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Capitol Update
By Senator Howard Marklein
March 23, 2018
Delivering For Rural Health Care

I was tremendously honored to be recognized by the Wisconsin Hospital Association (WHA) this week with the Health Care Advocate Award at their annual Advocacy Day on March 21, 2018. As a part of the presentation, they articulated all of the reforms and initiatives I have championed on behalf of healthcare in rural Wisconsin. It was a wonderful reminder of our hard work together since I joined the legislature in 2011.
Before joining the legislature, while I was in the private sector, I served on the Board of Directors of the Fort HealthCare for 10 years, including 4 years as Board Chair. This was a great experience and taught me a lot about health care. When I was first elected, I knew there were significant opportunities for reform that would benefit healthcare throughout our state.
In 2013, I authored Act 236 to Federalize Department of Health Services (DHS) Rule 124. This law was enacted on April 8, 2014.  Act 236 made compliance with state and federal rules less confusing for hospitals and the state regulators, thereby reducing costs associated with hospital regulatory compliance. DHS began using and enforcing the federal Medicare Conditions of Participation as the minimum standards that apply to hospitals. Prior to Act 236 hospitals had to comply with 2 different standards, a federal requirement and a state requirement.
The very next year, the WHA and hospital leaders in the 17th Senate District trusted me again to work on other key pieces of legislation.  I authored and passed Act 116, the Interstate Medical Licensure Compact Ratification – (Enacted December 16, 2015) and Act 287, the Health Care Data Modernization Act (Enacted March 30, 2016).
The medical licensure compact ratifies and entered Wisconsin into the Interstate Medical Licensure Compact, which is a multi-state agreement that creates a streamlined process for physicians to become licensed in multiple states.  The Compact creates a process by which a physician who is licensed in one state may become licensed in one or more other states without having to verify “static qualifications” in each state. This compact helps our hospitals to recruit providers and serve their patients.
The Health Care Data Modernization Act made technological updates to health care data laws while protecting patient-doctor relationships and confidentiality. It allowed hospitals to more efficiently target resources to areas where they identify health patterns. For example, if a particular community happened to have a lot of residents with diabetes, a health care provider may target programming geared toward managing diabetes.
This session, we took our enhancements further!  As a member of the Joint Finance Committee (JFC), I had the opportunity to focus my efforts on elements in the state budget that impact rural healthcare.  We achieved major strides by increasing funding for reimbursement programs, recruitment and retention grant programs and more.

  •          Nursing Home Reimbursement Rates – We increased the Medical Assistance reimbursement rates paid to nursing homes by 2% in each year of the biennium. We also increased funding for behavioral and cognitive impairment incentive payments and to care facilities for individuals with intellectual disabilities.
  •          Personal Care Worker Rate Increase – We increased the Medical Assistance reimbursement rate for personal care services by 2% in each year of the biennium. This provides additional funding to pay the people who take care of those in our state who need help with daily living.
  •          Dementia Care Specialists – many counties have Dementia Care Specialists who work with people and families struggling with dementia. The value of this role in our communities is proven and effective. We funded the existing 19 positions and included funding for 24 specialists beginning July 1, 2018 to expand the impact of Dementia Care Specialists in Wisconsin.
  •          Graduate Medical Education – We increased funding for grants to establish graduate medical training programs in addiction medicine or addiction psychiatry by $1.5 million.
  •          Disproportionate Share Hospital (DSH) Payments and Rural Critical Care Supplements – this funding is important to the medical providers in our communities. We increased payments to DSH facilities by $61 million, including Federal dollars. We also created a rural critical care supplement for hospitals that would otherwise qualify for DSH, but did not because they do not provide obstetric services.
  •          Grants for Training Allied Health Professionals – I am proud to have originally proposed Senate Bill (SB) 165, legislation that was woven into the state budget. In this action, we provided $500,000 annually for matching grants for training allied health professionals such as radiographers, physical therapists, nutritionist, respiratory therapists, surgical technicians and certified nursing assistants. This addresses the shortage and need for these professions in rural WI.
  •          Grants for Advanced Practice Clinicians - We also provided $500,000 annually for a grant program to provide training opportunities for physician assistants, nurse practitioners, certified nurse midwives, clinical nurse specialists or certified registered nurse anesthesiologists. This investment helps fund training, tuition, materials and stipends for reasonable expenses during training in rural areas.
  •          SeniorCare – we allocated funding to continue SeniorCare in Wisconsin. SeniorCare continues to be a helpful and effective program.

After the budget was wrapped up, the WHA approached me to solve a very time-sensitive issue with Act 135, the Enhanced Nurse Licensure Compact (eNLC). We needed to pass this legislation before 2018 to ensure that nurses in Wisconsin could receive a multi-state license. 
Representative Travis Tranel (R-Cuba City), Rep. Todd Novak (Dodgeville), Rep. Nancy VanderMeer (R-Tomah) and I worked fast. We successfully moved the eNLC bill through the legislative process in record time and it was enacted December 11, 2017.
This law made Wisconsin a member of the eNLC by updating Wisconsin’s current nurse licensure compact statute to maintain Wisconsin’s status as a compact state.  The eNLC provides an opportunity for nurses in Wisconsin to receive a multi-state license and allows nurses from other states to quickly fill vacancies in Wisconsin without receiving a duplicative single-state license. Nearly all Wisconsin nurses currently hold a compact license and will continue to have the benefit of an interstate license. It was widely supported by nurses, hospitals and other healthcare providers throughout Wisconsin. It also received unanimous support in the state legislature.
Finally, we passed Act 138 and it was signed on February 27, 2018.  This bill creates a reinsurance program to stabilize the Affordable Care Act. The Act permits the Office of the Commission of Insurance to seek a federal waiver to allow operation of a state-based reinsurance plan to stabilize the marketplace. If approved, the state will cover a portion of health insurance claims between $50,000 and $250,000 for those who are insured through the marketplace. Wisconsin will be subsidizing marketplace insurance for high-risk consumers.  We sought to stabilize the healthcare marketplace in Wisconsin by relieving some of the burden on insurers by managing high risk enrollees and creating a broader pool of people to absorb all other risk. It is our hope that this relief and stabilization will bring insurers back into the state, increase the number of plans available to consumers and lower the costs.
Next session, I will re-introduce Senate Bill 804, the Physical Therapist Licensure Compact. While this bill did not pass this session, it was widely supported.  Like the other compacts, it will allow WI to join other states that are members of the Physical Therapy Licensure Compact to create portability and opportunities for physical therapists in Wisconsin and organizations that employ physical therapists in Wisconsin. This is good policy and I will continue to work on it.
Overall, I am tremendously proud of our work on behalf of rural healthcare. I am honored to be recognized by the WHA and the hospital leaders in our communities who have trusted me to take the lead on their legislative goals. They have brought me great ideas that are very good policy for the people I serve. I look forward to delivering in the future for rural healthcare.
For more information and to connect with me, visit my website http://legis.wisconsin.gov/senate/17/marklein  and subscribe to my weekly E-Update by sending an email to Sen.Marklein@legis.wisconsin.gov. Do not hesitate to call 800-978-8008 if you have input, ideas or need assistance with any state-related matters.