Wisconsin November 2019 Fact Sheet

On November 25, 2019, Governor Tony Evers signed SB380 into law, defining telehealth and expanding telemedicine parity to Medicaid participants.  The bill provides telehealth coverage to equal services provided in-person. Effective on or before January 1, 2021, this bipartisan-supported bill also prevents Medicaid from denying coverage based on the patient’s location or requiring additional qualifications.

Definition

Wisconsin defined telehealth to include live video, store-and-forward, remote patient monitoring, and other asynchronous communication mediums.  The definition excludes telephone and email.

“ “Telehealth” means a practice of health care delivery, diagnosis, consultation, treatment, or transfer of medically relevant data by means of audio, video, or data communications that are used either during a patient visit or a consultation or are used to transfer medically relevant data about a patient. “Telehealth” does not include communications delivered solely by audio-only telephone, facsimile machine, or electronic mail unless the department specifies otherwise by rule.”

Service Parity

This bill extends Wisconsin’s telehealth coverage past mental health services and covers any service currently provided by Medicaid equal to services provided in-person to Medicaid participants.

“relating to: coverage of services under Medical Assistance provided through telehealth and other technologies, extending the time limit for emergency rule procedures, and granting rule-making authority.”

Payment Parity

In addition to service coverage, the bill mandates that services provided through telehealth are reimbursed equally to services provided in-person.

“DHS must pay for such a service provided by a certified provider of Medical Assistance at a distant site an amount equal to the amount the certified provider would receive under the Medical Assistance program if the service were provided through a method other than telehealth.

Originating Site

Currently, Wisconsin doesn’t reimburse for originating, however, SB380 introduced new information indicating further legislation could be leading in that direction.

“The department may not limit coverage or reimbursement of a service provided under par. (b) or (c) based on the location of the Medical Assistance recipient when the service is provided.”

For more information on telemedicine legislation in Wisconsin, visit their Telemedicine & Telehealth Reimbursement Overview.