WHN; June 28, 2023

A Senate committee voted unanimously Tuesday to advance a plan that would extend Medicaid postpartum coverage to a year. 

Currently, the program offers 60-day postpartum coverage to those making a little more than three times the federal poverty level. Federal officials are considering a request by the state to bump that to 90 days. 

All five members of the Committee on Insurance and Small Business voted by paper ballot to recommend passage of the yearlong extension. The bill has the support of 72 legislators and a number of healthcare organizations. It received a public hearing in March.  

“Postpartum care, including recovery from childbirth, follow-up on pregnancy complications, management of chronic health conditions and addressing mental health concerns, is essential to increasing positive health outcomes for mothers and babies, and often requires follow-up beyond the current 60-day period,” bill author Sen. Joan Ballweg, R-Markesan, wrote in testimony submitted at the public hearing. “This is especially true for pregnant women of color, who experience large disparities in maternal mortality before and after childbirth.” 

Assembly Speaker Robin Vos, R-Rochester, said at a Wisconsin Health News event in mid-June that he opposes the extension, in part because he wants to encourage people to leave Medicaid as soon as possible and enter the private insurance market.

Last week the Joint Committee on Finance voted to increase funding for MA reimbursement rates for ED physician services to 40% of Medicare rates. This is another needed increase to get Wisconsin in line with the rest of the United States! The budget will be approved in the next couple of weeks by the legislature and then go to the Governor. We expect the legislature to sign off and the Governor to ultimately approve (as he proposed an increase in his executive budget). So unless there is a full veto of the entire budget, we expect this increase to be implemented as of January 1, 2024 (still need to confirm after budget process) and the new rate will continue going forward.

This is another huge win for Emergency Medicine! Thank you to the WACEP Legislative Committee, Chaired by Dr. Lisa Maurer and WACEP’s Lobbying team Greg Hubbard, AJ Wilson and Dan Romportl at HWZ for their continued advocacy on this important issue.

Hubbard Wilson & Zelenkova

The State Budget process is moving forward. To date, the Joint Finance Committee (JFC) has taken on mostly low hanging fruit as a local funding (shared revenue) and local taxation stand-alone bill is being negotiated separately.  The local funding increase will have impacts on the rest of the state budget, so until that is resolved, bigger ticket items like MA and DHS will likely wait.   Either way, we expect MA and DHS to be voted on in the next two weeks or so.   Typically, JFC budget deliberation wraps up in early to mid-June and the legislature takes up the budget in the subsequent two weeks.   We still expect that to be roughly the case and hopefully the Governor will be signing a new 2023-25 budget into law in early July.   

Specific Issues

Emergency Physician Medicaid Reimbursement Increase:   As you recall, Gov. Evers proposed an executive budget that included a significant increase MA reimbursement for emergency physician codes.  The intent of the Governor’s provision is to increase overall emergency physician services reimbursement rates to 50% of Medicare.  This is part of the biennial budget bill and deliberations.  We are actively lobbying all members of the Joint Finance Committee and will continue to do so to include the Governor’s proposed increase in the final version of the budget.  

APRN /Nurse Independent Practice and Physician Title Protection:  The Senate Health Committee had a hearing on both SB 143 and SB 145 last week (APRN license/independent practice and Physician Title Protection).   This hearing was arguably premature as negotiations continue between stakeholder, key legislators, and the governor’s office.   As a coalition we continue to fight for four years of clinical experience before an APRN can practice independently, physician title protection, guardrails on APRN pain practice, and ED requirements.  As you recall, our advocacy resulted in the Governor including the following language in his executive budget proposal which he deems part of an overall deal on APRN:  50.36 (3s) of the statutes is created to read:  50.36 (3s) The department shall require a hospital that provides emergency services to have sufficient qualified personnel at all times to manage the number and severity of emergency department cases anticipated by the location. At all times, a hospital that provides emergency services shall have on-site at least one physician who, through education, training, and experience, specializes in emergency medicine.

We know that the WI Hospital Association is opposed to this language, as is the APRN senate bill author, so it is an uphill battle.  But we continue to work to keep this important provision on the table. 

Post-partum 12 Month Medicaid Extension:  WACEP is part of a coalition working to extend post-partum benefits to twelve months.  This provision was contained in the Governor’s budget and is also being circulated as stand-alone legislation by republican legislators as LRB 1377/1 and LRB 0324/1 authored by Senators Joan Ballweg and Mary Felzkowski and Representatives Donna Rozar and Tony Kurtz.

SB 205/AB 173: Suicide Prevention Grants:  WACEP also registered its support for this bill, authored by Sen. Jesse James and Rep. Shae Sortwell, that requires the Department of Health Services to award grants to  organizations or coalitions of organizations, including cities, villages, towns,  counties, and federally recognized American Indian tribes or bands, for 1) training staff at a firearm retailer or firearm range on how to recognize a person that may be considering suicide; 2) providing suicide prevention materials for distribution at a firearm retailer or firearm range; or 3) providing voluntary, temporary firearm storage for the lawful owner of a firearm. A grant recipient must contribute matching funds or in-kind services having a value equal to at least 20 percent of the grant amount.

Healthy Climate Wisconsin invites you to sign onto three letters that support "Solutions for Pollution". 

Read additional information here: https://www.wiclimatehealth.org/epa 

If you wish to sign on, please click here: https://www.wiclimatehealth.org/support-clean-air

The deadline is Friday, June 16th

WACEP and more than 400 other national, state, and local medical, public health, and research organizations sing on urging Congress to support funding for gun violence prevention research. The letter urges support providing $35 million for the Centers for Disease Control (CDC), $25 million for the National Institute of Health (NIH), and $1 million for the National Institute of Justice (NIJ) for firearm morbidity and mortality prevention research as part of FY 2024 appropriations. This research is critical for developing a comprehensive, evidence-based approach to reducing firearm-related violence, including suicides, violent crime, and accidental shootings.

Read the full Letter

WACEP, along with other organizations representing thousands of WI physicians urge legislators not to cosponsor LBR 0589 - APRN Legislation as drafted. 

Read full memo here. 

FEBRUARY 16, 2023

WISCONSIN EMERGENCY PHYSICIANS (WACEP)STATEMENT ON EXECUTIVE BUDGET PROPOSALS

The Wisconsin Chapter of the American College of Emergency Physicians commends Governor Evers for an executive budget proposal that prioritizes patient safety, care, and numerous health care needs for Wisconsin residents and providers.

The Governor’s proposed budget provides a significant and desperately needed increase to Medicaid rates that will help patients, facilities, and emergency physicians continue to provide the vital emergency services our communities expect.

Additionally, emergency departments across Wisconsin are regularly on the frontline of mental health crisis care. WACEP strongly supports the significant investment in mental health initiatives that will benefit our youth, our veterans, and all of our state residents. Funding for Crisis Urgent Care, Youth Crisis Stabilization Facilities, and 988 Suicide and Crisis Lifeline, among numerous other proposals, are vital investments in the well-being of Wisconsinites.

WACEP physicians are available 24 hours a day, 365 days a year to provide care regardless of the severity of a patient’s condition or a patient’s ability to pay. We thank the Governor for his recognition of our work and the needs of Wisconsin residents. We look forward to working closely with the Legislature to advance these important issues.

View the Press Release Here.

WACEP along with a number of other organizations signs on to extend 12-months Medicaid postpartum coverage. Read the full letter. 12-Month Extension Coalition 2023_FINAL.pdf

Wisconsin Health News
December 22, 2022

The Medical Examining Board on Wednesday signed off on a draft of a rule on use of chaperones and other observers during sensitive patient exams. The proposal will now head to the governor's office and then the Legislature for their consideration.

Jameson Whitney, an attorney for the Department of Safety and Professional Services, said the final version factors in comments from Legislative Council, public feedback and a meeting with the Wisconsin Hospital Association.  

Under the plan, the Medical Examining Board, when determining whether alleged misconduct occurred, could take into consideration the failure of a doctor to follow the rules established by their employer regarding chaperones or other observers in patient exams. 

Self-employed doctors or those practicing in practice settings that do not involve hospitals or employers will have to establish and comply with their own written procedures. They’d have to make those available and accessible to all patients likely to receive a non-emergency examination of the breasts, genitals or rectal area. 

The board couldn't find doctors in violation of the rule because a third-party didn't create a chaperone policy or allow its posting or notification.

Another change to the rule clarifies that it’s not intended to impose a requirement on any person or entity the board doesn’t oversee. There are also modifications to the definition of chaperone, whom is chosen by the doctor, and observer, whom is chosen by a patient. 

Matthew Stanford, WHA general counsel, said those working on the rule reached “a good place ... that both will protect patients and provide a good framework for physicians” to know what’s required and what’s not. 

Wisconsin Health News
December 12, 2022

Two doctors’ groups filed a brief with the Wisconsin Supreme Court last week arguing that courts shouldn’t compel physicians to provide the antiparasitic drug ivermectin as a COVID-19 intervention. 

The American Medical Association and Wisconsin Medical Society asked that the court uphold an appeals court ruling earlier this year that found no legal authority to compel private healthcare providers to administer treatments that they have determined are below the standard of care. 

The ruling came in a case brought by Allen Gahl, whose uncle was placed on a ventilator in October 2021 while hospitalized at Aurora Medical Center-Summit with COVID-19. 

Gahl obtained a prescription for ivermectin for his uncle, but the hospital staff declined to provide it after deeming the medication below the standard of care. Gahl sued, which led a Waukesha County Court to initially order that the hospital provide his uncle with the drug. 

The hospital appealed, and the Waukesha County judge later revised his order to require that the healthcare facility let Gahl find a doctor outside the hospital to administer ivermectin to his uncle. However, an appeals court put a hold on that order. 

In their brief, the American Medical Association and Wisconsin Medical Society wrote that most studies investigating ivermectin haven’t found it to be an effective COVID-19 treatment. The consensus view is, apart from clinical trials, it shouldn’t be used to treat the illness, they noted.

They wrote that the hospital met its legal and ethical duties by treating the patient with an “evidence-based protocol” that did not include the drug and that the Wisconsin Supreme Court should affirm the court of appeals' ruling.

"Holding otherwise would allow courts to compel treatments that the medical consensus finds to be substandard,” they wrote. “That outcome forces Wisconsin's physicians to choose between the law and their ethical duties, potentially exposing patients to harm and physicians to liability.”