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Wisconsin

Wisconsin

Click here to download the COVID-19 Virtual Visit & Reimbursement Guide for Wisconsin (Updated 4/30/21)

Medicaid Policies

*new update as of April 2021* PHE provisions (ending January 1, 2022 or upon ending of the Public Health Emergency): Providers from other states can temporarily practice in Wisconsin. Medical assistance reimbursement rate to be paid during PHEs is set.

*proposed update* Medical assistance telehealth excludes audio-only from its definition (except for mental health therapy). See SB306 and AB259.

*proposed update* Department of Health Services: Considering amendments to Medical Assistance telehealth rules specifying certain reimbursable and non-reimbursable Medical Assistance telehealth services. Updating administrative rules that guide behavioral health services to align with Act 56 (2019). Changing language around substance use disorders and updating standards relating to SUD and co-occurring mental health treatment.

TELEHEALTH DEFINITION: "Asynchronous telehealth service" is telehealth that is used to transmit medical data about a patient to a provider when the transmission is not a 2-way, real-time, interactive communication. “Interactive telehealth” means telehealth delivered using multimedia communication technology that permits 2-way, real-time, interactive communications between a certified provider of Medical Assistance at a distant site and the Medical Assistance recipient or the recipient's provider (reimbursable).

SERVICE PARITY: The Department of Health cannot require Medical Assistance providers to meet additional criteria solely because they are delivering services via telehealth. The services must be "functionally equivalent to face-to-face contact."

PAYMENT PARITY: "The department shall provide reimbursement under the Medical Assistance program for any benefit that is a covered benefit under s. 49.46 (2) and that is delivered by a certified provider for Medical Assistance through interactive telehealth." Additionally, the Department cannot limit reimbursement based on the location of the recipient when the service was provided.

PREREQUISITES TO TELEHEALTH: Certified providers of Medical Assistance are not required to have additional certification or meet additional requirements to deliver telehealth

ADDITIONAL PROVIDER REQUIREMENTS: The department may require providers to show that the telehealth service is functionally equivalent to face-to-face

NON-COVERED SERVICES: Store and forward, services that are not covered when delivered face to face

REMOTE MONITORING: Reimbursed (along with Remote physiologic monitoring, Remote evaluation of prerecorded patient information, Brief communication technology-based services, Care management services delivered through telehealth, Any other telehealth or communication technology-based services.)

ORIGINATING SITES ELIGIBLE FOR FACILITY FEE: Hospitals (including ED), office/clinic, SNF

PROVIDERS AT DISTANT SITES: Audiologists, Individual mental health and substance abuse practitioners not in a facility certified by the DQA (Division of Quality Assurance), Nurse midwives, Nurse practitioners, Ph.D. psychologists, Physician assistants, Physicians, Psychiatrists, Professionals providing services in mental health or substance abuse programs certified by the DQA

FQHCs & RHCs:

  • PROSPECTIVE PAYMENT SYSTEM (PPS) REIMBURSEMENT STRUCTURE
  • Services that are currently reimbursed at the PPS rate for Medicaid is reimbursed when delivered via telehealth provided it is functionally equivalent
  • Some services are considered “indirect” and are not eligible for a PPS rate as they are wrapped into the PPS rate
  • Some FFS services such as SBIRT

OTHER WI MEDICAID POLICIES:

Temporary COVID-19 Policies (WI Medicaid)

NEWLY ELIGIBLE SERVICES:

WAIVED REQUIREMENTS:

OTHER TEMPORARY WI MEDICAID POLICIES:

 

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