Public Policy Update from Director of Government Relations 

WOCN members, and other advocates, have been working in several states across the country to ensure that ostomy patients who are covered by Medicaid have access to the supplies they need.   As you may know, many state Medicaid programs fail to provide adequate extended wear ostomy products, which in many instances is well below even the Medicare standards.  Thanks to the advocacy of WOCN members and others, five states have recently expanded their monthly allotment of products, but we have more work to do.  There are an additional nine states that still have inadequate monthly limits on ostomy supplies and we need your help.

Please refer to the attached infographic which lists both the states who have recently increased their limits and those that still haven’t. For those regions and affiliates in Rhode Island, New Jersey, Kentucky, Mississippi, and Florida please note the new changes in coverage in the attached document, this will enable you to better treat your patients.  If you live or represent one of the nine states that have not yet increased their allotments, please contact WOCN to find out how you can get involved.

https://mideastregion.org/wp-content/uploads/2022/05/OC-EW-Market-Access-1.28.22.pdf

MER WOCN Public Policy and Advocacy Update, May 11, 2020

The Home Health Care at Home Act

This act would allow improve reimbursement for telehealth care while reducing restrictions to care, this act will last as through the Covid-19 emergency declaration. The ability to provide wound/ostomy consults via telehealth will reduce complications for those who otherwise would not seek treatment due to concern of encountering the Covid-19 virus.
https://govtrackinsider.com/health-care-at-home-act-would-make-it-easier-for-americans-to-have-virtual-doctors-visits-via-ae4a1c69f86e

Public Policy and Advocacy Hot Topics from the National WOCN Society

Deep Tissue Injury Coding Policy Reminder – included in the ICD-10 updates. Before October 1, 2019, there were no ICD codes for the stage of Deep Tissue Injury. Previously DTI had to be coded as unstageable thus complicating the clinical picture and plan of care.
https://www.wocn.org/page/DPICodingPolicy

Nursing Community Coalition – 58 professional nursing organizations working together to promote the Nations’ health – see the website for the current advocacy goals. The collective efforts of the NC are of benefit to public health and lends more power to influence common goals of prevention and treatment of disease processes including those that result in wound, continence and ostomy complications.
https://www.wocn.org/page/NursingCommunityCoalition

Regions and Affiliates Grassroots Taskforce – updates on progress. The regional and Affiliate Tool Kit is progressing well. The surveys received from WOCN society members reveal that the Public Policy and Advocacy Taskforce are on track with the needs and wants of members. A new link will be added in the future to the national website with the Grassroots Tool Kit
package. This will include education on how to start a campaign, a forum for discussion, forms and more. https://www.wocn.org/page/RegionsAffiliatesGrassrootsTaskforce

WOCN / CMMI Long Term Care Project – advocacy for the use of certified Wound/ Ostomy and trained staff to prevent and treat issues with pressure ulcer, ostomy care and fistula care in the long term and long-term acute care settings. The benefit of a WOC in the long-term care setting would result in decreased complications, reduced cost and hospitalizations. A literature
review is currently in process.
https://www.wocn.org/page/CMMILong-TermCare

Access & Care Coalition
The goal of the coalition is to counter the reduced access urologic and ostomy medical technology and supplies under Medicare, Medicaid and private insurances. Educational material has been created for both consumers and separately for home health providers and therapists to educate about the right to quality products and how to ensure they receive the
proper care and supplies. This education is linked in the national website:
https://www.wocn.org/page/AccessCareCoalition

Alliance of Wound Care Stakeholders Updates
The goal of the Alliance is advocacy for quality care and access to medical supplies for all. 2019 activities included: changes in coding, coverage and payment policies, enabling clinicians to better treat patients and manufacturers to bring innovative products to market more quickly; educated key regulatory decision-makers to improve existing and have input in developing
wound care policies. For details see:
https://www.wocn.org/page/AllianceofWoundCareStakeholders

Medicare Fistula Coverage
The society has expressed growing concern for the lack of Medicare/Medicaid coverage of fistula supplies. Currently only surgically created or treated fistulas are covered but with only one covered wound pouch (A6154). A white paper has been written on the subject. The task force is currently in the process of developing the next steps.
https://www.wocn.org/page/MedicareFistulaCoverage

CALL TO ACTION – The Home Health Care Planning Improvement Act
Contact your legislators to support the passage of the Home Health Care Planning Act. This act will allow advanced practice nurses to certify home health services for Medicare patients. Currently only a physician can certify that a patient is eligible for Medicare home health services.
https://www.wocn.org/page/HomeHealthCareAct

Prior Authorization Required for Pressure Reduction Support Surfaces 

Effective October 21, 2019 nationwide a prior authorization is required for pressure reduction support surfaces. It is important for WOC nurses to understand the process and share the information to help patients get the DME products they need for their condition. 

If you have feedback or have witnessed concern with this policy, Kate Lawrence, the WOCN Society Public Policy Coordinator or Chris Rorick, the WOCN Society Public Policy Coordinator, would like to hear from you: info@wocn.org. 

For more information about this policy and FAQ, follow this link: https://www.wocn.org/page/PressureReducingSupportSurfacesPriorAuthorization

Medicare Fistula Coverage 

WOCN members are concerned about the lack of availability of supplies for patients with fistulas: products for spontaneous fistulas are not covered; there is only one product that is covered despite the variation in fistula sizes and locations. 

WOCN has prepared a white paper. To review this white paper, follow this link: https://www.wocn.org/page/MedicareFistulaCoverage

An upcoming policy change will soon make it mandatory nationwide to submit prior authorization for Pressure Reducing Support Surfaces. Prior authorization is a process through which a request for provisional affirmation of coverage is submitted for review before an item is provided to a Medicare patient and before a claim is submitted for payment. This process helps to ensure that all applicable Medicare coverage, payment, and coding rules are met before an item is provided. As of October 21, 2019, when planning for discharge for patients that you believe may need a Pressure Reducing Support Surface (PRSS), you will need to submit a prior authorization.

WOC nurses must act to educate, collaborate and advocate with other medical professionals, case managers and DME companies about this process to ensure patients receive the appropriate medical equipment for their condition. The WOCN^® Society has created an FAQ document to help members comply with these new requirements. We encourage you to review this resource and share it with your colleagues, regardless of care setting, as this new policy change does not just affect one area of health care.

March 2019 WOCN Public Policy Report

The WOCN Public Policy and Advocacy team is working has narrowed down focus on three projects in
hopes of coordination and cohesiveness of regional and national WOCN affiliates. The projects have
been subdivided amongst three teams the focus is: public policy and advocacy survey, update the
grassroots tool kit (currently available on the national WOCN website) and Regional and Affiliate Public
Policy and Advocacy job descriptions.

While there has not been recent legislation directly related to Wound, Ostomy and Continence care; the
following could certainly have an impact:

S 296: Home Health Care Planning Improvement Act of 2019 – if passed this bill would allow Medicare
payment for home health care ordered by nurse practitioners, clinical nurse specialists, physician
assistants and certified nurse midwives. Currently, only physicians can order home health care. This bill
is currently awaiting committee assignment.

A simple resolution was declared March 12 making March 2019 “National Colorectal Cancer Awareness
Month.”

H.R. 525: Strengthening the Health Care Fraud Prevention Task Force Act of 2019. This act essentially
establishes a private-public partnership by contracting a third party to facilitate data sharing across
federal, state and private health care plans for the purposes of detecting fraud, abuse and waste.

T. Ellen Woodcock RN BSN CWON
MER WOCN Governmental Affairs

The NPUAP has released a consumer survey to be used by the IPUAP to inform the update of the 2019 International Guideline. If you or a loved one have had or work to prevent pressure injury, please take the time to fill out the survey.

To find more about the guideline, click: http://internationalguideline.com

To take the consumer survey, click: http://internationalguideline.com/consumers

Indiana Legislative Update

IHA (Indiana Health Association) has enacted new laws effective July 1 including: INSPECT (Indiana’s Prescription Drug Monitoring Program), Credentialing, POST and Hierarchy of Consent, Perinatal Level of Care, Newborn Screenings, Continuing Education Requirements, Suspected Human Trafficking and the repeal of the Fireworks Injury Reporting Law.
New laws with later effective dates include: Prior Authorization, National Accreditation in Lieu of Annual State Survey, and Regulation of Abortion. Article summarized from the June 14, 2018 Legislative Update News & Insight IHA Advocacy Team.

For further information: https://mailchi.mp/ihaconnect.org/iha-legislative-update-march-16-261133?e=ca5c756b19

The Society Submits Comment to CMS Regarding Pressure Injury Measures

For further information click the following link: https://www.wocn.org/news/news.asp?id=392387

T. Ellen Woodcock RN BSN CWON
MER WOCN Governmental Affairs

2554: Patient Right to Know Drug Prices Act

Currently there is a “Gag Clause” that prevents pharmacists from disclosing cost savings for prescriptions between using their insurance and paying out of pocket. The ”Patient Right to Know Drug Prices Act” seeks to discontinue this clause.

For further information:
https://www.govtrack.us/congress/bills/115/s2554/summary#oursummary

Retrieved on April 6, 2018
Governmental Affairs, T. Ellen Woodcock RN BSN CWON

It is expected that 81,000 people will be diagnosed with bladder cancer this year and over 17,000 will succumb to the disease. Click on the link below to find out ways you can promote awareness:

https://www.bcan.org/bladder-cancer-awareness-month/

Government Affairs – Ellen Woodcock, RN BSN CWON

H.R. 1478, the Gun Violence Research Act.

Despite gun violence being the leading cause of death for children, a decades-old law effectively stifles any research into this issue.

A bill in Congress right now could change that, allowing the Centers for Disease Control and Prevention (CDC) to restart gun violence research for the first time since 1996, paving the path to new, evidence-based ways to prevent more tragedies in our schools, homes, and communities.

This bipartisan bill will allow the CDC and other federal agencies to restart their research into the causes, effects, and evidence-based prevention options for gun violence in our communities.

Tell your Member of Congress to end the arbitrary ban on gun violence research – send your letter now >>

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Medicare Competitive Bidding

In March 2016, President Obama released his FY 2017 budget, which proposed that inhalation drugs, all prosthetic and orthotics, and ostomy, tracheostomy and urological supplies be listed as products subjected to competitive bidding. The Society expressed serious concerns with this proposal and in response to the flawed policy approach; the Society’s leadership developed an advocacy action plan to keep ostomy products excluded from Competitive Bidding. The Society will continue to fight to exclude these programs in the future.

In July 2016, CMS’s Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) held a meeting that focused on obtaining recommendations regarding treatment strategies for patients with lower extremity chronic venous disease.

President Trump has not yet released his complete FY 2018 budget. It’s worth noting that new HHS Secretary Tom Price has been a vocal critic of CMS Competitive Bidding Program.

Nursing Workforce

Health & Human Services (HHS) Secretary Tom Price recently testified before the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies on the President’s “skinny budget” proposal, which recommended that health professions and nursing workforce programs (Title VIII Nursing Workforce) be cut by $403 million dollars and the National Institutes of Health (NIH) be cut by $5.8 billion dollars, or 20 percent.

During the hearing, members of Congress pointed to the NIH being the front line of the U.S. healthcare operations, arguing a $6 billion cut would be devastating to the nation’s well-being. Rep. DeLauro (D-CT), Rep. Lowey (D-NY) and Rep. Roybal-Allard (D-CA) spoke against the extreme cuts saying they would not support the cuts proposed to the nursing community, particularly the training programs. Chairman Tom Cole (R-OK) also echoed this concern.

Rep. Davis (R-IL) and Rep. Bonamici (D-OR) circulated a “Dear Colleague” urging Members of the House to support Title VIII Nursing Workforce Development Programs in FY 2018. Davis and Bonamici are asking the Appropriations Committee to allocate $244 million for the Nursing Workforce Development Programs in Title VIII in a letter that notes nurses are “essential members of any healthcare team” and “comprise the largest population of the healthcare workforce.”

Title VIII programs have helped build the supply and distribution of qualified nurses needed in all healthcare settings. Title VIII programs bolster nursing education at all levels, from entry-level preparation through graduate study, and provide support for institutions that educate nurses for practice in rural and medically underserved communities.

Earlier this year, Rep. Joyce (R-OH) introduced H.R. 959, “Title VIII Nursing Workforce Reauthorization Act of 2017,” and over 25 Members have signed on as co-sponsors to the Bi-partisan bill, which aims to amend Title VIII of the Public Health Service Act to extend advanced education nursing grants to support clinical nurse specialist programs, and for other purposes.

Medicare Contractors Propose Changes to Wound Care Payments

The Society recently submitted comments to two contractors, First Coast Option and Novitas Solutions, who have proposed concerning changes to wound care policies. The Society provided comments directly to the changes available here: First Coast Option and Novitas Solutions, as well as participated in developing comment through the Alliance of Wound Care Stakeholders

Retrieved August 8, 2017 from:  http://www.wocn.org/news/news.asp?id=341011&hhSearchTerms=%22government+and+affairs%22