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WiAHC Government Affairs Report: Permanent Medicaid Telehealth Rules to Roll Out Next Year

September 28, 2021 1:21 PM | WiAHC Office (Administrator)

By Hoven Consulting – WiAHC’s Government Affairs Firm

The state’s Medicaid program will carry forward many of the temporary telehealth provisions it put in place at the start of the COVID-19 pandemic in a permanent policy that will take effect January 1, 2021.

“What you see right now is in many cases the same rule that you’re going to see in the future, with I think some improvements actually,” Medicaid Director Jim Jones said at a Wisconsin Health News virtual panel in September.

Jones said improvements include paying originating sites, like a pharmacy or medical office, to provide a place for Medicaid members to receive telehealth. They’re also looking at expanding tele-dentistry and doctor-to-doctor teleconsultation. 

Other changes like covering asynchronous telehealth, where patients, for instance, send a photo to their provider, are still being developed. 

A state law enacted in November 2019 requires that the Department of Health Services to treat telehealth the same as in-person care and mandates that Medicaid reimburse the same telehealth services that Medicare covers. The Department of Health Services initially anticipated taking six to nine months to roll out the law. 

But when the pandemic struck in March 2020, DHS “ripped the Band-Aid off” and moved quickly to set up a temporary policy to ensure members could still get access to services, Jones said. They've spent the time since working on a permanent rule.

Rep. Amy Loudenbeck, R-Clinton, who wrote the law, said it helped plant “the seed of what telehealth could be,” particularly in how it could boost access to mental healthcare. 

“This test period that we’re in has been really helpful and will inform rule-making,” she said. 

She’s now working on legislation that would apply the Medicaid definition for telehealth to the state occupational licensing law.

Jim Castellano, telehealth and virtual care manager at Marshfield Clinic Health System, said state and federal flexibilities boosted their ability to provide telehealth.

“In some ways, I think this was a unique opportunity for everybody to just really get down and dirty with the technology and see what it’s capable of,” said Dr. John Schneider, chief medical officer at the Milwaukee County Behavioral Health Division. 

He said telehealth has helped them reach more people, including easing the pivot from at-home visits to telecalls. He said there could be challenges with reimbursement in the future. 

John Nygren, Wisconsin Association of Health Plans executive director, said their members have embraced the use of telehealth, calling it the “one of the best things” that has come out of the pandemic. 


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