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New Intensive Outpatient Program Benefit

Beginning March 1, 2025, ForwardHealth will begin covering a nonresidential programmatic treatment service called intensive outpatient program (IOP). Providers may enroll with Wisconsin Medicaid as IOP providers beginning November 1, 2024. They must be certified by the Wisconsin Department of Health Services’ (DHS) Division of Quality Assurance in order to enroll.

The new IOP benefit will ensure member access to the full range of behavioral health services and continuity of care. This service component includes screening, assessment, and treatment for substance use disorder, mental health disorders, and co-occurring disorders. Treatment hours may total between 9–19 hours per week for members who are 18 years and older and 6–19 hours per week for members younger than 18 years old. ForwardHealth created the IOP benefit in response to Wisconsin Admin. Code ch. DHS 75 revisions, effective in 2022.

Provider Enrollment

Beginning November 1, 2024, the following providers must enroll with the new IOP provider specialty to be able to receive reimbursement.

  • Community health centers
  • Hospital-based programs
  • Mental health and substance abuse agencies
  • Rural health clinics
  • Tribal federally qualified health clinics

Coverage Begins

Beginning March 1, 2025, ForwardHealth expects that enrolled providers will be able to provide and bill for covered services.

Resources

Providers may refer to these resources when they become available:

 
 
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