Archive for the ‘Wisconsin Health Laws’ Category

Personal Care Service Providers and Wisconsin Medicaid

Friday, February 14th, 2014

By John Fisher, JD, CHC, CCEP

Personal Care Service Providers – Wisconsin Medical Assistance

Wisconsin Statute § 49.45(42)(d)3 describes the types of organizations that qualify to receive Medicaid reimbursement for “personal care services.”  Qualified entities include licensed home health agencies and other entities that are certified under section (2)(a)(11) to provide personal care services under section 49.46(2)(b)6j.  The DHS does not appear to have implemented regulations that specifically describe the criteria that “other entities” must meet in order to become qualified to receive reimbursement from Medicaid for the provision of personal care services.

The applicable provisions of section 49.45(2)(a)(11) do not contain specific criteria that “other entities” must meet but simply refers to the requirement that DHS promulgate rules establishing qualifications of providers.  The referenced statutory provision does not refer specifically to the requirements that “other entities” must meet in order to qualify to receive reimbursement for personal care services.

The requirements that must be met in order to become a licensed home health are more extensive than the personal care services entity.  However, becoming licensed as a home health agency will qualify you to provide and bill for personal care services directly.  It would also permit you to bill private pay patients for skilled nursing and other

Read more here: Health Law Blog


MSA Metropolitan Statistical Areas Wisconsin

Thursday, April 11th, 2013

Metropolitan Statistical Areas in the State of Wisconsin

Wisconsin contains 11 Metropolitan statistical areas that are totally within the state and an additional four MSAs that overlap state borders.  The Wisconsin MSAs include the following areas:

1.         Appleton (Outagamie and Calumet)

2.         Eau Claire (Eau Claire and Chippewa)

3.         Fond du Lac (Fond du Lac(

4.         Green Bay (Brown, Oconoto and Kewaunee)

5.         Janesville (Rock)

6.         Madison (Dane, Columbia and Iowa)

7.         Milwaukee-Waukesha-West Allis (Milwaukee, Waukesha, Ozaukee and Washington)

8.         Oshkosh-Neenah (Winnebago)

9.         Racine (Racine)

10.       Sheboygan (Sheboygan)

11.       Wausau (Marathon)

The four cross-border MSAs applicable to the State of Wisconsin include:

1.         La Crosse (La Crosse/WI plus Houston/MN

2.         Minneapolis-St. Paul-Bloomington (Anoka, Carver, Chicago, Dakota, Hennepin, Isanti, Ramsey, Scott, Sherburne, Washington and Wright/MN plus Pierce and St. Croix, Wisconsin)

3.         Duluth (Carlton and St. Louis/MN plus Douglas, WI

4.         Chicago-Naperville-Joliet (Cook, Dekalb, DuPage, Grundy, Kane, Kendall, Lake, McHenig and Will/IL plus Jasper, Lake, Newton and Porter/IN plus Kenosha, WI

When Does HIPAA Override State Medical Privacy Laws

Thursday, March 14th, 2013

HIPAA Preemption of State Law

The HIPAA Privacy Rule provides a Federal floor of privacy protections for individuals’ individually identifiable health information where that information is held by a covered entity or by a business associate of the covered entity. State laws that are contrary to the Privacy Rule are preempted by the Federal requirements, unless a specific exception applies. These exceptions include if the State law:

  • relates to the privacy of individually identifiable health information and provides greater privacy protections or privacy rights with respect to such information
  • provides for the reporting of disease or injury, child abuse, birth, or death, or for public health surveillance, investigation, or intervention, or
  • requires certain health plan reporting, such as for management or financial audits. In these circumstances, a covered entity is not required to comply with a contrary provision of the Privacy Rule.

Additional areas that permit State law to have an exception from the Federal preemption rules can be created by formal request from the State if certain requirements are met.  The Department of Health and Human Services (HHS) may, following request from a State, determine that a provision of State law which is “contrary” to the Federal requirements – as defined by the HIPAA Administrative Simplification Rules – and which meets certain additional criteria, will not be preempted by the Federal requirements. The Secretary of HHS must determine that one of the following criteria apply before granting and exception from the HIPAA preemption rules. These criteria require a showing that the state law at issue:

  1.  is necessary to prevent fraud and abuse related to the provision of or payment for health care,
  2. is necessary to ensure appropriate State regulation of insurance and health plans to the extent expressly authorized by statute or regulation,
  3. is necessary for State reporting on health care delivery or costs,
  4. is necessary for purposes of serving a compelling public health, safety, or welfare need, and, if a Privacy Rule provision is at issue, if the Secretary determines that the intrusion into privacy is warranted when balanced against the need to be served; or
  5. has as its principal purpose the regulation of the manufacture, registration, distribution, dispensing, or other control of any controlled substances (as defined in 21 U.S.C. 802), or that is deemed a controlled substance by State law.

Only State laws that are “contrary” to the Federal requirements are eligible for an exemption determination. In order to be considered “contrary”  it must be impossible for a covered entity to comply with both the State and Federal requirements, or that the provision of State law is an obstacle to accomplishing the full purposes and objectives of the Administrative Simplification provisions of HIPAA.

Physician Pay Cut Averted By Doc Fix in the Fiscal Cliff Legislation

Monday, January 7th, 2013

Physicians can breathe a sigh of relief that their Medicare reimbursement will not be decreased for at least another year.  The “fiscal cliff” legislation that was passed by Congress on New Year’s Day and signed by President Obama Wednesday night (January 2, 2013) averted the planned cut in Medicare payments for physicians that were scheduled to take place on January 1, 2013.  The press has primarily focused on the income tax aspects of the American Taxpayer Relief Act of 2012.  However, the legislation included several provisions relating to health care and the Medicare program, not the least of which was the “doc fix” provision that averted the “physician pay cut.”

Doc Fix – V-Blog Presentation

You can view our v-blog presentation in the Fiscal Cliff and the Doc Fix by clicking on the following link:


Note: Music provided under Creative Commons License:  Op. 7, No. 2 – The Rooms in Cerro Concepción by Tom Fahy

Op. 7, No. 2 – The Rooms in Cerro Concepción (Tom Fahy) / CC BY-SA 3.0
For coverage of additional health care provisions that were contained in the Fiscal Cliff Legislation, view our more recent blog post.  Health Care – Fiscal Cliff

Wisconsin Anesthesiologist Assistants – DHS Published Provider Guidance

Tuesday, December 18th, 2012

Wisconsin Anesthesiologist Assistant Licensing – DHS Publishes Guidance for Providers

On November 29, 2012, the Wisconsin Division of Quality Assurance published a new memorandum (DQA Memo 12-018) that provides information to health care providers regarding Wisconsin Act 160.  Act 160 created new licensing requirements for anesthesiology assistants.  Act 160 (the “AA Licensure Act”) was signed into law by Governor Walker in March and went into effect on November 1, 2012.

The AA Licensure Act added a new category of licensed health care providers in the state known as “anesthesiologist assistants” and created an infrastructure to create requirements to promote the safe and competent practice of individuals who attain this new licensure status.

The passage of the AA Licensure Act is but the latest development in the legal dynamics between Anesthesiologists and Certified Registered Nurse Anesthetists that began when Wisconsin opted to permit CRNAs to independently bill for their services which was affirmed in 2007.  The AA Licensure Act creates a separate class of licensed professional that can only operate under supervision from a physician anesthesiologist.

Council On Anesthesiologist Assistants

The AA Licensure Act created a new council on anesthesiologist assistants within the Department of Safety And Professional Services by adding section 15.407(7) to the Wisconsin Statutes.  The council is created to make recommendations to the medical examining board regarding the scope of practice of anesthesiologist assistants.  The membership of the counsel is to be selected from a list of recommended appointees to be submitted by the president of the Wisconsin Society of Anesthesiologists after considering the recommendations of the Wisconsin Academy of Anesthesiologist Assistants. 

The members of the council are subject to final approval by the medical examining board and hold three-year terms.  Members on the council must include a member from the medical examining board, a licensed anesthesiologist assistant, and two physician anesthesiologists.

Practice Locations and Temporary Licensure

Licensed anesthesiologist assistants may practice in Wisconsin hospitals, critical access hospitals and ambulatory surgical center in the state of Wisconsin.  Section 448.04(1)(g) that was created by the new law permits a temporary license to be issued to individuals who meet certain requirements and who are eligible for but have not yet passed the certification examination to become and anesthesiologist assistant.  The temporary license may only be issued for up to 18 months.

Supervision and Supervision Agreement

An anesthesiologist assistant is only permitted by the scope of licensure to assist an anesthesiologist and must practice under the supervision of an anesthesiologist.  The statute specifies details that must be maintained by the supervising anesthesiologist in order to meet the definition of “supervision.”  The supervising anesthesiologist must at all times be immediately available in the same location or facility and must be able to intervene in the procedure if required.  Supervision requirements should be reviewed in detail and incorporated into specific protocols that are applicable to the provision of anesthesia services in a facility.

Employment Requirement

The statute requires an anesthesiologist assistant to be employed by a hospital, ambulatory surgery center or an affiliate of a hospital.  Anesthesiologist assistants can only practice under a  supervision agreement with a physician anesthesiologist who represents the employer of the anesthesiologists assistant.  The statutes defined specific provisions that must be included within the supervision agreement between the anesthesiologist and the anesthesiologists assistant.

Limited Permitted Activities

The statute defined a limited scope of practice for an anesthesiologist assistant who is only authorized to perform the following types of tasks:

(a)        Developing and implementing an anesthesia care plan for a patient;

(b)        Obtaining a comprehensive patient history and performing relevant elements of a physical exam;

(c)        Pretesting and calibrating anesthesia delivery systems and obtaining and interpreting information from the systems and from monitors;

(d)       Implementing medically accepted monitoring techniques;

(e)        establishing basic and advanced airway interventions, including intubation of the trachea and performing ventilatory support;

(f)        Administering intermittent vasoactive drugs and starting and adjusting vasoactive infusions;

(g)        Administering anesthetic drugs, adjuvant drugs, and accessory drugs;

(h)        Implementing spinal, epidural, and regional anesthetic procedures;

(i)         Administering blood, blood products, and supportive fluids;

(j)         Assisting a cardiopulmonary resuscitation team in response to a life threatening situation; and

(k)        Participating in administrative, research, and clinical teaching activities specified in the supervision agreement.

The new category of provider will require hospitals and other facilities to take a look at their credentialing policies, anesthesia policies, procedures and protocols, and their compliance program risk areas.  The new supervision requirements need to be closely examined and integrated into procedure.  Credentialing implications of the temporary and permanent licensure categories should also be considered.  Facilities should also look at their applicable conditions of participation and/or accreditations agency policies to determine whether any issues are raised.

Reimbursement Issues

Medicare generally permits reimbursement to be received for the services of appropriately supervised anesthesia assistants.  However, the supervision requirements for anesthesiologist assistants is generally more stringent than for Certified Registered Nurse Anesthetists who, depending on state law, may be permitted to independently bill for their services without supervision.

A good place to start on reimbursement issues is the Medicare MLN Matters Article found at

You can access the DQA Memo at the following link: DQA Memo 12-018 –

You can directly access Act 160 that created the new category of provider at the following link: Wisconsin Act 160 –

For more information on the requirements of the new anesthesiologist assistant law and its implications, please feel free to contact John H. Fisher, CHC, CCEP, a health care law and compliance attorney in our law firm.