Act 98 Pharmacist as a Provider Project

2021 Wisconsin Act 98

2021 Wisconsin Act 98 grants the Wisconsin Department of Health Services (DHS) authority to reimburse licensed pharmacists for services delegated to them by a physician or within the scope of the pharmacists’ practice. 2021 Wisconsin Act 98 was enacted into law on December 3, 2021.

This page will focus on the ongoing ForwardHealth project and serve as a landing page for DHS meetings, agendas, and resources regarding the project including FAQs. It will be updated as information becomes available.

March 2024 Update

Pharmacists may start the enrollment process to become a provider in ForwardHealth. Pharmacists should refer to ForwardHealth Update 2024-06, “Provider Enrollment Information For Licensed Pharmacists,” for enrollment information. As a reminder, there is an enrollment training and checklist that can be used as additional help when enrolling in ForwardHealth.

Pharmacists should contact HMOs to learn if the HMO will require pharmacists to go through a credentialling process.

DHS continues to work on identifying and developing the system requirements and modifications needed to allow a pharmacist to:

• Bill for covered medical services.
• Receive reimbursement for covered medical services.

It is anticipated that pharmacists may begin billing for services they provide to ForwardHealth members beginning in July 2024.

DHS is recommending pharmacists view the following training in preparation of billing for covered medical services:

• Portal Basics for New Users
• Options for Electronic Claims Submission
• Provider Electronic Solutions Software
• Overview of Security Enhancements to the ForwardHealth Portal
• Interactive Maximum Allowable Fee Schedule
  • How to Search the Maximum Allowable Fee Schedule
  • Understanding Search Results Using the Interactive Maximum Allowable Fee Schedule

DHS is also suggesting pharmacists view the following trainings:

• Office of the Inspector General Trainings
  • Module 1: Overview of the OIG
  • Module 2: Provider Fraud, Waste, and Abuse in the Wisconsin Medicaid Program
  • Module 3: Wisconsin Medicaid Enrollment Tips for Providers
  • Module 4: Wisconsin Medicaid Self-Audit Tips for Providers
• Payment Integrity Review Program

As a reminder, all provider trainings can be found on the ForwardHealth Portal.

September 2023 Update

DHS continues to work on system changes that would allow pharmacists to enroll in ForwardHealth as a provider beginning in March 2024. Pharmacists must enroll with ForwardHealth to serve Medicaid members. Contact the Medicaid HMO to determine if you need to be contracted. Contracting may or may not include additional credentialing requirements. This process varies by HMO and may need to be completed with multiple HMOs if the pharmacist wishes to serve all HMO members in their service area. When pharmacists are notified of their provider status in ForwardHealth, pharmacists may begin the contracting process with HMOs.

An upcoming training for provider enrollment will be available for providers in October 2023 on the Trainings page of the ForwardHealth Portal. The Trainings page includes links to existing trainings that are available to providers. Additional information regarding enrollment will be communicated in a ForwardHealth Update closer to the enrollment date.

DHS continues to work on identifying and developing the system requirements and modifications needed to allow a pharmacist to:

• Bill for covered medical services.
• Receive reimbursement for covered medical services.

It is anticipated that pharmacists may begin billing for services they provide to ForwardHealth members beginning in July 2024.

April 2023 Update

DHS is working on system changes that would allow pharmacists to enroll in ForwardHealth as a provider. As part of this effort, DHS is identifying and developing the system requirements needed to allow a pharmacist to bill and receive reimbursement for medical services. In addition, DHS is collaborating with stakeholders to determine the types of medical services provided by a pharmacist that can be covered by Wisconsin Medicaid.

External Stakeholder Meetings

DHS provided a project update at the April 27, 2023, stakeholder meeting.

At the stakeholder meeting, DHS gathered feedback on the following:

• What types of medical services generally fall within a pharmacist's scope of practice?
• What types of medical services fall under a collaborative practice agreement?

DHS has been working to identify specific medical services that pharmacists may provide, such as medication injection, chronic disease management, smoking cessation therapy, blood pressure monitoring, and point-of-care testing and results management.

In addition, pharmacists are ideally positioned to provide the following services that may have more immediate beneficial impacts on the health of ForwardHealth members:

• Maternal health
  • Counseling for contraception, prenatal vitamins
  • Screening and consultation for maternal health and wellness
  • Prescribing oral contraceptives
  • Prescribing prescription prenatal vitamins
  • Taking vital signs
• Opioid use disorder
  • Counseling and dispensing naloxone
  • Screening and consultation associated with drug therapy to treat addiction

DHS received feedback at this meeting regarding these potential covered services and the specific services pharmacists would be likely to perform.

Stakeholder Meetings

Below are the recorded public meetings and PowerPoint presentations.

April 27, 2023:

• Agenda
• PowerPoint (PDF)

August 3, 2022:

• Agenda (PDF)
• Recorded meeting (One hour)
• PowerPoint (PDF)

FAQs

DHS has developed an FAQ document with questions and answers regarding the project. DHS will update the FAQ document as additional questions and answers are added.

Publications and Notices

Public Notice Pharmacist as a Provider

Training

Below are training resources available to providers:

• Pharmacist as a Provider Enrollment Training
• Pharmacist as a Provider Enrollment Checklist

Resources

Below are the Wisconsin Acts related to pharmacy practice:

• 2021 Wisconsin Act 98 (PDF), which relates to reimbursement of pharmacist’s services.
• 2021 Wisconsin Act 3 (PDF), which relates to the administration of vaccines or drugs.
• 2019 Wisconsin Act 24 (PDF), which relates to the administration of vaccines on the Advisory Committee on Immunization Practices’ immunization schedule without prescription.
• 2013 Wisconsin Act 294 (PDF), which relates to services delegated by a physician.

Keep in Touch

Providers may email DHS at DHSDMSAct98@dhs.wisconsin.gov with any questions.