The 2017-18 State Legislative Process in Review – Wisconsin and Illinois

Summer 2018 brings the conclusion of the state legislative process in both Wisconsin and Illinois. This is a good time to recap the major discussions and developments in health policy that Michael Best Strategies has been following for The Alliance.

These highlights were prepared by my colleagues Nathan Houdek in Wisconsin and Stephanie Vojas in Illinois. We shared this information with the Alliance Health Policy Committee at its June meeting.

Wisconsin

The 2017-2018 Wisconsin legislative session ended on Thursday, March 22. An outsized number of bills related to health care were considered in this session, including:

• AB 798/SB 670. This bill would have created a model for direct primary care agreements, under which a patient would receive an unlimited amount of specified routine services for a flat monthly fee paid to a health care provider.
• AB 920/SB 806. This bill would have allowed for the establishment of employer groups to jointly provide health care benefits on a self-funded basis to their own employees and their dependents.
• AB 621/SB 532. This bill would have cleared the way for stricter regulation of pharmacy benefit managers, requiring them to register with the Commissioner of Insurance and prohibiting unregistered persons from engaging in the activities of a pharmacy benefit manager.
• AB 679/SB 575. This bill, now Wisconsin Act 149, allows a pharmacist to dispense an interchangeable biological product in lieu of the prescribed biological product if the interchangeable product is the less expensive of the two.
• SB 770/AB 885. This bill, now Wisconsin Act 138, creates a state-based reinsurance program for health insurance carriers participating in the federal health care exchange.

Despite the heightened activity, the reinsurance program and the interchangeable biological products legislation were the only major proposals to become law. As was expected, the worker’s compensation legislation supported by the Worker’s Compensation Advisory Council did not pass either chamber. This legislation would have created a schedule of maximum fees for health services provided for injured employees as well as making changes to disability benefits.

Legislative Council Study Committees: Direct Primary Care

Until the Legislature convenes for its next session in January 2019, it will hold a series of Legislative Council Study Committee meetings. These meetings bring together legislators, subject matter experts and other stakeholders for in-depth conversations about issues that the Legislature plans to address during the upcoming season. These study committees do not have the policymaking authority of regular legislative standing committees, but they provide an opportunity to take a closer look and offer recommendations on complex issues outside of the traditional committee process.

One of the study committees this year will be taking a close look at direct primary care. The committee is expected to review the emergence of direct primary care as a health care delivery option and recommend legislation.

Illinois

State Budget Update:  Focus on Medicaid

For the first time in recent memory, both chambers of the Illinois Legislature have passed a full year budget, which Governor Bruce Rauner signed into law on June 4.  The Budget Implementation Bill (BIMP) that supports the budget was also passed.

The Medicaid budget was fully funded and in fact included some increases:

• Supportive Living Facility rate increase ($4.3 million)
• Specialized Mental Health Rehabilitation Facility bed hold ($1 million)
• Psychiatric hospital payments ($1 million)
• Medically Complex Facilities for Persons with Developmental Disabilities rate increase ($5 million)
• Critical Access Pharmacy program ($5-$10 million)
• Ambulance rate increase ($5 million)
• Adult dental services rate increase ($12 million)
• Specialized Mental Health Rehabilitation Facility rate increase ($6 million)
• $14.5 million to safety net hospitals

2018 Legislative Session Update:

The Legislature considered a number of bills related to health care. These included several coverage mandates, a re-write of the Hospital Assessment Tax Program, a transformation of the Illinois Medicaid program, several pharmacy bills, and two telehealth bills. The following bills have passed both chambers of the legislature and are headed to the governor:

• HB 4516 requires coverage for hearing instruments and related services for all patients under the age of 18.
• HB 4281 modifies rules regarding coverage for stage 4 cancer treatment, mandating that plans not limit or exclude coverage for drugs by requiring that the patient fail to respond to a different drug or provide proof of a history of failure of the drug.
• HB 5351 mandates that plans that cover telehealth services must also cover the cost of home visits for dietitians, nutritionists and diabetes educators for senior diabetes patients.
• HB 4707 creates an 18-member task force to examine the overprescribing of opioids and recommend legislation.
• SB 3170 mandates that a prescription for medication is valid for 15 months for purposes of refills, unless the prescription states otherwise.

While these coverage mandates do not apply to self-funded employers, they are instructive as they may have the effect of changing norms of medical practice over time.

2018 Election Update and Races to Watch

Wisconsin

• Primary elections for governor, attorney general, all Assembly members, and half of the State Senate members will be held on August 14. There were also two recent special elections: one which saw Democrat Caleb Frostman take the 1^st Senate District seat, and another in which Republican Jon Plumer won the 42^nd Assembly District seat.
• Election watchers are especially focused on the Governor’s race, a half-dozen Senate races, and 15 to 20 Assembly races. Also of note is the news that three veteran State Senators and 12 veteran Assembly members have announced they will not seek re-election. The November 2018 election will nonetheless serve up an influx of new faces in each chamber and may tighten  the current Republican majorities in the Wisconsin Legislature.

Illinois:

• The Governor’s race has the potential to be extremely expensive, given that billionaires won both partisan primaries. Incumbent Governor Rauner will take on Democratic nominee J.B. Pritzker in the general election. Their running mates are Evelyn Sanguinetti and Juliana Stratton, respectively.
• Attorney General Lisa Madigan will not seek re-election, so the attorney general’s race will come down to two new faces: State Senator Kwame Raoul and Erica Harold.
• The Illinois House of Representatives saw two incumbents lose their primaries: Democrat Daniel Burke and Republican David Reis. In addition, 16 members are retiring. In the State Senate, one incumbent—embattled Sen. Ira Silverstein—lost a primary race. Four retirements—three Republicans and one Democrat—could also give way to an altering of the landscape.