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Residential SUD Treatment Resources Page

Residential Substance Use Disorder Treatment Benefit Resources

This page includes summaries and explanations of recently published materials and resources related to the new Wisconsin Medicaid residential SUD treatment benefit.

Understanding the New Residential Substance Use Disorder Treatment Benefit

The new residential SUD treatment benefit provides treatment for adults and youth to promote recovery from SUD and to reduce the incidence and duration of institutional care members might otherwise need. Coverage is available in medically monitored treatment and transitional treatment facilities certified in Wisconsin under Wis. Admin. Code §§ DHS 75.11 and 75.14. The residential SUD treatment benefit does not include coverage in non-treatment residential settings, such as sober living homes, recovery residences, or community living arrangements.

The December 2020 ForwardHealth Update (2020-42), titled “New Benefit for Residential Substance Use Disorder Treatment,” offers policy information for covered and noncovered services, prior authorization, claims submission, and reimbursement. Attachment A of the Update provides definitions of residential SUD treatment services. Attachment B clarifies enrollment information and residential SUD treatment provider specialty enrollment criteria.

Enrollment Criteria

For more information about enrollment criteria for the residential substance use disorder treatment provider type and specialties, providers should visit the Information for Specific Provider Types Portal page.

Notifying Income Maintenance Agencies of Member Eligibility Changes

Beginning on February 1, 2021, residential SUD treatment providers should complete the Residential SUD Treatment for BadgerCare Plus and Medicaid Members form, F-02766 (02/2021), and send it to the appropriate document processing unit on the member’s behalf. This will inform income maintenance agencies of a member’s participation in residential SUD treatment. Members who self-report the information to their income maintenance agency will still need their provider to complete and submit the Residential SUD Treatment for BadgerCare Plus and Medicaid Members form as verification. Failure to report this information could prevent providers from being reimbursed for services.

The Residential Substance Use Disorder Treatment for BadgerCare Plus and Medicaid Members form can be found on the Forms page of the ForwardHealth Portal.

Members living in Milwaukee County Members living outside of Milwaukee County
For members living in Milwaukee County, providers may submit the Residential SUD Treatment for BadgerCare Plus and Medicaid Members form using either of the following methods:
  • Fax—Forms may be faxed to 888-409-1979.
  • Mail—Forms may be mailed to the following address:
     Milwaukee Document Processing Unit
     PO Box 05676
     Milwaukee WI 53205
For members who live in Wisconsin but not in Milwaukee County, providers may submit the Residential SUD Treatment for BadgerCare Plus and Medicaid Members form using either of the following methods:
  • Fax—Forms may be faxed to 855-293-1822.
  • Mail—Forms may be mailed to the following address:
     Centralized Document Processing Unit
     PO Box 05234
     Janesville WI 53547

Contact HMOs and Managed Care Organizations

ForwardHealth encourages providers to contact HMOs and managed care organizations to notify them that they are a Medicaid-enrolled residential SUD treatment provider. ForwardHealth expects providers to notify the member’s managed care organization with 48 hours of admission, and to coordinate with the managed care organization before discharge to develop a continuing care plan. Contacts for these organizations are provided for provider convenience in the HMO and MCO Contact Information list.

Reimbursement Rates

Residential SUD treatment benefit services are reimbursed fee-for-service for all BadgerCare Plus and Medicaid members. Refer to reimbursement rates available on the Portal for residential SUD treatment services.

American Society of Addiction Medicine Criteria Course

Wisconsin Connect, a nonprofit organization, offers the American Society of Addiction Medicine (ASAM) Criteria Course trainings about residential SUD treatment. Providers can sign up for the ASAM Criteria Course on the ASAM trainings page of Wisconsin Connect’s website. For more resources and trainings, providers should visit Wisconsin Connect’s website.
In addition, the Department of Health Services, Division of Care and Treatment Services will host monthly community of practice (CoP) trainings beginning on February 26.

ForwardHealth Trainings

ForwardHealth will host weekly technical assistance calls on Thursdays from 1-2 PM beginning on February 4, 2021. These weekly calls will be held in February and March 2021 and more meetings may be scheduled after March 2021, if needed.

The weekly calls are available to all Medicaid-enrolled residential SUD treatment providers to give technical assistance on enrollment, prior authorization, claims, and other ForwardHealth policies and processes.

The weekly technical assistance calls will be virtual on Zoom. The Zoom link is https://dhswi.zoom.us/j/89026027808 and the meeting ID Is 890 2602 7808. Residential SUD treatment professionals can also call into the Zoom meetings with the phone number 312-626-6799.

ForwardHealth Online Handbook

ForwardHealth added a new service area, Residential SUD Treatment, to the ForwardHealth Online Handbook. ForwardHealth’s policy changes can be found in published ForwardHealth Updates and the Online Handbook. Providers should refer to the Online Handbook for real-time policy information.

Frequently Asked Questions

ForwardHealth will provide FAQs to help address provider questions about the residential SUD treatment benefit.

Stay Informed

Join the DMS - Medicaid Behavioral Health Services email list to get updates about this topic from the Department of Health Services. ForwardHealth announces policy changes with ForwardHealth Updates; sign up for the ForwardHealth email list to get the latest information from ForwardHealth.

 
 
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