Wisconsin

MASTER MEDICAID TELEHEALTH LAWS
WITH THE HELP FROM GD

Summary

Forward Medicaid allows reimbursement for live video under some circumstances. There is no reimbursement for store-and-forward or remote patient monitoring as services must be delivered at the same functional equivalency as face-to-face care.

Definitions

Telehealth enables a provider who is located at a distant site to render the service remotely to a member located at an originating site using a combination of interactive video, audio, and externally acquired images through a networking environment.

Source: WI ForwardHealth Update. Feb. 2018. (Accessed Apr. 2019).

 

“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)(b)1.b (Accessed Apr. 2019).

Live Video

Policy

ForwardHealth allows for certain covered services to be provided via telehealth.

 

Source: WI ForwardHealth Update. Feb. 2018. (Accessed Apr. 2019).
Eligible Services / Specialties

Alabama Medicaid reimburses for the following services when billed with a GT modifier:
• Consults;
• Office or other outpatient visits;
• Individual psychotherapy;
• Psychiatric diagnostic services;
• Neurobehavioral status exams.
However, for some specialties, special conditions or circumstances must be present for reimbursement to occur.

 

Source: AL Medicaid Management Information System Provider Manual, (28-17), & AL Admin. Code r. 560-X-6-.14
(Accessed Mar. 2019).

Telehealth may also be used to deliver Nursing Assessment and Care and Rehabilitative services when certain conditions are met.

Source: AL Medicaid Management Information System Provider Manual, (105-13) (Accessed Mar. 2019).
Eligible Providers

Allowable providers:
• Audiologists
• 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 (Division of Quality Assurance)
Ancillary Providers
Claims provided via telehealth by distant site ancillary providers should be billed under
the supervising physician’s NPI using the lowest appropriate level office or outpatient visit
procedure code. These services must be supervised by an onsite physician.
Certified Mental Health And Substance Abuse Treatment Providers
Required to meet telehealth certification requirements to provide telehealth.
Community Health Centers, Tribal FQHCs and RHCs
They may serve as a distant site provider for telehealth services. See manual for details.

Source: WI ForwardHealth Update. Feb. 2018. (Accessed Apr. 2019).

 

Community Health Centers, Tribal FQHCs and RHCs
They may serve as originating site providers for telehealth services.
Distant Site Tribal FQHCs and RHCs may report services provided via telehealth on the cost settlement report when the FQHC or RHC served as the distant site and the member is an established patient of the tribal FQHC or RHC at the time of the telehealth service.
CHCs may not report services provided via telehealth as an encounter. Instead, CHCs
should submit claims for distant site services on a professional claim form and will be reimbursed in accordance with the maximum allowable fee schedule.
Allowable originating sites:
• Hospitals, including emergency departments
• Office/clinic
• Skilled nursing facility

Source: WI ForwardHealth Update. Feb. 2018. (Accessed Apr. 2019).
Eligible Sites

Community Health Centers, Tribal FQHCs and RHCs
They may serve as originating site providers for telehealth services.
Distant Site Tribal FQHCs and RHCs may report services provided via telehealth on the cost settlement report when the FQHC or RHC served as the distant site and the member is an established patient of the tribal FQHC or RHC at the time of the telehealth service.
CHCs may not report services provided via telehealth as an encounter. Instead, CHCs
should submit claims for distant site services on a professional claim form and will be reimbursed in accordance with the maximum allowable fee schedule.
Allowable originating sites:
• Hospitals, including emergency departments
• Office/clinic
• Skilled nursing facility

Source: WI ForwardHealth Update. Feb. 2018. (Accessed Apr. 2019).
Facility/Transmission Fee

Reimbursement for facility fee.

Source: WI ForwardHealth Update. Feb. 2018. (Accessed Apr. 2019).

Store-and-Forward

Policy

No reimbursement. Services must be functionally equivalent to face-to-face.

 

Source: WI ForwardHealth Update. Feb. 2018. (Accessed Apr. 2019).
Email / Phone / Fax

No reimbursement for telephone.
No reimbursement for written electronic communication (text, email).

Source: WI ForwardHealth Update. Feb. 2018. (Accessed Apr. 2019).
Consent

Informed consent required.

Source: WI ForwardHealth Update. Feb. 2018. (Accessed Apr. 2019).
Out of State Providers

Out-of-state providers who do not have border status enrollment with WI Medicaid are required to obtain prior authorization (PA) before providing services. WI Medicaid is prohibited from paying providers located outside of the US, the District of Columbia and its territories.

Source: WI ForwardHealth Update. Feb. 2018. (Accessed Apr. 2019).
Miscellaneous

POS code 02 required.

 

Source: WI ForwardHealth Update. Feb. 2018. (Accessed Apr. 2019).

Professional Regulation /
Health & Safety

Online Prescribing

When a physician uses a website to communicate with a patient located in this state, the physician may not provide treatment recommendations, including issuing a prescription unless the following
requirements are met:
• The physician shall be licensed in the state;
• The physician’s name and contact information must be made available to the patient;
• Informed consent is required;
• A documented patient evaluation performed;
• A patient health care record is prepared and maintained.
Prescribing based on a static electronic questionnaire does not meet the minimum standard of competent medical practice.

 

Source: Admin. Code MED Ch. 24.07 (Accessed Apr. 2019)
Consent

Informed consent required.

Source: Admin. Code MED Ch. 24.07(c). (Accessed Apr. 2019).
Miscellaneous

Professional Board Telehealth-Specific Regulations
• Medical Examining Board (Source: MED Ch. 24) (Accessed Apr. 2019).

Definitions

Telemedicine means the practice of medicine when patient care, treatment or services are provided through the use of medical information exchanged from one site to another via electronic communications. Telemedicine does not include the provision of health care services only through an audio only telephone, email messages, text messages, facsimile transmission, mail or parcel service or any combination thereof.

 

Source: Admin. Code MED Ch. 24. (Accessed Apr. 2019).
Cross-State Licensing

WI medical license required.

Source: Admin. Code MED Ch. 24.04 (Accessed Apr. 2019).

 

Member of the Interstate Medical Licensure Compact.

Source: Interstate Medical Licensure Compact. (Accessed Apr. 2019).

 

Member of the Nurse Licensure Compact

Source: Nurse Licensure Compact (Accessed Apr. 2019).

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