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  • Tuesday, March 12, 2024 9:55 AM | WiSCA (Administrator)

    The 2023-24 legislative has come to an end, and legislators are shifting their focus to the upcoming election season and the need to connect with voters. With that in mind, it is more important than ever for WISCA members to strengthen their relationships with their state lawmakers (and new legislative candidates) to educate them on the ASC model of care, the regulatory challenges we face, and the legislative solutions we need to increase access to affordable, quality care provided in the ASC setting. Remember, decisions state legislators make in the Capitol can have a significant impact on the ASC industry, your organization, and your profession.

    One of the best ways you as a WISCA member can engage your local legislators is to invite them to tour your ASCs to illustrate firsthand the many benefits of surgery center care. These visits provide a tremendous advocacy opportunity, which is why WISCA members across the state have already hosted numerous successful legislative tours. But we need to maintain the enthusiasm for this critical grassroots advocacy program, and WISCA is excited and ready to set-up additional tours today.

    If you would like to host a legislative tour at your site, please contact the WISCA office at WISCA@badgerbay.co. We will work with you and your legislators to coordinate the meetings and will provide participating members with full support, including legislator bios, advocacy tips, issue briefings, and supporting documents.

  • Tuesday, March 12, 2024 9:50 AM | WiSCA (Administrator)

    WISCA works closely with our national association partner – the Ambulatory Surgery Center Association (ASCA) – on advocacy and other issues important to our members. In fact, the WISCA Government Affairs Team joins a national ASCA state chapter call twice a month for a federal regulatory and legislative briefing and closely follows their published Government Affairs Updates. Here is the latest federal government affairs news from ASCA:

    • CMS Releases Supporting Information on Prior Authorization Demonstration Project
      As previously reported by ASCA, the Centers for Medicare & Medicaid Services (CMS) recently announced that it “seeks to develop and implement a Medicare demonstration project, which CMS believes will assist in developing improved procedures for the identification, investigation, and prosecution of Medicare fraud occurring in ambulatory surgical centers providing services to Medicare beneficiaries.” Under pilot program, ASC providers would have to submit documentation to their Medicare Administrative Contractors (MAC) that shows a service meets applicable Medicare coverage, coding, and payment rules prior to rendering the service.
      CMS has now released Supporting Statement Part B, which provides more information on the proposed prior authorization demonstration project for ASCs. The supporting information includes the states impacted, which are: Arizona, California, Florida, Georgia, Maryland, New York, Ohio, Pennsylvania, Tennessee and Texas. It also includes the specific codes that would be subject to the demonstration, which fall within the following categories:

      1. Blepharoplasty, Blepharoptosis Repair, and Brow Ptosis Repair
      2. Botulinum Toxin Injection
      3. Panniculectomy, Excision of Excess Skin and Subcutaneous Tissue (Including Lipectomy), and related services
      4. Rhinoplasty, and related services
      5. Vein Ablation, and related services

      ASCA staff reached out to the contact on the demonstration notice to ask who the responsibility falls on since the notice refers several times to “ASC providers.” The email ASCA received in response states, “The physician needs to submit the prior authorization request or materials requested by the MAC for preclaim review and that drives the process.”

    • ASCA Submits Codes for Consideration for Addition to ASC-CPL
      ASCA submitted codes by the March 1 deadline in response to the ASC Covered Procedures List (ASC-CPL) Pre-Proposed Rule Recommendation Request. This is a new way to submit codes for consideration that the Centers for Medicare & Medicaid Services (CMS) rolled out this year. Based on feedback from members, including our new cardiovascular working group, ASCA submitted the following:
      1. Cardiovascular codes: Electrophysiology Studies and Ablations: 93613, 93619, 93620, 93623, 93650, 93653, 93654, 93655, 93656, and 93657 Peripheral Vascular – Diagnostic: 75630, 75710, 75716, and 75736 Cardioversion and TransEsophageal Echocardiogram: 92960 and 93355
      2. Spine codes: (Posterior Lumbar Inter-body Fusion (22630) and Combined Posterior Lumbar and Posterior Lumbar Inter-body Fusion (22633)
  • Tuesday, March 12, 2024 9:49 AM | WiSCA (Administrator)

    It’s been nearly a year since Janet Protasiewicz was elected to the Wisconsin Supreme Court flipping it from a 4-3 conservative court to a 4-3 liberal court. Since that time there has been constant speculation as to what that result would mean for Wisconsin’s legislative district boundaries and a potential new redistricting process. It appears that we now know the answer. In late December, the Court found that the lines as constructed resulted in an unconstitutional partisan gerrymander and requested from the legislature and Governor that they present them with new maps that better fit their definition of “fair” maps.

    The maps in question currently yield a 22-11 majority for republicans in the state senate and a 64-35 majority for republicans in the assembly. Nearly two-thirds of all legislators are republican even though democrats have won fourteen of the last seventeen statewide elections. Democrats have said that the districts are gerrymandered and should be redrawn to better reflect Wisconsin’s electorate.

    Republicans have countered that the maps were constructed in accordance with the law and that Wisconsin’s population makes it such that democrats are more concentrated in certain areas of the state which gives republicans a natural geopolitical advantage. They also argue Republicans do better in down ballot races so that the top of the ticket performance shouldn’t be the primary factor in assessing whether or not maps are fair.

    The Supreme Court requested that parties submit new maps by January 12th and appointed two nonpartisan consultants to review the maps and make suggestions by February 1st. Various entities including republicans and democrats in the legislature, the Governor, the plaintiffs in the case and others did submit maps. On February 1st, the consultants found that of the six maps in consideration, the two republican maps did not “deserve further consideration” because they were considered “partisan gerrymanders”. According to the consultants, the four remaining maps fit the criteria sought by the Court and could be considered for the final maps. All four of these maps would have the very likely result of pushing the Senate and Assembly to a more evenly balanced partisan split.

    While the Supreme Court was considering how to determine final maps, Republicans in the legislature surprisingly made the decision to pass the exact maps that Evers submitted. Surprising because under the Evers version of the maps many current republican incumbents would either be paired with other incumbents or drawn into districts that are more favorable to democrats. By the numbers alone the Evers maps would significantly bridge the partisan gap in both the Senate and Assembly and would give democrats a chance at some point to win the majority in one of the houses. Something they haven’t done since they lost both houses in the 2010 elections. Governor Evers signed his maps (sent to him by the legislature) and barring a court challenge Wisconsin will indeed have new maps going in to the 2024 elections.

    The new maps still lean slightly republican, but democrats will have more representation in both houses and have an outside chance to gain the majority in both the Senate and the Assembly. Regardless of whether the houses flip, the margins will certainly be compressed, and the overall dynamics will shift next session.

  • Tuesday, March 12, 2024 9:43 AM | WiSCA (Administrator)

    On Tuesday, March 12th the State Senate had what is expected to be its final session day of the year. All that remains now is the Governor’s action on a number of bills. It is possible the legislature returns for a veto override attempt, but for most legislative activity the session is over.

    There were a handful of bills WISCA was tracking until the end. Here is how they ended up:

    • Advance Practice Registered Nurse Bill (AB 154/SB 145) – This bill has passed both houses and awaits the Governor’s final decision. He vetoed a similar bill last session, and while there were some changes made to accommodate his concerns, it is unclear if the amendments were enough for him to sign the bill. The Wisconsin Medical Society and the Wisconsin Society of Anesthesiologists remain opposed to the bill. WISCA was interested in this bill as one of the proposed amendments would’ve made changes to collaborative agreements with nurse anesthetists and doctors that would’ve presented significant challenges to some of our ASC’s. Ultimately this amendment failed.

    • Hospital Price Transparency Bill (AB 338/SB 328) – This bill died but there is some talk of a legislative study committee this summer that will include a broader scope beyond just hospitals.

    • International Physicians Bill (AB 954/SB 900) – This bill allows for licensure of international physicians provided they meet a number of requirements. WISCA requested and received an amendment that included ASCs as potential landing places for qualified physicians. The bill passed both houses and is expected to be signed by the Governor.

    • Preliminary Health Care Credentials Legislation (AB 144/SB 158) – WISCA supported this legislation as it aims to reduce the time it takes for DSPS to license health care professionals. The bill will provide temporary licensure if certain requirements are met in order to speed up the process. The bill passed both houses and will likely be signed by the Governor.

    • Surgical Black Box Bill (AB 870) – This bill allows patients to have their surgeries recorded. It did not receive a hearing in either house and is “dead” for the session. It is expected to return next session.

    • Informed Consent Bill (SB 127/AB125) – ASCs were added to this bill late in the process. It would require providers to obtain informed consent for any pelvic examinations of a patient while they are under anesthesia. The bill failed to pass and is “dead” for this session. We expect it to return next session.

    *Join us April 4 for the next Online Legislative Update*

    WISCA legislative updates are open to all members and held monthly. The next update is Thursday, April 4 at 12pm by Zoom.
    Sign up today (register here). 

  • Thursday, January 18, 2024 6:40 AM | WiSCA (Administrator)

    WISCA works closely with our national association partner – the Ambulatory Surgery Center Association (ASCA) – on advocacy and other issues important to our members. In fact, the WISCA Government Affairs Team joins a national ASCA state chapter call twice a month for a federal regulatory and legislative briefing and closely follows their published Government Affairs Updates. Here is the latest federal government affairs news from ASCA:

    • Federal Regulatory Update
      • ASCA’s ASC Quality Reporting Program Resources Updated for 2024: ASCA has updated our ASC Quality Reporting (ASCQR) Program home page to reflect 2024 measures and deadlines. You can also visit ASCA's updated ASCQR Program requirements webpage for information on how to comply with ASCQR Program requirements in 2024, and the Ambulatory Surgical Center Quality Reporting Specifications Manual for more information on all measures. Facilities should also be sure to check out the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) Survey page which provides more information on the OAS CAHPS survey which will become a mandatory component of the ASCQR Program in 2025. Contact Kara Newbury with questions.
      • Pre-Proposed Rule CPL Recommendation Process: The Centers for Medicare & Medicaid Services (CMS) has provided more information regarding the new recommendation processfor the ASC Covered Procedures List (ASC-CPL). This process enables interested parties to submit codes for consideration to be added to Medicare's ASC-CPL. The submission period will start on January 1, 2024, and conclude on March 1, 2024, for 2025 rulemaking. ASCA will continue to advocate for the addition of complexity-adjusted code combinations and alignment with the Hospital Market Basket to update reimbursement rates. More information about the recommendation process will be available in January in ASC Focus Magazine’s Digital Debut. If you have specific procedures you would like ASCA to advocate for, please contact Kara Newbury.
      • Clinician Reimbursement Correction Notice: Medicare reimbursement for clinicians is set to decline by 3.37 percent unless Congress acts. Several major specialties that operate in ASCs, such as orthopedic surgery, ophthalmology and vascular surgery, are expected to see negative impacts. ASCA has been active in advocating for relief from these cuts, most recently signing on to a letter with 53 other health organizations requesting congressional action. Representatives Mariannette Miller-Meeks (R-IA), Ami Bera (D-CA), Larry Bucshon (R-IN), and Kim Schrier (D-WA) circulated a “Dear Colleague” letter to members of the US House urging quick legislative action to prevent the 3.37 percent reimbursement cut scheduled for January 1, 2024. In previous years, a correction notice has been issued to resolve this issue.
    • Update on Federal Price Transparency Legislation: On December 11, the Lower Costs, More Transparency Act (H.R. 5378) passed the US House of Representatives by a vote of 320–71. As previously reported, language pertaining to ASCs under Sec. 104 of H.R. 5378 is identical to the price transparency legislation that ASCA lobbied against in July. On Thursday, December 14, the companion bill, S. 3548, was introduced in the US Senate. Section 5 (5)(B)(i-ii) of the legislation nearly matches the language of H.R. 5378. ASCA has been working closely with committee staff to improve the legislation and will report on any updates. If passed, implementation would begin in January 2026.
    • Pertinent takeaways from Sec. 104 (Ambulatory Surgical Center Price Transparency):
      • ASCs must publicly disclose all of their standard charges for all items and services they offer.
      • This information must be free and accessible without subscription.
      • ASCs must also disclose their prices for a minimum of 300 shoppable services, including all Centers for Medicare & Medicaid Services (CMS)-specified shoppable services they provide and additional ASC-selected shoppable services to reach the 300 minimum; if an ASC offers less than 300 shoppable services, it must disclose prices for all of the services it does offer.
      • For CMS-specified shoppable services not offered, ASCs must clearly indicate their nonavailability.
      • PENALTIES: This legislation allows CMS to issue penalties of $300 per day for noncompliance.
      • More information is available in ASCA’s Digital Debut.
    • Contact David Opong-Wadee at dopongwadee@ascassociation.org with any questions.


  • Thursday, January 18, 2024 6:40 AM | WiSCA (Administrator)

    The APRN bill still sits in a stalemate with no movement since our last report, although some action in the Assembly is expected soon. The APRN bill establishes an Advance Practice Registered Nurse credential in Wisconsin.  WISCA has been closely monitoring AB 154/SB 145, as one of the biggest sticking points within that new credential relates to pain management procedures and the collaborative agreements surrounding nurse anesthetists. 

    An amendment to the bill was introduced requiring CRNA’s have a collaborative agreement with a physician who has a pain management background.  WISCA has pushed back against this amendment arguing that it would hurt our ability to provide services, especially in more rural areas, where there are fewer physicians with a pain management background.  The bill has passed the Senate without this amendment and is being considered in the Assembly.  In addition to our concerns, it appears the Governor still has certain issues with the bill, and it is unclear how and if it will become law.  

    Outside of APRN legislation, bills related to price and access have been introduced by Republicans and Democrats that are making their way through the legislative process.  Most of them are unlikely to find consensus and become law without compromise.  These include a price transparency bill to align Wisconsin law with the federal law as it relates to hospitals posting their pricing; a proposal to make several changes to how pharmacy benefit managers (PBMs) are regulated; legislation to allow for direct primary care in Wisconsin; and a bill to create a provisional license for international physicians. 

    Lastly, the Surgical Black Box bill has been introduced in the Assembly.  AB 870 would allow for patients to have their surgeries recorded.  WISCA has opposed this bill in the past and will do so this session. 


  • Thursday, January 18, 2024 6:39 AM | WiSCA (Administrator)

    In what many predicted after Wisconsin’s Supreme Court flipped from conservative to liberal in April of 2023, the new State Supreme Court found Wisconsin’s current maps unconstitutional and ordered new legislative maps to be drawn in time for the 2024 elections. 

    The court set a deadline of January 12 for the various parties to the case to submit proposed remedial maps. The court also appointed two “referees,” political science academics who have worked as redistricting consultants in other states, to help the court evaluate the proposals. In a letter to the court, the referees explain how they will analyze the proposals by using demographic and election data to assess the following factors based on the court’s directive:

    ·         Population equality

    ·         Political subdivision splits

    ·         Contiguity

    ·         Compactness

    ·         Federal law compliance

    ·         Community considerations

    ·         Political neutrality

    The referees are to return their evaluations to the court by February 1.


  • Thursday, January 18, 2024 6:36 AM | WiSCA (Administrator)

    While there are only a few months left in Wisconsin’s 2023-24 biannual legislative session, there could be a lot packed into the remaining calendar days before both houses wrap-up their work for the year in March.

    One of the most pressing issues will be whether the Legislature and Governor Evers can come to an agreement on Wisconsin’s $7 billion budget surplus.  They failed to come to an agreement during state budget negotiations and have yet to make progress since.  The legislature wants to fund a significant tax cut while the Governor wants to see money go toward childcare and a smaller tax cut.  There are other spending priorities for both sides, but a deal will have to be cut or we can expect to start the next budget process with a fat surplus once again. 

    In addition to the surplus, some other hot-button issues remain.  Speaker Robin Vos has said he is going to bring a medical marijuana bill to the floor.  Wisconsin is nearly surrounded by states that have legalized recreational marijuana, but most legislators in the Badger State are not supportive of full legalization.  Vos’s bill could be a compromise.

    In recent interviews, Majority Leader Devin LeMahieu has mentioned two of his priorities being a bill that would allow Wisconsin to access $84 million in federal funding to build Electric Vehicle Infrastructure, as well as a bill that would give Wisconsin companies the first option to build transmission lines in Wisconsin.  As of today, each of these proposals has had at least one public hearing with more action in both houses expected soon. 

    Other issues that the legislature may address include PFAS (forever chemicals), abortion, election reform and artificial intelligence.  On the health care front, we’ll expect to see some activity surrounding the Advanced Practice Registered Nurse (APRN) bill and price transparency and pharmacy benefit manager bills. 


    *Next Legislative Update February 1*

    WISCA legislative updates are open to all members and held monthly.  The next update is Thursday, February 1 at 12pm by Zoom.  Sign up today (register here).


  • Tuesday, January 09, 2024 9:00 AM | WiSCA (Administrator)

    Visit ASCA's ASCQR Program requirements webpage for information on changes to ASCQR Program requirements in 2024, and the Ambulatory Surgical Center Quality Reporting Specifications Manual for more information on all measures. Additional resources, such as reporting dates and measure resources, can be found on CMS' ASCQR Program Resources webpage.

    • ASC-1: Patient Burn; ASC-2: Patient Fall; ASC-3: Wrong Site, Wrong Side, Wrong Patient, Wrong Procedure, Wrong Implant; ASC-4: All-Cause Hospital Transfer Admission are outcome measures that were previously suspended as of January 1, 2019, but data collection resumed in CY 2023 for reporting via the HQR Secure Portal in CY 2024. Data for these measures must be collected for all patients, not just fee-for-service Medicare beneficiaries, and must be submitted by May 15, 2024.
    • ASC-9Endoscopy/Polyp Surveillance: Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients is a web-based measure that is reported via the HQR secure portal. This aggregate data must be reported by all Medicare-certified ASCs, regardless of specialty or case mix. If your center does not perform colonoscopies, select the box under the measure name and description that states: “Please enter zeros for this measure as I have no data to submit.” Data collected in 2021 must be submitted via the HQR secure portal by May 15, 2024.
    • Facilities do not need to report data for ASC-12Facility 7-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy, as the data will be pulled from claims previously submitted by the hospital that the patient visits within seven days of the colonoscopy.
    • ASC-13Normothermia Outcome is used to assess the percentage of patients having surgical procedures under general or neuraxial anesthesia of 60 minutes or more in duration who are normothermic within 15 minutes of arrival in PACU. Like ASC-9, this is a sampling measure. If your center does not perform procedures related to this measure, select the box under the measure name and description that states: “Please enter zeros for this measure as I have no data to submit." Data collected in 2021 must be submitted via the HQR secure portal by May 15, 2024.
    • ASC-14Unplanned Anterior Vitrectomy is used to assess the percentage of cataract surgery patients who have an unplanned anterior vitrectomy. If your center does not perform procedures related to this measure, select the box under the measure name and description that states: “Please enter zeros for this measure as I have no data to submit." Data collected in 2021 must be submitted via the HQR secure portal by May 15, 2024.
    • ASC-17Hospital Visits after Orthopedic Ambulatory Surgical Center Procedures data is pulled from claims previously submitted by the hospital that the patient visits within seven days of the orthopedic procedure.
    • Facilities do not need to report data for ASC-18Hospital Visits after Urology Ambulatory Surgical Center Procedures as the data is pulled from claims previously submitted by the hospital that the patient visits within seven days of the urology procedure.
    • Facilities do not need to report data for ASC-19Facility-Level 7-Day Hospital Visits after General Surgery Procedures Performed at Ambulatory Surgical Centers as the data is pulled from claims previously submitted by the hospital that the patient visits within seven days of the general surgery procedure.
    • ASC-20COVID-19 Vaccination Coverage Among Health Care Personnel data is submitted quarterly via a web-based tool, the National Healthcare Safety Network (NHSN). The 2024 reporting deadlines are February 15, 2024 (2023 third-quarter data), May 15, 2024 (2023 fourth-quarter data), August 15, 2024 (2024 first-quarter data) and November 15, 2024 (2024 second-quarter data).
    • Please note that ASC-15 a-e: Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) Survey measures are available for voluntary reporting in CY 2024, with mandatory reporting beginning with the CY 2025 reporting period for CY 2027 payment determination. CMS has added two approved survey modes: electronic with phone and electronic with mail. ASCs must use an approved OAS CAHPS Survey vendor: and pre-register via the OAS CAHPS website. For more information, visit our OAS CAHPS Survey page.
  • Tuesday, January 09, 2024 8:56 AM | WiSCA (Administrator)

    The Centers for Medicare & Medicaid Services (CMS) has provided more information regarding the new recommendation process for the ASC Covered Procedures List (ASC-CPL). This process enables interested parties to submit codes for consideration to be added to Medicare's ASC-CPL. The submission period will start on January 1, 2024, and conclude on March 1, 2024, for 2025 rulemaking. ASCA will continue to advocate for the addition of complexity-adjusted code combinations and alignment with the Hospital Market Basket to update reimbursement rates. More information about the recommendation process will be available in January in ASC Focus Magazine’s Digital Debut.  If you have specific procedures you would like ASCA to advocate for, please contact Kara Newbury.

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