Wisconsin Medical Society
July 21, 2022

The state of Wisconsin’s Medical Examining Board (MEB) will likely move in a new direction on a proposed administrative rule designed to promote the use of chaperones for physicians conducting sensitive physical exams. The change in direction follows more than a year’s input from physicians around the state and two separate Economic Impact Assessment (EIA) periods on two different versions of the proposal.

Results of the second EIA period showed that physician offices, clinics and hospitals would face an estimated $75 million in training and compliance costs in just the first year under that version of the rule. Under state law, any proposed administrative rule that would cost more than $10 million in additional costs over two years requires the rule’s progress to be halted and instead submitted to the state legislature as potential legislation – a path the MEB does not appear to desire.

The Wisconsin Medical Society (WisMed) has been the lead force raising concerns about another part of the proposed rule: if a physician did not use a chaperone during an exam and an inappropriate touching/conduct complaint is subsequently filed, then the physician would have been presumed guilty and forced to prove their innocence. This change in “presumption” is the opposite of the current discipline procedure, fundamentally interfering with physicians’ rights. The new proposed language removes that presumption of guilt and instead aims at ensuring patients are aware of any office/clinic/hospital policy on chaperones. The new language includes:

Med 10.03 (2)(f)(4): A physician who practices in a hospital or works for any other employer shall comply with the rules established by their hospital or employer regarding chaperones or other observers in patient examinations. Physicians who are self-employed or in other practice settings that do not involve hospitals or employers shall establish written procedures for the use of chaperones or other observers in patient examinations and shall comply with these procedures once established. A physician shall make a copy of the rules and procedures regarding the physician’s use of chaperones or other observers available to patients and shall post their procedures or policy regarding chaperones or other observers in at least one location that is visible to all patients.

The MEB’s attorney explained that this language would not require a facility to have any specific chaperone policy – or even offer chaperones at all. For example, a facility could fulfil the rule’s requirements by posting “this facility does not offer chaperones as part of a patient visit” if that is the case. The attorney termed this version of the rule: "Have a policy. Follow the policy. Make the policy available."

The MEB plans to use this language as a starting point for discussion at its next scheduled meeting on August 17, 2022. During the June 20 meeting, Board Chair Sheldon Wasserman, MD, asked WisMed for initial thoughts on the new language. WisMed Chief Policy and Advocacy Officer Mark Grapentine replied that at first glance it was positive to see the guilt presumption provision removed, and he thanked the MEB for listening to physician feedback on that issue. Grapentine also emphasized WisMed members’ agreement with the MEB that inappropriate sexual conduct complaints should be thoroughly investigated, with wrongdoers severely disciplined following a finding of guilt.

Contact WisMed Chief Policy and Advocacy Officer Mark Grapentine, JD via email or message him in WisMed Mobile for more information. 

WACEP Board Report

Hubbard Wilson & Zelenkova

June 2, 2022

Policy Issues

APRN Bill/Nurse Independent Practice:  Although the legislature is out until next January, work continues on policy issues and initiatives.  Nurse groups have gone on the attack concerning the veto of their APRN bill (SB 394) and turned an early resignation by the BON chair into a cause for media attention.  This effort has been bolstered by conservative Americans For Prosperity.   Since an initial burst of media, however, there has no new attention to the issue. 

Medicaid Reimbursement:  WACEP intends to again prioritize an increase of Medicaid reimbursement rates associated with emergency codes.  While the increase obtained in the last budget has taken effect and improved reimbursement for emergency codes for the first time in three decades, there is still more work to be done to get on par with other states.  Outreach to the Administration will begin this summer in hopes of including another boost in agency budget request, the Governor’s executive budget, and ultimately through the legislative Joint Finance Committee.

Political Landscape

The US Supreme Court overruled the Wisconsin Supreme Court’s approval of the Evers drawn state legislative maps in March based on Voting Rights Act violations.   This action required the Wisconsin Supreme Court to approve a new set of maps, under a very tight timeline, because districts needed to be established by April 15—the date nomination papers begin to be circulated.   After a couple weeks of silence from the Court, they ended up approving the maps passed by the legislature and drawn by Republicans.  As we reported before, while the Evers map could have been considered a “win” for democrats compared to the alternative of the Court selecting the legislative republican-drawn maps, both maps still reflected clear majorities for republicans in the state based on historical electoral results.

On June 1, all candidates for state and federal office were required to have their nomination papers turned in.   We will now know definitively who is on the ballot for the November election and which races we expect to be competitive.  

Below is a list of what may be competitive races in the legislature.   At bottom is a list of all retirements.

ASSEMBLY

AD 1 (Kitchens)--Held by GOP.  Door County and Kewaunee County.  Always a seat that is identified as competitive.   Kitchens has won by double digits in the past 4 elections.

AD 4 (Steffen)—Held by GOP.   Green Bay, Ashwaubenon, Allouez.   GOP numbers have reduced in 2018 and 2020 making it a seat to watch

AB 21 (Rodriguez)—Held by GOP.  South Milwaukee and Oak Creek.  Highly competitive (51%) GOP district.   Rodriguez tends to outperform the top of the ticket.

AD 29 (Moses)—Held by GOP.  NW WI—Menomonie, Colfax, Baldwin.   This is a Lean GOP District (53%), but it changed significantly in redistricting reducing the benefit of incumbency.

AD 33 (Vruwink)—Held by DEM.  SC WI—Fort Atkinson, Jefferson, Palymyra.   Redistricting moved Vruwink out of his old seat (AD 43) into AD 33, which is much more competitive.  Top of the ticket it is a 51% GOP, but Vruwink has been on the ballot in over half the new district.

AD 49 (Tranel)—Held by GOP.  SW WI—Grant County.   Highly competitive as the top of the ticket slightly lean Dem (51%).  However, Tranel greatly outperforms the top of the GOP ticket since 2014

AD 51 (Novak)—Held by GOP.   SC WI—Monroe, Lafayette Co, Iowa Co.  This is the seat the Dems target every election.   54% Dem top of the ticket, but Novak wins. 

AD 85 (Snyder)—Held by GOP.  Wausau, Schofield.   Highly competitive GOP seat (51%).  Snyder usually outperforms by 2-3 points.

AD 94 (Doyle)—Held by DEM.  Onalaska, West Salem, Holmen.  Highly competitive Dem seat (51%).  Doyle has held the seat since 2012 and performs much better in gubernatorial years.

AD 96 (Oldenburg)—Held by GOP.  Monroe Co, Vernon Co and Crawford Co.  Highly competitive Dem (51%).  Assembly Republicans have continually outperformed the top of the ticket for decades.

SENATE

SD 5 (OPEN)—Held by GOP.  Brookfield, Wauwatosa, New Berlin.  Senator Kooyega held the seat but decided not to run.  It was highly competitive in the last election but picked up 4 GOP points after redistricting.  It will still be competitive as an open seat.

SD 17 (Marklein) –-Held by GOP.   SW Wisconsin.   Highly competitive Dem seat (51%).   Marklein won 54% in 2018 and 55% in 2014.

SD 19 (Open)—Held by GOP.  Appleton, Neenah, Menasha.   Highly competitive GOP seat (52%).   Formerly held by Sen Roth, who decided to run for Lt. Governor.   It will be competitive as an open seat.

SD 25 (OPEN)—Held by Dem.  NW WI.   Held by Sen Bewley, who decided not to run.   This once strong Dem area has changed over the last decade to a true 50-50 seat.    As an open seat, it will be highly competitive.

LEGISLATORS NOT SEEKING RE-ELECTION

Congress

• District 3 - Ron Kind (D) - Not Seeking Re-election

State Senate:

• District 15 – Janis Ringhand (D) – Not Seeking Re-election
• District 25 – Janet Bewley (D) - Not Seeking Re-election
• District 27 – Jon Erpenbach (D) - Not Seeking Re-election
• District 23 – Kathy Bernier (R) - Not Seeking Re-election
• District 19 – Roger Roth (R) - Running for Lt. Governor
• District 29 – Jerry Petrowski (R) - Not Seeking Re-election
• District 5 –  Dale Kooyenga (R)

State Assembly:

• District 5 –  Jim Steineke (R) - Not Seeking Re-election
• District 6 –  Gary Tauchen (R)  - Not Seeking Re-election
• District 10 – David Bowen (D) – Not seeking Re-election
• District 13 – Sara Rodriguez (D) – Running for Lt. Governor
• District 15 – Joe Sanfelippo (R)  - Not Seeking Re-election
• District 19 – Jonathan Brostoff (D) – Not Seeking Re-election
• District 27 – Tyler Vorpagel (R) - Not Seeking Re-election
• District 31 – Amy Loudenbeck (R)  - Running for Sec. of State
• District 33 – Cody Horlacher (R) - Not Seeking Re-election
• District 45 – Mark Spreitzer (D) – Running for Senate
• District 46 – Gary Hebl (D) – Not Seeking Re-election
• District 52 – Jeremy Thiesfeldt (R)  - Not Seeking Re-election
• District 54 – Gordon Hintz (D) - Not Seeking Re-election
• District 55 – Rachel Cabral-Guevara (R)  – Running for Senate
• District 59 – Tim Ramthun (R) - Running for Governor
• District 61 – Samantha Kerkman (R) – Won Kenosha County Executive Race
• District 68 - Jesse James (R)  – Running for Senate
• District 73 – Nick Milroy (D) – Not Seeking Re-election
• District 74 – Beth Meyers (D) - Not Seeking Re-election
• District 79 – Dianne Hesselbein (D) - Running for Senate
• District 80 – Sondy Pope (D) – Not Seeking Re-election
• District 82 – Ken Skowronski (R) - Not Seeking Re-election
• District 84 – Mike Kuglitsch (R) - Not Seeking Re-election

Notes: 

Sen. Brad Pfaff (D)– free shot at CD 3

Sen. Patrick Testin (R) – free shot at Lt. Gov.

Wisconsin ACEP PAC Short of Fundraising Goal

The Wisconsin Emergency Medicine PAC Board has set a goal of $20,000 to be raised this election cycle. This is a very important cycle as many offices are up for re-election at the state level and because we recently had a significant number of legislative wins. The PAC is another avenue to continue building relationships with our legislators. We currently have $15,000 raised which is a fantastic amount but we are hoping to do a bit more to extend our influence.

The PAC supports bipartisan candidates as well as party committees. Funds typically support candidates who have demonstrated positions on issues important to emergency physicians or serve on relevant legislative committees.

PAC contributions can be made via PayPal or by mail with this PAC contribution form.

Donate Online

Consider joining many of your peers with a monthly recurring donation! This stability ensures the ongoing ability of our PAC to respond to needs even after the conventional fund-raising season is over.

Recommended Annual Donation Levels:

• $500 (~$42/month) – Match the commitment made by the WACEP Board members
• $365 (~31/month) – Participate at the “Dollar a Day” Level
• $200 ($17/month) – Can’t swing the dollar a day? $200 makes a huge impact for us still!
• $60 ($5/month) – Residents are encouraged to consider a $5/month contribution
• Other – Any amount helps!

ACEP’s Legislative and Advocacy Conference was in Washington DC May 1-3 of this year. WACEP had five attendees this year (including one virtual). They met with 6 (of 8) of the congressional offices as well as both senator offices regarding several topics important to Emergency physicians.

Senator Baldwin made a special guest appearance this year speaking at a special lunch event on “Diversity in Action: Women in Politics.” Senator Baldwin is also the author of “The Workplace Violence Prevention for Health Care and Social Services Workers Act.” This bill, which has corresponding legislation which already passed the House asks OSHA to issue a standard which would require workplace violence prevention plans be considered by hospitals.

The group also discussed with their representatives the instability of Medicare with a total of a 9% cut anticipated at the end of year unless Congress acts. This is the result of anti-inflationary and budget neutrality policies of CMS. Essentially, even though we are netting 10,000 beneficiaries per day being added to the Medicare role, Congress and CMS have decided that we won’t be spending additional funds to deliver this care. In the past, congress had elected to forego this requirement such that rates are not cut for the subsequent year. This goes without saying with inflation increasing the disparity between the consumer price index (CPI) and physician reimbursement by the Medicare system will continue to grow as it has for the last 20+ years. Our ask at this point is the congress act before the end of the year to avoid cuts to Medicare reimbursement rates as well as consider a permanent fix to this so we can avoid this issue year after year.

LAC 2023 is scheduled from April 30-May 2, 2023. Please email us at WACEP@badgerbay.co should you have interest attending next year or add yourself to the interest list to get the latest updates from ACEP: https://www.acep.org/lac/interested/

Ukrainian Medical Association of North America (https://umana.org/)  are working with the Illinois chapter (https://www.facebook.com/UMANAIllinois) to build out a medical supply pipeline from Chicago O'hare to Ukraine via Lublin, Poland.  2 cargo flights of up to 100 tons have already gone over

They are now running a parallel operation here in Wisconsin through a donated warehouse outside Milwaukee (https://www.facebook.com/UMANA.Wisconsin)

There's a list of high need medications and supplies here, but basically anything you would need in a trauma suite and in trauma aftercare are the highest needs:

http://umanawisconsin.org/

The Milwaukee Rotary is helping to organize. People can sign up to volunteer for this drive and/or future ones here

http://milwaukeerotary.com/bigdreamslocally/ukraine-support/

You can also directly donate to UMANA (https://umana.org/UkraineDonation.php

Happy Spring WACEP,

Thank you to everybody who was able to make it to the WACEP Spring Symposium this week. While “Getting the Band Back Together” was an appropriate and catchy slogan, it really was amazing to gather IN PERSON for the first time in three years and I look forward to this again being an annual event.  The ability to reconnect with so many across the state, to learn from some from expert lecturers and innovative research, and to celebrate some of the accomplishments of WACEP and some its individual members was simply wonderful.  I wanted to use this opportunity to also recap the report I shared during our business meeting:

• This was another busy year in the state legislature with some significant wins for WACEP that really demonstrate the power and value of WACEP.  Just a few (very important) highlights include the governor’s veto of the APRN bill and the long overdue Medicaid reimbursement rate increases.
• WACEP hosted a webinar in January that included updates on pediatric respiratory care as well as OB emergencies, targeted at providers who may practice in more resource limited sites.  We are looking at expanding this valuable resource to our members across the state.
• WACEP membership numbers continue to remain steady with 538 total members.  Please encourage any partners you have or colleagues who are not a member of WACEP to consider joining
• WACEP continues to be in a very good financial position ending 2021 with approximately 38 months in operating reserves.
• Congratulations to the award winners who were announced.  This includes:
• • WACEP Resident Advocate Award:
  • • From UW: Dr. Rudi Zurbuchen
    • From MCW: Dr. Paul Benz
  • WACEP Distinguished Service Award: Dr. Jeff Pothof
  • WACEP Past President’s Award: Dr. Brad Burmeister

Thank you again to all who worked so hard to organize such an incredible event as well as all our sponsors and exhibitors who made this event possible.

Please as always, let us know what WACEP can do to support you and the important work that you do and THANK YOU!!

Best,
Brian

WACEP Legislative Report
Hubbard Wilson & Zelenkova
April 20, 2022

The two-year legislative session ended in March, which means that all legislation previously introduced that did not pass is dead. 

SB 394/AB 396 – the APRN Bill - authored by Senator Patrick Testin, Rep. Rachel Cabral Guevara did of course pass both houses of the legislature.  We are very happy to report that the Governor vetoed this legislation last Friday.   While the bill was improved slightly in the assembly to at least include two years of clinical experience before an APRN could practice independently, it was not improved enough.   To that end we advocated for the veto including the grassroots action alert and countless meetings along the way with the Governor’s team. 

In the end, the physician coalition’s position was, and continues to be, that the bill needed to include at least the following: 

1.  4 years of clinical experience as a requirement for independent practice - 2 years as an RN and 2 years as an APRN or 4 years as an APRN.   (This requirement would at least be relatively on par with many medical residencies.)

2.  For the practice of pain management, continue to require collaboration with a physician, specifically with a physician trained/experienced in pain medicine.  (This is a basic guardrail that still provided far more leeway than our pain specialists were comfortable with given the complexities of pain medicine and chronic pain management). 

3. Explicit “Truth in advertising”/“Title Protection” for physician specialty titles and terms associated with physicians. This is the one true ask of physicians in defense of their profession and credential and is basic common sense to include in a bill that will no doubt reduce transparency and increase confusion among patients in a new universe of “independent practice”.  

The Assembly moved forward without addressing all of our concerns - adopting an amendment that only included the following:

1.  2 years (3840 hours) of clinical experience as an APRN before being allowed to practice completely independently.

2.  Require physician collaboration for an APRN to practice pain management independently; except if the APRN is working in a hospital or in a hospital affiliated clinic - then no collaboration requirement.  (It does not include that the collaborating physician be a physician who is trained and experienced in pain medicine.)   So that’s worse than current law, slightly better than the original bill, but not enough.

We expect this bill to come back next session regardless of election outcomes.  Interesting note: the senate author Testin is running for Lieutenant Governor and the assembly author, Cabral Guevara, is running to replace Roger Roth who is retiring from his Appleton senate seat to also run for Lt. Governor. 

SB 532/AB 529, introduced by Senator Kathy Bernier of northwestern Wisconsin and Rep. Jesse Rodriguez of Oak Creek / Milwaukee County, created a regulatory framework for naturopaths.   Naturopaths were not regulated at all in WI.  WMS negotiated a compromise on this bill  and the result rewrites the legislation in a way that significantly skinnies down the overall scope that includes the creation of a regulatory board that will NOT have future scope rulemaking abilities; naturopaths are prohibited from prescribing controlled substances; the title “naturopathic medical doctor” is NOT allowed; and a specific provision in the definitions sections regarding what naturopaths are allowed to do makes it clear that it is distinct from the definition of “practice of medicine and surgery” that applies to physicians.  AB 529 was signed into law by the Governor with the compromise amendment. 

Emergency Psych:   Proposed JFC 13.10 request re: crisis stabilization:  Governor Evers’ 2021-23 biennial budget recommended $17.6 million GPR and statutory changes to establish and support crisis urgent care and observation centers as a new provider category, as well as support short-term residential crisis stabilization and inpatient psychiatric beds. The Legislature did not adopt the Governor’s recommendation and instead placed $10 million GPR in the Committee’s appropriation for crisis services.

DHS has drafted a request to the Joint Finance Committee for the transfer of funds from the Committee’s appropriation to support grants to strengthen the system under current law. The Department plans to award the funds in FY 23 through a competitive grant application process to organization(s) that aim to support and improve regional crisis intervention and stabilization services through a county-based collaborative approach.

Certified county crisis programs will be invited to apply for the funding opportunity focused on partnership with local agencies such as law enforcement, providers of crisis supports, or hospital systems. The grants can be used to expand or enhance current operations in the county crisis system with the intention of reducing the number of emergency detentions in inpatient facilities and reducing the burden on law enforcement in responding to and transporting individuals in crisis.

This proposal has been discussed with the EmPsych Taskforce.  No sense on whether this is going to move forward sat this point. 

Surprise Billing/NSA:  While the federal No Surprises Act and the interim rule are in effect, in a recent development, the U.S. District Court for the Eastern District of Texas vacated some problematic provisions of the Interim Final Rule related to the independent dispute resolution process.  The lawsuit was brought by the Texas Medical Association.  The decision will likely be appealed but if it stands will hopefully balance out the unfair advantages health insurance companies have in the interim rule’s IDR process.  ACEP, the American College of Radiology, and the American Society of Anesthesiologists have an ongoing challenge to similar provisions of the rule in a District Court in Chicago.  WACEP has interacted with the WI OCI recently on this issue but it appears clear that OCI will be strongly deferring to the federal law and rule.  Input was shared on some ways to simplify processes in Wisconsin regarding identification of what type of plan a patient is insured by to know if NSA even applies.  We do not know yet whether this input was well-taken.   

Redistricting:  State legislative boundaries are still in limbo.  Previously the WI Supreme Court chose maps drafted by Governor Evers.  Its ruling was appealed to the US Supreme Court which overturned the decision related to concerns on the number of “majority-minority” districts in the Milwaukee area.  The WI Supreme Court, as opposed to only adjusting the districts that SCOTUS took issue with, went in a very different direction and instead selected the proposal submitted previously by legislative republicans.  We expect this decision to also be appealed to the US Supreme Court.  Whether the high court will hear it, remains to be seen.  But it appears that new district lines – at least in state assembly and senate seats – remain in uncertain for a few more days or even weeks.  

Legislative Not Running for Re-election in Current Office: 

Congress

• District 3 - Ron Kind (D) - Not Seeking Re-election

State Senate:

• District 15 – Janis Ringhand (D) – Not Seeking Re-election
• District 25 – Janet Bewley (D) - Not Seeking Re-election
• District 27 – Jon Erpenbach (D) - Not Seeking Re-election
• District 23 – Kathy Bernier (R) - Not Seeking Re-election
• District 19 – Roger Roth (R) - Running for Lt. Governor
• District 29 – Jerry Petrowski (R) - Not Seeking Re-election
• District 5 – *Dale Kooyenga (R) (If he stays drawn out of seat after Redistricting)

State Assembly:

• District 5 – Jim Steineke (R) - Not Seeking Re-election
• District 6 – Gary Tauchen (R)  - Not Seeking Re-election
• District 10 – David Bowen (D) – Running for Lt. Governor
• District 13 – Sara Rodriguez (D) – Running for Lt. Governor
• District 15 – Joe Sanfelippo (R)  - Not Seeking Re-election
• District 27 – Tyler Vorpagel (R) - Not Seeking Re-election
• District 31 – Amy Loudenbeck (R)  - Running for Sec. of State
• District 33 – Cody Horlacher (R) - Not Seeking Re-election
• District 45 – Mark Spreitzer (D) – Running for Senate
• District 46 – Gary Hebl (D) – Not Seeking Re-election
• District 52 – Jeremy Thiesfeldt (R)  - Not Seeking Re-election
• District 54 – Gordon Hintz (D) - Not Seeking Re-election
• District 55 – Rachel Cabral-Guevara (R)  – Running for Senate
• District 59 – Tim Ramthun (R) - Running for Governor
• District 61 – Samantha Kerkman (R) – Won Kenosha County Executive Race
• District 68 - Jesse James (R)  – Running for Senate
• District 73 – Nick Milroy (D) – Not Seeking Re-election
• District 74 – Beth Meyers (D) - Not Seeking Re-election
• District 79 – Dianne Hesselbein (D) - Running for Senate
• District 80 – Sondy Pope (D) – Not Seeking Re-election
• District 82 – Ken Skowronski (R) - Not Seeking Re-election
• District 84 – Mike Kuglitsch (R) - Not Seeking Re-election

Notes: 

Sen. Brad Pfaff (D) (SD 32) – free shot at CD 3

Sen. Patrick Testin (R) (SD 24) – free shot at Lt. Gov.

Fellow designation speaks to your contributions to ACEP and highlights your commitment to emergency medicine. Congratulations to our newest class of FACEP designees! Congratulations to WI ACEP's own Shera Teitge, MD, FACEP and Scott Kunkle, DO, FACEP your Fellow Designation!

Learn more at acep.org/FACEP.

ATLS Instructor Course is a 1–1½-day course designed for MDs who satisfy the qualifications and characteristics of the model ATLS Instructor. The Instructor Course teaches MDs how to teach in the ATLS Program. Established educational principles form the foundation for the design and development of the Instructor Course. These principles are essential to the conduct of the course, and the basic course de¬sign may not be altered to fit individual or institutional desires. Learning is enhanced when the process occurs within a short period during which cognitive activity is closely linked in time and content with application of teaching skills. Therefore, the course is conducted over a 1–1½ day consecutive period with a mutual sequencing of learning and teaching skills.

You may register for this course on MyLearning or through the Education Hotline at 651-254-7788

No Surprise Act Update and Resources Written by: Lisa Maurer, MD - Legislative Committee Chair As of January 1st, the No Surprises Act prohibits emergency physicians from billing patients for the balance of charges after an out-of-network payor pays for the services, a practice historically referred to as “balanced billing.” Relatedly, it provides a mechanism for negotiation and arbitration if the physician does not find the payment to be reasonable. WACEP has been closely tracking progress of this federal law, participating in federal advocacy on behalf of emergency physicians as the regulations have been released over the last year, and is now staying up to date on implementation in our state. National ACEP has published a fantastic website displaying an overview of the No Surprises Act with infographics and tables. In Wisconsin, almost all processes for out of network billing will revolve around federal law, regulation, and enforcement of those requirements. As opposed to some other states, Wisconsin does not have it’s own law governing balanced billing practices and determination of payment for out-of-network services. The Wisconsin Office of the Commissioner of Insurance (OCI) recently held a public hearing where it was outlined what portions of the new federal process they would be responsible for enforcing as opposed to federal CMS. OCI will be enforcing compliance for claims for services provided to patients insured by individual and group commercial insurance products. CMS will enforce compliance for federally regulated ERISA (employer funded) insurance products. CMS will oversee all remaining processes including determination of qualifying payment amounts and independent dispute resolution. There are multiple lawsuits currently in process against the federal government regarding the regulations that determine how arbiters would determine the reasonable payment amount for out of network services. ACEP is involved in one of those lawsuits, having filed suit against the federal government along with the federal specialty societies for anesthesiologists and radiologists, charging that the rules released last year are in conflict with the law that Congress passed in late 2020. Although we must move forward with processing bills according to the rules as they stand now, WACEP will keep you informed of any changes based on legal action going forward. If you would like to receive updates regarding the No Surprises Act from the Wisconsin OCI, please request that you be added to a recipient list by emailing ocinsacomplaints@wisconsin.gov with your name, email, phone number and address. For more information, please see OCI’s summary of the No Surprises Act or feel free to contact WACEP at WACEP@badgerbay.co