Continuing Care and Concurrent Service Resources
Beginning December 1, 2025, ForwardHealth expanded the availability of continuing care and concurrent service options to providers administering mental health and substance abuse treatment, per Wis. Admin. Code § DHS 75.
Continuing Care
The Wisconsin Department of Health Services (DHS) defines “continuing care” as treatment for such members who plan to continue contact with their provider, either at agreed-upon intervals or on an unplanned basis based on unexpected needs, without completing a new clinical assessment, intake or treatment plan.
Some members who have been discharged following the completion of a course of outpatient SUD or integrated treatment may be eligible for continuing care, which is a new utilization flexibility.
This flexibility is available to agency providers certified under Wis. Admin. Code §§ DHS 75.49 and 75.50 within the outpatient substance abuse benefit and select procedure codes within the outpatient mental health benefit.
Online Handbook Topics
Continuing Care, #23943
Online Handbook Topic
Continuing care defined as a “utilization flexibility”
Procedure Codes, #5807
Outpatient substance abuse treatment procedure codes
Procedure Codes, #6123
Outpatient mental health procedure codes, including the new continuing care billing modifier
Modifiers, #6218
Outpatient mental health modifiers
Covered Services, #5800
Continuing care definition and assessment requirements
Concurrent Services
Allowed Concurrent Outpatient Mental Health and Substance Use Disorder Services
DHS defines "concurrent services" as treatment by two distinct and appropriately credentialed providers for a member who has multiple substance use needs or co-occurring substance use and mental health needs.
Eligibility Criteria
Substance use services or co-occurring substance use and mental health services may be provided concurrently when they are considered medically necessary, non-duplicative, and appropriate. Providers of concurrent services must demonstrate that both services are diagnostically appropriate for the member and coordinate with each other on the member's treatment and ongoing needs.
Prior Authorization
Providers aren’t required to get PA for a member to receive concurrent behavioral health services. However, if one or more of the services typically require PA, providers must request PA for the service according to the policy for that service.
Coverage Policy
The concurrent service policy also impacts:
Concurrent Services, #23944
Concurrent services mental health and substance use treatment service definition and criteria
Concurrent Adult Mental Health Day Treatment Services, #5917
Program requirements for adult mental health day treatment services concurrent with other mental health and substance abuse services
Concurrent Mental Health Prior Authorizations, #6497
PA requirements for concurrent mental health
Expectations and Documentation Requirements for Collaborating Providers, #21337
Provider documentation requirements for the provision of concurrent services
Coverage of Outpatient Mental Health Services Concurrent With Other Mental Health or Substance Abuse Services, #6097
Program requirements for outpatient mental health services concurrent with other mental health and substance abuse services, including residential SUD program
Concurrent Behavioral Treatment and Behavioral Health Services, #19019
Provider responsibilities for delivery concurrent behavioral treatment and behavioral health services
Point-of-Care Drug Testing, #22937
Point-of-care drug testing for SUD treatment
Coordination Between Comprehensive Community Services and Residential Substance Use Disorder Treatment, #22997
Coverage requirements and exceptions for the concurrent use of CCS and residential SUD programs
Procedure Codes, #23741
IOP and point-of-care drug testing procedure codes
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