Newly enacted legislation allows for APNPs to order without physician co-signature

An old Medicaid statute; Chapter 49.46 was amended and signed by Governor Walker on November 30, 2017.  The legislation was amended to allow for APNPs to order for the Medicaid patients without a physician co-signature.

2017 Wisconsin Act 119 specifies that certain services may be covered by the Medical Assistance program if prescribed or ordered by a provider acting within the scope of the provider’s practice under laws that govern the provider’s practice. The federally mandated benefits affected by this change are certain skilled nursing home services; federally mandated benefits provided by a hospital on an outpatient basis; home health services; laboratory and X-ray services; and services and supplies for family planning. Other services affected by this change are intermediate care facility services; physical and occupational therapy; speech, hearing, and language disorder services; medical supplies and equipment; certain services for patients of any institution for mental diseases; nursing services; legend and over-the-counter drugs; personal care services; certain mental health rehabilitative and psychosocial services; community recovery services; and respiratory care services for ventilator-dependent individuals. The Medical Assistance program is a joint federal and state program that provides health services to individuals who have limited financial resources.

This issue was brought to WNA’s attention as health systems were beginning to change their reimbursement policies to reflect the prior law.  APRNs and physicians expressed their concerns about this statue as it increased physician time in co-signing APNPs Medicaid orders.  APNPs had concerns about requiring a physician to co-sign on a patient that he/she may not have any knowledge of.

Wisconsin Act 119 does not change any provider’s scope of practice and maintains the already recognized Medicaid policy acknowledging valid orders made within a provider’s scope of practice under statutes, rules and regulations governing the provider’s practice.

WNA communicated this issue in a meeting with the Department of Health Services, Chief Legal Counsel, Sandra Rowe on September 25, 2017.  In addition, WNA worked with the Wisconsin Hospital Association who was working with the Department of Health Services staff as a means of getting legislation changed.  WNA registered in support for the legislative changes. The legislation moved very quickly through both houses.

Sen. Leah Vukmir (R-Brookfield) and Rep. John Nygren (R-Marinette) were the sponsors of the bills.

Learn more about WNA’s legislative efforts on our Advocacy page. 

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