Attention Providers: The Act 98 Pharmacist as a Provider Project page will be discontinued on September 30, 2024. Providers should refer to the ForwardHealth Online Handbook for all policies and procedures specific to their service areas.
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.
Pharmacists enrolled as Wisconsin Medicaid providers under 2021 Wisconsin Act 98 may begin to provide and submit claims for covered medical services provided to ForwardHealth members. Pharmacists should refer to the maximum allowable fee schedule to determine which codes are available for reimbursement for provider type 23 (Pharmacist). Additional information can be found in ForwardHealth Update 2024-17, “Coverage Policy for Medicaid-Enrolled Pharmacists.”
Pharmacists should refer to the appropriate service area of the Online Handbook (such as Physician) for policies related to the covered services provided to ForwardHealth members. Pharmacists are required to follow all established policies and procedures in the Online Handbook.
DHS recommends pharmacists review the following Online Handbook topics:
Pharmacists were authorized to begin enrolling in Wisconsin Medicaid as a provider on March 1, 2024. Pharmacists should refer to 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:
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:
DHS is also suggesting pharmacists view the following trainings:
As a reminder, all provider trainings can be found on the ForwardHealth Portal.
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 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.
DHS provided a project update at the April 27, 2023, stakeholder meeting.
At the stakeholder meeting, DHS gathered feedback on the following:
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:
DHS received feedback at this meeting regarding these potential covered services and the specific services pharmacists would be likely to perform.
Below are the recorded public meetings and PowerPoint presentations.
April 27, 2023:
August 3, 2022:
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.
Public Notice Pharmacist as a Provider
Below are training resources available to providers:
Below are the Wisconsin Acts related to pharmacy practice:
Providers may email DHS at DHSDMSAct98@dhs.wisconsin.gov with any questions.
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