PUBLIC NOTICE
Department of Health Services
Substance Use Disorder (SUD) Health Home
The State of Wisconsin reimburses providers for services provided to Medical Assistance recipients under the authority of Title XIX of the Social Security Act and ss. 49.43 to 49.47, Wisconsin Statutes. This program, administered by the State's Department of Health Services (the Department), is called Medical Assistance (MA) or Medicaid. In addition, Wisconsin has expanded this program to create the BadgerCare Plus programs under the authority of Title XIX and Title XXI of the Social Security Act and s. 49.471 of the Wisconsin Statutes. Federal statutes and regulations require that a state plan be developed that provides the methods and standards for reimbursement of covered services. A plan that describes the reimbursement system for the services (methods and standards for reimbursement) is in effect. Change in Covered Services and Payment Methods
Recipients of services under Medical Assistance, BadgerCare, and BadgerCare Plus (recipients) can receive a range services through a health home model to improve treatment for substance use disorders (SUD). The Department will expand services for Medicaid beneficiaries with SUDs to enhance care coordination and specialized supports to integrate physical and behavioral health services for these members.
Three selected pilot sites will function as providers of SUD health home services and will use procedure codes H0001 and H0006. Procedure code H0006 claims may include a modifier to identify a higher level of the service intensity: moderate intensity (TF) or high intensity (TG).
SUD Health Homes Services |
HCPCS | Modifier | Description | Reimbursement Rate |
H0001 | | Comprehensive Assessment | $ 389.24 |
H0006 | | Low Intensity Services | $ 153.65 |
H0006 | TF | Moderate Intensity Services | $ 619.24 |
H0006 | TG | High Intensity Services | $ 1,319.39 |
The change will be effective June 15, 2021, and will apply to claims with dates of service on or after that date. The change to Medicaid, BadgerCare, and BadgerCare Plus is projected to result in increased annual expenditures of $4.5 million all funds (AF), composed of $4.2 million federal match (FED) and $0.4 million state funds/general purpose revenue (GPR).
Copies of Changes
Copies of the SUD health home Medicaid state plan amendment may be obtained free of charge by calling or writing:
Mail:
Laura Brauer
Bureau of Benefits Policy
Division of Medicaid Services
P.O. Box 309
Madison, WI 53701-0309
Phone:
(608) 266-5368
Fax:
(608) 266-1096
Attention: Laura Brauer
E-Mail:
Copies of the state plan change will be made available for review at the main office of any county department of social services or human services.
Written Comments
Written comments are welcome. Written comments on the proposed changes may be sent by FAX, e-mail, or regular mail to the Division of Medicaid Services as described above. All written comments will be reviewed and considered.
Because the State Office Building at 1 West Wilson Street, Madison, Wisconsin is currently closed to the public, written comments will not be available for in person public review. Requests to review written comments received may be submitted to the Division of Medicaid Services as described above. Revisions may be made in the proposed change based on comments received.
