New Behavioral Treatment Benefit

In July 2014, the federal Centers for Medicare and Medicaid Services (CMS) directed states to cover autism treatment services under the Medicaid State Plan.

In response, the Department of Health Services (DHS) is transitioning coverage of autism treatment services from the Children's Long-Term Support (CLTS) Waiver Program to a new behavioral treatment benefit under ForwardHealth.

ForwardHealth began coverage of the new behavioral treatment benefit on January 1, 2016.

In order for a member to be eligible for the new behavioral treatment benefit:

• The member must be enrolled in BadgerCare Plus, Medicaid, or the Katie Beckett Program.
• The member must have a diagnosed need for behavioral treatment.
• The member's Medicaid-enrolled behavioral treatment provider must obtain prior authorization from ForwardHealth, approving medically necessary behavioral treatment for the member.

Sign up to Receive Behavioral Treatment Benefit Information from ForwardHealth

Provider Enrollment Available

Providers are required to be Medicaid-enrolled as a behavioral treatment provider in order to render behavioral treatment services under the new benefit. Providers may enroll as a behavioral treatment provider from the Provider Enrollment Information page on the ForwardHealth Portal. The October 2015 ForwardHealth Update (2015-55), "Provider Enrollment for the New Behavioral Treatment Benefit," contains detailed information on how to enroll in Wisconsin Medicaid.

ForwardHealth Updates

2016-34	New and Clarified Policy for the Behavioral Treatment Benefit
2015-62	New ForwardHealth Behavioral Treatment Benefit
2015-55	Provider Enrollment for the New Behavioral Treatment Benefit

Behavioral Treatment Benefit Service Area of the Online Handbook

The Behavioral Treatment Benefit service area of the Online Handbook is now available. The Online Handbook allows providers access to policy and billing information in one centralized place.

To begin using the Behavioral Treatment Benefit service area of the Online Handbook:

• Go to the ForwardHealth Portal home page.
• Select the Online Handbook link from the Provider links on the left side of the Portal home page.
• Select BadgerCare Plus and Medicaid from the Choose a program drop-down list on the upper right side of the page.
• Select the Behavioral Treatment Benefit from the Choose a service area drop-down list located on the upper right side of the page.
• Click the applicable section to see a list of chapters and topics available for selection.

Once a topic is clicked, information will be displayed. Each topic is assigned a topic number, displayed above the topic title, for reference. A topic number may be entered into the Search and the Advanced Search tools to locate the corresponding topic. Topic numbers are for reference only and are not pertinent to the information contained within the topic or to the information in other topics with topic numbers assigned in close sequence.

ForwardHealth Desktop Reference for Behavioral Treatment Providers

This updated document contains links to numerous ForwardHealth resources applicable to the behavioral treatment benefit, including links to the Online Handbook, information about how to establish a secure Provider account on the Portal, and provider enrollment.

Email Box for Behavioral Treatment Benefit Coordination of Benefits Questions

ForwardHealth has established an email box for behavioral treatment providers to submit questions related to coordinating the ForwardHealth benefit with the member's commercial insurance. Providers can submit questions to ForwardHealth at DHSBTCOB@wi.gov. Some inquiries may require research; therefore, additional time for responses may be required.

Providers should call Provider Services at 800-947-9627 or contact a Provider Relations representative for any other behavioral treatment-related questions.

Access to Previous Training Information

ForwardHealth held in-person behavioral treatment provider training sessions throughout the state in February 2016. Handouts from the training are available below.

• Training Presentation
• Secure ForwardHealth Portal Accounts
• Self-Paced Learning Checklist

The Department of Health Services conducted provider training on the new behavioral treatment benefit on November 4, 2015, at the Mendota Mental Health Institute in Madison. A webcast of the training and additional handouts from the training are available below.

Note: Information in these materials is current as of November 4, 2015, and is subject to change pending negotiations with CMS.

• Training Agenda
• Training Presentation
• Provider Specialty Grid
• Provider Enrollment on the ForwardHealth Portal (Screenshots)
• Current Procedural Terminology (CPT) Claim Codes for Adaptive Behavior Assessment and Treatment (Note: This information is no longer current; refer to Update 2015-62, which is linked under ForwardHealth Updates above, for current information.)
• ForwardHealth Behavioral Treatment Rates (DRAFT only) (Note: This information is no longer current; refer to Update 2015-62, which is linked under ForwardHealth Updates above, for current information.)
• Provider Services and Resources

CMS Approval

The Department of Health Services submitted the state plan amendment (SPA) to CMS in September 2015. Until the SPA is approved, dates may be subject to change. Refer to the public notice for more information about the SPA.

Additional Information

• Behavioral Treatment Providers Required to Use G2 Qualifier for Rendering Provider on Electronic Claims
• Reminder to Behavioral Treatment Providers Regarding the Transition Schedule
• Wisconsin Medicaid Behavioral Treatment Provider Meeting Presentation
• Indicating Billing and Rendering Providers for Behavioral Treatment Services
• Reminder: Multiple Organizations May Be Added to One ForwardHealth Portal Account

Refer to the DHS website for the Behavioral Treatment FAQs for Families and for additional information regarding the transition of services from the CLTS Waiver Program to ForwardHealth.