will receive a response within five business days. Additional information regarding urgent services is available.

Note: Prior authorization is not required for emergency services, defined as services that are necessary to prevent the death or serious impairment of the health of the individual. Reimbursement is not guaranteed for services that normally require prior authorization that are provided in emergency situations; those services still must meet all ForwardHealth coverage requirements, including medical necessity.

Governor Evers announced today that he be issuing a “Safer at Home” order effective Tuesday, March 24.  Organizations and individuals providing essential care and services will be allowed to continue travelling to and from work.  This includes healthcare professionals, grocers and family caregivers.  The full details of the order to be announced by the Governor’s office.  Everyone else is asked to not take any unnecessary trips, and to limit travel to essential needs such as getting medications and groceries.

This order is based on the advice and counsel of public health experts, healthcare providers and first responders on the front line of our state’s response to the pandemic.  These unprecedented measures are necessary to reduce rate of spread in COVID-19 cases.  We must do everything we can to keep our healthcare systems from becoming overwhelmed, and protect both the public and essential healthcare workers who are taking care of the critically ill.

July 12, Wisconsin Health News

Workers’ compensation premiums for businesses are set to decline by 6.03 percent this October, according to a statement from the Department of Workforce Development.

That could result in an estimated $134 million in annual savings for businesses, the Tuesday statement noted. It’s the third year that workers’ compensation rates have declined, following an 8.46 percent decrease last year and a 3.19 percent decline in 2016.

“A safe workplace results in a more productive and profitable one for employers,” Ted Nickel, insurance commissioner, said in a statement. "Employers are recognizing the relation between their employees' safety and the savings that ensue as premiums continue to decline."

Mark Grapentine, senior vice president of government relations for the Wisconsin Medical Society, said the report shows that “good news keeps coming” for the state’s workers’ compensation program.

“We’re already a national model, with faster return to work, fantastic patient satisfaction and ready access to the highest-quality healthcare in the nation – all at a cost per claim that is below the national average,” he wrote in an email. “Another significant insurance rate reduction is just more evidence that Wisconsin’s system is win-win for both businesses and their employees.”

Grapentine added that there’s room for improvement, pointing to a need for the state’s on-the-job injury rate drop below the national average. He added that healthcare providers are “always striving to find better ways to improve care.”

Chris Reader, director of health and human resources policy, also lauded the announcement. He said the reduction follows a national trend as employers and workers have invested in and focused on safety. But he noted that costs for medical treatment for workplace injuries are on the rise.

“Had Wisconsin enacted a medical fee schedule like almost every other state, medical costs also would have been kept in check and the insurance reduction today would have been even greater," he wrote in an email.

Reader also argued that the rate reduction doesn’t mean much to fully-insured employers who don’t pay insurance costs and are left footing “incredibly high medical bills.”

Proposals to establish a fee schedule haven't gained traction with lawmakers.

Physicians who were previously ineligible for the Public Service Loan Forgiveness program may now qualify under a temporary opportunity announced yesterday by Federal Student Aid. The Consolidated Appropriations Act, 2018 has made possible limited funding on a first-come, first-serve basis for loan forgiveness of some or all payments of Federal Direct loans.

To find out if you are eligible, to learn more about the program or to apply, visit StudentAid.gov. Borrowers with questions also may contact FedLoan Servicing at 855.265.4038 from 8 a.m. to 9 p.m. Eastern time, Monday through Friday.

The Wisconsin Supreme Court heard arguments this morning in Mayo v. Wisconsin Injured Patients and Families Compensation Fund, a case involving a constitutional challenge to Wisconsin’s $750,000 cap on noneconomic damages in medical liability cases (Cap). The case could have far-reaching effects on Wisconsin’s well-balanced, relatively stable medical liability environment.

On July 5, 2017 the Wisconsin Court of Appeals struck down the Cap, concluding that it violates the equal protection rights of plaintiffs in medical liability cases. The Wisconsin Supreme Court subsequently agreed to review the lower appellate court’s decision. On Jan. 18, 2018 the Society, along with the AMA Litigation Center, filed an amicus brief in support of the Cap, explaining its value to patients and the health care community alike. For more background on the Mayo case, see this article from the Oct. 9, 2014 Medigram.

Today’s arguments provided the Court’s seven members with the opportunity to ask questions, follow up on points raised in briefs, including the Society’s amicus brief, and give an indication of their thinking.

“It’s clear from the questions raised today that the Court understands the lengths the legislature went to create a well-balanced, comprehensive medical liability system that provides unique protections for Wisconsin patients and why the cap is essential to that system,” said Society General Counsel John Rather, JD. “We are encouraged with what we heard today and are hopeful the Court will restore the cap.”

The Court spent a considerable portion of the arguments exploring the relationship of the Cap to controlling health care liability and overall health care costs, attracting and retaining physicians and protecting the viability of the Fund.

A decision by the Supreme Court is expected by mid-summer. For more information, contact John Rather, JD. For an in-depth examination of the Mayo case and its implications for Wisconsin health care, listen to Episode 3 of WisMed OnCall, “The Mayo Case and Its Potential Impact,” available here.

March 23, Wisconsin Medical Society Insurance and Financial Services

The Injured Patients and Families Compensation Fund (Fund) Board this week approved a 10 percent decrease in Fund fees for the 2018-2019 fiscal year. This is the sixth decrease approved by the Fund Board in as many years.

Wisconsin’s excellent medical liability environment is good for your organization’s business: money not spent to obtain coverage and settle claims can be allocated to improve quality and the overall patient experience.

Your Wisconsin Medical Society (Society) continues to work vigilantly to preserve Wisconsin’s relatively stable medical liability environment, most recently by filing amicus briefs at both the appellate and Supreme Court level in Mayo v. the Injured Patients and Families Compensation Fund—a case that has challenged the constitutionality of the state’s cap on noneconomic damages in medical liability cases. We are also maintaining our active involvement in the primary insurance market, working with our exclusive partner, ProAssurance. Additionally, the WMS Holdings Risk Purchasing Group and Captive are designed to help health systems decrease liability costs and improve quality and efficiency.

The Society was influential in obtaining this rate reduction through its participation on the Fund Board. This is a great example of how the Society’s advocacy efforts—which the profits generated by Wisconsin Medical Society Insurance & Financial Services help support—benefit the medical community in Wisconsin.

Doctor Day 2018 is fast approaching and it’s important that physicians like YOU participate in our annual advocacy event in Madison on Tuesday, Jan. 30. 

It’s a full day of speakers, issue briefings and a visit to the Capitol to advocate on behalf of your profession. The day will conclude with a reception at DLUX.  The tentative schedule and online registration can be found at widoctorday.org. The event is free to all physicians and medical students thanks to very generous support from sponsorship organizations. 

Each year, Doctor Day attendees hear from some of the leading voices in Wisconsin politics and health care policy. We’re awaiting final confirmation from speakers, but physicians attending Doctor Day 2018 will enjoy the same high-level experience. Also, our speakers will update physicians on health care issues still under debate in the State Capitol. The January 30 meeting date coincides nicely with the final days of the state legislature’s activity, and therefore puts physicians in policymakers’ offices at the best time to maximize impact on the issues physicians care about. 

Physicians also will hear the latest regarding Wisconsin's cap on noneconomic damages in medical liability cases—currently being heard by the Wisconsin Supreme Court. One of the state’s top medical liability attorneys, Guy J. DuBeau, will explain how a lone case—tried in Milwaukee County—left Wisconsin with no limit on noneconomic damages and what physician organizations are doing to fix that problem. 

Staff and committee members will take care of every detail—from breakfast, briefings, speakers, lunch and scheduling your visits with legislators to the reception at the end of the day! 

Please consider joining us for a great day of advocacy on behalf of your profession and your patients!  Register now on the Doctor Day website.

December 6, Wisconsin Health News

The Department of Health Services has accepted the resignation of Medicaid Director Michael Heifetz, who is leaving for the private sector, according to a statement.

Heifetz, who also serves as administrator of the Division of Medicaid Services, will leave the department Dec. 13. Deputy Administrator Casey Himebauch will serve as the division's interim leader.

“Michael has been invaluable in his role as Medicaid director, representing Wisconsin’s vision for the future in the national spotlight,” DHS Secretary Linda Seemeyer said in a statement. “We will greatly miss his leadership and insight, as well as his candor and energy.”

A DHS spokeswoman said that Heifetz is "pursuing career opportunities" in the private sector. She did not respond to a question asking for more specifics.

Heifetz joined the department as Medicaid director in September of last year. He previously served as state budget director. Before that, he was vice president of governmental affairs at Dean Clinic and SSM Health of Wisconsin.

Heifetz has also left his position on the Group Insurance Board and was replaced by State Budget Director Waylon Hurlburt in October.

The legislature is considering legislation based on proposals from the Workers Compensation Advisory Council.  The proposals were developed Labor and Management representatives on the Council.  But not all of the proposals share the support of the Council’s health care representatives, including a recommended fee schedule.  Health care organizations will need to be even more active this session than last to again defeat the fee schedule proposal.

It is important to note that works compensation premiums have dropped – without a government mandated fee schedule.  This year alone, employers received an 8.46 percent reduction in their worker’s compensation insurance premiums, saving employers an estimated $170 million.  At the same time, Wisconsin’s health care system continues to lead the nation in outcomes with injured employees returning to work a full three weeks earlier than the national average.  And health care costs per worker’s comp claim lower than the national average.

Your calls are needed to both the State Assembly and State Senate to explain why the proposed health care fee schedule could harm Wisconsin’s model worker’s compensation system. Entering your address under "Who Are My Legislators" on the State Legislature’s website to locate their contact information.

Let your State Representative and State Senator know you are a physician in their district, serving patients who are also constituents and that you are opposed to an artificial fee schedule for a worker’s compensation system that provides the nation’s best care at a below-average worker’s compensation cost.  Thank you for your time and action on this important issue.