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.
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.
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.
December 5 - Wisconsin Medical Society Medigram
The Wisconsin Medical Society is excited to announce that WisMed Community – the new online community just for WisMed Members – will be live on Monday, December 9! This new member benefit will allow physicians to connect, collaborate and celebrate their successes.
Initially, there will be two community groups: WisMed Members (for general discussions about things like tips and recommendations) and Share a Success (for you to share the great work you or a colleague is doing to advance health care). More community groups will go live in the coming months including Advocacy in Action, so be sure to check back often.
Members will receive an email on Monday with information about how to get logged in and start connecting with colleagues. Please add connectedcommunity.org to your safe sender list so you stay connected.
Contact Anne Hauer with questions.
The Wisconsin Medical Society has partnered with the Medical College of Wisconsin and the University of Wisconsin School of Medicine and Public Health to bring together experts on emerging health care trends within the transition zone of adolescents becoming young adults for the Society’s Annual Meeting CME Conference. Navigating the Transition Zone: From Adolescence through Young Adulthood,* will be April 17 and 18 at the Monona Terrace Community and Convention Center, Madison, Wis.
Saturday’s keynote, Childhood Adversity and Lifelong Health: The Science Behind Trauma-informed Care, will be presented by Pamela McGranahan, DNP, RN, Clinical Assistant Professor at the University of Wisconsin Madison School of Nursing, DNP Program Director.
With a focus on mental and behavioral health, sexual health, adolescent lifestyles and complex diseases within the transition zone of adolescents becoming young adults, this conference is designed for physicians and other members of the health care team to gain valuable insight on topics that are relevant across specialties.
Plan your weekend! The Wisconsin Medical Society Foundation’s Annual Fundraising Dinner and Silent Auction will be from 5 pm – 8:30 pm on Friday, April 17 and the Society House of Delegates meeting will be on Sunday, April 19.
Contact Brianna Farwell at 608.442.3791 with questions.
* This conference has been approved for AMA PRA Category 1 Credit™ and AAFP Credit.
Find more information here!
October 21, Wisconsin Health News
The annual economic cost of binge drinking in Wisconsin is $3.9 billion, according to a new report from the University of Wisconsin Population Health Institute.
The report called binge drinking a “critical public health concern” and said it leads to increased spending on healthcare, crime and other costs.
“Everyone who lives and works in Wisconsin is affected by the health and economic costs of excessive alcohol consumption, including binge drinking,” the report noted.
The prevalence of binge drinking in Wisconsin last year was 24 percent, compared to the median of 16 percent in the United States.
Productivity losses contributed to 66 percent of the total cost of binge drinking, with 10 percent attributed to healthcare, 15 percent to criminal justice and 9 percent to other losses like motor-vehicle crashes. The annual cost per resident, including children, is $666.
Local, state and federal governments pay for around 41.4 percent of total binge drinking costs, which is around $1.6 billion.
The state alcohol tax revenue in Wisconsin last year was $60.9 million, 1.6 percent of the total cost of binge drinking.
The report noted limitations like the numbers being “substantially underestimated” due to gaps in data and by not including intangible costs like pain and suffering.
Correction: The initial story misstated the revenue collected through the state’s alcohol tax. The correct number is $60.9 million.
October 11, Wisconsin Health News
Hospital leaders weighed in on what health systems can do to cut costs and the role they should play in addressing the social determinants of health at a Wisconsin Health News panel this week.
· Dr. Scott Rathgaber, CEO, Gundersen Health System
· Damond Boatwright, President, SSM Health Wisconsin
· Luke Beirl, CEO, Hayward Area Memorial Hospital
Charles Franklin, PhD, nationally recognized government scholar and pollster, will headline Doctor Day 2020.
Doctor Franklin has served as director of the Marquette Law School Poll since its inception in 2012. During that year’s highly scrutinized election cycle, he established Marquette as the definitive source for information concerning public opinion in Wisconsin.
Under Doctor Franklin’s direction as a visiting professor at Marquette, the poll became the largest independent polling project in state history. It accurately captured voter attitudes before every major election in 2012, including the gubernatorial recall, U.S. Senate and presidential races.
Since joining Marquette as a professor of law and public policy in August 2013, Doctor Franklin has used the poll to continue tracking political races of interest to voters and explore additional public policy issues.
At Doctor Day on January 29, 2020, Franklin will share his insight and polling data relevant healthcare policy and the 2020 election.
Click here for more information!
Contact WCMS563 Carter Court, Suite B, Kimberly, WI 54136
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