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RULE TEXT
SECTION 1. DHS 101.03 (66m), and (174m) are created to read:
DHS 101.03 (66m) “Functionally equivalent” means a service provided via telehealth that meets all of the following criteria:
(a) The quality, effectiveness, and delivery mode of the service provided is clinically appropriate to be delivered via telehealth.
(b) The service is of sufficient quality as to be the same level of service as an in person visit. Transmission of voices, images, data, or video must be clear and understandable.
DHS 101.03 (174m) (a) “Telehealth” means the use of telecommunications technology by a certified provider to deliver functionally equivalent services allowable under s. DHS 107.02 (5) and ss. 49.45 (61) and 49.46 (2) (b) 21. to 23., Stats., including assessment, diagnosis, consultation, treatment, or transfer of medically relevant data. (b) “Telehealth” may include real-time interactive audio-only communication.
(c) “Telehealth” does not include communication between a certified provider and a recipient that consists solely of an electronic mail message, text, or facsimile transmission.
SECTION 2. DHS 105.24 (1) (b) 1. is amended to read:
DHS 105.24 (1) (b) 1. A registered nurse and a registered occupational therapist shall be on duty available to participate in program planning, program implementation and daily program coordination;
SECTION 3. DHS 105.25 (2) (a) is amended to read:
DHS105.25 (2) (a) An alcohol and drug counselor certified as provided in ss. DHS 75.02 (84) and 75.03 (4) (d) shall be on duty available during all hours in which services are provided to participate in treatment planning and implementation and daily program coordination. SECTION 4. DHS 105.27 (2) is amended to read:
DHS 105.27 (2) PHYSICAL THERAPIST ASSISTANTS. For MA certification, physical therapist assistants shall have graduated from a 2−year college−level program approved by the American physical therapy association, and shall provide their services under the direct, immediate, on−premises supervision of a physical therapist certified pursuant to sub. (1) and. ss. 448.53, 448.56, and 448.985, Stats. Documentation of supervision shall be maintained and provided to the department upon request. Physical therapist assistants may not bill or be reimbursed directly for their services. When performing services, physical therapist assistants are to be submitted as renderer on billing claims. SECTION 5. DHS 105.27 (2) (Note 1) is created to read:
SECTION 6. DHS 105.28 (2) (intro.) is renumbered DHS 105.28 (2) and amended to read:
DHS 105.28 (2) OCCUPATIONAL THERAPY ASSISTANTS. For MA certification, occupational therapy assistants shall be certified by the American occupational therapy association. Occupational therapy assistants may not bill or be reimbursed directly for their services. When performing services, occupational therapy assistants are to be submitted as renderer on billing claims. Occupational therapy assistants shall provide services under the direct, immediate on−premises supervision of an occupational therapist certified under sub. (1) except that they may provide services under the general supervision of an occupational therapist certified under sub. (1) under the following circumstances: and ss. 448.961, 448.963, and 448.966, Stats. Documentation of supervision shall be maintained and provided to the department upon request. SECTION 7. DHS 105.28 (2) (a) to (c) are repealed.
SECTION 8. DHS 105.28 (2) (Note 2) is created to read:
SECTION 9. DHS 105.48 (2m) is created to read:
DHS 105.48 (2m) Out-of-state providers who meet the definition of a border-status provider as described in s. DHS 101.03 (19) and who provide services to Wisconsin members via telehealth, regardless of provider location, may apply for certification as Wisconsin border-status providers if they are licensed in Wisconsin under applicable Wisconsin statute and administrative code. SECTION 10. DHS 106.02 (9) (b) (intro.) and 1. to 7. are amended to read:
DHS 106.02 (9) (b) Medical record content. (intro.) A provider shall include in a recipient’s medical record all of the following written documentation, as applicable:
1. Date, department or office of the provider, as applicable, and provider name and profession;.
2. Chief medical complaint or purpose of the service or services;.
3. Clinical findings;.
4. Diagnosis or medical impression;.
5. Studies ordered, such as laboratory or x−ray studies;.
6. Therapies or other treatments administered;.
7. Disposition, recommendations and instructions given to the recipient, including any prescriptions and plans of care or treatment provided; and.
SECTION 11. DHS 106.02 (9) (b) 9. is created to read:
DHS 106.02 (9) (b) 9. Delivery mode of the services provided, when provided via telehealth as established under s. DHS 107.02 (5), including all of the following: a. Whether provided via audio-visual telehealth, via audio-only telehealth, or via telehealth externally acquired images.
b. Whether provided synchronously or asynchronously.
SECTION 12. DHS 107.01 (2) (d) is amended to read:
DHS 107.01 (2) (d) The student provides services under the direct, immediate on−premises supervision of a certified provider in accordance with their profession’s regulatory body; and
SECTION 13. DHS 107.02 (5) is created to read:
DHS 107.02 (5) SERVICES PROVIDED VIA TELEHEALTH. The department shall reimburse providers for medically necessary and appropriate health care services listed in this chapter and ss. 49.46 (2) and 49.47 (6) (a), Stats., when provided to currently eligible Medical Assistance recipients via telehealth. Services provided via telehealth are subject to the same restrictions as services provided in an in person setting unless otherwise specified in chs. DHS 101 to 109. Providers shall ensure that the locations from which they provide services via telehealth ensure privacy and confidentiality of recipient information and communications in a functionally equivalent manner to services provided in person. Benefits or services that may not be delivered via telehealth include any of the following:
(a) Services that are not covered when provided in person.
(b) Services that do not meet applicable laws, regulations, licensure requirements, or procedure code definitions if delivered via telehealth.
(c) Services when a provider is required to physically touch or examine the recipient and delegation is not appropriate.
(d) Services the provider declines to deliver via telehealth.
(e) Services the recipient declines to receive via telehealth.
(f) Services provided by personal care workers, home health aides, private duty nurses, or school based service care attendants.
(g) Transportation. SECTION 14. DHS 107.03 (1) is amended to read:
DHS 107.03 (1) Charges Service charges for telephone calls;
SECTION 15. DHS 107.06 (1) is amended to read:
DHS 107.06 (1) Covered services. Physician services covered by the MA program are, except as otherwise limited in this chapter, any medically necessary diagnostic, preventive, therapeutic, rehabilitative or palliative services provided in a physician's office, in a hospital, in a nursing home, in a recipient's residence or elsewhere, and performed by or under the direct, on-premises supervision of a physician within the scope of the practice of medicine and surgery as defined in s. 448.01 (9), Stats. These services shall be in conformity with generally accepted good medical practice. SECTION 16. DHS 107.06 (4) (cm) is created to read:
DHS 107.06 (4) (cm) Interprofessional consultation. Interprofessional consultations shall be covered if all of the following apply:
1. The consultation is a professional service furnished to a recipient by a certified provider at the request of the treating provider.
2. The consultation constitutes an evaluation and management service in which the certified provider treating a recipient requests the opinion or treatment advice of a consulting provider with specific expertise to assist the treating provider in the evaluation or management of the recipient’s problem without requiring the recipient to have face-to-face contact with the consulting provider.
3. The consulting provider provides a written report that becomes a part of the recipient's permanent medical record.
SECTION 17. DHS 107.06 (5) (c) and 107.07 (4) (b) are repealed.
SECTION 18. DHS 107.07 (4) (c) is amended to read:
DHS 107.07 (4) (c) Equivalent services or separate components of a service performed on the same day.
SECTION 19. DHS 107.07 (4) (k) 1. is repealed.
SECTION 20. DHS 107.11 (1) (c) is amended to read:
DHS 107.11 (1) (c) “Home health visit" or “visit" means a period of time of any duration during which home health services are provided through personal contact by agency personnel of less than 8 hours a day in the recipient's place of residence for the purpose of providing a covered home health service. The services are provided by a home health provider employed by a home health agency, by a home health provider under contract to a home health agency according to the requirements of s. DHS 133.19 or by arrangement with a home health agency. A visit begins when the home health provider enters the residence to starts to provide a covered service and ends when the worker leaves the residence the service is complete. SECTION 21. DHS 107.13 (2) (a) 4. h. is created to read:
DHS 107.13 (2) (a) 4. h. A location that ensures privacy and confidentiality of recipient information and communications in functionally the same manner as services provided in person, when the provider is providing services via telehealth.
SECTION 22. DHS 107.13 (2) (a) 5. and (b) 4. e., (3) (a) 5. and 6., (b) 4. d., (3m) (d) 6., and (4) (a) 8. and (d) 7. are amended to read:
DHS 107.13 (2) (a) 5. The provider who performs psychotherapy shall engage in face−to−face contact with the recipient with the recipient via in person, real-time interactive audio-visual telehealth, or real-time interactive audio-only telehealth for at least 5/6 of the time for which reimbursement is claimed under MA;
DHS 107.13 (2) (b) 4. e. A statement of the estimated frequency of treatment sessions, the estimated cost of treatment and the anticipated location place of service of treatment.
DHS 107.13 (3) (a) 5. AODA treatment services are performed only in the office of the provider, a hospital or hospital outpatient clinic, an outpatient facility, a nursing home or a school or by telehealth when functionally equivalent to services provided in person;
DHS 107.13 (3) (a) 6. The provider who provides performs alcohol and other drug abuse treatment services engages in face−to−face contact shall engage in contact with the recipient via in person, real-time interactive audio-visual telehealth, or real-time interactive audio-only telehealth for at least 5/6 of the time for which reimbursement is claimed; and
DHS 107.13 (3) (b) 4. d. A statement of the estimated frequency of treatment sessions, the estimated cost of treatment and the anticipated location place of service of treatment.
DHS 107.13 (3m) (d) 6. AODA day treatment provided in person in the recipient’s home.
DHS 107.13 (4) (a) 8. The groups shall be led by a qualified professional staff member, as defined under s. DHS 105.24 (1) (b) 4. a., and the staff member shall be physically present throughout the group sessions and shall perform or direct the service. DHS 107.13 (4) (d) 7. Day treatment provided in person in the recipient's home; and
SECTION 23. DHS 107.16 (1) (a) is amended to read:
DHS 107.16 (1) (a) General. Covered physical therapy services are those medically necessary modalities, procedures and evaluations enumerated in pars. (b) to (d), when prescribed by a physician and performed by a qualified physical therapist (PT) or a certified physical therapy assistant under the direct, immediate, on−premises supervision of a physical therapist pursuant to s. PT 5.01. Specific services performed by a physical therapy aide under par. (e) are covered when provided in accordance with supervision requirements under par. (e) 3. SECTION 24. DHS 107.16 (1) (e) 3. a. is renumbered DHS 107.16 (1) (e) 3. And amended to read:
DHS 107.16 (1) (e) 3. The physical therapy aide shall provide services under the direct, immediate, one−to−one supervision of a physical therapist under s. PT 5.02. In this subdivision, “direct immediate, one−to−one supervision” means one−to−one supervision with face−to−face contact between the physical therapy aide and the supervising therapist during each treatment session, with the physical therapy aide assisting the therapist by providing services under subd. 1. The direct immediate one−to−one supervision requirement does not apply to non−billable physical therapy aide services. SECTION 25. DHS 107.16 (1) (e) 3. b. is repealed.
SECTION 26. DHS 107.24 (4) (j) is created to read:
DHS 107.24 (4) (j) The cost of mailing or delivery, such as shipping and handling charges and fees, of diagnostic tools or equipment needed to assess, diagnose, repair or setup medical supplies, hearing aids, cochlear implants, or other equipment cannot be billed to the recipient.
SECTION 27. EFFECTIVE DATE: This rule takes effect on the first day of the month following publication in the Wisconsin Administrative Register as provided in s. 227.22 (2) (intro.), Stats.
