This page includes summaries and explanations of recently published materials and resources related to the new Wisconsin Medicaid residential SUD 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 75.54 and 75.53. 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.
The Wisconsin Department of Health Services has published the Residential SUD Treatment Benefit Member Brochure, P-02615, to educate BadgerCare Plus and Medicaid members about the new residential SUD treatment benefit. The member brochure gives a high-level overview of the benefit and explains how members can find a residential SUD treatment provider.
The member brochure is available in both Spanish and English. Providers are encouraged to download the member brochure for distribution.
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.
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.
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.
Providers may need to connect with the county human services department from the member’s county of residence to coordinate care or discuss other supports, such as room and board assistance. Contacts for each county human service agency are provided on the Wisconsin Community Program, Social Service, and Human Service Agencies webpage.
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.
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.
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.
ForwardHealth has answered residential SUD treatment benefit FAQs (last updated 10/03/2022) about the new residential SUD treatment benefit. Questions can be submitted to DHSMedicaidSUD@dhs.wisconsin.gov. These FAQs may be updated periodically.
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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