MAY 22, 2017 - By Mike Amery, Esq., Senior Legislative Counsel
Congress is back in action after a short break and first up last week was a hearing and a vote on a top AAN priority, the Furthering Access to Stroke Telemedicine (FAST) Act.
Senate Finance Committee Votes on the CHRONIC Care Act
Senate version of FAST Act Now Has Seven Cosponsors
The House Version of the FAST Act Is up to 85 Cosponsors
With the addition of:
VA Developing National Telestroke Center
Drug Pricing Discussions Heat Up
AAN Agrees to Support S. 771 by Sen. Al Franken (D-MN)
HELP Committee Announces Plans to Hold Hearing on US Drug Prices
Senate Confirms Commissioner of the FDA
PALF Grad Highlighted by People Magazine
The management side of a council charged with developing changes to the state's workers' compensation system has proposed creating a fee schedule for healthcare services.
The Worker's Compensation Advisory Council, which consists of representatives from management and labor, crafts a bill that updates state law around workers' compensation every two years. Management and labor introduced their proposals at a meeting last week.
Management is calling for setting initial rates at 150 percent of Medicare rates starting in 2017. The schedule would adjust each year with the medical consumer price index.
The proposal differs from a measure that was pursued by the council four years ago but failed to make it into law, which was based on rates for surgeries and procedures negotiated by group health plans.
"The goal is the same, which is to bring cost containment to the state," said Chris Reader, an advisory council member and director of health and human resources policy at Wisconsin Manufacturers and Commerce.
He said it's easier to construct the fee schedule using Medicare as it's difficult for the state to obtain average group health plan rates. More than 40 other states have fee schedules, he said.
Mark Grapentine, Wisconsin Medical Society senior vice president of government relations and liaison to the council, questioned why Wisconsin would want to mimic other states when it already has a successful system.
"The value of the current workers' comp system as it exists is by just about every measure fantastic," he said. "For whatever reason, the management side tends to have this fascination with sticker prices of individual procedures and not the overall cost of care."
Reader pointed to other proposals from management they believe could help with costs. That includes allowing employers to direct workers to healthcare providers and requiring providers to follow treatment guidelines.
If a provider decides to deviate from the guidelines, they would have to get prior approval. That ensures providers get employees back to work as soon as possible, he said.
"Let me be clear - most do an excellent job of getting workers back to work," he said. "But having strong treatment guidelines will ensure that everybody has to do that unless there's a good reason not to."
Grapentine said they're concerned about both proposals. Treatment guidelines could make it inefficient and frustrating for physicians to provide care to injured workers, he said.
The proposal relating to guidelines, he said, is coupled with the fee schedule approach. States with fee schedules aren't as efficient in providing care, and treatment guidelines can cut utilization. He compared it to pushing on both sides of a balloon at the same time.
"If you push on both sides of the balloon really hard, you know what happens," he said. "Why on earth would you do that to a system that people across the board think is a national model?"
Management and labor are set to negotiate over the coming months to craft an agreed-upon bill for introduction to the Legislature.
Stephanie Bloomingdale, secretary-treasurer of the AFL-CIO and an advisory council member, declined to comment through a spokeswoman.
Joint Finance Committee Co-Chair Rep. John Nygren, R-Marinette, will provide an update on the state budget, preview what's next for the HOPE agenda and discuss the outlook for other pressing healthcare legislation at a Wisconsin Health News Newsmaker Event, Monday, June 5 in Madison at the Madison Club.
The event is Monday, June 5 at the Madison Club (5 E Wilson Street, Madison). Lunch begins at 11:45; conversation starts at 12:15pm and adjourns by 1pm.
Doctors and acupuncturists oppose a bill that would allow chiropractors to perform physical examinations for student athletes and practice "chiropractic acupuncture" and "chiropractic dry needling" if they receive additional training.
The bill received a public hearing Wednesday before the Assembly Committee on Health.
Under the proposal, schools that require a pupil to have a physical examination to participate in sports and other activities will have to accept a physical examination completed by a chiropractor the same way it accepts those completed by doctors. The chiropractor would have to hold a certificate in health or physical examinations.
The same requirement would apply to the state's technical colleges or a two-year campus within the University of Wisconsin System that require physical examinations for students to participate in sports.
"With some additional training, doctors of chiropractic could provide a high quality exam," Mark Cassellius, a chiropractor practicing in Onalaska, told lawmakers.
Dr. Tosha Wetterneck, past president of the Wisconsin Medical Society, opposes the bill.
The physical examination isn't just focused on the athletics, but on at-risk behaviors, immunizations and other factors that might impact sports participation, she said. That requires extensive training.
"This is rocket science," she said. "This is difficult."
The bill would also allow chiropractors to practice "chiropractic acupuncture" if they complete at least 200 hours of instruction and the acupuncture examination administered by the National Board of Chiropractic Examiners.
The bill would also allow chiropractors to practice "chiropractic dry needling," which involves puncturing the skin with needles to treat "neuromusculoskeletal pain and performance," if they complete 50 hours of postgraduate study.
Shawano-based chiropractor Brian Grieves said the bill could help address the opioid epidemic by increasing access to alternatives pain treatments.
"We have very limited, proven, effective non-drug options to offer people for pain," he said. "Being able to augment that by offering chiropractic acupuncture would greatly expand that access."
Elissa Gonda, chair of the legislative committee for The Wisconsin Society of Certified Acupuncturists, opposes the bill.
"Acupuncture is a serious and rigorous profession," she said. "It's not a method or technique that can be employed on an occasional basis by another healthcare practitioner."
Steve Conway, executive director of the Chiropractic Society of Wisconsin, said they're generally supportive of the bill but they're still vetting it.
The Medical Examining Board approved permanent rules last week that govern the practice of telemedicine and mandate continuing medical education requirements for doctors on opioid prescribing.
The rules are expected to go into effect June 1, Department of Safety and Professional Services staff told board members.
The final telemedicine rule clarifies that a physician-patient relationship can be established through telemedicine and provides guidelines on the use of telemedicine.
The other rule requires doctors renewing their licenses to complete two hours of training on guidelines written by the board that relate to opioid prescribing. Doctors have to complete 30 hours of continuing medical education every two years.
The Wisconsin Medical Society continues to voice concerns regarding HR 1628, the American Health Care Act (AHCA), which may receive a vote in the U.S. House of Representatives as soon as tomorrow.
The Society sent this letter to members of the Wisconsin Congressional delegation earlier today, cautioning that the MacArthur Amendment, which was introduced earlier this week, does not solve the problems inherent in the AHCA.
“Instead, it pushes those decisions to the states while leaving unanswered important questions such as whether Wisconsin’s Medicaid program will be adequately funded under the AHCA. We believe the legislation as currently drafted could have dramatic negative effects on our state’s sickest and poorest citizens,” stated Society Board Chair Jerry Halverson, MD, and President Noel Deep, MD, in the letter.
The Society’s Board of Directors suggested a set of Health System Reform Principles earlier this year that calls for any health reform plan to ensure that Medicaid is properly funded, that those who currently have health insurance maintain coverage, and that some of the key patient protections encompassed in the Affordable Care Act (ACA) such as guaranteed coverage for preexisting conditions and no lifetime caps for coverage be maintained.
The MacArthur Amendment—named for its principal proponent Rep. Tom MacArthur—would allow states to apply for waivers from some of the consumer protections provided in the ACA, including the age rating ratio of 3 to 1, the requirements that health insurers must cover certain essential health benefits, and the ban on health status underwriting.
The American Medical Association (AMA) also expressed concern this afternoon in a letter to Speaker Paul Ryan and Minority Leader Nancy Pelosi.
“The current ban on health status underwriting protects individuals from being discriminated against by their medical conditions. Prior to the passage of the ACA, such individuals were routinely denied coverage and/or priced out of affordable coverage,” wrote AMA President James L. Madera, MD. “We are particularly concerned about allowing states to waive this requirement because it will likely lead to patients losing their coverage. Although the MacArthur Amendment states that the ban on preexisting conditions remains intact, this assurance may be illusory as health status underwriting could effectively make coverage completely unaffordable to people with preexisting conditions.”
The AMA is encouraging physicians to contact their U.S. Representative. Click here for more information.
In partnership with the Wisconsin Department of Justice (DOJ) and the Drug Enforcement Administration (DEA), local law enforcement agencies will be holding Drug Take Back events throughout Wisconsin on Saturday, April 29.
Drug Take Back Day provides a safe, convenient and responsible means of disposal of unused or expired drugs, while also educating the community about the potential abuse and consequences of improper storage and disposal of these medications.
“More than two thirds of people who have abused prescription painkillers got them illegally from a friend or family member,” said Wisconsin Attorney General Brad Schimel. “Wisconsinites can help cut down on prescription drug abuse by storing prescription drugs securely and disposing of unused medication through proper methods, like DOJ’s biannual Drug Take Back Day.”
Drug take back days are held each spring and fall across the country, and according to Schimel, in Wisconsin they’ve resulted in the collection and safe destruction of over 207,000 pounds of unused medications. Last October, Wisconsin ranked second behind only Texas in the volume of medication turned in.
For more information, including a list of accepted medications, visit the DOJ’s website. Additional information also is available on the “Dose of Reality” website, which features an interactive map people can use to find a drug take-back location near them
The Senate Committee on Education approved two bills Monday that are part of a special session ordered by Gov. Scott Walker to tackle the opioid epidemic.
A bill that would provide $50,000 to help establish a recovery charter school, which would serve 15 high school students in recovery from substance use disorder, passed out of committee 6-1. Sen. Steve Nass, R-Whitewater, voted against it.
An additional proposal providing $200,000 a year to expand the use of a substance abuse screening by the Department of Public Instruction passed 7-0. The Assembly has already approved both measures.
Wisconsin will receive $7.6 million from the federal government to combat opioid addiction, the Department of Health and Human Services announced Thursday night.
HHS is providing $485 million to all 50 states, the District of Columbia and six U.S. territories. The funding, made available under the 21st Century Cures Act, will go toward prevention, treatment and recovery services.
States were awarded funding based on rates of overdose deaths and unmet need for treatment. Florida received the most money at $27.2 million, while five territories received $250,000 each.
Gov. Scott Walker directed the Department of Health Services to seek the funding in an early January executive order. DHS can re-apply for additional funding next year.
Gov. Scott Walker has signed into law a bill ending state penalties for those who possess cannabidiol without psychoactive effect if they have written certification from a doctor.
The bill also directs the state's Controlled Substances Board to reschedule CBD oil, which is derived from marijuana and sometimes used to treat seizures in children, within 30 days following a change at the federal level. The bill passed the Senate 31-1, and the Assembly 98-0.
The bill builds on a 2014 law that aimed to make the drug available with a prescription in the state. But supporters said that providers weren't able to prescribe the drug, which is still illegal to obtain under federal regulations.
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