Covered and Noncovered Services : Covered Services and Requirements

Nurse Practitioner and Nurse Midwife Services

Nurse practitioner and nurse midwife services are covered as RHC services when the services are:

• Provided by a nurse practitioner or nurse midwife employed by or under contract with an RHC
• Performed under the general supervision of a physician
• Provided in accordance with clinic policies for a patient's care and treatment
• Performed within the legal scope of practice as defined under the Wisconsin Board of Nursing licensure or certification
• Included in the individual nurse practitioner's protocols or a collaborative relationship with a physician as defined by the Board of Nursing

Nurse practitioner and nurse midwife services include diagnosis, treatment, therapy, and consultation performed directly by a nurse practitioner or nurse midwife.

Supervision

Medicaid-enrolled nurse practitioners who work under the general supervision of a physician are required to be supervised to the extent required pursuant to Board of Nursing Wis. Admin. Code N 6.02(7), which defines general supervision as the regular coordination, direction, and inspection of the practice of another and does not require the physician to be on site.

Pursuant to Board of Nursing Wis. Admin. Code N 8.10(7), APNPs work in a collaborative relationship with a physician. The collaborative relationship means an APNP works with a physician, "in each other's presence when necessary, to deliver health care services within the scope of the practitioner's professional expertise."

Clinics that are not physician directed must arrange with a physician to provide supervision and guidance to nurse practitioners and nurse midwives, according to protocols and established clinic policies and procedures. The arrangement must be consistent with Wisconsin state law. The physician must be a doctor of medicine or osteopathy.

In the case of a physician-directed clinic, one or more clinic staff physicians must perform general supervision of nurse practitioners and nurse midwives.

Covered Services

Medically necessary nurse practitioner and nurse midwife services are covered when they are also considered covered physician services.

Medicaid-enrolled nurse midwives are limited to providing the following categories of covered services:

• Family planning services
• Laboratory services
• Obstetric services
• Office and outpatient visits
• TB-related services

The practice of nurse midwifery means the management of women's health care, pregnancy, childbirth, postpartum care for newborns, family planning, and gynecological services consistent with the standards of practice of the American College of Nurse Midwives and the education, training, and experience of the nurse midwife (Board of Nursing Wis. Stats. § 441.15).

Only antepartum and postpartum visits and outpatient treatment of complications are eligible for cost-based reimbursement.