On Tuesday, March 12, the State Senate concluded what is expected to be its last session for the 2023-25 floor period. The Senate joins the Assembly, which held its last scheduled session day on February 22.

Barring any emergent issues, this means that the State Legislature has wrapped up its work until the new legislative session begins in January of 2025, with the exception of committee activity and other work that does not require floor votes.

How Did LTC Fare in the 2023-25 Biennial Legislative Floor Period?

Overall, the 2023-25 session was a positive one for LTC providers. Below, find a summary of major proposals relevant to LTC, along with their ultimate fate as the legislative session has drawn to a close.

Finance:

• State Budget. Earlier in the session, providers were successful in securing historic funding for the LTC sector in the state budget. Read more about our budget successes here.
• Assembly Bills 1086 and 1087 – these bills would have established new funding for addressing challenges related to finding post-acute placement for complex patients: the bill included $10M in state funds (plus any federal matching funds) for enhanced rates to nursing homes who admit new residents with complex bariatric or wound care needs. The bill also includes an additional $10M in state dollars for a complex patient pilot fund, which would allow health care partners (defined as a hospital system plus one or more post-acute settings, including SNF or AL). The complex patient pilot program was signed into law as part of the current biennial budget, and is aimed at allowing health care partnerships in Wisconsin to find innovative solutions to help facilitate hospital transfers to appropriate post-acute settings. Lastly, the bill provides $20M for hospital supplemental payments when a hospital is unable to find post-acute placement for complex patients ready for discharge. Importantly, the legislation ensures that the state captures critical data from hospitals to continue to examine and address complex patient challenges into the future.
  • These bills passed through the Assembly, and received a public hearing in the Senate Committee on Health, but did not advance any further and will not be signed into law. See also the below companion bill, AB 1088, also related to addressing challenges of complex patient placement.

Regulatory:

This session presented opportunities and challenges on the regulatory front, both for nursing homes and assisted living settings.

On Nursing Home Survey/Enforcement, WHCA/WiCAL worked with legislators to draft survey reform legislation. However, WHCA/WiCAL has worked closely with the Governor’s office and DHS/DQA to implement some of our ideas without the need for legislation, and we are beginning to see outcomes. For example, WHCA/WiCAL advocated for provider participation on DQA’s IJ calls, which is now an opportunity for providers as part of a 3-month pilot.

WHCA/WiCAL was also successful in preventing the passage of or altering the scope of a number of bills that would impact LTC providers:

• Senate Bill 919/Assembly Bill 1007 – this bill would have required 1-2 and 3-4 bed Adult Family Homes have primary responsibility for comprehensive relocation services when an AFH is closing or changing its level of services. WHCA/WiCAL opposed this bill, as it will be impractical and impossible for small AFHs to be equipped with the staff to complete comprehensive relocation services – including relocation conferences, tours of alternative placements, and coordinating with MCOs on where the MCO is willing to place the resident. WHCA attempted to work with the bill authors to find a more workable solution, but the authors moved forward with their own approach.
  • SB 919 received a Senate committee hearing, but did not pass either legislative chamber and is not expected to advance in the legislative process due to the likely end of the 2023-25 legislative floor session.
• Senate Bill 155/Assembly Bill 162 – as amended, this bill would require a nursing home or community-based residential facility (CBRF) that has residents who are recipients of the Family Care benefit which intends to terminate its contract with a Managed Care Organization due to a decision to change its type or level of services or the means of reimbursement it accepts, the nursing home or CBRF must provide at least 60 days’ written notice before relocation to each resident who must be relocated. WHCA/WiCAL opposed this bill, as it would create additional unnecessary notice requirements, given current safeguards that prohibit involuntary discharges without an appropriate alternative setting being identified first, and involvement by residents and families in the comprehensive, person-centered relocation process. WHCA attempted to work with the bill author to find a more workable solution, but the author moved forward with their own approach.
  • Current law/regulations require a 30-day involuntary discharge notice requirement. That requirement is not changed under this bill. The bill would create a new, separate 60-day MCO contract termination notice.
  • SB 155 passed the State Senate and received a committee hearing in the Assembly. But the bill did not pass the Assembly, and is not expected to advance in the legislative process due to the likely end of the 2023-25 legislative floor session.
• Senate Bill 884/Assembly Bill 942 – this bill would create new training requirements for falls prevention/recovery, as well as certification requirements for CPR, for staff of community-based residential facilities (CBRF), residential care apartment complexes (RCAC), nursing homes, and hospice. The bill also imposes a duty to provide aid for falls or to administer CPR. WHCA/WiCAL did not formally opposed the bill, but we did share our practical concerns with the bill authors, including concerns about another unfunded regulatory mandate.
  • SB 884 received a hearing in the Senate Committee on Health. It did not receive a committee vote and the bill will not advance any further this session.
• Assembly Bill 1088/Senate Bill 1027 – this bill was aimed at addressing post-acute placement challenges for complex patients ready for hospital discharge. The bill had three major components: 1) a “patient’s representative” decisionmaker framework to allow patients without court-appointed guardians or HCPOAs to be placed in either a SNF or CBRF, with safeguards in place for the patient, the patient’s representative, and the provider; 2) giving DHS discretion to allocate up to 250 limited-use nursing home beds for purposes of placing complex patients; and 3) building out a policy framework for a complex patient pilot program, which was funded with $5 million in the 2023-25 state budget. WHCA/WiCAL supported this bill.
  • AB 1088 passed the Assembly and was passed out of committee in the Senate, but the bill did not receive a floor vote in the Senate and will not be signed into law this session.
• Assembly Bill 973/Senate Bill 940 – this bill, as amended, would require human trafficking training be provided to CBRF employees that have regular, direct contact with facility residents who are on probation, extended supervision, or parole. The original version of this bill required all CBRF employees who have regular, direct contact with any facility residents receive this training. WHCA/WiCAL had raised concerns with the original scope of the bill, but was not opposed to the bill as amended.
  • This bill passed both houses of the legislature and is currently awaiting consideration by the Governor. WHCA/WiCAL will follow up with DQA on enforcement of this policy and will share any new developments with CBRF members.

What’s Next:

For the above listed bills that were not signed into law, WHCA/WiCAL anticipates that many if not all could be re-introduced next session. WHCA/WiCAL will continue to engage with bill authors and other legislators, and be prepared to respond accordingly next session.

WHCA/WiCAL also has ongoing legislative advocacy that will continue even though the legislative floor session has concluded:

• HCBS Minimum Fee Schedule: DHS will soon be requesting passive review approval of the legislature’s Joint Finance Committee for the use of federal ARPA funding for implementation of an HCBS minimum fee schedule. WHCA/WiCAL has been supportive of this request and has participated in advocacy with members of the Joint Finance Committee. This legislative activity occurs outside of the legislative floor period and does not require approval by the entire legislature. WHCA/WiCAL continues to engage with key lawmakers on this request.
• Complex Patient funding: as noted above, the 2023-25 state budget set aside $5M for a complex patient pilot. Since enabling legislation to build out the framework for the pilot did not pass, WHCA/WiCAL will turn its advocacy on this matter to the Joint Finance Committee, which also has the authority to release the funds upon request by DHS, which DHS has already submitted.

As Legislators Enter Campaign Mode, WHCA/WiCAL Urges Members’ Political Involvement

WHCA/WiCAL is also turning its focus to the campaign trail, and supporting those decisionmakers who have supported our sector. Look for more information on opportunities to be involved in WHCA/WiCAL’s political giving operation in the near future. Please consider contributing to WHCA/WiCAL’s Political Action Committee via a personal contribution here.

Please direct any legislative/advocacy questions to VP of Government Relations and Regulatory Affairs, Jim Stoa.