ForwardHealth has published Alert 009, titled "Temporary Changes for Durable Medical Equipment and Disposable Medical Supplies Face-to-Face Requirements," to the ForwardHealth COVID-19 Portal Page (link). Beginning March 12, 2020, ForwardHealth will not require a face-to-face visit with a physician or authorized non-physician practitioner for an initial prescription of any durable medical equipment or disposable medical supplies. A prescription will continue to be required for durable medical equipment and disposable medical supplies.

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).

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.

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).

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).

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.

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.

Wisconsin Health News

The Assembly signed off on raising the tobacco purchase age to 21 during a floor session on Thursday.

The federal government raised the age last year, but state and local law enforcement don't have the authority to enforce federal law.

States have to comply with the federal law or else risk losing funding on a block grant for mental health services that relies on compliance with the policy.

Lawmakers approved an amendment to the original bill striking the mention of the age 21 and instead referencing the age set by federal law.

Bill author Rep. John Spiros, R-Marshfield, said that would ensure that lawmakers won't have to modify state law if federal law changes again.

"By passing this bill, not only are we ensuring that Wisconsin does not lose federal funding, but we are also helping to stop the public health crisis in its tracks," Spiros said.

Rep. Jill Billings, D-La Crosse, offered an amendment voted down by Republicans that would provide $2 million for smoking cessation and education.

For some young adults who smoke, raising the age could cut off access to tobacco purchase, she said.

Read more.

Wisconsin Medical Society / Medigram

Two bills that the Wisconsin Medical Society has been tracking received votes on the Assembly floor this week. The first was the CARES Act (AB 575) which passed on a voice vote on the floor. The version that passed was the amended version that the Society worked on with the bill authors, physician assistants and hospitals. The Society was neutral on this amended version. Information on the parameters of the amended bill can be found here.

The second bill that passed related to pharmacy benefit managers or PBMs (AB 114). Like the CARES Act, the PBM bill that passed was a substitute amendment and involved significant changes to the initial bill after substantial discussions between the PBMs, pharmacies and insurers.

Highlights of the PBM bill include:

• new licensing and registration requirements created for PBMs
• “gag clauses” repealed
• list of audit requirements of PBMs
• transparency requirements
• drug substitution provisions
• cost-sharing limitations

The substitute amendment kept similar language to the original bill regarding prohibitions on gag clauses (which prevent pharmacists from informing patients that a given medication would be cheaper if they paid for it out-of-pocket rather than with insurance). Similar language was also maintained regarding cost-sharing limitations, whereby PBMs would not be able to require patients to pay more than the lower amount of either their copay, or what they would pay had they not used insurance to purchase the drug. There is also language prohibiting PBMs from rejecting a pharmacy claim without due cause.

The two versions differed significantly on the other provisions in the bill. Regarding licensure, the amended bill only requires PBMs to be licensed by the state, but not registered. PBMs would also not have to adhere to a list of rules that would have been created by the Office of the Commissioner of Insurance (OCI). The network requirements also differed in that rather than adhere to stipulations regarding network adequacy and distance, PBMs would only be required to provide pharmacies with a written notice of certification and accreditation requirements. There were also significant differences between the two bills on the audit requirements and processes of PBMs.

On the transparency end, PBMs will be required to submit reports to OCI on the aggregate rebates they received from manufacturers and did not pass through to insurers. These reports will not be made public on the grounds that they are “trade secrets” under the amended bill. Conversely, pharmacies will have to make publicly available the retail price of the 100 most commonly prescribed drugs on a monthly basis.

The PBM passed the Assembly 96-0 on Tuesday and will head to the Senate for its final floor session.

Please contact HJ Waukau with any questions.

December 19, Medigram

Wisconsin Medical Society staff continues to gather member feedback on proposed changes to the Society’s policy creation process. After hosting eight events across the state this fall and speaking with 77 individual physicians about the proposed changes, Society staff and member leadership will be heading out again in January and February for a second round of district meetings. While the first meetings were designed to gather a wide range of ideas, these meetings will provide a more tangible framework for the future of Society governance.

Key to the future process is the development of a dynamic and accessible digital platform to facilitate submission and review of policy resolutions on a year-round basis. With the recent launch of WisMed Community, the Society now has the technological infrastructure to support this framework. Based heavily on the model used by Colorado Medical Society, the emerging process is designed to include more members in policy creation and allow for more timely review of developing state and federal policy.

“It is an exciting time for the Society,” said Peter Welch, Chief Operating Officer, “Our investment in technology will ensure that we have more of today’s busy physicians engaged in the policymaking process right at their fingertips.”

Over the next two months, Society staff will be traveling to each of the 8 districts to hear feedback on this process. Click here to RSVP for your district’s meeting. You can also fill out this form with your questions and concerns about these proposed changes.

Contact Peter Welch with questions.