WISEWOMAN Program Information for Healthcare Providers

The Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) Program is offered through the Rhode Island Department of Health (RIDOH). WISEWOMAN provides additional preventative health services to eligible women enrolled in the Women’s Cancer Screening Program (WCSP), and to women enrolled in RI Medicaid. WISEWOMAN services are designed to help participants reduce their risk of heart disease, stroke, diabetes, hypertension, and other conditions through healthy eating, increased physical activity, and lifestyle support programs.

Patient Enrollment, Screening, and Referral

To be eligible for the WISEWOMAN Program, a woman must 1) meet the eligibility criteria for the Women’s Cancer Screening Program and be 30-64 years of age, OR 2) be a RI Medicaid recipient and be 40-64 years of age.

Once determined eligible, the WISEWOMAN participant can meet with trained staff to complete the WISEWOMAN Baseline Screening during an integrated office visit. The Baseline Screening includes the completion of a Health Risk Assessment (i.e., an evaluation of health risks and quality of life), lab work (Total Cholesterol, HDL, LDL, Triglycerides, Fasting Blood Glucose, A1C), Blood Pressure, Body Mass Index, and Risk Reduction Counseling.

Risk Reduction Counseling is the time spent verbally reviewing screening results and providing a Health Risk Assessment to participants. The information from the Health Risk Assessment helps sites work collaboratively with participants to establish health priorities and improve health. Risk Reduction Counseling is also an opportunity for patients to receive referrals to Lifestyle Programs, Community Resource Programs, and Health Coaching. Referrals are based on the participant’s health risk factors, identified health goals, and readiness to change. Motivational Interviewing techniques should be used during Risk Reduction Counseling to engage participant and strengthen participant motivation for change.

Reimbursable Services

  • Start-Up Services of WISEWOMAN within an agency once each participating site completes the trainings, orientation, patient flow diagram, and pilot of program with ten WCSP/Uninsured patients with corresponding data. Receipts are needed for reimbursement of devices purchased for start-up.
  • Screenings, Follow-Up Services, Internal Health Coaching, and Re-screenings once corresponding data are submitted.
  • Patient Supplies and Medical Translation Line will be reimbursed upon receipt of invoice and receipts.
  • Sites are not responsible for the direct payment or data collection for Health Coaching Plus, Diabetes Prevention Program, Chronic Disease Self-Management Program, Diabetes Self-Management Program, Gym Memberships, Weight Loss/Weight Management Programs, and Fitness Programs when referral is made through the Community Health Network (CHN) Referral Program.

WISEWOMAN funds should be spent as cost-effectively as possible. WISEWOMAN must be the payer of last resort, meaning sites cannot use WISEWOMAN funds to pay for services that are covered by a Medicaid state compensation program, insurance policy, or other payer.

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