TUE AM News: GOP bill aims to change prior authorization process for certain health services; Chippewa Falls health workforce training program getting state grant

— GOP lawmakers are seeking to make changes to the prior authorization process in Wisconsin, in which health care providers have to get an OK from insurers for certain medical services. 

Sen. Patrick Testin of Stevens Point and Rep. Nancy VanderMeer of Tomah recently sent a cosponsorship memo on the bill to other lawmakers, arguing this process has “increasingly become a significant barrier” to patients receiving timely and effective care. 

They say the rise of third-party reviewers in the health care field — such as utilization review organizations or utilization management organizations — has complicated the prior authorization process.

These entities aim to ensure the requested service or procedure is appropriate and delivered in the correct setting, for the purposes of cost control, care coordination and improved internal communication, according to a report published online in the National Institutes of Health’s National Library of Medicine. 

But Testin and VanderMeer argue this process has “led to significant administrative burdens for both providers and patients, ultimately resulting in delays in care and adverse patient outcomes.” 

To support that notion, they reference a survey of physical therapy providers from the state chapter of the American Physical Therapy Association. The survey found 90 percent of physical therapists reported the prior authorization process has led to gaps in patient care, while 78 percent said it has delayed patient progress and 52 percent said it has led to patients “abandoning” care, the memo shows.

The Legislative Reference Bureau notes the bill would make changes to the prior authorization process for physical therapy, occupational therapy, speech therapy, chiropractic services, and other health care services by certain health plans. 

Under the legislation, any decision on reauthorizing coverage for a service that was previously approved would need to be made within 48 hours, or prior authorization is assumed, according to the memo. Plus, requiring prior authorization for the first 12 sessions of physical, occupational or speech therapy, or chiropractic visits, would be prohibited. 

The bill would also disallow requiring prior authorization in chronic pain cases for the first 90 days, require compensation for the time spent entering information required for third-party authorization, and bar the third-party groups from using claims data as “evidence of outcomes” for developing approval policies, among other changes. 

It’s supported by the Wisconsin Speech-Language Pathology and Audiology Association, the Wisconsin Occupational Therapy Association, the Wisconsin Chiropractic Association, the Chiropractic Society of Wisconsin, and the American Physical Therapy Association-Wisconsin, the memo shows. 

The cosponsorship deadline is 5 p.m. tomorrow. 

See the memo: 


See the NLM report here: https://www.ncbi.nlm.nih.gov/books/NBK560806/ 

— A health care workforce training program in Chippewa Falls is getting a $75,000 state grant to expand its facilities. 

In a release yesterday, the Wisconsin Economic Development Corp. announced the funding for the Dove Healthcare Community Foundation, supporting an expansion of the Chippewa Falls Healthcare Workforce Training Institute’s Education Center. 

The institute was launched in spring 2022, offering training programs for people pursuing careers as certified nursing assistants, certified medication aides, residential care facility workers and others. 

Paula Gibson, the institute’s director, says the WEDC funding will help the foundation double the size of the education center and expand the courses it offers. In its first 15 months of operation, the institute has had more than 1,000 students, including more than 500 graduating from the CNA program. 

“This support will allow us to continue to grow and serve even more looking to enter the field of health care and create a well-trained readily available workforce to meet the demand for care statewide,” Gibson said in the release. 

See the release: https://wedc.org/blog/state-grant-to-support-expansion-of-healthcare-workforce-training-institute/ 

<br><b><i>Top headlines from the Health Care Report…</b></i> 

— Sen. Brad Pfaff is promoting legislation that would cap the price of insulin in the state at $35 for a one-month supply. 

<i>For more of the most relevant news on COVID-19, reports on groundbreaking health research in Wisconsin, links to top stories and more, sign up today for the free daily Health Care Report from WisPolitics.com and WisBusiness.com.</i> 

Sign up here: http://forms.gle/o8FtqTLviGJPja8C9 

— The state Department of Workforce Development is getting $11.25 million in federal funding to update its unemployment insurance system. 

DWD yesterday announced the grant from the U.S. Department of Labor, part of a $204 million round of funding going to 18 states and the U.S. Virgin Islands. 

The state agency says the dollars will help recipients upgrade and redesign unemployment insurance programs, combat fraud more effectively and streamline the process for maintaining and changing UI systems going forward. 

In a statement on the funding, DWD Secretary Amy Pechacek touts the agency’s ongoing efforts to use technology to “improve the speed and accuracy of unemployment benefit payments” and make the system easier to use. 

“We look forward to investing these funds in additional efforts to overhaul our state’s decades-old unemployment insurance infrastructure and benefits delivery system,” she said. 

See the release: https://dwd.wisconsin.gov/press/2023/230925-usdol-dwd-award.htm 

— Rep. Rob Brooks, co-author of the GOP’s $700 million Brewers ballpark maintenance bill, expects changes will be made to the current plan including a lower contribution from Milwaukee city and county governments.

The Saukville Republican adds there likely isn’t enough support yet to pass the bill in the Assembly.

“It would be very close and very tough if we had to do it,” Brooks said on WISN’s “UpFront,” which is produced in partnership with WisPolitics. “I think we’re going to need some Dem votes, but what I have found in talking to Speaker Vos and my colleagues, every time we explain the details to people one on one, they get it.”

Brooks said it’s his goal to get half of the Democratic caucus to eventually back the plan.

“I would hope 14 to 18,” he said. “Do I need that many? I don’t know.”

Brooks said he met with local officials in Milwaukee and Milwaukee County in recent days and anticipated the local buy-in requirement would drop from $7.5 million annually to $5 million between the city and county. The lower amount would put the local contribution at $135 million over 27 years rather than the $202.5 million proposed in the bill.

See further details and more from the show here: https://www.wisn.com/upfront


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<i>See these and other press releases: 

https://www.wisbusiness.com/press-releases/ </i>

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