DDES Memo Series
September 20, 2004
STATE OF WISCONSIN
Department of Health and Family Services
Division of Disability and Elder Services
Area Administrators/Assistant Area Administrators
County Departments of Community Programs Directors
County Departments of Developmental Disabilities Services Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
Grassroots Empowerment Project
Licensing Chiefs/Section Chiefs
Mental Health and AODA Coordinators
Mental Health and Substance Abuse Certified Programs
State Council on Alcohol and Other Drug Abuse
State Council on Mental Health
Tribal Chairpersons/Human Services Facilitators
Wisconsin Family Ties
Re: Mental Health And Substance Abuse Telehealth – Criteria For
The purpose of this memo is to provide background information on
Mental Health and Substance Abuse Telehealth and share the attached
Request for Approval to Use Telehealth. This request form outlines the
specific requirements that certified mental health and substance abuse
programs must follow if they want to use telehealth technology as a means
of service provision with consumers.
The purpose of this memo is to provide background information on Mental
Health and Substance Abuse Telehealth and share the attached Request for
Approval to Use Telehealth. This request form outlines the specific
requirements that certified mental health and substance abuse programs
must follow if they want to use telehealth technology as a means of
service provision with consumers. County agencies, providers, state staff,
consumers and family members have reviewed and commented on this criterion
and the Wisconsin County Human Service Association has endorsed the
What is Telehealth
Mental Health and Substance Abuse Telehealth is generally described as
the use of telecommunication equipment to link mental health and/or
substance abuse providers and consumers in different locations. Telehealth
is sometimes referred to as telepsychiatry, however treatment
professionals other than psychiatrists may use telehealth. Psychologists,
Master level therapists, AODA counselors, psychiatric nurses and other
staff who are part of a certified program can provide Telehealth services.
Telehealth technology allows for the provision of quality behavioral
health services, including interactive consultation between a consumer and
a professional, assessments, pharmacological management, clinical
counseling and consumer screening, with greater access and frequency, and
without the additional cost of staff travel or unnecessary consumer
Telehealth has been used in the provision of mental health and
substance abuse services in other states for a number of years. The first
implementation of telepsychiatry was conducted in the early 1950s at the
Nebraska Psychiatric Institute, where they investigated the potential of
closed-circuit television as a teaching aid. Ten years later, the first
telepsychiatry consultations were performed at the Institute. Telehealth
is not new technology that we are testing in Wisconsin. This technology is
widely used in Nebraska, Montana, Oregon, Texas, South Carolina, and other
states with great success.
Benefits of Telehealth
Telehealth has been proven to result in many benefits to consumers as
well as treatment professionals and funding agencies. Some of the benefits
- increase access to child, geriatric, deaf, forensic and specialty
- reduce travel costs, staff time, and per diem costs for consultants;
- increase elements of continuity of care and professional contact;
- increase urban to rural areas skill pools through information
- increase speed and accuracy of diagnosis and treatment; and,
- increase access to select skills such as sign language, diagnosis,
treatment and consultation.
For example, a number of counties in rural Wisconsin have a difficult
time recruiting psychiatrists, and when they do they often must pay the
psychiatrist from the time they leave their home until they reach the
county and begin to provide services. This means the county agency may use
significant fiscal resources just for travel time without the psychiatrist
even seeing a consumer. Telehealth will allow the county to more easily
attract a qualified psychiatrist and pay only for the time the person is
actually seeing consumers. In addition, if the consumer is in need of
hospitalization, the psychiatrist may be more available, through
telehealth consultation, to the admitting hospital, as well as with the
other treatment professionals, family members, natural supports, etc.
Telehealth will also enhance the ability of small, remote, rural
counties to access specialty services such as child and geriatric
psychiatry. This technology should assist in better diagnostic services,
correct medication determinations and more successful treatment planning
for those individuals most in need.
Services Provided Through Telehealth
Telehealth services can be provided to consumers involved in any
certified mental health and/or substance abuse programs, such as
outpatient services, crisis services, community support services, day
treatment programs, inpatient, etc. All staff employed by these programs
may provide services via telehealth, provided they have received the
necessary training and meet program certification standards. Specific
staff providing the services should be outlined in the plan, as required
in the certification process.
Funding for Telehealth
The Division of Health Care Financing will reimburse for
Medicaid-covered services provided via telehealth in the same way it
reimburses for face-to-face contacts provided that the following
requirements are met.
- The agency is a certified program under one of the following program
standards: HFS 34, 36, 40, 61, 63, or 75 (except does not include
75.15), Wis. Admin. Code. Professional staff providing telehealth must
be part of one of these certified programs.
- Medicaid will only accept claims for telehealth from providers that
are certified under HFS 34, 36, 40, 61, or 75 (except does not include
75.15). Medicaid will not accept claims from individual professional
- The HFS certified program is certified for telehealth by the Bureau
of Quality Assurance.
- The service is a service that is covered under one of the Medicaid
mental health or substance abuse benefits: outpatient mental health,
outpatient substance abuse, pharmacologic management, mental health
day treatment, substance abuse day treatment, crisis intervention,
community support program, comprehensive community services, or
child/adolescent day treatment services.
- The service is not group therapy.
- The provider indicates the "GT" modifier on the claim
detail for the specific procedure code. The "GT" modifier
definition is "Via interactive audio and video telecommunication
- Providers must continue to follow all Medicaid coverage policies and
all other requirements for each particular service.
If you have any questions regarding reimbursement, please contact
Christine S. Wolf, LICSW, MH/SA Policy Analyst, Division of Health Care
Financing, P. O. Box 7850, Madison, WI 53701, or email her at firstname.lastname@example.org
For insurance billings for telehealth services the agency will need to
check with individual policies to determine if telehealth is covered.
Process for Telehealth Certification
Only certified mental health and/or substance abuse services, or
agencies planning to be certified as a mental health and/or substance
abuse provider, may apply for telehealth certification. The first step in
the process is for the agency to write a plan addressing each section in
the attached template. Once the plan is completed it should be sent to the
Bureau of Quality Assurance (BQA) Program Certification Unit, 2917
International Lane #300, Madison, WI 53704.
UPDATED ADDRESS AS OF 2013:
Attn: Sally Andrews
Behavioral Health Certification Section
Division of Quality Assurance
Department of Health Services
P.O. Box 2969
1 W. Wilson St.
Madison, WI 53701-2969
It is strongly suggested for agencies interested in using telehealth as
a means of service provision to establish a stakeholder advisory
committee, which should include consumers and family members. The purpose
of this committee is to help write the plan for certification and to
determine how and when telehealth will be used, and for which services.
Provider’s electing to utilize telehealth must demonstrate compliance
with an approved plan to the Bureau of Quality Assurance during a site
review or other unannounced focus visits.
Key Points for Certification
There are several provisions in the attached template that are
important for successful application of telehealth for mental health
and/or substance abuse services. These include:
- Certified services shall meet the requirements for the corresponding
Administrative Code, e.g. HFS 75, HFS 34, HFS 61, etc
- It is critical that agencies meet the minimum transmission standards
to ensure that the telehealth service is of high quality and as close
to a face to face visit as possible.
- All staff using telehealth for service provision must receive
orientation and ongoing training on the use of the equipment, the
clinical application of telehealth, safety and security during
telehealth visits, privacy and confidentiality, back-up procedures if
there is equipment failure, and consumer preparation for telehealth.
- Consumers must be educated about the provision of services provided
through telehealth, the history of telehealth, success rate of
telehealth services and how telehealth sessions are conducted.
- The agency has an ongoing method for obtaining consumer satisfaction
on telehealth visits and evaluating the results of this survey
- Consumers are given the choice of having a face to face visit with a
professional or seeing this person via telehealth.
Regional Office Contact:
Area Administrator/Assistant Area Administrator
Central Office Contact:
Office of Strategic Finance
Department of Health and Family Services
PO Box 7850 Room 633
Madison, WI 53707-7850
Telephone – 608-261-7812
MEMO WEB SITE:
(fillable Word document) - renamed OQA-2589
Mark Hale, BQA
Chris Wolf, DHCF
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