Governor Evers and Wisconsin Department of Health Services (DHS) Secretary-designee Andrea Palm today exercised their authority under Article V, Section 4 of the Wisconsin Constitution and Sections 323.12(4) and 252.02(6) of the Wisconsin Statutes to simplify healthcare license renewals during the COVID-19 public health emergency and to encourage recently retired professionals with expired licenses to re-enter practice. This full order is available online (link).

The order includes the following policy changes:

Interstate Reciprocity: allows any out-of-state health can provider licensed and in good standing to practice in Wisconsin without a Wisconsin credential. The order requires the out-of-state physician to apply for a temporary or permanent Wisconsin license within 10 days of first working at a Wisconsin health care facility; and the health care facility must notify DSPS within 5 days. The order temporarily suspends the visiting physician practice limitations in Med 3.04. 

Temporary License: Any temporary licensed to an out-of-state provider during the emergency will be valid until 30 days after the conclusion of the emergency. 

Telemedicine: Allows physicians licensed and in good standing in Wisconsin, another U.S. state or Canada to provide telemedicine services to Wisconsin residents. 

Physician Assistants: Suspends several current rules regulating the practice of PAs in Wisconsin. This includes: the requirement of PAs to notify the MEB of changes to their supervising physician within 20 days (order changes it to 40 days); the requirement that PAs limit their scope of practice to that of their supervising physician (the order allows them to practice to the extent of their experience, education, training and abilities. It also allows them to delegate tasks to another health provider); the physician to PA ratio of 4:1 (the order allows a physician to oversee up to 8 on-duty PAs at a time, but there is no limit on how many PAs a physician may provide supervision to over time. It also allows a PA to be supervised by multiple physicians while on duty). 

Nurse Training and Practice: The order suspends many rules related to nursing. This includes suspending a rule that prohibits simulations from being utilized for more than 50% of the time designated for meeting clinical learning requirements. It also suspends the requirement for nurses to submit an official transcript in order to get a temporary license and allows a temporary license to remain valid for up to 6 months. In addition, it suspends the rule requiring license renewal within 5 years. 

Advanced Practice Nurse Prescribers: Temporarily suspends the requirement that Nurse Prescribers must facilitate collaboration with other health care professionals, at least 1 of whom shall be a physician or dentist.

Recently Expired Credentials: Requires the state to reach out to individuals with recently lapsed credentials about renewal options. The order also suspends many of the late renewal fees and continuing education requirements for most health professions. The order temporarily suspends MED 14.06(2)(a) to allow a physician whose license lapsed less than 5 years ago to renew without fulfilling the continuing education requirements. It also suspends RAD 5.01 (1) and (2) to allow radiographers or LXMO permit holders who have let their license lapse renew without completing continuing education. 

Fees: The order also gives DHS the ability to suspend fees or assessments related to health care provider credentialing. 

The order is effective immediately and will remain in effect through the duration of the public health emergency.

The full version of the Governor’s press release is available online (link).

Governor Evers released a 65-page draft piece of legislation and a draft joint resolution on Saturday night aimed at addressing COVID-19. The Governor also released a chart outlining the proposal.  The Legislative Fiscal Bureau also provided a Summary of provisions of Governor Evers’ proposed legislation and Joint Resolution indefinitely extending public health emergency to state legislators.

The bill includes several healthcare provisions, including language related to out-of-network bills that occur during the public health emergency. The language caps physician payment rates at 250% of the Medicare rate.

Insurance 

• Prohibits health plans from charging patients more for out-of-network services related to the diagnosis and treatment of the condition for which a public health emergency has been declared than they do for in-network services (if an in-network physician is not available).
• The bill requires the plan to reimburse the out-of-network provider at 250% of the Medicare rate. Providers and facilities are prohibited from charging patients more than what they are reimburse by the plan. 
• Creates a process for out-of-state physicians to have liability coverage in Wisconsin during a public health emergency. They would need to provide OCI with a certificate of insurance for a policy of health care liability insurance issued by an insurer that is authorized in a jurisdiction accredited by the National Association of Insurance Commissioners. 
• Requires health plans to cover without cost-sharing any testing, treatment or vaccines related to COVID-19.
• Requires health plans to cover any services provided via telehealth if they cover that service when it is provided in-person. 
• Prohibits health plans from canceling policies due to non-payment during the COVID-19 emergency 
• Prohibits health plans and pharmacy benefit managers from requiring prior authorization for any early refills of prescriptions or restricting the period of time in which a drug may be refilled. 
• Creates a process for pharmacists to extend prescription orders by up to 30 days during public health emergencies. 

Emergency Preparedness 

• Provides $300 million to the Department of Military Affairs to respond to the public health emergency. 
• Provides $200 million to the Department of Administration to respond to the public health emergency. 

Health 

• Creates a public health emergency fund for the Department of Health Services.
• Provides $100 million for a new health care provider grant program specific to planning, preparing for and responding to COVID-19. 
• Provides $17.4 million to local health departments. 
• Creates 64 positions within the Department of Health Services’ Division of Public Health.
• Allows DHS to suspend any premium or cost-sharing requirements for childless adults on BadgerCare in order to qualify for enhanced federal Medicaid matching funds related to COVID-19.  
• Exempts the Department of Health Services, during a public health emergency, from the current law legislative review requirements for submitting waiver requests to the federal government, amending the state Medicaid plan or raising Medicaid reimbursement rates.  
• Expands the definition of public health emergency to include toxins or other threats to health. 

Health Care Workforce 

• Allows former health care providers to receive a temporary license to provide services during a public health emergency. This would apply to physicians, nurses, PAs, dentists, pharmacists, phycologists, social workers and other health providers who have practiced within the last 5 years but do not currently have a license. The temporary license would be valid until 90 days following the conclusion of the health emergency. 
• Allows out-of-state health care providers to receive a temporary license to practice in Wisconsin. The temporary license would be valid until 90 days following the conclusion of the health emergency.
• Allows the state to waive licensure fees for physicians, physician assistants, nurses, dentists, pharmacists, psychologists, and certain behavioral health providers. 
• Exempts certain health care provider credentials issued by credentialing boards in DSPS from having to be renewed during the public health emergency. 

Unemployment Insurance

• Eliminates the one-week waiting period for Unemployment Insurance

Voting

The bill contains several provisions related to voting during public health emergencies. Specifically, for elections held during a declared public health emergency, it would: 

• Require elections held during public health emergencies to be held by mail. 
• Waive the state’s Photo ID requirement.
• Waive the requirement that mail-in absentee ballots need a witness signature.
• Allow mail-in ballots to be counted as long as they are postmarked by Election Day.
• Allow voters to register electronically until 5 days before the election.

Governor Evers directed the Wisconsin Department of Health Services (DHS) Secretary-designee Andrea Palm to temporarily order the suspension of evictions and foreclosures amid the COVID-19 public health emergency. The full order is available online (link).

The order prohibits landlords from evicting tenants for any reason unless failure to proceed with the eviction will result in an imminent threat of serious physical harm to another person and mortgagees from commencing civil action to foreclose on real estate for 60 days. Wisconsinites who are able to continue to meet their financial obligations are urged to do so. This order does not in any way relieve a person's obligation to pay their rent or mortgages.

The full press release is available on the Governor’s website (link).

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.