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  • March 28, 2020 9:29 AM | Anonymous

    Governor Evers and Wisconsin Department of Health Services (DHS) Secretary-designee Andrea Palm today exercised their authority under Article V, Section 4 of the Wisconsin Constitution and Sections 323.12(4) and 252.02(6) of the Wisconsin Statutes to simplify healthcare license renewals during the COVID-19 public health emergency and to encourage recently retired professionals with expired licenses to re-enter practice. This full order is available online (link).

    The order includes the following policy changes:

    • Interstate Reciprocity: allows any out-of-state health can provider licensed and in good standing to practice in Wisconsin without a Wisconsin credential. The order requires the out-of-state physician to apply for a temporary or permanent Wisconsin license within 10 days of first working at a Wisconsin health care facility; and the health care facility must notify DSPS within 5 days. The order temporarily suspends the visiting physician practice limitations in Med 3.04. 
    • Temporary License: Any temporary licensed to an out-of-state provider during the emergency will be valid until 30 days after the conclusion of the emergency. 
    • Telemedicine: Allows physicians licensed and in good standing in Wisconsin, another U.S. state or Canada to provide telemedicine services to Wisconsin residents. 
    • Physician Assistants: Suspends several current rules regulating the practice of PAs in Wisconsin. This includes: the requirement of PAs to notify the MEB of changes to their supervising physician within 20 days (order changes it to 40 days); the requirement that PAs limit their scope of practice to that of their supervising physician (the order allows them to practice to the extent of their experience, education, training and abilities. It also allows them to delegate tasks to another health provider); the physician to PA ratio of 4:1 (the order allows a physician to oversee up to 8 on-duty PAs at a time, but there is no limit on how many PAs a physician may provide supervision to over time. It also allows a PA to be supervised by multiple physicians while on duty). 
    • Nurse Training and Practice: The order suspends many rules related to nursing. This includes suspending a rule that prohibits simulations from being utilized for more than 50% of the time designated for meeting clinical learning requirements. It also suspends the requirement for nurses to submit an official transcript in order to get a temporary license and allows a temporary license to remain valid for up to 6 months. In addition, it suspends the rule requiring license renewal within 5 years. 
    • Advanced Practice Nurse Prescribers: Temporarily suspends the requirement that Nurse Prescribers must facilitate collaboration with other health care professionals, at least 1 of whom shall be a physician or dentist.
    • Recently Expired Credentials: Requires the state to reach out to individuals with recently lapsed credentials about renewal options. The order also suspends many of the late renewal fees and continuing education requirements for most health professions. The order temporarily suspends MED 14.06(2)(a) to allow a physician whose license lapsed less than 5 years ago to renew without fulfilling the continuing education requirements. It also suspends RAD 5.01 (1) and (2) to allow radiographers or LXMO permit holders who have let their license lapse renew without completing continuing education. 
    • Fees: The order also gives DHS the ability to suspend fees or assessments related to health care provider credentialing. 

    The order is effective immediately and will remain in effect through the duration of the public health emergency.

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

  • March 27, 2020 10:01 AM | Anonymous

    Governor Evers directed the Wisconsin Department of Health Services (DHS) Secretary-designee Andrea Palm to temporarily order the suspension of evictions and foreclosures amid the COVID-19 public health emergency. The full order is available online (link).

    The order prohibits landlords from evicting tenants for any reason unless failure to proceed with the eviction will result in an imminent threat of serious physical harm to another person and mortgagees from commencing civil action to foreclose on real estate for 60 days. Wisconsinites who are able to continue to meet their financial obligations are urged to do so. This order does not in any way relieve a person's obligation to pay their rent or mortgages.

    The full press release is available on the Governor’s website (link).

  • March 25, 2020 12:42 PM | Anonymous

    Governor Evers has issued Emergency Order #12 to institute a Safer At Home policy. The order is effective at 8:00 am on Wednesday, March 25, 2020 and remain in effect until 8:00 am Friday, April 24, 2020, or until a superseding order is issued.

    Wisconsin residents must comply with this order. As outlined in the order, individuals can leave their home to perform tasks essential to maintain health and safety, get services and supplies necessary for staying home, and care for others.

    After reviewing the order, if a business believes their business is doing essential work and they are not exempted in this order please go to this link https://wedc.org/essentialbusiness/.

    These are important steps to ensure we working to slow the spread of COVID-19. 

    Essential services, such as healthcare and public health operations, will continue to be provided to the communities across Wisconsin, including the work done by mental health and substance abuse providers. 

  • March 16, 2020 9:46 AM | Anonymous

    Opioid Treatment Program (OTP) Guidance

    SAMHSA recognizes the evolving issues surrounding COVID-19 and the emerging needs OTPs continue to face. SAMHSA affirms its commitment to supporting OTPs in any way possible during this time. As such, we are expanding our previous guidance to provide increased flexibility.

    Read more.

  • March 15, 2020 10:01 AM | Anonymous

    Fox 6 Now / Amanda St. Hilaire

    View the full article and watch the news report here.

    MILWAUKEE -- When Dr. TJ Harrington's patients struggle to quit smoking, he can instantly connect them with options like the nicotene patch.

    But the Aurora Health Care Senior Chief Resident of Family Medicine says getting patients help for opioid addiction has been much more complicated.

    "He actually ended up overdosing and passing away," Harrington said, describing a patient who struggled with addiction. "It was upsetting, it was heartbreaking, and I think frustrating knowing that maybe we could have had a different outcome."

    Now, that different outcome is within reach. Aurora, along with health systems like Ascension and ProHealth, is part of a statewide effort to make it easier for patients to access buprenorphine, a medication used for addiction treatment.

    "Thank goodness," Harrington said with a sigh. "I’ve got something that can maybe help."

    Clearing the hurdles

    Buprenorphine is a medication used to assist in addiction treatment. Many patients know it by the brand name Suboxone, which is a combination of buprenorphine and naloxone.

    Buprenorphine works by partially acting like an opioid and binding to the same receptors in the brain, without getting patients high. Doctors say the medication protects their patients from cravings and withdrawals, allowing them to focus on counseling and therapy.

    "I didn't have the cravings all the time," Tina Kasten, a woman who says buprenorphine helped her fight heroin addiction,  told FOX6. "It wasn't constantly on my mind like, 'OK, am I going to use? Am I not? Am I going to use? Don't do it. Oh, but you should.' It's like the devil and the angel and [buprenorphine] tells them to be quiet and go home."

    Methadone and naltrexone, often known by the brand name Vivitrol, are also medications used to help treat addiction. But there are strict regulations surrounding the administration of methadone, and naltrexone requires the patient to first abstain from opioid use for several days.

    Buprenorphine is seen as the most accessible option, because patients can start taking it right away. It also tends to be more affordable for the uninsured or under-insured.

    Because burprenorphine acts like an opioid, doctors need a waiver to prescribe it for addiction treatment. That waiver requires training that family doctors, OB-GYNs, and other primary care providers traditionally have not had.

    That means instead of being able to get a buprenorphine prescription at their regular doctors appointments, patients have had to deal with barriers like transportation, additional cost, and wait times in order to see an addiction specialist.

    "Addiction is a terminal illness," Ascension All Saints Medical Director of Addiction Services Dr. David Galbis-Reig. "Without treatment, you end up dying."

    Galbis-Reig is also president of Wisconsin Society of Addiction Medicine.

    "If we're talking a four week gap in treatment, in four weeks if someone continues to use, every day is a risk of overdose and death," Galbis-Reig said.

    Not all addiction treatment facilities offer buprenorphine.

    Federal data from the Substance Abuse and Mental Health Services Administration shows 104 published addiction treatment facilities within 50 miles of Milwaukee. Only 40 percent are listed as prescribing buprenorphine.

    "I'm old enough to have delivered some of my patients who are now adults," Dr. Jake Bidwell, Advocate Aurora Health Wisconsin VP for Medical Education said. "It's very frustrating to not be able to help them through a chronic problem in their life."

    The solutions

    There is a statewide push in Wisconsin to expand training so that more primary care doctors can prescribe buprenorphine directly to their patients, eliminating barriers to treatment.

    "When you ask personal questions to someone that you know really well, that trust and that rapport that's there actually provides the foundation to open up and say, 'Yeah, you know what? Something isn't right, Doc,'" Harrington said.

    Aurora is now making buprenorphine training a resident requirement for Wisconsin OB-GYNs, family doctors, and internal medicine physicians. The health system will roll out its program, in which those doctors can directly prescribe buprenorphine to patients, over the summer.

    Ascension has a full-service addiction unit, along with a program to get patients burprenorphine prescriptions immediately in the emergency room.

    ProHealth started its push to expand buprenorphine access when doctors noticed a trend of babies born dependent on opioids.

    "It was often unexpected," ProHealth Medical Director of Opioid Use Disorder Program Dr. Susanne Krasovich said. "Often mom's use was unknown or undisclosed. And we really wanted to figure out how to get a handle on that."

    ProHealth now requires family medicine residents to train to prescribe buprenorphine.

    "Without that type of collaboration and partnership between health systems, we're not going to make that large of an impact," Wisconsin Department of Health Services Director of Opioid Initiatives Paul Krupski said.

    DHS helps coordinate buprenorphine training, with the goal of allowing more patients to get their medications at regular doctors appointments. Since that effort started at the end of 2018, there's been a 43 percent jump in doctors who are able to prescribe the medication in Wisconsin.

    DHS is also in the process of getting input to eventually update state rules about addiction treatment.

    "The changes that you can make are literally saving lives, saving families, making communities safer," Krupski said.

  • March 13, 2020 3:56 PM | Anonymous

    *NOTE: The following information and the attached document are from Wisconsin's State Opioid Authority (download the full document here)

    The following information is meant to support opioid treatment programs (DHS 75.15 certified agencies) in their response to COVID-19. This guidance contains recommendations and resources that will be updated as this is an evolving situation. All OTPs are to contact the state opioid treatment authority (SOTA) if they have a patient that tests positive for COVID-19.

    How do we reduce transmission in our program facility?

    The Centers for Disease Control and Prevention has provided interim infection prevention and control recommendations in health care settings.

    https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhcp%2Finfection-control.html

    SAMHSA has issued guidance for specifically for OTPs.

    https://www.samhsa.gov/medication-assisted-treatment/statutes-regulations-guidelines/covid-19-guidance-otp

    The Wisconsin Department of Health Services has a COVID-19 webpage that is updated daily. It includes materials created by DHS for partners and providers.

    https://www.dhs.wisconsin.gov/disease/covid-19.htm

    Anyone with a respiratory illness (e.g., cough, runny nose) should be given a mask before entering your facility.

    Provide hand sanitizer at the front desk.

    Clean all surfaces and knobs several times each day with EPA-approved sanitizers.

    Can we dose someone in a separate room if they present with a fever or cough?

    Yes.

    Develop procedures for OTP staff to take clients who present at the OTP with respiratory illness symptoms, such as fever and cough to a location other than the general dispensary and/or lobby, to dose clients in closed rooms as needed.

    OTP staff should use interim infection prevention and control recommendations in health care settings published by the Centers for Disease Control and Prevention.

    If someone presents and is diagnosed with or directed to self-quarantine, can we provide them with take-home dosing?

    Individuals who present with symptoms of a respiratory infection and cough and fever may be eligible for up to two weeks of take-home dosing at the discretion of their OTP physician.

    For individual client cases, please submit exceptions through the SAMHSA OTP extranet website. Consider communication outreach to clients through phone calls, emails, and signage on-site to let them know if they become sick to contact the OTP before coming on-site, so take-home approval can be prepared in advance for dispensing.

    Can we provide delivery of medication to our clients who are diagnosed with COVID-19 or ask to self-quarantine if they cannot leave their home, or a controlled treatment environment?

    This may be possible with appropriate staff to transport the medication (at least 2 staff one being a nurse) that have appropriate personal protective equipment (PPE) and can secure the medication (locked container), although resources to offer this level of service may vary by program. For information on how to attain approval for take-home dosing please see previous question and answers.

    What should we do if we need to allow for more take-homes than permitted by state rule or do not have the ability to meet state staffing requirements due to illness, etc.?

    All state certified entities have the ability to request a variance or waiver to state rules that govern their programs.

    https://www.dhs.wisconsin.gov/regulations/waiver-variance-behavioral-health.htm

    What warrants a shutdown of an OTP?

    You must consult with both your local public health jurisdiction and the Wisconsin State Opioid Treatment Authority (Elizabeth Collier) before making decisions about operations.

    OTPs are considered essential public facilities and should make plans to stay open in most emergency scenarios to be able to induct new clients. No OTP can hold new client admissions at this time.

    What else should my OTP be doing to prepare for or respond to COVID-19?

    Ensure you have up-to-date emergency contacts for your employees and your clients.

    Ensure your program leadership has the contact information of the State Opioid Treatment Authority Elizabeth Collier:

    Develop procedures for OTP staff to take clients who present at the OTP with respiratory illness symptoms, such as fever and coughing to a location other than the general dispensary and/or lobby, to dose clients in closed rooms as needed.

    Develop protocols for provision of take-home medication if a client presents with respiratory illness such as fever and coughing.

    Develop a communications strategy and protocol to notify clients who are diagnosed with or exposed to COVID-19, and/or clients who are experiencing respiratory illness symptoms such as fever and coughing, that whenever possible the client should call ahead to notify OTP staff of their condition. This way OTP staff can have a chance to prepare to meet them upon their arrival at an OTP with pre-prepared medications to be dispensed in a location away from the general lobby and/or dispensing areas.

    Develop a plan for possible alternative staffing/dosing scheduling in case you experience staffing shortages due to staff illness. Develop a plan for criteria for staff members who may need to stay home when ill and/or return to the workforce when well.

    OTPs may want to ensure they have enough medication inventory onsite for every client to have access to two weeks of take-home medication or more. Every Wisconsin OTP should be at least two weeks ready.

    Current guidelines recommend trying to maintain a six-foot distance between clients on-site in any primary care setting, as best as possible. We realize in an OTP setting that this guidance may be difficult to achieve, but should be attempted to the best of everyone’s ability in an aspirational sense, while considering the space and patient flow within your OTP’s physical location. OTPs may want to consider expanding dosing hours to help space out service hours to help mitigate the potential for individual clients queuing in large numbers in waiting room and dosing areas.

    Should your clinic experience an identified exposure to COVID-19, consider how you will continue to dose patients that are at risk and cannot safely manage their medications.  Referring patients to the hospital to be dosed is not an acceptable backup plan.

    Consider a plan for the self-pay patients who may not be able to work due to illness and/or business closures and have no sick/vacation pay or benefits.

    Prepare for periodic surges to help other clinics. Communicate with area clinics regarding your plans and how you can help one another. Review with staff how they will verify doses and identify patients.

    Ensure that all patient information is up to date in Lighthouse.

  • March 10, 2020 11:36 AM | Anonymous

    NEENAH, Wis. – ThedaCare serves more than 600,000 people throughout Northeast and Central Wisconsin and is committed to the mission of improving the health of the communities they serve. ThedaCare leaders and caregivers know it is a responsibility of the organization to understand health issues in those communities, including opioid dependency.

    “Opioid dependency is a national problem, and Northeast and Central Wisconsin are not immune to the issue,” said Dr. Kelli HeindelThedaCare’s Medical Director of Primary Care, Clinically Integrated Network. “We want to help patients, families and communities understand how to use opioids safely and where to find help if necessary.”

    Drug abuse was among the top three health problems identified in a ThedaCare Community Health Needs Assessment completed in 2016. To combat that emerging crisis, in 2018 ThedaCare created a multi-disciplinary team to develop a system-wide strategy to reduce opioid use and increase awareness of the risks of using opioids. It combined its efforts with the Centers for Disease Control’s (CDC) national campaign entitled “It Only Takes a Little to Lose a Lot.” The campaign included billboards, social media, medication takeback boxes and public service announcements across the service area.

    Dr. Heindel noted that ThedaCare physicians have adopted best practices as identified by the Centers for Disease Control and other organizations and guidelines around prescribing opioids. Doctors are using opioids less frequently for chronic pain, prescribing lower doses and searching out alternative treatments.

    In addition, ThedaCare is now increasing its capacity to provide medically assisted treatment (MAT) for those addicted to opioids.

    “Medically assisted treatment is effective for people who are currently addicted to opioids by treating them with medications that help them to stop using opioids,” Dr. Heindel said. “Some forms of MAT requires additional certification for the doctor or advanced practice clinician and a specific level of support staff for a clinic to qualify to provide services.”

    As a result, in April, ThedaCare will be hosting a Buprenorphine DEA X-Waiver training session. This series, managed by Wisconsin Society of Addiction Medicine (WISAM), is designed to increase treatment capacity for opioid use disorders by training more prescribers to be able to treat opioid use disorders with buprenorphine.

    Read more.

  • March 06, 2020 10:03 AM | Anonymous

    Wisconsin Health News

    Milwaukee County's Behavioral Health Division has received a $1.2 million, three-year federal grant to develop a plan to reduce the risk of overdose deaths and enhance treatment at the county's House of Correction.

    The funding comes from the Department of Justice Bureau of Justice Assistance.

    To be eligible for treatment, a person must be within 30 to 90 days of release and have an opioid addiction.

    The division will work with its partner agencies to develop care plans that include medication-assisted treatment, recovery housing, individual counseling, peer specialists, outpatient services and recovery support.

    “This grant will help us take a practiced and proven approach when it comes to ensuring every resident in every community across Milwaukee County has what they need to thrive," Milwaukee County Executive Chris Abele said in a statement.

  • March 04, 2020 2:16 PM | Anonymous

    Wisconsin Health News

    Gov. Tony Evers signed into law four bills on Tuesday that target substance use disorder and opioid use in Wisconsin.

    Evers said more needs to be done to expand access to healthcare across the state and bolster treatment and recovery services.

    “Folks have seen firsthand how substance use disorder—especially opioid use—has torn apart families and communities across our state, and we need to get serious about tackling this issue in Wisconsin," Evers said in a statement. "I am proud to sign these bipartisan bills into law today that are a step in the right direction, but we know that there is more work we have yet to do."

    The bills are part of Marinette Republican Rep. John Nygren's Heroin, Opioid Prevention and Education Agenda. The four bills bring the total number of HOPE Agenda laws to 34.

    “While there is always more work to be done, more lives to save, and more avenues to recovery that need opening, today’s actions are another arrow in the state’s quiver to combat substance abuse," Nygren said in a statement.

    Nygren also called on the Senate to act on two more bills that passed the state Assembly.

    One bill would repeal a sunset for a law that provides some legal immunity for aiders who help a person experiencing an overdose as well as overdose victims. 

    The other would create a Medicaid benefit for acupuncture and increase rates for chiropractors and physical therapists.

    The bills signed by Evers will:

    • Allow county jails to enter into agreements to obtain naloxone and training and require the Department of Health Services to study the availability of medication-assisted treatment for opioid use disorder in county jails and prisons.
    • Prevent state employees from being disciplined for using or possessing a controlled substance if they're using it as part of their treatment, require DHS to maintain a registry of recovery residencies and mandate that the residencies allow residents to participate in medication-assisted treatment.
    • Extend a sunset date on a mandate that prescribers check the prescription drug monitoring program before issuing a prescription order through April 1, 2025.

    Create a Medicaid benefit for peer recovery coach services and mandate that DHS establish a program to coordinate and continue care following an overdose. 

    Evers also signed into law additional healthcare-related bills that will:

    • Allow medication or treatment records administered at a recreational camp to be maintained electronically.
    • Allow for changes in the supervision of physical therapy and physical therapy assistant students.
    • Increase the amount of funding for an award grant program for retired volunteer firefighters, first responders and emergency medical technicians.
    • Allow physician assistants, registered nurses and nurse anesthetists to perform official duties of the armed services or federal health services in Wisconsin without being licensed by the state.
    • Clarify that reimbursement of patient-incurred expenses in cancer clinical trials aren't considered undue inducement to participate.
    • Require the DHS to implement a diabetes care and prevention plan.
    • Update state law for respiratory therapists.
    • Create a Lyme disease awareness campaign.
    • Allow municipalities to increase levy limits to pay for charges assessed by a joint emergency medical services district. 
  • February 27, 2020 1:36 PM | Anonymous

    Wisconsin Health News

    Attorney General Josh Kaul said Wednesday that an agreement with a generic drugmaker will help provide more resources to fight the opioid epidemic. 

    Ireland-based Mallinckrodt, currently the largest generic opioid manufacturer in the United States, announced Tuesday that it's tentatively agreed to pay $1.6 billion to settle thousands of lawsuits related to the epidemic. 

    Under the deal, the company's future generics opioid business would be subject to strict rules that prevent marketing. The company would also have to ensure systems are in place to prevent diversion. 

    “Getting accountability from pharmaceutical companies is an important part of our strategy for fighting the opioid epidemic,” Attorney General Josh Kaul said in a statement. “With this agreement, more resources will be available to help combat this crisis.”

    Mallinckrodt is the subject of a multi-state investigation that Wisconsin is participating in, said DOJ spokeswoman Rebecca Ballweg.

    Negotiation of how the funds will be distributed is ongoing, she added. The agency is focused on ensuring that the money goes to addressing the opioid epidemic. 

    The agreementsubject to court approval and other conditions, is backed by a group of 47 state and U.S. territory attorneys general. 

    The majority of payments would go to a trust that would establish an abatement fund to cover the cost of opioid-addiction treatment and provide support to communities impacted by the crisis. 

    The settlement would become effective after the company’s subsidiaries focused on specialty generics go through a court-supervised bankruptcy process. 

    Mallinckrodt CEO Mark Trudeau said that reaching the agreement and associated debt refinancing activities will help resolve uncertainties in their business related to the litigation and provide a “clear path forward to achieving our long-term strategy.”

    Last May, Kaul announced Wisconsin filed lawsuits against two Purdue Pharma entities and Richard Sackler, alleging deceptive and false marketing practices in the sale of opioids.

    Wisconsin is part of multi-state investigations of opioid distributors Amerisource Bergen, Cardinal Health and McKesson.

    Wisconsin counties have sued over the opioid crisis.
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