LAtest News

  • 03/28/2020 1:35 PM | Bree Clarksen (Administrator)

    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).


  • 03/28/2020 1:32 PM | Bree Clarksen (Administrator)

    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.

     


  • 03/27/2020 1:31 PM | Bree Clarksen (Administrator)

    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).


  • 03/27/2020 1:31 PM | Bree Clarksen (Administrator)

    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).


  • 03/27/2020 1:30 PM | Bree Clarksen (Administrator)

    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.


  • 03/23/2020 1:30 PM | Bree Clarksen (Administrator)

    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.


  • 09/30/2019 4:26 PM | Bree Clarksen (Administrator)

    WSP continues to advocate on behalf of members regarding Anthem's fee schedule. In addition to previously contacting the office of the commissioner of insurance, WSP has directly contacted Anthem.  WSP urges all members to review their Anthem contracts and discuss any fee change concerns directly with Anthem.

    Read full letter here.
  • 08/12/2019 9:04 AM | Bree Clarksen (Administrator)

    In response to member feedback, WSP sent a letter to the Wisconsin Office of the Commissioner of Insurance over recently proposed rate cuts by Anthem. The rate cuts to Wisconsin pathologists are part of a multi-state rate cut strategy by Anthem that has garnered national attention. CAP has also weighed in by contacting Anthem for clarification on the pathology service changes. WSP expressed concern over the magnitude of the rate cuts and the subsequent impact on potential in-network status and patient access to health care. WSP also expressed concern over the rationale for the cuts as well as the notification and response process. 

    Click here to read the letter.
  • 06/05/2019 4:08 PM | Bree Clarksen (Administrator)

    Dear WSP members,

    The following alert was recently forwarded by CAP regarding out of network billing legislation.  This is a critical time period and our field needs all pathologists to participate in grass roots efforts to inform our congressional representatives about our concerns. Please take a few minutes to read the alert below and follow the link to CAP's PathNET action center to email your congressional representative. From this link, CAP members should be able to enter their email and zip code that will generate a pre-populated letter that can be customized if desired and subsequently forwarded to your congressional representatives.

    WSP has also partnered directly with CAP drafting a written response to congress about our concerns.  In addition, Wisconsin Medical Society is working on the issue on behalf of Wisconsin hospital based physicians, including pathologists.

    Thank you for your time. Please forward any questions or concerns.

    From CAP:

    You may have seen Congress is quickly advancing surprise medical billing legislative proposals at an alarming rate without properly vetting the potential consequences it could have on your ability to treat patients. Below is a quick recap:

    • There were several bills and drafts introduced to address surprise billing in both the House and Senate that the CAP has significant concerns with. These legislative proposals include the use of an out-of-network payment methodology exclusively tied to median in-network-rates which is unnaceptable to the CAP. It allows health plans to unilaterally determine the value of physician services and will turn the physician component of hospital care over to their financial control. That is a solution that will only benefit the health insurance industry to the detriment of the health care delivery system, and as such, is opposed by the CAP. The CAP cannot support any proposal that supports that provision.
    • Physician members of Congress, led by Reps. Raul Ruiz (D-CA) and Phil Roe (R-TN), released an outline for legislation that is a positive step in the right direction. As we’re encouraged by the direction of the outline by Reps. Ruiz and Roe, we need you to support them by using the buttons below to contact your member of Congress.

    The solutions as proposed by Dr. Ruiz and Dr. Roe would take necessary steps to accomplish our goals of holding patients financially harmless from surprise medical bills while creating a fair reimbursement system that keeps patients out of the middle of billing disputes. In particular, the CAP is pleased to see inclusion of a baseball-style arbitration process that allows consideration for a range of factors, including the usual and customary rate that reflects the market value of physician services. 

    While we are still hopeful that any final proposal will include network adequacy provisions, this is a far better starting point than other proposals we have seen.

    Make your voice heard on this important issue that may permanently affect your payment and potentially limit patient access to your services. We look forward to advocating for the Ruiz-Roe proposal to be adopted in place of legislation adverse to pathologists. 

    To contact your legislatures, click on the following link: https://capactioncenter.aristotle.com/SitePages/Homepage.aspx


  • 05/14/2019 10:30 AM | Bree Clarksen (Administrator)

    WSP member Kristina Matkowskyj, MD, PhD recently presented on a video series from UW-Madison called Carbone Classroom. This series features UW-Madison faculty presenting on a variety of cancer topics to try to educate their patients. Dr. Matkowskyj's presentation focuses on how Pathologists diagnose cancer. Make sure to check out the video linked below! 

    Carbon Classroom: How Pathologists Identify Cancer

 
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