Provider Enrollment and Ongoing Responsibilities : Provider Enrollment

Provider Enrollment

County and Tribal Agencies

BadgerCare Plus and Wisconsin Medicaid require county or tribal agencies interested in providing CRS to have enrollment specific to CRS. CRS may not be billed under other Medicaid enrollments. County and tribal agencies wishing to become CRS providers are required to apply and be approved by the state DCTS, and then enrolled in Wisconsin Medicaid. Interested agencies should complete the County/Tribal Agency Application form and submit it to DCTS using the address provided on the form. County/Tribal Agency Applications must comply with the CRS Agency Certification Standards, and Policy and Procedure Requirements. The certifying agency's effective date for DCTS approval shall be the date an approvable application is received by the DCTS or, if the application as first received cannot be approved, the date upon which the additional materials required to make the application approvable are received.

Following approval by DCTS, agencies must submit an enrollment application. Agencies are required to be enrolled in Wisconsin Medicaid to be reimbursed for CRS.

Wisconsin Medicaid will send county or tribal agencies a notice of enrollment decision. Enrollment through the Medicaid program for CRS is retroactive to the effective date the agency received from the DCTS.

CRS providers will not be reimbursed for services provided prior to the date of their Medicaid enrollment.

Contracting for Community Recovery Services

Medicaid-enrolled CRS county and tribal providers may contract with other providers to deliver any part of their CRS. However, the Medicaid-enrolled CRS county or tribal provider retains all legal and fiscal responsibility for the services provided by contractors. Contracted CRS providers do not need to be individually enrolled in Wisconsin Medicaid.

ForwardHealth notifies Medicaid-enrolled CRS county and tribal providers of policy and procedure changes. It is the Medicaid-enrolled county or tribal provider's responsibility to ensure that their contracted service providers provide services and maintain records in accordance with the Medicaid requirements for the provision of CRS.

The Medicaid-enrolled CRS county or tribal provider is responsible for ensuring that its contractors:

• Meet all provider qualifications as outlined in the SPA.
• Are notified of changes to policies and procedures.
• Have a current license, or certification, or meet any of the following requirements (if applicable):
• Adult Family Homes (3-4 Beds)—Licensed under Wis. Stat. ch. 50, Wis. Admin. Code ch. DHS 88.
• CBRFs—Licensed under Wis. Stat. ch. 50, certified under Wis. Admin. Code ch. DHS 83.
• RCACs—Certified under Wis. Stat. ch. 50, and Wis. Admin. Code ch. DHS 89.
• Supportive Home Care Agency—Licensed under Wis. Stat. ch. 50, certified under Wis. Admin. Code § DHS 105.17.
• Supported Employment Specialist—Currently there are no statutory licensure or certification requirements.
• Peer Specialists—Currently there are no statutory licensure or certification requirements; however, the employing agency is responsible for verifying that the peer specialist has completed a state-approved training course and passed a competency-based exam.

Each contracted CRS provider (that is, the service provider with whom the Medicaid-enrolled county or tribal provider contracts for the provision of CRS) is required to complete the CRS Benefit Provider Agreement and Acknowledgement of Terms of Participation for CRS Provider Entities form or the CRS Benefit Provider Agreement and Acknowledgement of Terms of Participation for Individual or Non-Specified Community Recovery Services Providers form. The Medicaid-enrolled CRS county or tribal provider shall retain such forms and renew them periodically as required.

All Medicaid-enrolled CRS county and tribal providers and contracted providers are required to follow all of ForwardHealth's policies and procedures.