Wisconsin Pharmacist Provider Status Initiative
The Wisconsin Plan aims to include licensed pharmacists as covered Medicaid providers, allowing them to directly bill for patient care services. This State Plan Amendment addresses criteria for Medicaid coverage of pharmacist services and the key points of the initiative.
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Presentation Transcript
PHARMACIST PHARMACIST PROVIDER STATUS PROVIDER STATUS
THE WISCONSIN PLAN Mission Add licensed pharmacists to the insurance list of covered patient care providers which would allow pharmacists to enroll with insurance companies and directly bill/receive payment for patient care services Vision Ensure every patient in Wisconsin has sustainable access to pharmacist provided care Initial Goal Pass legislation that requires Medicaid to add licensed pharmacists to the list of covered Medicaid providers (requires State Plan Amendment)
STATE PLAN AMENDMENT Criteria for Medicaid Coverage of Licensed Pharmacist Services means that services are: Provided in accordance with the scope of practice as defined by the State Board of Pharmacy Care provided via face to face, telephone, and telemedicine/telehealth or via modalities as consistent with other covered providers Performed by pharmacists who are duly licensed to practice pharmacy and are approved by the Board of Pharmacy Or, performed by pharmacists employed by a federally recognized tribe Coverage Limitations Medical services must be performed in accordance with the pharmacist scope of practice or as delegated 450.033 Services delegated by physician. 450.033 Services delegated by physician. A pharmacist may perform any patient care service delegated to the pharmacist by a physician, as defined in s. 448.01 (5). Pharmacists are reimbursed the lesser of the pharmacist s usual and customary charge for a service or the physician's maximum allowable fee for the procedure. Pharmacists use the physician maximum allowable fee schedule. This SPA submission request is to allow Licensed Pharmacists to enroll directly as Medicaid Providers, which allows them to directly bill and to receive direct payment.
HOW DID WE GET HERE? Review of other states methods, including conversations with Tennessee and Washington pharmacist associations Review of current Wisconsin law relating to other providers Recognition that Wisconsin s current scope for pharmacists was sufficient ***NOT NOT prescriber status*** Identification of lack of payment as largest barrier in Wisconsin
KEY POINTS Provider Status is designed to add pharmacists to list of covered Medicaid Medicaid patient care providers in the state of Wisconsin Applies to clinical services as encompassed by pharmacists scope of practice, including those delegated by a physician Covered under medical medical benefit Not aiming to add prescriptive authority to pharmacists scope of practice
WILL PROVIDER STATUS BE REQUIRED? NOPE. Goal: All Pharmacists, Pharmacy Technicians, Students support Provider Status Legislation Ready Ready to use provider status? Not Not ready ready to use provider status? With PSW s support, start developing infrastructure to deliver billable pharmacist provided care No requirement to use provider status
KEY MESSAGE nsure sustainable patient access sustainable patient access to pharmacist provided care pharmacist provided care Pharmacists should be equitably paid for providing services, within their scope, that would be traditionally reimbursed for other healthcare providers As medication costs continue to rise, Pharmacists are best positioned to ensure optimal medication related outcomes Pharmacists must be recognized as part of the integrated healthcare team Provider Status will help progress the profession of pharmacy to improve patient access to care in the state of Wisconsin Provider Status will e Provider Status will ensure to
WHAT IS INCLUDED? Pharmacists would be able to bill and be reimbursed for covered Pharmacists would be able to bill and be reimbursed for covered medical services within their scope of practice medical services within their scope of practice A few examples: Immunizations Medication injections Point of care testing and management Travel medicine visits Comprehensive medication management and chronic disease state management under collaborative practice agreements Asthma, BPH, COPD, Diabetes, Heart Failure, Hypertension, Hyperlipidemia, Hypothyroidism, Gout, Vitamin deficiencies, Women s Health, and so much more!
COVID-19 TESTING EXAMPLE Pharmacist Performing COVID-19 Testing Pharmacist takes a patient medical history Assess appropriateness of COVID-19 testing Administers COVID-19 testing Interprets test result and performs clinical decision making Educates patient on test outcome and appropriate clinical care management Places referrals to other providers as appropriate Documents patient care encounter
BLOOD PRESSURE EXAMPLE Pharmacist Managing BP Under Collaborative Practice Agreement Pharmacist takes a patient medical history Assesses subjective patient information Patient shares information verbally including lifestyle information Assesses objective patient information Home blood pressures, current visit blood pressure, lab values, medication review Interprets subjective/objective information and performs clinical decision making Educates patient, engages patient in shared decision making Provides clinical care management including adjustment of medications as appropriate per practice guidelines and CPA Places referrals to other providers as appropriate Documents patient care encounter
WHAT IS EXCLUDED? Excluded: Services associated with the medication dispensing process including counseling consistent with medication dispensing procedures Care billed via the drug benefit Cannot bill for the same services through both the drug and medical benefits
REQUIREMENTS Must become enrolled/credentialed by Medicaid Medical services must be performed in accordance with the pharmacist scope of practice or as delegated 450.033 Services delegated by physician. delegated by physician. 450.033 Services A pharmacist may perform any patient care service delegated to the pharmacist by a physician, as defined in s. 448.01 (5).
SPREADING THE MESSAGE INTERNAL STAKEHOLDERS PSW Boards, Sections, and Advisory Committees Provider Status Core Taskforce Provider Status Advisory Group PSW Membership EXTERNAL STAKEHOLDERS
LEGISLATIVE TIMELINE January 2021: Bill introduction March 2021: Legislative Day *peak member engagement needed* March-June 2021: Per PSW guidance, contact legislators and testify June 2021: Earliest that we may hear
NEXT STEPS Building awareness of the message through education and communication Building relationships Building enthusiasm and preparedness What specifically can people do? See Mobilizing Your Engagement in Pharmacist Provider Status guide Engage your pharmacy and non-pharmacy leadership Start working with your team to think through how to operationalize in your practice setting Legislation that will be introduced in Jan 2021 will need your support and advocacy, especially on Legislative Day 2021
