Wisconsin State Telehealth Laws and Reimbursement Policies

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Information Provided ByCenter for Connected Health Policy

© Public Health Institute/ Center for
Connected Health Policy 2019: http://cchpca.org

Wisconsin Forward Health

Wisconsin

Medicaid Program: Forward Health

Medicaid Program Administrator: Wisconsin Dept. of Health Services

Regional Telehealth Resource Center:
Great Plains Telehealth Resource and Assistance Center University of Minnesota/Institute for Health Informatics 330 Diehl Hall
505 Essex Street S.E.
Minneapolis, MN 55455
(888) 239-7092
www.gptrac.org

STATE LAW/REGULATIONS MEDICAID PROGRAM
Definition of telemedicine/telehealth
“Telehealth” is a service provided from a remote location using a combination of interactive video, audio, and externally acquired images through a networking environment between an individual at an originating site and a provider at a remote location with the service being of sufficient audio and visual fidelity and clarity as to be functionally equivalent to face-to-face contact. “Telehealth” does not include telephone conversations or Internet-based communications between providers or between providers and individuals.

Source: Wisconsin Statute 49.45 (29w). “Telemedicine services (also known as “Telehealth”) are services provided from a remote location using a combination of interactive video, audio, and externally acquired images through a networking environment between a member (i.e., the originating site) and a Medicaid-enrolled provider at a remote location (i.e., distant site). The services must be of sufficient audio and visual fidelity and clarity as to be functionally equivalent to a face-to-face contact. Telemedicine services do not include telephone conversations or Internet-based communication between providers or between providers and members.

Source: WI Forward Health, Provider Publications, Physician, pg. 132 (Published Policy Through March 31, 2017).
Live Video Reimbursement
(see Medicaid column) Forward Health will reimburse for medical and mental/behavioral health services via live video.

Eligible services:

⦁ Office or other outpatient services;
⦁ Office or other outpatient consults;
⦁ Initial inpatient consults;
⦁ Outpatient mental health services;
⦁ Health and behavior assessment/intervention;
⦁ End stage renal disease-related services;
⦁ Outpatient substance abuse services.

Eligible providers:

⦁ Physicians and physician clinics;
⦁ Rural Health Clinics;
⦁ Federally Qualified Health Center;

STATE LAW/REGULATIONS MEDICAID PROGRAM
⦁ Physician assistants;
⦁ Nurse practitioners;
⦁ Nurse midwives;
⦁ Psychiatrists;
⦁ Ph.D. psychologists.
Reimbursement is subject to the same restrictions as in- person services.

Only one eligible provider may be reimbursed per member per date of service (DOS), unless it is medically necessary for the participation of more than one provider.

Separate services provided by separate specialists for the same patient at diff erent times on the same date may be reimbursed separately.

Providers may receive enhanced reimbursement for pediatric services, for members 18 years old and under, and for HPSA-eligible services.

HPSA-enhanced reimbursement is allowed when the patient or the provider is located in a HPSA-designated area.

Out-of-state providers, except border-status providers, must obtain prior authorization (PA) before delivering services to Wisconsin Medicaid members.

Source: WI Forward Health, Provider Publications, Physician, pg. 133-134 (Published Policy Through March 31, 2017).

Mental health services provided through telehealth are reimbursable by the Medical Assistance program if the provider of the service satisfies the following criteria:
⦁ The provider is a certified provider of mental health services under the Medical Assistance
program and is an agency that is certified by a mental health program. (Please see bill text for specific program list).
⦁ The provider and the individual providing the service comply with all Medical assistance
coverage policies and standards
⦁ The provider is certified for telehealth by the department.
⦁ The individual who is providing the service is licensed or registeredand in good standing with
the appropriate state board.
⦁ The provider is located in the United States. The provider is not required to be located in the state.

Source: W,sconsin Statute 49.45 (29w) (2).
Store and Forward Reimbursement
No reference found. No reimbursement.

STATE LAW/REGULATtONS MEDICAID PROGRAM

Source: WI Forward Health, Provider Publications, Physician, pg. 138 (Published Policy Through March 31, 2017).
Remote Patient Monitoring Reimbursement
No reference found. No reference found.
Email/Phone/FAX
“Telehealth” does not include telephone conversations or Internet-based communications between providers or between providers and individuals.

Source: Wisconsin Statute 94.45 (29w). No reimbursement for email or Internet-based communications.
No reimbursement for telephone. No reference found for FAX.

Source: WI Forward Health, Provider Publications, Physician, pg. 132 (Published Policy Through March 31, 2017).
Online Prescribing
No reference found. No reference found.
Consent
No reference found. No reference found.
Location
No reference found. Eligible originating sites:

⦁ Physician offices;
⦁ Hospitals (inpatient or outpatient, excluding emergency rooms);
⦁ Any other appropriate place of service with necessary equipment and staffing.

Source: WI Forward Health, Provider Publications, Physician, pg. 138 (Published Policy Through March 31, 2017).
Cross-State Licensing
WI adopted the Federation of State Medical Boards’ Interstate Medical Licensure Compact.

Source: Wisconsin Statute 14.89. WI Act 116 (AB 253, 2015). No reference found.
Private Payers
No reference found. No reference found.
Site/Transmission Fee
No reference found. Reimbursement for originating site facility fees. Eligible originating sites:
⦁ Physician offices;
⦁ Hospitals (inpatient or outpatient, excluding emergency rooms);
⦁ Any other appropriate place of service with necessary equipment and staffing.

STATE LAW/REGULATIONS MEDICAID PROGRAM
The originating site may not be an emergency room. An originating site facility fee is not an RHC/FQHC service, and may not be reported as an encounter on cost reports. Any reimbursement for the originating site facility fee must be reported as a deductive value.

Outpatient hospitals will receive only a facility fee. Wisconsin Medicaid will not separately reimburse the rate-per-visit for that member, unless the patient receives other covered services on the same date. Professional
services provided in the outpatient hospital are separately reimbursable.

Source: WI Forward Health, Provider Publications, Physician, pg. 138 (Published Policy Through March 31, 2017).
Miscellaneous
Information in the physician section of the WI Forward Health Covered and non-covered services manual is repeated in the following manuals as well:
⦁ Adult Mental Health Day Treatment
⦁ Ambulatory Surgery Centers
⦁ Child/Adolescent Day Treatment
⦁ Community Support Program
⦁ Comprehensive Community Services
⦁ Crisis Intervention
⦁ End-Stage Renal Disease
⦁ Family Planning
⦁ Federally Qualified Health Centers
⦁ Hospital, Inpatient
⦁ Hospital, Outpatient
⦁ In-Home Mental Health/Substance Abuse Services
⦁ Narcotic Treatment Services
⦁ Nurse Midwife
⦁ Nursing Home
⦁ Outpatient Mental Health
⦁ Outpatient Mental Health and Substance Abuse Services
⦁ Outpatient Substance Abuse
⦁ Rural Health Clinic
⦁ Substance Abuse Day Treatment
Source: WI Forward Health, Provider Publications (accessed Mar. 2017).
https:llwww.forwardhealth.wi.gov/WIPortaVcontent/Provider/Upda tesllndex.htm.spage

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