• August 29, 2023 2:59 PM | Anonymous

    “All Copays Count” applies discounts and other assistance toward patients’ out-of-pocket costs 

    Guest Column by WI Senator André Jacque

    Patients would receive protections from rising health care costs by ensuring that health plans count copay assistance toward a patient’s maximum out-of-pocket cost or annual deductible, under bipartisan “All Copays Count” legislation (Senate Bill 100) I introduced with several of my colleagues earlier this session.

    Amid nationwide inflation, health plans have increasingly shifted costs to patients and created barriers between individuals and the medications on which they rely.  For advocates of Wisconsin patients and the providers who care for them, this bill is a clear solution to help those individuals afford the critical medications their physicians prescribe to them to manage their health.

    Copay assistance programs often act as a lifeline to help patients afford specialty medications they need to treat serious health conditions. Sixteen other states have already enacted such protections.

    Just when patients think they’ve reached their out-of-pocket limit, insurers and benefit managers keep moving the goalposts, and folks wind up paying more.  For someone suffering from a complex disease, the financial hit is especially hard, leaving them to choose between groceries, utilities and mortgage payments - and the prescription medications that keep their condition under control.

    In 2020, the average deductible for single coverage was $1,364, which is a 364% increase from 2006. Over the past five years, the percentage of covered workers with a general annual deductible of $1,000 or more for single coverage has grown from 23% to 57%.  Further, in 2020 more than one in four covered workers was enrolled in a plan with a deductible of $2,000 or more.

    Many of these patients rely on copay coupons and vouchers to afford their prescribed treatments at the pharmacy counter.  Insurers should not have the power to prevent that copay assistance from counting toward their out-of-pocket expense or deductible.  If patients can’t afford their medications, they may choose to skip doses or stop treatment altogether, which can lead to increased costs in the overall healthcare system.  And worse.

    The All Copays Count legislation would ensure that the copay assistance programs patients use to afford their medications count toward their out-of-pocket costs.  It would also close the loophole that allows insurers to define prescription drugs as non-essential and therefore not eligible to count toward their deductible.  At the same time, under this initiative Wisconsin insurers would retain flexibility with their plans, while making sure patients can continue to afford the medications they need.

    If you have cancer, epilepsy or any other serious health condition, the last thing you should have to worry about is whether you’ve met your deductible.  “All Copays Count” is about giving patients peace of mind that they can pay for their prescriptions. 

    Senator André Jacque represents Northeast Wisconsin’s First Senate District, consisting of Door and Kewaunee Counties and portions of Brown, Calumet, Manitowoc, and Outagamie counties.

  • August 29, 2023 2:59 PM | Anonymous

    As was reported in the last edition of the WAO Advocacy Newsletter, last month the Centers for Medicare & Medicaid Services (CMS) released the 2024 proposed payment rule for Ambulatory Surgery Centers (ASC) and hospital outpatient departments (HOPD), which aims to update Medicare payment rates and policies under the Outpatient Prospective Payment System (OPPS) and ASC Payment System. CMS also issued the proposed 2024 update to the Medicare Physician Fee Schedule.

    In the proposed ASC rule, CMS recommends updating the OPPS conversion factor by 2.8 percent, which includes a market basket increase of 3.0 percent and a productivity adjustment of negative 0.2 percent. CMS also proposes applying the 2.8 percent update to ASC payments in 2024. However, it is important to note that CMS does not consider sequestration in its proposed rule. This statutory 2.0 percent reduction remains in effect unless Congress acts.

    Under the proposed Medicare Physician Fee Schedule, clinicians would see a 3.36% decrease to the physician conversion factor. The proposed conversion factor for 2024 is $32.75, which is a reduction compared to the 2023 conversion factor of $33.89.

    The WAO will be submitting comments to CMS on both rules, outlining our concerns and other thoughts on the two proposals. The WAO will be using talking points from the American Academy of Ophthalmology to draft our comments, which will not only be submitted to CMS, but also shared with the WAO membership.

    Both rules are open for public comment until Sept. 11. CMS has said it will issue the final rules in November.

  • August 21, 2023 12:00 PM | WAOAdmin (Administrator)
    Wisconsin Sen. Cory Tomczyk (R-Mosinee) recently visited the Eye Clinic of Wisconsin in Wausau, WI, as part of the WAO Capitol Connection program. The program is aimed at connecting WAO physician members with their local state legislators to show them firsthand the importance of ophthalmology and medical eye care for Wisconsin patients.

    “The Eye Clinic of Wisconsin provides exceptional eye care to the communities we serve. We are dedicated to quality patient care, both today and in the future,” said Eye Clinic of Wisconsin ophthalmologist, Dr. Deepak Sambhara, MD. “We were excited to provide Sen. Tomczyk with a tour of our Wausau location and show him the exceptional care provided by our physicians and staff.”

    Tomczyk, who was first elected to the Wisconsin Senate in 2022, represents the 29th Senate District, which stretches from Marathon County northwest into Sawyer County and includes the Cities of Mosinee and Wausau. He currently serves as Chairman of the Senate Transportation and Local Government Committee.

    “It was great to see the work of the Eye Clinic of Wisconsin firsthand,” said Sen. Tomczyk. “Their decades long effort to provide vision care in northern and central Wisconsin is vital to the residents of the 29th Senate District.”

    For 60 years, the Eye Clinic of Wisconsin has provided vision care for residents throughout northern and central Wisconsin. They believe clear vision requires comprehensive, experienced care, offering full-service eye care for the patients they serve. 

    In the Academy’s ongoing effort to raise the profile of ophthalmology and our organization in the State Capitol, the WAO Capitol Connection program was created to encourage WAO members to invite their local legislators to visit their clinics and facilities. To date, numerous WAO members across the state have held successful legislative tours. Hosting a legislator at your site is easy, enjoyable, and can make a significant advocacy impact, so we would encourage all WAO members to participate in this highly effective advocacy program.

    If you would like to host a legislative tour at your site, please contact the WAO office at wao@badgerbay.co. We will work with you and your legislators to coordinate the meetings and will provide participating members with full support, including legislator bios, advocacy tips, issue briefings, and supporting documents. 


  • August 08, 2023 11:02 AM | Becca Liebers

    The Lighthouse Center for Vital Living in Duluth offers in-home Low Vision Occupational Therapy to residents of Northwestern Wisconsin. Upon request, low vision occupational therapy evaluations can be provided in eyecare clinics.  At its center in Duluth, the Lighthouse offers the full spectrum of vision rehabilitation services for people who are blind or visually impaired – including orientation and mobility training, braille instruction, technology training, daily living skills training and more.

    Lighthouse services also include general occupational therapy services as well as assistive technology assessments and training – addressing functional challenges related to any disability or condition, not just vision loss.   Our new Center in Duluth offers a large assistive technology demonstration and loan library.

    The Lighthouse goal is to help people retain and improve their functional independence, safety, and quality of life. For information call 218-624-4828 or fill out a referral form at LCFVL.org/referral

    Services in NW Wisconsin are funded with grants from the Miller-Dwan Foundation and Bader Philanthropies. 

    View Flyer Here

  • July 27, 2023 8:45 AM | Becca Liebers

    Initial June data shows renewals initiated by members

    The Wisconsin Department of Health Services (DHS) recently launched a new webpage showing statewide data in BadgerCare Plus and Wisconsin Medicaid enrollment following the end of the federal continuous coverage requirement that had kept members enrolled during the COVID-19 pandemic. Between June 2023 and May 2024, more than 1.6 million, or about 1 in 4, Wisconsinites will need to renew to see if they can stay covered under their current state program.

    “We want to be transparent about the unprecedented changes happening with Medicaid this year, and the data we post each month will always be a snapshot in time as we will see the numbers change over time,” said DHS Secretary-designee Kirsten Johnson. “Our preliminary figures begin to paint a picture of what we’re seeing so far. We've seen at least 60% of Medicaid members who were scheduled to renew their coverage in June take action to start the process.”

    The data on the new webpage show that in June 2023, 99,037 members of Wisconsin’s health care programs were due to renew their coverage and 61,057 members took some action to initiate the renewal process (this figure does not reflect current processing status or outcome). Some of those who did not initiate the renewal process may already have other coverage or may have known they were above the income limit for their program. Members who missed their renewal window can still submit their information up to three months past their renewal month to see if they are still eligible for coverage and get it reinstated.

    “We are committed, as are our local and tribal agencies, health plans, and partner organizations, to continue to help people through this process, even after their renewal month has passed,” said Wisconsin Medicaid Director Jamie Kuhn. “Our priority is ensuring Wisconsinites continue to have health care coverage – whether through our state programs, an employer, or a plan purchased through HealthCare.gov.”

    Additional data on the webpage show enrollment in BadgerCare Plus, Medicaid, and other state-funded programs and subprograms that provide health insurance coverage. These data help illustrate the impact of Medicaid in Wisconsin. DHS plans to update this page by the third Thursday of each month to reflect renewal activity in the previous month. DHS will be reviewing the data snapshot each month to learn and to improve our processes and messaging.

  • July 27, 2023 8:44 AM | Becca Liebers

    With work on the 2023-25 state budget bill – the state’s two-year spending plan – wrapped-up, state lawmakers have turned their attention to hundreds of pending stand-alone bills, some of which could impact WAO members and the patients they serve across Wisconsin. Fortunately, the WAO Government Affairs Team – headed by Gregg Hubbard and AJ Wilson from HWZ Consulting – closely monitor and lobby on legislative proposals important to WAO. 

    However, you can also track the bills and issues WAO is lobbying on during the 2023-24 legislative session. Please CLICK HERE to review WAO’s legislative activity on the state of Wisconsin’s Eye on Lobbying website.

  • July 27, 2023 8:44 AM | Becca Liebers

    According to a recent report from the Wisconsin Department of Health Services, the state’s Medicaid program finished the 2021-23 budget biennium, which ended  on June 30, with a projected $875.5 million surplus. The projected surplus is $79.1 million more than what DHS projected earlier this year and is due to numerous factors, including lower costs for prescription drugs and long-term health care.  After the exact amount of the surplus is confirmed at the of this month, the additional funds will be transferred to the state’s general fund. 

  • July 27, 2023 8:44 AM | Becca Liebers

    Earlier this month, Gov. Tony Evers signed the $99 billion state budget bill sent to him by the GOP-controlled Legislature, but not before using his powerful veto pen to make 51 vetoes to the two-year spending plan for the state.

    One of the Governor’s vetoes eliminated $3.3 billion in income tax cuts approved by lawmakers. Primarily because of this veto, the state of Wisconsin is projected to have a balance of more than $4 billion at the end of the 2024-25 fiscal year. Prior to Evers vetoes, the projected balance was $588 million.

    Republican lawmakers are expected to send another tax cut to the Governor via a stand-alone bill prior to the end of the 2023-24 legislative session.

  • July 27, 2023 8:43 AM | Becca Liebers

    Republican Paul Melotik (R-Grafton) defeated Democrat Bob Tatterson (D-Mequon) in a special election held on July 18 to fill the vacant 24th Assembly District –which includes portions of Ozaukee, Washington, and Waukesha Counties.

    Melotik won the historically Republican-leaning district with 53.7% of the vote, compared to Tatterson’s 46.3% vote total. The Melotik victory gives the GOP a 64-35 majority in the 99-member Assembly.

    Melotik, an accountant, small business owner, and former local official who has served on the Ozaukee County Board and Town of Grafton Board, will replace Dan Knodl (R-Germantown) in the Assembly. Knodl was elected to the state Senate (8th Senate District) in an April 4 special election.

  • July 27, 2023 8:42 AM | Becca Liebers

    On July 13, the Centers for Medicare & Medicaid Services (CMS) released the 2024 proposed payment rule for Ambulatory Surgery Centers (ASC) and hospital outpatient departments (HOPD), which aims to update Medicare payment rates and policies under the Outpatient Prospective Payment System (OPPS) and ASC Payment System.

    In the proposed Rule, CMS recommends updating the OPPS conversion factor by 2.8 percent, which includes a market basket increase of 3.0 percent and a productivity adjustment of negative 0.2 percent. CMS also proposes applying the 2.8 percent update to ASC payments in 2024. However, it is important to note that CMS does not consider sequestration in its proposed rule. This statutory 2.0 percent reduction remains in effect unless Congress acts.

    CMS also issued the proposed 2024 update to the Medicare Physician Fee Schedule. Under the proposed rule, clinicians would see a 3.36% decrease to the physician conversion factor. The proposed conversion factor for 2024 is $32.75, which is a reduction compared to the 2023 conversion factor of $33.89.

    Both proposed rules are open for public comment until Sept. 11. CMS has said it will issue the final rules in November.

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Wisconsin Academy of Ophthalmology

563 Carter Court, Suite B
Kimberly, WI 54136
Ph: 920-560-5645 • WAO@badgerbay.co

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