Public Notice: Medicaid State Plan Amendment

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

The Department is making the following changes to the reimbursement structure of the SUD health home program:

1. Two new tiers have been added to the per-member-per-month rate that providers receive for administering the six core health home services.

2. The billing requirements to qualify for tiers of reimbursement will be based on core services rendered to the member each month. Core services include both the time spent with the member present and collateral contacts without the member present for fundamental activities defined in the 6 core health home services. To bill for any level of services, providers must have at least one real-time contact with the member in-person, over the phone, or via telehealth during that month.

The change will be effective May 1, 2022 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 $773,330 all funds (AF), composed of $695,997 federal match (FED) and $77,333 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: Bailey Dvorak

Bureau of Benefits Policy Division of Medicaid Services

P.O. Box 309 Madison, WI 53701-0309

Phone: [phone]

Fax: [phone]

Attention: Bailey Dvorak

E-Mail: [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.