WACEP Legislative Report
Hubbard Wilson & Zelenkova
April 20, 2022
The two-year legislative session ended in March, which means that all legislation previously introduced that did not pass is dead.
SB 394/AB 396 – the APRN Bill - authored by Senator Patrick Testin, Rep. Rachel Cabral Guevara did of course pass both houses of the legislature. We are very happy to report that the Governor vetoed this legislation last Friday. While the bill was improved slightly in the assembly to at least include two years of clinical experience before an APRN could practice independently, it was not improved enough. To that end we advocated for the veto including the grassroots action alert and countless meetings along the way with the Governor’s team.
In the end, the physician coalition’s position was, and continues to be, that the bill needed to include at least the following:
1. 4 years of clinical experience as a requirement for independent practice - 2 years as an RN and 2 years as an APRN or 4 years as an APRN. (This requirement would at least be relatively on par with many medical residencies.)
2. For the practice of pain management, continue to require collaboration with a physician, specifically with a physician trained/experienced in pain medicine. (This is a basic guardrail that still provided far more leeway than our pain specialists were comfortable with given the complexities of pain medicine and chronic pain management).
3. Explicit “Truth in advertising”/“Title Protection” for physician specialty titles and terms associated with physicians. This is the one true ask of physicians in defense of their profession and credential and is basic common sense to include in a bill that will no doubt reduce transparency and increase confusion among patients in a new universe of “independent practice”.
The Assembly moved forward without addressing all of our concerns - adopting an amendment that only included the following:
1. 2 years (3840 hours) of clinical experience as an APRN before being allowed to practice completely independently.
2. Require physician collaboration for an APRN to practice pain management independently; except if the APRN is working in a hospital or in a hospital affiliated clinic - then no collaboration requirement. (It does not include that the collaborating physician be a physician who is trained and experienced in pain medicine.) So that’s worse than current law, slightly better than the original bill, but not enough.
We expect this bill to come back next session regardless of election outcomes. Interesting note: the senate author Testin is running for Lieutenant Governor and the assembly author, Cabral Guevara, is running to replace Roger Roth who is retiring from his Appleton senate seat to also run for Lt. Governor.
SB 532/AB 529, introduced by Senator Kathy Bernier of northwestern Wisconsin and Rep. Jesse Rodriguez of Oak Creek / Milwaukee County, created a regulatory framework for naturopaths. Naturopaths were not regulated at all in WI. WMS negotiated a compromise on this bill and the result rewrites the legislation in a way that significantly skinnies down the overall scope that includes the creation of a regulatory board that will NOT have future scope rulemaking abilities; naturopaths are prohibited from prescribing controlled substances; the title “naturopathic medical doctor” is NOT allowed; and a specific provision in the definitions sections regarding what naturopaths are allowed to do makes it clear that it is distinct from the definition of “practice of medicine and surgery” that applies to physicians. AB 529 was signed into law by the Governor with the compromise amendment.
Emergency Psych: Proposed JFC 13.10 request re: crisis stabilization: Governor Evers’ 2021-23 biennial budget recommended $17.6 million GPR and statutory changes to establish and support crisis urgent care and observation centers as a new provider category, as well as support short-term residential crisis stabilization and inpatient psychiatric beds. The Legislature did not adopt the Governor’s recommendation and instead placed $10 million GPR in the Committee’s appropriation for crisis services.
DHS has drafted a request to the Joint Finance Committee for the transfer of funds from the Committee’s appropriation to support grants to strengthen the system under current law. The Department plans to award the funds in FY 23 through a competitive grant application process to organization(s) that aim to support and improve regional crisis intervention and stabilization services through a county-based collaborative approach.
Certified county crisis programs will be invited to apply for the funding opportunity focused on partnership with local agencies such as law enforcement, providers of crisis supports, or hospital systems. The grants can be used to expand or enhance current operations in the county crisis system with the intention of reducing the number of emergency detentions in inpatient facilities and reducing the burden on law enforcement in responding to and transporting individuals in crisis.
This proposal has been discussed with the EmPsych Taskforce. No sense on whether this is going to move forward sat this point.
Surprise Billing/NSA: While the federal No Surprises Act and the interim rule are in effect, in a recent development, the U.S. District Court for the Eastern District of Texas vacated some problematic provisions of the Interim Final Rule related to the independent dispute resolution process. The lawsuit was brought by the Texas Medical Association. The decision will likely be appealed but if it stands will hopefully balance out the unfair advantages health insurance companies have in the interim rule’s IDR process. ACEP, the American College of Radiology, and the American Society of Anesthesiologists have an ongoing challenge to similar provisions of the rule in a District Court in Chicago. WACEP has interacted with the WI OCI recently on this issue but it appears clear that OCI will be strongly deferring to the federal law and rule. Input was shared on some ways to simplify processes in Wisconsin regarding identification of what type of plan a patient is insured by to know if NSA even applies. We do not know yet whether this input was well-taken.
Redistricting: State legislative boundaries are still in limbo. Previously the WI Supreme Court chose maps drafted by Governor Evers. Its ruling was appealed to the US Supreme Court which overturned the decision related to concerns on the number of “majority-minority” districts in the Milwaukee area. The WI Supreme Court, as opposed to only adjusting the districts that SCOTUS took issue with, went in a very different direction and instead selected the proposal submitted previously by legislative republicans. We expect this decision to also be appealed to the US Supreme Court. Whether the high court will hear it, remains to be seen. But it appears that new district lines – at least in state assembly and senate seats – remain in uncertain for a few more days or even weeks.
Legislative Not Running for Re-election in Current Office:
- District 3 - Ron Kind (D) - Not Seeking Re-election
- District 15 – Janis Ringhand (D) – Not Seeking Re-election
- District 25 – Janet Bewley (D) - Not Seeking Re-election
- District 27 – Jon Erpenbach (D) - Not Seeking Re-election
- District 23 – Kathy Bernier (R) - Not Seeking Re-election
- District 19 – Roger Roth (R) - Running for Lt. Governor
- District 29 – Jerry Petrowski (R) - Not Seeking Re-election
- District 5 – *Dale Kooyenga (R) (If he stays drawn out of seat after Redistricting)
- District 5 – Jim Steineke (R) - Not Seeking Re-election
- District 6 – Gary Tauchen (R) - Not Seeking Re-election
- District 10 – David Bowen (D) – Running for Lt. Governor
- District 13 – Sara Rodriguez (D) – Running for Lt. Governor
- District 15 – Joe Sanfelippo (R) - Not Seeking Re-election
- District 27 – Tyler Vorpagel (R) - Not Seeking Re-election
- District 31 – Amy Loudenbeck (R) - Running for Sec. of State
- District 33 – Cody Horlacher (R) - Not Seeking Re-election
- District 45 – Mark Spreitzer (D) – Running for Senate
- District 46 – Gary Hebl (D) – Not Seeking Re-election
- District 52 – Jeremy Thiesfeldt (R) - Not Seeking Re-election
- District 54 – Gordon Hintz (D) - Not Seeking Re-election
- District 55 – Rachel Cabral-Guevara (R) – Running for Senate
- District 59 – Tim Ramthun (R) - Running for Governor
- District 61 – Samantha Kerkman (R) – Won Kenosha County Executive Race
- District 68 - Jesse James (R) – Running for Senate
- District 73 – Nick Milroy (D) – Not Seeking Re-election
- District 74 – Beth Meyers (D) - Not Seeking Re-election
- District 79 – Dianne Hesselbein (D) - Running for Senate
- District 80 – Sondy Pope (D) – Not Seeking Re-election
- District 82 – Ken Skowronski (R) - Not Seeking Re-election
- District 84 – Mike Kuglitsch (R) - Not Seeking Re-election
Sen. Brad Pfaff (D) (SD 32) – free shot at CD 3
Sen. Patrick Testin (R) (SD 24) – free shot at Lt. Gov.