Call for Cases - Perinatal Substance Use Disorders
The Periscope Project

We are excited to partner with the Addiction and Co-morbid Conditions: Enhancing Prevention and Therapeutics (ACCEPT) program through the UW School of Medicine and Public Health to offer an educational session on substance use disorders in the perinatal population. The session will be streamed live through ACCEPT’s Project ECHO series. We are looking for a few clinical cases to present during the session. Cases should be focused on pregnant or postpartum patients with substance use disorders including, but not limited to, opioid, alcohol, benzodiazepine, marijuana, or stimulant use. During the session, experts will review and discuss the case in an interactive session followed by a brief didactic. If you’d like your clinical case presented, please email Shelby Kuehn (shkuehn@mcw.edu).

Learn more about ACCEPT and the UW Addiction Consultation Provider Hotline.

The State Legislature passed, and the Governor has signed, the state's COVID-19 response package, which includes liability immunity provisions. A late amendment broadens the measure and ensures there is no ambiguity about protections applying to COVID and non-COVID patients alike. 

The legislation also includes provisions that will help the state draw down additional federal dollars for Medicaid as well as a provision related to out of network billing.  

Below is the liability immunity language as adopted.

SECTION 98. 895.4801 of the statutes is created to read:

895.4801 Immunity for health care providers during COVID-19 emergency.

(1) DEFINITIONS. In this section:

(a) “Health care professional” means an individual licensed, registered, or certified by the medical examining board under subch. II of ch. 448 or the board of nursing under ch. 441.

(b) “Health care provider” has the meaning given in s. 146.38 (1) (b) and includes an adult family home, as defined in s. 50.01 (1).

(2) IMMUNITY. Subject to sub. (3), any health care professional, health care provider, or employee, agent, or contractor of a health care professional or health care provider is immune from civil liability for the death of or injury to any individual or any damages caused by actions or omissions that satisfy all of the following:

(a) The action or omission is committed while the professional, provider, employee, agent, or contractor is providing services during the state of emergency declared under s. 323.10 on March 12, 2020, by executive order 72, or the 60 days following the date that the state of emergency terminates.

(b) The actions or omissions relate to health services provided or not provided in good faith or are substantially consistent with any of the following:

1. Any direction, guidance, recommendation, or other statement made by a federal, state, or local official to address or in response to the emergency or disaster declared as described under par. (a). 
2. Any guidance published by the department of health services, the federal department of health and human services, or any divisions or agencies of the federal department of health and human services relied upon in good faith.

(c) The actions or omissions do not involve reckless or wanton conduct or intentional misconduct.

(3) APPLICABILITY. This section does not apply if s. 257.03, 257.04, 323.41, or 323.44 applies. 

Governor Evers announced that the state is seeking volunteers to support Wisconsin's healthcare system during the COVID-19 pandemic. Active and retired healthcare professionals and those who wish to help in non-clinical support positions are encouraged to sign up to volunteer through the Wisconsin Emergency Assistance Volunteer Registry (WEAVR). 

The number of patients in Wisconsin who need to be treated for COVID-19 is expected to surge in the coming weeks. Building a network of available volunteers now will greatly reduce the hardships on hospitals and clinics that would not normally have the capacity to care for the increase in patients. 

Both active and retired healthcare professionals can volunteer for critical clinical roles by entering their information into the WEAVR, a secure, password-protected, web-based volunteer registration system for healthcare and behavioral health professionals. Individuals who are not licensed professionals are also encouraged to sign up to volunteer for non-clinical support positions.

Volunteers will be assigned to locations across Wisconsin to support ongoing efforts related to the COVID-19 national emergency. Those who are willing to travel should note that when they sign up. All volunteers should also be aware that they will be required to complete a background check.

The full copy of the Governor’s press release is available online (link).

Governor Evers announced that Wisconsin has been granted a major disaster declaration for the entire state of Wisconsin, as a result of the COVID-19 pandemic. The declaration provides access to Public Assistance programs for all 72 Wisconsin counties and the state’s federally recognized tribes.

Gov. Evers earlier this week requested that the federal government provide the following programs to support the state’s response: Public Assistance, Direct Assistance, Hazard Mitigation (statewide), and certain Individual Assistance programs; Crisis Counseling, Community Disaster Loans and the Disaster Supplemental Nutrition Program.

The Federal Emergency Management Agency (FEMA) notified the state today that it is granting the request for Public Assistance to help provide reimbursement for emergency protective measures taken by state and local governments in their response to the COVID-19 outbreak. The declaration also authorizes direct Federal Assistance which means when the State and local governments lack the capability to perform or to contract for eligible emergency work and/or debris removal, the State may request that the work be accomplished by a federal agency. The governor’s additional requests for assistance remain under review.

The major disaster declaration covers assistance to public entities, and will cover eligible projects submitted by counties, cities, townships, tribes, and certain private, not-for-profit organizations. Local governments in the declared counties are now eligible for federal assistance and should contact county emergency management directors for further information. Under the program, FEMA provides 75 percent of eligible costs, while the remaining 25 percent is the responsibility of state and local agencies.

The Governor’s full press release is available online (link).

The Department of Health Services announced the creation of the Resilient Wisconsin Initiative (website) on Friday, which provides Wisconsinites with resources to cope with stress and mental health challenges from COVID-19.

DHS recommends that Wisconsinites do the following:

• Get the three goods. That’s good-for-you foods, a good night’s sleep, and a good amount of exercise every day.
• Stay connected to your support system. Reach out to family and friends, colleagues, and community groups in whatever way you can—calls, texts, video chats, and more.
• Spend time away from focusing on COVID-19. Don’t let the pandemic take over what you read, watch, or talk about. And don’t be afraid to ask friends and family to talk about something else.
• Reduce anxiety by reducing your risk. Stay safer at home. Wash your hands for at least 20 seconds. Cover your nose and mouth when you cough or sneeze. Stay at least 6 feet apart while running essential errands at the store, pharmacy, or gas station. Knowing you’re doing everything you can to stay healthy can help you worry less.
• Check in with yourself. Everyone’s reaction to stress is different. Difficulty concentrating or sleeping, irritability, fatigue, and even stomachaches can be normal. But if you find you are overwhelmed or having thoughts of self-harm or suicide, reach out for help right away. Text HOPELINE to 741741 or call the National Suicide Prevention Lifeline at 1-800-273-8255.

Governor Evers signed Executive Order 21 on April 3.  The Order suspends a number of rules related to Opiate Addiction Services.  The order specifically makes changes to:

• Suspends in part DHS 75.15(4)(a) that requires Medical Director accessibility and responsiveness as defined by striking the 45 minute requirement;
• Partially suspends DHS 75.15(4)(b) to allow an RN to be onsite or remote to supervise dosing and other functions delegated by a physician;
• Suspends in part the ratio of patients in service defined in DHS 75.15(4)(d);
• Suspends requirement in DHS 75.15(5)(h) for treatment programs to notify the State authority prior to treating non-residents, self-pay patients;
• Suspends in part DHS 75.13(13)(b) related to drawing blood for testing; and
• Partially suspends DHS 75.15(17)(a) and DHS 75.15.17)(c) related to screens for TB, viral hepatitis and STDs by asking treatment providers to use a risk assessment tool to determine if patients need to be referred for a test and follow-up.

The full executive order is available online (link).

A new Marquette Law School poll of Wisconsin registered voters finds strong support for government actions to control the coronavirus pandemic, even as the poll also shows these actions to be having a substantial financial impact on voters.

The survey found:

• Eighty-six percent say that it was appropriate to close schools and businesses, and restrict public gatherings, while 10 percent say that this was an overreaction to the pandemic;
• A large majority of voters approve of Gov. Tony Evers’ handling of the coronavirus issue, with 76 percent saying they approve and 17 percent saying they disapprove;
• A majority, 51 percent, approve of President Donald Trump’s handling of the pandemic, while 46 percent disapprove;
• Opinion is divided on holding the April 7 spring election as scheduled, with 51 percent saying the date should be moved and 44 percent saying it should be held as scheduled.

A full copy of the survey is available online (link).

Governor Evers today announced a second package of comprehensive legislative proposals that would provide critical investments in health services, support for essential workers, and assistance for Wisconsin families and businesses in response to the COVID-19 pandemic. The governor’s announcement today comes just days after Gov. Evers announced a first piece of legislation, which included additional funding and flexibility for public health professionals and healthcare professionals, a repeal of the one-week waiting period for unemployment insurance, expanding and improving access to telehealth services, among many other proposals.  

As additional needs and issues arise from agencies and stakeholders, the governor is committed to working with legislators to find bipartisan solutions. The governor’s office welcomes the opportunity to hear and consider any proposals that legislators have to address the impacts of COVID-19 on the health and well-being of Wisconsin residents, businesses and communities. 

This package, among many other proposals, includes:  

• Increasing funding for Medicaid providers via supplemental payments and rate increases to support the healthcare system’s response to the public health emergency;  
• Establishing a fund to reduce providers’ uncompensated care costs targeting reimbursement for treatment-related costs for uninsured individuals;
• Establishing a COVID-19 reinsurance program to reduce health insurance premiums; 
• Providing grant funding to provide food assistance and meal delivery;  
• Prohibiting utility cooperatives from disconnecting customers and prohibiting land-lord directed disconnections from rental units during a public health emergency; 
• Ensuring workers receive back payment for any lost unemployment insurance benefits as a result of the delay in suspending the one-week waiting period; 
• Providing supplemental payments to child care providers, if that provider needed to shut down during the public health emergency;  
• Allowing households to apply for heating assistance under the low-income energy assistance program anytime during the 2020 calendar year; 
• Increasing the Earned Income Tax Credit for low-income families;  
• Providing municipalities the flexibility to implement multiple installments of three or more payments for 2020 property taxes;  
• Waiving interest and penalties on delinquent property taxes included in the 2019 payable 2020 tax roll, on and after April 1, 2020;  
• Creating a fund through the Wisconsin Housing and Economic Development Association to provide 6 months of support for prevention of single-family foreclosures and providing refinancing opportunities to current borrowers; and  
• Providing grant funding for small businesses and workers through the Wisconsin Economic Development Corporation. 

The Governor’s first COVID-19-related legislation was introduced last week as LRB-5920 and is available here for review. A brief explanation of LRB-5920 is available here. A brief explanation of the governor’s second round of proposed legislation announced today is available online (link).

Effective for dates of service on and after April 1, 2020, ForwardHealth, which has an expedited emergency supply policy dispensing option available for certain drugs, has expanded the list of drugs available through expedited emergency supply and will allow most drugs to be dispensed in up to a 100-day expedited emergency supply.

A table with the expanded list of drugs available by expedited supply is included below and is also available on the Pharmacy Resources page of the ForwardHealth Portal. Pharmacy providers should continue to follow the current processes for requesting an expedited emergency supply of drugs detailed in the Emergency Medication Dispensing topic (#1399) of the ForwardHealth Online Handbook.

This Action Alert 10 and others are available on the ForwardHealth website (link).

Governor Evers issued the following statement regarding the upcoming April 7 election:

“We have three branches of government to ensure a system of checks and balances, and questions about our elections typically rely on all three playing a role. If I could have changed the election on my own I would have but I can’t without violating state law. I’ve asked the legislature to do its part to ensure a fair and safe election and I hope we can get some clarity as soon as possible. The bottom line is that we have to keep folks safe and we have to make sure everyone who wants to vote has the opportunity to make their voice heard.”

Previously, the governor proposed legislation that had several provisions aimed at making voting easier and more accessible during the public health emergency. A brief summary of that legislation is available here for review. Additionally, he called for the Legislature to act on this issue in a video, available here. 

The amicus brief submitted on behalf of the governor is available here.