Wisconsin

In Wisconsin, most local health departments (LHDs) were not seeking Medicaid reimbursement for lead-related activities because reimbursement rates were historically low and only provided for children with very high blood lead levels (BLLs).

Between 2017 and 2018, the Wisconsin Childhood Lead Poisoning Prevention Program supported the development of new policies to financially support LHDs conducting lead-related services. Under the new policy, LHDs were reimbursed for several lead-related services for children enrolled in Medicaid. Key elements of the new reimbursement policy include:

• Services being reimbursed for children with a BLL as low as 5 µg/dL (capillary or venous).
• Prior authorization from Medicaid  no longer being required before  submitting a reimbursement claim.
• Field representatives are available to assist LHDs with billing questions.
• The reimbursement rate for nurse education visits is $100/hour (the previous reimbursement was $27/hour), and LHDs can bill for multiple visits.
• The reimbursement rate for the initial environmental investigation of a home is $800 (the previous reimbursement was $105), and LHDs can bill for investigations of two residences in cases of shared custody.
• The reimbursement rate for a follow-up lead investigation is $300 (the previous reimbursement was $50), and the LHD can bill for additional follow-up investigations until the property passes clearance.

• Five additional LHDs billed Medicaid for lead-related services.
• Compared with 2017, LHDs received $53,000 in additional Medicaid reimbursement for lead investigations and $5000 in additional Medicaid reimbursement for nurse education visits in 2018.