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Credentialing of Certain Health Care Providers

Report 21-5 | March 2021

SUMMARY

2019 Wisconsin Act 185 requires the Legislative Audit Bureau to use risk-based criteria to review selected programs affected by Act 185 and selected expenditures made with funds authorized by Act 185. In this report, we reviewed the credentialing of certain health care providers.

To practice in Wisconsin, health care providers must possess a valid credential from the Department of Safety and Professional Services (DSPS). Act 185 allowed certain providers formerly credentialed in Wisconsin or credentialed in other states to temporarily practice without Wisconsin credentials through June 10, 2020. On March 27, 2020, the Governor and the Department of Health Services (DHS) had issued Emergency Order 16, which contained similar provisions. We found that facilities did not consistently notify DSPS in a timely manner that providers credentialed in other states had begun practicing in Wisconsin.

In order for a health care provider formerly credentialed in Wisconsin or credentialed in another state to practice in Wisconsin, Act 185 required a provider’s practice to be necessary for a health care facility to ensure continued and safe delivery of services, and a facility’s needs have reasonably prevented a provider from obtaining a credential before practicing at a facility.

 


1 Includes 1,720 health care providers formerly credentialed in Wisconsin or in other states.
2 Includes providers such as pharmacists, respiratory care practitioners, physical therapists, and occupational therapists.

Act 185 and Emergency Order 16 required health care facilities to notify DSPS within five days of when health care providers credentialed in other states had begun practicing at those facilities. We found that facilities did not notify DSPS in a timely manner that 36 of 83 health care providers (43.4 percent) credentialed in other states had begun practicing in Wisconsin. In addition, facilities notified DSPS that 18 providers had begun practicing in Wisconsin before February 18, 2020, which preceded the issuance of Emergency Order 16 on March 27, 2020.

On October 1, 2020, the Governor and DHS issued Emergency Order 2, which authorizes certain health care providers credentialed in other states to temporarily practice without Wisconsin credentials. Health care facilities must notify DSPS within 10 days of the dates when such providers begin practicing at these facilities. Emergency Order 2 is in effect until April 21, 2021, but indicates it will be extended if the secretary of the federal Department of Health and Human Services determines that the current public health emergency continues. Therefore, we recommend that DSPS carefully review the notification forms provided by health care facilities and ensure that these forms are submitted in a timely manner and contain accurate information.