Earlier this month, Gov. Tony Evers announced his appointment of Kirsten Johnson as the next secretary of the Wisconsin Department of Health Services (DHS). Johnson, who begins her new role on Feb. 27, will replace former Secretary Karen Timberlake’s who left the state agency at the end of 2022.

According to a press release issued by the governor’s office, Johnson has over 20 years of experience as a public health leader in local, state, national, and international organizations. Most recently, she served as the health commissioner for the city of Milwaukee following her appointment in January 2021. Prior to serving the city of Milwaukee, Johnson led the Washington-Ozaukee Public Health Department for more than a decade as the director and health officer. Johnson also served as a health policy fellow and advisor for U.S. Congressman Ron Kind and helped develop policy for the House Committee on Ways and Means.

“Over the past 20 years of my career in public health, I have worked to address the challenges and health disparities facing Wisconsin’s rural, urban, and suburban communities alike—disparities that were laid bare by the pandemic,” said Johnson. “I am excited and honored to join Gov. Evers’ administration to lead DHS, where I look forward to using my expertise and knowledge to continue this important work.” 

Johnson has her master’s degree in public health from Tulane University of Public Health and Tropical Medicine and holds certifications as a public health professional and certified education specialist.

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 government affairs news from ASCA:

• Public Health Emergency update:
• • On January 30, the Biden-Harris administration announced its intent to end the national emergency and public health emergency (PHE) declarations related to the COVID-19 pandemic on May 11, 2023. The Centers for Medicare & Medicaid Services (CMS) has resources available to help you prepare for the end of the PHE, including provider-specific fact sheets for information about COVID-19 PHE waivers and flexibilities. One such waiver is the Hospitals Without Walls initiative that allowed ASCs to temporarily enroll as hospitals, which is set to expire along with the PHE declaration. “Under the Hospitals Without Walls initiative: CMS permitted ambulatory surgical centers (ASCs) to temporarily reenroll as hospitals and to provide hospital services to help address the urgent need to increase hospital capacity to take care of patients. . . . When the PHE ends, ASCs must decide either to meet the certification standards for hospitals at 42 CFR Part 482, or return to ASC status. If they choose to return to ASC status, they can only be paid under the ASC payment system for services on the ASC Covered Procedures List.” Updates will continue to be provided as the end of the PHE approaches, so please visit the CMS Current emergencies page for the most up-to-date information.

• ASC Quality Reporting program:
• • ASCA recently updated its Medicare Ambulatory Surgical Center Quality Reporting (ASCQR) Program resources, including the main Quality Reporting webpage. To ensure you are ready for compliance in 2023, the “How to Meet Medicare’s 2023 ASC Quality Reporting (ASCQR) Program Requirements” resource takes you through the measures that remain in the program for 2023 and what you need to do to avoid penalties in 2024. Other resources available include the following:
  • • December Digital Debut article that includes a 2023 ASCQR Program Overview
    • January Digital Debut article on data collection resuming for ASC-1 through ASC-4
    • FAQ webpage that answers commonly asked questions regarding the OAS CAHPS Survey, which becomes mandatory in 2025
  • The deadline for submitting other web-based measures is May 15. For more information, please consult our Government Affairs update.

• CMS payment policy meeting:
• • ASCA met with CMS payment policy staff on Wednesday, February 22. Thanks to those who completed the ASC Covered Procedures List (ASC-CPL) survey. We used the information collected to advocate for expansion of the ASC-CPL.

• Outpatient Surgery Quality and Access Act
• • The Outpatient Surgery Quality and Access Act, endorsed by Ambulatory Surgery Center Association, has been reintroduced in both chambers of Congress. U.S. Senators Richard Blumenthal (D-CT) and Bill Cassidy, M.D. (R-LA) and U.S. Representatives Brad Wenstrup, D.P.M. (R-OH), and John B. Larson (D-CT) reintroduced the bipartisan, bicameral legislation seeks to increase Medicare patients’ access to ambulatory surgery centers, ensure adequate reimbursement, and provide better quality metrics across sites of care.

As mentioned above, Gov. Evers recently introduced his 2023-25 budget proposal – the state’s two-year spending plan – before a Joint Session of the Wisconsin Legislature. Although the Republican-controlled Legislature is expected to scrap most of the Evers budget and craft their own version by working off current spending levels, it is likely the Legislature will adopt some of the governor’s proposals.

According to Evers, his budget includes proposals that would increase access to affordable healthcare coverage, improve the quality of healthcare services in the state, and expand the scope of benefits available through Medicaid. Please find below a brief overview of items included in governor’s budget proposal that may be of interest to WISCA members:

• Expand Medicaid eligibility for parents and adults from 100% of the federal poverty line ($27,750 annually in 2022 for a family of four) to 138% of the federal poverty line ($38,300 annually in 2022 for a family of four). According to the Evers Administration, this expansion would result in 89,700 low-income individuals becoming eligible for Medicaid, of which approximately 30,300 are uninsured. Under this proposal, the state would realize a savings of over $1.6 billion and draw down an additional $2.2 billion in federal funding over the two-year budget cycle. Republicans who control the Legislature are firmly opposed to this proposal.

• Provide $200 million in additional funding for Wisconsin Innovation Grants, a current program previously funded with federal dollars to design and implement plans to address workforce challenges. This proposal includes a $100 million allocation to specifically focus on fortifying the state’s healthcare workforce by providing grants to healthcare employers and related organizations.

• Provide $10 million to expand the state’s nurse educators program.

• Provide over $900,000 to the Department of Workforce Development to support healthcare profession apprenticeship curriculum development and to advance new collaborations related to healthcare workforce.

• Provide nearly $4 million and increased staffing to the Department of Safety and Professional Services to streamline the state’s credentialing process for licensed professionals and provide more efficient processing of license applications.

The WISCA Government Affairs Team will continue to analyze the recently introduced budget bill and keep the membership updated throughout the budget process.

Author: Andrew Engel - WISCA Lobbyist (Hamilton Consulting)

Gov. Evers gave his third biennial budget address on February 15, unveiling his 2023-25 executive budget. He proposes an operating budget of $103.8 billion over the next two fiscal years. For comparison, the 2021-23 state budget spent $87.5 billion.

The complete budget bill, budget in brief, and other executive budget documents are available here. The governor has also published his prepared remarks and a recording of his address, as well as selected excerpts.

For an overview of the provisions in Gov. Evers’ budget, separated by issue area follow Hamilton Consulting’s 2023-25 State Budget page.

A couple items of note for ASCs, the Governor’s budget did include a full repeal of the personal property tax.  A provision we believe will result in savings for many ASC’s should the legislature approve the change.

Additionally, the Governor included additional spending and position authority for the Department of Safety and Professional Services’ (DSPS) in an effort to improve the processing time of occupational license applications. 

By law, Gov. Evers’ budget will be introduced as a bill in the Wisconsin Legislature. The Joint Committee on Finance (usually Joint Finance Committee, JFC) will spend several months reviewing and altering the proposal. Based on past experience, we expect the following to happen:

• The Legislative Fiscal Bureau (LFB) will release a plain-language summary of the budget recommendations in about a month, that is, by the middle of March.
• JFC will hold agency briefings and conduct public hearings on the budget recommendations.
• The co-chairs of JFC will identify non-fiscal policy items and slate them for removal from the budget bill, which should occur roughly by the middle of April.
• JFC will vote, agency by agency, on changes to the budget.
• By June, the full budget should be available for debate and passage by both houses of the Legislature.

Lastly, republican legislative leaders were very critical of Governor Evers’ budget and have stated numerous times they intend to build the Legislature’s version of the budget from “base” instead of using the Governor’s budget proposal.  Most of Gov. Evers’ budget recommendations will be stripped or modified. Joint Finance Committee co-chairs Rep. Mark Born (R-Beaver Dam) and Sen. Howard Marklein (R-Spring Green) said the Joint Committee on Finance will work off spending levels in current law rather than Gov. Evers' proposal as they build the Legislature’s version of the 2023-25 budget. They also said they will remove Gov. Evers’ policy provisions from the budget.

Author: Hamilton

Tony Evers Sworn in for Second Term as Governor

Inauguration Day in Wisconsin took place on January 3. Democratic incumbents Gov. Tony Evers and Attorney General Josh Kaul began their second terms in office, while Sara Rodriguez was sworn in as the state’s new lieutenant governor. Gov. Evers spent the majority of his second inaugural address laying out his administration’s goals and policy priorities for the next four years, including the following statements:

• “Fully fund our public schools, keep class sizes small, invest in kids’ mental health, and retain and build upon our talented education workforce” and “make quality childcare and early childhood education more affordable and accessible.”
• Provide tax relief for “the middle class” and “working families,” not “big breaks to millionaires and billionaires.”
• “Expand BadgerCare and work to ensure everyone has access to quality, affordable healthcare” and “lower the cost of medication and cap the cost of insulin.”
• “Restore the freedoms that Wisconsinites had until June 23, 2022, the day before the U.S. Supreme Court overturned Roe v. Wade.”
• “Ensure that every Wisconsinite has access to clean, safe water… that means urgently addressing PFAS and lead and nitrates and getting those contaminants out of our water.”

2023-24 Legislature Begins with 31 New Members

Inauguration Day also marked the beginning of the 2023-24 Session of the Wisconsin Legislature, and 31 new members were sworn in, nearly 25 percent of the Legislature’s total membership. Republicans continue to control both chambers of the Wisconsin Legislature with strong majorities. Caucus leadership from both parties has remained mostly the same, while the budget-writing Joint Finance Committee will have five new members.

In the 33-member Senate, there will be seven new members, five Republicans and two Democrats. Sen. Cory Tomczyk (R-Mosinee) will be brand new to the Legislature; the other new members of the Senate previously served in the Assembly. In the 99-member Assembly, there will be 24 new members, 16 Republicans and eight Democrats.

This turnover was almost entirely due to legislators retiring or seeking other offices. Only Rep. Don Vruwink (D-Milton), who was moved into a differently numbered district due to redistricting, lost his bid for reelection. Shortly after the election, Sen. Alberta Darling (R-River Hills) retired, setting up a special election to select her replacement.

Key Issues: State Budget and Tax Reform

With another legislative session comes another biennial state budget bill, and Wisconsin is expected to have a surplus of $6.6 billion when the current biennium ends on July 1.

Late last year, Assembly Speaker Robin Vos said a top priority for him will be for the 2023-25 budget to cut taxes by at least $3.4 billion and possibly “significantly” more. The 2021-23 budget cut income and property taxes by that amount.

During the 2022 election, Gov. Evers said that his upcoming budget proposal will include additional funding for K-12 education and an increase in shared revenue for municipalities. He also proposed an income tax cut of 10 percent for single filers at $100,000 or less and joint filers at $150,000 or less. Gov. Evers will present his executive budget proposal to a joint session of the Legislature on February 15.

Recently, Senate Majority Leader Devin LeMahieu proposed changing the state income tax to a flat rate of 3.25 percent for all taxpayers by 2026. Currently, Wisconsin’s income tax rates start at 3.54 percent and rise to a high of 7.65 percent. Speaker Vos has also indicated he would support a flat tax. Last month, Gov. Evers called a flat tax a “non-starter,” saying “we prefer a progressive tax system that we have now.”

Sign-up to host a legislative tour of your ASC

With the 2023-24 legislative now upon us – and legislators busy at work on critical health care policy – it is more important than ever for WISCA members to strengthen their relationships with their state lawmakers and 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. Remeber, decisions state legislators make in the Capitol building 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.   

·         Legislative Session

Both the State Senate and the State Assembly were on the floor this month, but only dealt with limited calendars. Both houses adopted an amendment to the constitution relating to bail imposed on defendants awaiting trial, as well as a resolution to create an advisory referendum to be held at the April non-partisan election on the issue of whether individuals receiving public assistance should be subject to a work requirement. The proposed constitutional amendment will also go before voters (to approve or deny) in April.

·         Protasiewicz with Early Supreme Court Fundraising Lead

The first campaign finance reports for WI Supreme Court candidates were due earlier this month, and Milwaukee County Circuit Court Judge Janet Protasiewicz reported raising $756,000 in the last 6 months of last year, more than doubling her next closest competitors.  Waukesha County Circuit Court Judge Jennifer Dorow raised $306,000, former Supreme Court Justice Dan Kelly raised $312,000 and Dane County Circuit Court Judge Everett Mitchell raised $115,000.  The four face off in a primary in February, with the top two vote getters moving on to the April General Election.  While the Supreme Court is nonpartisan, its members do loosely line up along ideological lines, with Conservatives holding a 4-3 advantage. For Conservatives to maintain their majority, either Dorow or Kelly would need to win the April Election.

·         Legislative Republicans circulate Tax Proposals

Legislative Republicans have proposed two bills early this session focusing on tax cuts, fulfilling campaign promises from last fall.  Earlier this month, Senate Majority Leader Devin LeMahieu circulated a bill that would phase in a flat tax over the next four years.  The State currently has four income tax brackets, and if this bill were to pass, everyone in Wisconsin would be paying a rate of 3.25%, down from 7.65%, which is what taxpayers in the upper bracket are currently paying.  Governor Evers has said he does not support this proposal, although he is likely to introduce his own income tax relief proposal in his budget bill.

Republicans have also re-introduced legislation to eliminate the personal property tax in Wisconsin.  While Evers vetoed a bill to repeal the personal property tax last session, Republicans hope a compromise on the issue can be reached this session.

·         Medicaid Budget Surplus

The Wisconsin Department of Health Services (DHS) recently announced the state’s Medicaid program is now projected to finish the fiscal year with a $774.8 million surplus, roughly $270 million more than what was expected late last year. Former DHS Secretary Karen Timberlake, who stepped down from her post earlier this month, attributed the surplus to several factors, including the federal government’s continuation of enhanced reimbursement rates and reduced costs for prescription drugs. Given the nearly $300 million upper to the Medicaid fund, the state is expected to finish the current fiscal year with an overall budget surplus of close to $6.9 billion.

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 government affairs news from ASCA:

• Public Health Emergency Expected to End in 2023:

According to reporting by Politico, the Biden administration is considering ending the federal government’s formal declaration of a public health emergency (PHE) due to the COVID-19 pandemic at the end of the most recent renewal on January 11, 2023. The PHE was originally declared on January 31, 2020, by former US Department of Health & Human Services (HHS) Secretary Alex Azar, and has been renewed continuously since then. If the Biden administration chooses not to renew the PHE again, it is set to expire mid-April 2023. Numerous waivers that were introduced to ease administration of health services during the pandemic, including the Hospitals Without Walls initiative that allowed ASCs to bill as hospital outpatient departments (HOPD), would expire along with the PHE declaration.

• What Procedures Should Be Added to Medicare’s ASC Covered Procedures List?:

Help ASCA advocate for the expansion of the Centers for Medicare & Medicaid Services’ (CMS) ASC Covered Procedures List by completing a brief survey. The ASC-CPL contains codes that CMS considers clinically appropriate for ASCs to provide to Medicare beneficiaries. Participants must complete one survey for each procedure they would like added. For example, if you would like to see three procedures added, you would need to complete three surveys. Per 42 CFR §416.166 - Covered surgical procedures, unlisted codes (generally ending in 99) are not payable in ASCs. In addition, codes that are currently on the inpatient-only list may be recommended, but please note that it is generally a multiyear process for those codes to be considered for the ASC-payable list. Take the survey by Friday, February 10, 2023. Contact Kara Newbury with any questions.

• ASC-1 through ASC-4 Data Collection Resumed January 1:

CMS decided in 2022 rulemaking to resume data collection and reporting beginning in 2023 for ASC-1: Patient Burn; ASC-2: Patient Fall; ASC-3: Wrong Site, Wrong Side, Wrong Patient, Wrong Procedure, Wrong Implant; and ASC-4: All-Cause Hospital Transfer/Admission. These measures were previously suspended as of January 1, 2019. Facilities do not report these measures on claims as was previously required. Instead, ASCs must collect data for these measures for all patients, not just fee-for-service (FFS) Medicare beneficiaries, and will submit the data in calendar year (CY) 2024 via the Hospital Quality Reporting (HQR) secure portal (also known as QualityNet). Data collected in 2023 must be reported through the HQR secure portal by May 15, 2024. For more information, read last week’s Digital Debut.

Sign-up to host a legislative tour of your ASC

With the 2023-24 legislative session right around the corner, it is increasingly important for WISCA members to strengthen their relationships with key state lawmakers and candidates for state legislative office and 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.

One of the best ways to do that is for members to invite their local legislators to tour their 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/candidate bios, advocacy tips, issue briefings, and supporting documents.   

State Senator Alberta Darling has announced her resignation from the Wisconsin Legislature. After a career that spanned 32 in the State Capitol, she will step down from her seat on Dec. 1. Darling was initially elected to the Assembly in 1990, but only served a single two-year term. She was elected to the Senate in 1992.

Following the Nov. 8 elections, and heading into the 2023-24 Legislative Session, the GOP was set to hold a 22-11 veto proof majority in the senate. With Darling’s retirement, Senate Republicans will be one seat short of a two-thirds supermajority, at least until Gov. Tony Evers calls a special election to fill the seat.

The 8th Senate District, which Darling is vacating, covers portions of Waukesha, Ozaukee, and Washington Counties, including the municipalities of Mequon, Cedarburg, Germantown, and Menomonee Falls. The district leans Republican, but the special election could be competitive, especially if it is held in conjunction with the April general election that has a WI Supreme Court race on the ballot.

Darling, who was the first woman lawmaker to co-chair the Legislature’s powerful Joint Finance Committee, helped to shape the state’s finances and budget policies for over two decades. She served on the committee for 22 years, including 12 years as the co-chair.