Greg Hubbard and AJ Wilson of Hubbard Wilson & Zelenkova
September 12, 2021
The state budget was signed into law in early July. The legislature has not been in session since but there has been an unusual amount of legislative activity for the summer months, including bills of significant concern to WACEP.
BUDGET WRAP UP
The biennial state budget process wrapped up at the beginning of July and included the first increase in MA reimbursement for emergency services in over two decades. While the Governor did propose a greater increase, the legislature settled on a 15% in rates going forward. We are working with DHS at present to provide input on how the additional funding will be allocated among emergency department codes.
The final budget also included provisions that were supported by the Emergency Pscyh Taskforce that will support an increase in crisis stabilization services.
Funding for regional crisis services grants was included by the Legislature and signed by the Governor, but the funding was a bit less than originally proposed.
The legislature also enumerated $5million in bonding to North Central Health Care to renovate the existing mental health facility in Marathon County that will provide 16 inpatient psychiatric beds, five beds for emergency stabilization and five beds for detoxification and substance abuse treatment. It will serve Forest, Langlade, Lincoln, Marathon, Oneida and Vilas Counties.
In addition, the legislature’s budget included $15 million in bonding for the Eau Claire County psychiatric bed expansion but the Governor vetoed the language and kept the appropriation so that those funds could be used across the state. We are presently working with DHS and other stakeholders on how best to utilize those funds and seek legislative authorization to do so.
HWZ is presently engaged on two proposals of significant concern and presently monitoring a third.
- SB 394/AB 396 authored by Senator Testin, Rep. Cabral Guerra, and Rep. Magnafici is an Advanced Practice Registered Nurse designation/licensure bill that also includes significant scope expansion. This legislation is similar to bills introduced in previous sessions, but goes much further. The bill proposes to designate and license nurse practitioners, certified nurse-midwives, certified registered nurse anesthetists, and clinical nurse specialists as APRN. It proposes to eliminate requirements for these APRNs to collaborate with physicians; codifies in state statute, the ability for an APRN to assess, diagnose and treat patients, including prescribing most drugs independently from a physician; mandates that the state "opt out" of federal certified registered nurse anesthetist supervision requirements; and eliminates current law requiring certified nurse midwives to have a collaborative arrangement with a physician who has experience with obstetrics. WACEP is registered against this bill, HWZ has been engaged against this bill on WACEP’s behalf. Additionally, we will be circulating a memo from WACEP to committee members in the near future.
- SB 532/AB 529, introduced by Senator Kathy Bernier of northwestern Wisconsin and Rep. Jesse Rodriguez of Oak Creek / Milwaukee County area would create a regulatory framework for naturopaths. Naturopaths are not regulated at all in WI. While regulatory framework for naturopaths may make sense, this bill has troubling provisions in it in addition to creating the framework for regulation. The bill allows prescribing - not all prescriptions and not narcotics - but it does allow prescribing; It creates a “naturopathic medicine examining board” and gives it the power to determine the scope of practice for “naturopathic medical doctors” going forward. Finally, it also authorizes the title “NMD”- naturopathic medical doctor - which is troubling. WACEP has registered against this bill as has WMS and several other physician groups.
- SB 407/AB430 authored by Senator Darling and Rep. Zimmerman removes the exemption under current law that allows physicians to prescribe opioids without checking the ePDMP. As a result, providers will need to consult the ePDMP even when prescribing opioids in quantities of three days or less. The WMS Council on Legislation voted to oppose the bill. This bill has had no action taken.
ADMINISTRATIVE RULES: State Implementation of the federal “No Surprises Act”
WACEP was engaged in discussions regarding out of network / surprise billing legislation during the budget process. Thankfully, the legislature inevitably deferred to the federal law that will come on line in January 2022. Since that time, WACEP, working with the anesthesiologists’ and radiologists’ associations, have met with the Office of the Commissioner of Insurance regarding state rules on implementation. Most recently an interim rule was released on the federal level. WACEP along with other stakeholders will continue to work with OCI to ensure that its point of view is recognized for state rulemaking and implementation purposes.