Wyoming Medicaid to Cover Transitional Care Management in 2024

Wyoming Medicaid to Cover Transitional Care Management in 2024

The time of transition from an inpatient hospital stay to a residential setting can be of high risk of readmission, particularly for those with higher acuity medical issues or complex living situations. Potential pitfalls include medication reconciliation, scheduling follow-up appointments, and transportation. In 2022, Wyoming Medicaid paid approximately $9M in claims associated with readmissions.

Transitional Care Management (TCM) aims to facilitate prompt follow-up with a primary care provider after a hospital admission to reassess a patient’s condition and treatment plan. Medicare covers TCM since 2013. Studies show a significant reduction in hospital readmissions in patients who received a TCM visit. Effective 1/1/24 Wyoming Medicaid will be covering codes 99495 (moderate acuity; follow-up within 14 days) and 99496 (high acuity; follow-up within 7 days). These visits may be provided by telehealth.

To facilitate TCM visits, I want to remind Wyoming physicians and PAs about the Notify feature on the WYFI (Wyoming Frontier Information) exchange. Notify alerts providers when a patient is admitted, discharged, or transferred from a hospital. These notifications can be tailored to provider preference. Some of you may be registered with WyFI through your clinics. Most Wyoming hospital-based EMRs are also connected with WyFI. To see if you are connected with WyFI or to enroll in Notify, you may contact the WYFI team at wdh-wyfi-hie@wyo.gov for assistance.

Wishing you and your families a healthy and happy 2024!