Earlier this month, on Oct. 6, the Wisconsin Supreme Court issued a 4-3 decision – split down ideological lines – agreeing to hear a legal challenge to the state’s current legislative maps, which were drawn following the 2020 U.S. Census and after a series of rulings by the Wisconsin Supreme Court and the U.S. Supreme Court. The lawsuit, filed on behalf of Wisconsin voters, claims Wisconsin Assembly and Senate legislative districts were gerrymandered in violation of the state constitution.

Depending on a final ruling by the liberal-leaning court, new legislative maps could be in place by next year and could shift the balance of power in the Legislature. Republicans have held large majorities in both houses since 2011. The state’s high court will hear oral arguments in the case on November 21, but has not provided a timeline for when it will issue a decision.

Author: Andrew Engel – WISCA Lobbyist (Hamilton Consulting)

For the second session in a row, the Senate has passed the “APRN Modernization” bill, which will allow advanced practice nurses to work independently.  The bill passed on a 23-9 bi-partisan vote and now moves to the Assembly.  An amendment was attached to the bill increasing the hours of experience needed for the new APRN credential, but otherwise the language passed is similar to last session’s bill that was vetoed by Governor Evers.

WISCA is watching this bill closely to make sure that any new provisions won’t negatively impact ASC’s abilities to work with APRNs, most specifically we are watching proposed amendments that relate to pain management as some proposed amendments could restrict ASC’s, especially in rural areas, from utilizing CRNA’s (see third bullet under Med Society’s proposed changes). 

The Wisconsin Nurses Association characterizes provisions in the bill as such:

·        Provides licensing for APRNs and describes the strict educational/experience requirements to obtain a license.

·        Grants title protection for APRN and the four specialties.

·        Sets the stage for future APRN Compact agreements with other states.

·        Standardizes the APRN professional titles to be consistent with the other states.

·        Gives the Wisconsin Board of Nursing greater authority in regulating APRNs and APRN graduate schools.

·        Provide technical amendments to replace Advanced Practice Nurse Prescriber (APNP) with APRN.

·        Modernizes Wisconsin’s Nurse Practice Act, § Chapter 441 to reflect the national consensus model being adopted across the country. Specifically the APRN Modernization Act;

·        Adds a definition for Advanced Practice Registered Nurse (APRN) and scope of practice.

·        Provides formal licensure for advanced practice registered nurses (APRN), recognizing the four different practice roles; Certified Nurse Midwife, Certified Registered Nurse Anesthetist, Clinical Nurse Specialist and Nurse Practitioner. Requires the licensee to hold national board certification

·        Requires graduating with a master’s degree or higher in an APRN role; and graduated from a school of nursing with national accreditation.

·        Requires demonstration of medical malpractice and liability insurance coverage.

·        Creates the conditions for an APRN to prescribe, consult, collaborate, and refer patients to other health care providers and health systems.

·        Allows currently practicing APNPs be licensed as APRNs without application.

·        Repeals §441.15 – Nurse Midwife Practice Act

·        Repeals §441.16 – Prescription Privileges for Advanced Practice Nurses

The Wisconsin Medical Society continues to oppose the bill and is calling for changes:

·        Requiring an APRN to have at least four years of real-world, team-based care experience before being allowed to practice independently. Two of those years must occur after receiving APRN certification.

·        Adding statutory certainty that certain words and terms used to connote physicians and their specialties (including words such as “physician,” “anesthesiologist” etc.) may only be used by those who have earned a medical doctor (MD) or doctor of osteopathy (DO) degree. A separate bill to achieve this goal has been introduced as Senate Bill 143, which was also on the public hearing docket.

·        Protecting patients seeking complex pain management services by requiring certified registered nurse anesthetists (CRNA) to work in collaboration with a physician specializing in pain medicine. Current law requires CRNAs to work in collaboration with a physician, with no requirements that the physician have any experience in pain medicine.

The Assembly still needs to act on the bill before it is sent to the Governor.  It is expected that there will be additional amendments brought forward, but it is unclear if there will be a compromise that paves the way to passage.

Wisconsin Sen. Rob Stafsholt (R-New Richmond) and Rep. Shannon Zimmerman (R-River Falls) recently visited the Valley Surgery Center in Hudson, WI. Their visit was part of the Association of Wisconsin Surgery Centers (WISCA) Capitol Connection program to connect WISCA members with their local state legislators to show them firsthand the benefits of the Ambulatory Surgery Center (ASC) model of care.

“Valley Surgery Center leadership was pleased to host Sen. Stafsholt and Rep. Zimmerman for a tour of the recently opened Valley Surgery Center,” said Dan Zismer, Ph.D., who serves as President of the surgery center’s Board of Governors. “As Board President, I can speak for my colleagues when I say we were impressed with their understanding of the importance of ambulatory surgery centers to the residents of western Wisconsin, as well as their interests in the policy issues that impact cost-effective health care delivered by ASCs.”

Zimmerman is currently serving his fourth term in the state Assembly representing the 30^th Assembly District. Regarding his visit to Valley Surgery Center, he said he had “great discussions with several care providers as we toured the beautiful new facility in Hudson,” and is pleased that “western Wisconsin has newly developing healthcare options that will help area residents receive the care they need much closer to home.”

Stafsholt, who represents the 10^th Senate District, was first elected to the Senate in 2020 after serving two terms in the state Assembly.

The Valley Surgery Center is a multi-specialty ambulatory surgery center owned and operated by the medical groups that perform surgery there. The Center’s surgeons, who provide the highest quality surgical care, and the patient care staff recognize the importance of improving the health, well-being, and quality of life for every patient they serve.

If you are interested in hosting a legislative visit at your ASC, please contact the WISCA office at WISCA@badgerbay.co.

Thank you to Valley Surgery Center for hosting their local state legislators, Rob Stafsholt (R-New Richmond) and Rep. Shannon Zimmerman (R-River Falls).

Earlier this month, the GOP-controlled state Assembly passed a nearly $3 billion state income tax cut proposal that would drop income tax rates from 5.3% to 4.4% for individual filers with incomes between $27,630 and $304,170 and deliver the same tax relief for married couples with incomes between $18,420 and $405,550. The legislation would also exclude the first $150,000 of a couple’s retirement income from state income taxes. The provision would apply to residents over the age of 67.

Gov. Tony Evers has promised to veto the legislation, saying it would jeopardize priorities such as public schools, child care, and public safety. On the flip side of the debate, Assembly Republicans said the measure, which passed on a partisan vote, will help fight inflation, encourage retires to stay in Wisconsin, and give a large portion of the state’s $4 billion surplus back to taxpayers.

The bill is currently under further consideration in the Senate.

The Republican-controlled state Assembly recently passed a redistricting reform plan to completely overhaul how legislative district maps are drawn in Wisconsin. Under the proposal, which is based on the model used in Iowa, a nonpartisan committee would draw the legislative maps. The maps drawn by committee would be subject to approval by the state Legislature. 

Gov. Tony Evers roundly criticized the proposal, saying it was essentially election interference by the GOP and strongly inferred he would veto the measure if it made it to his desk. Assembly Republicans praised the legislation as not only the fairest approach to redistricting for citizens, but also a plan that would avoid costly political and legal battles.

Recent polling has shown that a large majority of Wisconsin residents would prefer legislative district maps be drawn by a nonpartisan commission rather than elected officials.

The proposal, which passed the Assembly on a largely partisan vote with one Democrat voting for the measure, is awaiting further action in the Senate.

On August 31, Governor Tony Evers and the state Department of Safety and Professional Services (DSPS) unveiled a new online dashboard that provides high-level data on occupational license processing.  In addition to showing the average number of days to process all new applications, all health applications, and all business applications, users may also look up application review times by profession. 

On August 8, Governor Tony Evers called a special session of the Legislature, urging lawmakers to consider a $1 billion workforce development package the Governor said was needed to address the state’s workforce shortage crisis.

Republicans, who control both houses of the Legislature, convened the session as required by law, but quickly adjourned without acting. They called the special session a “political stunt” that was fiscally irresponsible and did not provide real solutions to Wisconsin’s workforce challenges.

The Governor’s proposed legislative package included $365 million to support childcare programs; the creation of a paid family and medical leave program that would cost $243 million; $66 million for the UW; $40 million for the state’s technical colleges; and nearly $60 million to help address the shortage of healthcare workers across the state. The funding to address the healthcare worker shortage included:

·        $10 million for the state’s nurse educators program, which incentivizes nursing professors to remain in Wisconsin.

·        $6 million for the WisCaregiver Careers program, which is intended to increase the number of certified nursing assistants employed at nursing homes.

·        $17 million for healthcare opportunity grants, which will go to local workforce development boards to help individuals obtain employment in the healthcare field.

·        $936,600 for the state Department of Workforce Development to work on healthcare apprenticeships.

·        $22.5 million for healthcare innovation grants, which will help the healthcare industry recruit and retain employees.

·        Over $1.2 million for graduate medical training support grants.

Author: Andrew Engel – WISCA Lobbyist (Hamilton Consulting)

Following what was effectively a summer break for many legislators, the Assembly and Senate held their first days of votes in the fall floor period that started in September, and regular committee hearings have resumed. Here are a few key highlights:

• Gov. Evers called a special session of the Legislature on September 20 “to complete their work on the 2023-25 biennial budget and pass a meaningful, comprehensive plan to address the state’s longstanding, generational workforce challenges.” The governor’s press release lists $1 billion in proposals. Republicans gaveled in and out of the special session without taking any action. 

• Speaker Vos and Majority Leader LeMahieu indicated that they are more interested in reducing income taxes to attract and retain employees and employers, with Speaker Vos saying that Republicans’ first priority in September “will be to give Gov. Evers another chance to fix his mistake by signing a middle-class tax cut.” To that end, Assembly Republicans have introduced and passed legislation to enact an income tax cut for Wisconsin’s largest tax bracket, including married joint filers earning between $36,840 and $405,000. The Senate has yet to act on the bill.

• Republican legislators have also introduced and passed a package of childcare-related bills to increase the current child to teacher ratios in group settings; decrease age limits for child care teachers; create a new category of large family-based day care providers; allow parents and guardians who do not have an employer-sponsored flexible spending account to open state-issued child care savings accounts; and create a new renovation loan program administered by the Wisconsin Economic Development Corporation. These bills passed the Assembly on a party line vote and if they pass the Senate are expected to be met with vetoes from the Governor as he is more focused on his proposal that would provide direct funding to childcare providers.    

While there is hope that the Governor and legislature will find common ground on the two issues resulting in a compromise providing a tax cut and money for childcare, the discussions at this point and time do not appear promising. 

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:

Price Transparency Legislation

On July 26, the US House Ways & Means Committee voted to send H.R. 4822, the Health Care Price Transparency Act of 2023, to the House floor. The legislation, which was introduced on July 24, impacts various healthcare providers and would require ASCs to compile and make public, including:

·         Standard charges for each item and service furnished by the ASC.

·         Information on the facility’s prices for as many of the CMS-specified shoppable services that are furnished by the ASC, and additional ASC-selected shoppable services, as may be necessary for a combined total of at least 300 shoppable services.

·         An indication that a service is not furnished by the ASC for each CMS-specified shoppable service that is not furnished.

This legislation allows CMS to issue penalties of $300 per day for noncompliance. ASCA has been working closely with Ways & Means and Energy and Commerce committee staff to improve the legislation and has already successfully pushed back the effective date in the bill to 2028 from 2026, as originally proposed. In addition, ASCA got language removed that would have provided the secretary of the US Department of Health & Human Services broad discretion to require ASCs to submit “any additional information specified by the Secretary.” ASCA staff and lobbyists will continue to work with members of Congress over the August recess to reduce burdens on facilities and try to ensure that any price transparency legislation enacted would benefit patients and the general public.

As was reported in last month’s edition of the WISCA Advocacy Newsletter, the Centers for Medicare & Medicaid Services (CMS) released the 2024 proposed payment rule for ASCs and hospital outpatient departments (HOPD) on July 13.

Of note, CMS concurred with ASCA’s request and proposed to continue to align the ASC update factor with the one used to update HOPD payments, extending the five-year interim period an additional two calendar years (CY) through 2025. In addition, if the proposed rule were to be finalized as drafted, ASCs would see, on average over all covered procedures, an effective update of 2.8 percent—a combination of a 3.0 percent inflation update based on the hospital market basket and a productivity reduction mandated by the Affordable Care Act of 0.2 percentage points. It is important to note that CMS does not consider sequestration in its proposed rule. This statutory 2.0 percent reduction remains in effect unless Congress acts.

The Ambulatory Surgery Center Association (ASCA) – our national partner organization – has been keeping WISCA fully briefed on the proposed rule and has developed a national stakeholder letter outlining the ASC industry’s concerns and general thoughts on the rule. WISCA has signed onto the comment letter, which will be submitted to CMS prior to the September 11, 2023, deadline.