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:
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.
Health Care Workforce
The bill contains several provisions related to voting during public health emergencies. Specifically, for elections held during a declared public health emergency, it would:
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 RequestsFor 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.
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.
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:
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.
WCMS563 Carter Court, Suite B, Kimberly, WI 54136Email: WaukeshaCMS@badgerbay.co