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2021 State Directed HCBS Rate Increase – Impacted Service Codes

Family Care HCBS Inclusion Logic

SPCs Covered

102.00 Adult Day Care
110.00 Daily Living Skills Training
706.00 Day Habilitation Services
202.11 AFH 1-2 bed (care&supervision)
202.22 AFH 3-4 bed (care&supervision)
506.71 CBRF- 5-8 bed (care&supervision)
506.76 CBRF- greater than 8 beds (care&supervision)
711.02 RCAC- (care&supervision) daily
103.99 Respite Care
104.00 Supportive Homecare – Daily
104.20 Supportive Homecare
104.30 Supportive Homecare

Procedure Codes Not Covered

S5120 Chore Services, per 15 min
S5121 Chore Services, per day

Covered Supported Employment Codes

108.10 Prevocational Services
114.00 Vocational Futures Planning & Support
615.00 Supported Employment
615.10 Supported Employment- Integrated

Procedure Codes:

H2025 Supported employment, ongoing coaching
T2014 Community based prevocational services
T2015 Community based prevocational services
T2018 Integrated: 1-2 Members
T2019 Integrated: 1-2 Members
T2038 HJ Voc Futures Planning

Family Care Partnership HCBS Inclusion Logic

Procedure Codes Not Covered: A0000 through R9999
Revenue Codes Not Covered: 0550 through 0559

Procedure Codes Covered

99509 RN Supervisory visit for personal care
99600 Skilled Nursing services
H2014 Daily Living Skills Training
S5100 Day care services, adult; per 15 minutes
S5101 Day care services, adult; per half day
S5102 Day care services, adult; per diem
S5105 Adult day care:
S5125 Attendant Care, per 15 mins
S5126 Attendant Care, per day
S5130 SHC-Routine Health Care Service
S5136 Supportive Home Care – per day: Community Supported Living
S9125 Respite care-institutional setting, per diem
T1005 Respite care in the home, per 15 minutes
T2012 Daily Living Skills; per day
T2013 Daily Living Skills per hour
T2021 Day Services; per 15 minutes
S5135 Companion Care; per 15 min
T2020 Community-Based Day Services, per day

Revenue Codes Covered

0220 AFH bedhold ancillary residential care services only; per day
0229 CBRF bedhold ancillary residential care services only, day
0240 AFH- 1-2 bed C/S
0241 AFH- 3-4 Bed C/S
0242 CBRF < 8 bed C/S
0243 CBRF > 8 bed C/S
0670 RCAC- C/S
0672 SHC- C/S

Supported Employment Codes Covered

H2025 Supp Employ Coaching, hour
T2014 Prevocational services; per diem
T2015 Prevocational services; per hour
T2018 Supported Employment
T2019 Supported Employment
T2038 HJ Voc Futures Planning
2022-03-07T17:57:12+00:00July 9th, 2021|Provider Announcements|

DHS Notice – 2021 State Directed Rate Increase for HCBS Providers


Wisconsin Department of Health Services

2021 State Directed Rate Increase for Home and Community-Based Service Providers

Home and Community-Based Services Provider,

The Wisconsin Department of Health Services will provide funding to the MCOs for the 2021 State Directed Rate Increase for home and community-based services, which the MCO will distribute to home and community-based services providers.

Home and community-based services provider means a provider of adult day care services, daily living skills training, habilitation services, residential care (adult family homes of 1-2 beds, adult family homes of 3-4 beds, community-based residential facilities, residential care apartment complexes), individual and group supported employment, prevocational employment, vocational futures planning, respite care services provided outside of a nursing home, and supportive home care. Providers of self-directed services are not eligible for this increase for self-directed services. Nursing homes and personal care agencies are not home and community-based services providers.

MCOs are required to provide a unit rate increase to all eligible providers equal to 4.24% of each eligible provider’s rates for Family Care and Family Care Partnership covered services in effect on June 1, 2021. The 4.24% unit rate increase on covered services equates to a unit rate increase of 3.51% when calculated on covered and non-covered services for residential providers. This unit rate increase will be labeled “2021 State Directed Rate Increase” in provider contracts as a separate line item from other components of the contracted rate with the provider. MCOs may negotiate other components of the MCO’s reimbursement rates to providers.

MCOs will be communicating the details of this increase and the associated contract amendment. Timely responses to these updates and submission of requested claims resubmissions dating back to the retroactive start of this increase, June 1st, 2021 will help ensure timely payment of this increase to providers.

Please contact if you have any general questions about the 2021 State Directed Rate Increase.

2022-03-07T17:20:51+00:00July 9th, 2021|Provider Announcements|

Inclusa Expands Service Region to Serve Fond du Lac, Manitowoc, Winnebago, Calumet, Outagamie, and Waupaca Counties.

New choice: Inclusa available to support long-term care needs.


April 1, 2021 – Inclusa, Inc., a nonprofit organization that provides community-centered support for people needing long-term care services, is now an available choice to serve residents of Fond du Lac, Manitowoc, Winnebago, Calumet, Outagamie, and Waupaca counties.

Inclusa is one of several managed care organizations that offers Family Care, a state Medicaid-funded long-term care program designed to help frail elders and adults with disabilities connect to the supports and services they need to thrive in the communities they call home. The organization currently serves over 15,000 Wisconsinites in 62 counties.

“Inclusa may be new to this area, but with more than 20 years of experience, we are not new to long-term care,” said Mark Hilliker, chief executive officer of Inclusa.

Over 6,500 people in the region use a long-term care program option to support their needs.

“A recent quote from the member satisfaction survey stated: ‘For me, they are excellent.’ With that ideal in mind, we look forward to working alongside local partners and providers to deliver excellent care to this area,” stated Hilliker.

Visit local Aging and Disability Resource Centers for more information about long-term care program options and eligibility. For more information about Inclusa, visit

Inclusa is a Wisconsin-based nonprofit organization that provides person-centered and community-focused long-term care services and supports. With a special emphasis on supporting Life. Defined by you, their program helps members live independently in the communities they call home. It works under a contract with the Wisconsin Department of Health Services and with local providers to help eligible elders and adults with disabilities connect with community resources needed to live independently and actively participate in everyday life.

2022-03-07T16:41:51+00:00April 1st, 2021|Uncategorized|

Self-Determination & Self-Directed Supports

Freedom. Plain and Simple.

Meet Sandra!

Sandra is living her best life by partnering with others to live a self-determined life. Self-Determination is a theory of motivation which focuses on individuals having control over their lives and exercising the basic rights of citizenship, freedom, liberty, and the pursuit of happiness.

A Self-Determined life encourages choice, risk, and responsibility, and is associated with greater independence and improved quality of life.

With Sandra taking the lead, she and her Interdisciplinary Team work together to explore and achieve what’s possible. They proactively partner to develop a plan that encourages dignity, choice and connections, focusing on Sandra’s independence and community involvement.

Sandra uses Self-Directed Supports (SDS) as one option to support living a self-determined life, where:

  • Sandra decides who she wants to provide her services and supports.
  • Sandra controls how her budget is used for services.
  • Sandra is the boss of her caregivers and services; she hires, trains, supervises, and fires
    her direct care workers.

What does this look like?

What better way, than to hear from the people living it?

(Sandra) “I do self-directed supports because I’ve had agencies before and they just don’t really fit with what you need. […] So, when they started the self-directed supports program I tried it, and I’ve never gone back.

“My sister who had helped me for several years was burnt out and she just couldn’t [anymore]. She said, “I just can’t. I’m sorry.” and I came home and I was really struggling […].”

(Sandra’s Self-Directed Support Employee) “When Sandra and I were introduced the [Community Resource Coordinator] called me and asked me if I would be willing to interview with [Sandra] and told me what some of her needs were and I said yes. And so, we set up a time, and we interviewed each other; so she asks me questions and then I ask her questions. And then we you know, I’ll tell her what I will and what I do and what I don’t want to do and she’s talking about what her needs are and we you know, decide on how many hours with the [Interdisciplinary Team] what the salary is going to be and you come to all the terms and agreements and then you get hired on. You get to really be part of these peoples’ lives and touch them not just in the medical area but in their personal, psychological and their well-being.”

“Even though some things Sandra can’t do totally, she can still do part of it. And like I said earlier, I’m kind of like her extended hands and feet. So, when we make a meal for her and her husband, she does as much prep as she possibly can and then I do the parts that she can’t do. So, she still has a big role to play in what we do. Not just in the kitchen, but when we do wound care, she tells me you know, if she’s got something new or if she has questions, I can answer. So, she is totally involved in her care and we discuss how she wants things done in every aspect. What shampoo she wants, what ointments she wants, what medications she wants to use – so she runs the show! She gets to decide how she wants to be taken care of, what she wants done and how she wants it done.”

So how does this really all happen?

Well, with the assistance of fiscal agencies. Fiscal agencies help members to easily hire, and employ, caregivers legally by handling the required employer and employee paperwork. This may include time tracking, payroll, tax filing, and insurance concerns. Payments to caregivers are made through the fiscal agency.

(Sandra’s Self-Directed Support Employee) “We submit a timesheet and they send back a paycheck. The fiscal agency takes care of the timecards, writing out the checks, taking out the proper taxes, and I do believe that since there’s so many of us now, I do believe that there’s workers comp available […]. I know a lot of people think we work for the [fiscal agent] but it’s totally separate so they just, they do the checking part and the taxes, which is really nice.”

(Sandra) “Yes, they have been very helpful that way. And they always send me an email telling me, because I email that time sheet to them and they always send me an email making sure I know that they got it. If you have a question, they’re right there. They’re answering and helping.”

*Names are changed to protect identity.

If you are interested in learning more about Self-Directed Supports within Inclusa or becoming a self-directed employee, please contact us to learn more. 

2020-08-04T23:06:55+00:00August 13th, 2020|Uncategorized|

Update regarding the Wisconsin Nursing Home and ICFs/IID Testing Opportunity

Division of Quality Assurance: Notifications & Updates

Attn: All Wisconsin Nursing Homes and Intermediate Care Facilities for Individuals with Intellectual Disabilities

Update regarding the Wisconsin Nursing Home and ICFs/IID Testing Opportunity

In follow up to Governor Ever’s guidance to the State Emergency Operations Center (SEOC) to facilitate a plan to test every nursing home and ICFs/IID resident and staff member in Wisconsin for COVID-19, providers across the state are actively participating in this initiative. To date, approximately 76% of these long-term care providers are testing or have tested their residents and staff. Thank you all for your ongoing efforts to protect some of our most vulnerable citizens!

DHS supports and encourages providers to continue testing and conducting case management infectious disease practices to help keep residents and staff as safe as possible. Providers are encouraged to send the specimens back on a daily basis as testing is conducted, if possible; this will ensure the integrity of the specimens and assist in timely processing. DHS will issue additional guidance about ongoing testing strategies, in line with CMS guidance, to support each facility’s ability and safety to reopen to visitors.

Testing is a key strategy for identifying individuals who have COVID and to prevent others from becoming infected, which is particularly important for the individuals who live in these settings. It is not too late to start testing. However, if a provider does not intend to begin testing at this time, please do not order test kits until ready to do so; this allows the current supply to be sent to organizations that are actively testing. Exact Science test kits continue to be available and should be returned to the lab for processing no later than December 31, 2020 which is the current end of the CARES Act funding.

New resources for addressing staffing issues will be posted under “Planning for Staffing Shortages” on the COVID-19: Long-Term Care Facilities and Services webpage.

Updated information is also posted under “Testing Criteria” on the COVID-19: Long-Term Care Facilities and Services webpage:

Overview, forms, and fact sheets:

Webinars and notifications:

Resources related to information to share with staff about COVID-19 testing, criteria for Point Prevalence Survey (PPS) retesting and testing guidance for other provider types is coming soon.

If you have questions about the testing process or suggestions for other publications that would be helpful, please email WI COVID-19 SNF Testing.

2020-05-27T21:44:05+00:00May 27th, 2020|Uncategorized|

Update for Emergency Nurse Aide Training Programs Due to End of Public Health Emergency

Inclusa Received the following message and is sharing, on behalf of DHS:

Attn: Nurse Aide Training Programs

Update for Emergency Nurse Aide Training Programs Due to End of Public Health Emergency

As of May 11, 2020, the public health emergency ended and Emergency Order #21 is no longer in effect; therefore, the Department has established a waiver request process to allow entities and facilities to continue to hire and train caregivers through the Emergency Nurse Aide Training Programs.

DHS is actively working to promulgate an emergency rule. Until the emergency rule is promulgated, both approved and temporary Emergency Nurse Aide Training Programs may request a waiver to allow the provider to continue to hire and train nurse aides to work in their facility.

  • The request should include the name of the facility and a request for a waiver of “all applicable regulations to allow for the continuation of the Emergency Nurse Aide Training Program.” It is not necessary to include specific regulatory references in your request.
  • Please send your waiver request via email to Nurse Aide Training and Testing.

We are able to accept students via the survey who were hired and started training while the emergency order was in effect. Therefore, currently approved Emergency Nurse Aide Training Programs may continue to train students who began their training on or before May 18, 2020, without a waiver. Temporary nurse aides who have completed an Emergency Nurse Aide Training Program may also continue to work at this time.

The Division of Quality Assurance (DQA) will schedule a webinar to provide additional information as needed. The date and time of the webinar will be communicated via this listserv messaging. Thank you for your continued efforts to train much-needed nurse aides during this time.

If you have any questions about this information, please email Nurse Aide Training and Testing

2020-05-22T18:07:28+00:00May 22nd, 2020|Uncategorized|

Internet and Communications Resources Available to Support Increased Needs during Safer at Home and COVID-19

DHS has provided Inclusa with the following guidance around internet and communication resources available during the COVID19 Public Health Emergency.  This includes information on obtaining and replacing phones for members and cellphone minutes.

If you require assistance to follow up with any of these directions, please contact your Inclusa Community Resource Coordinator or Health and Wellness Coordinator – they will be glad to help! If you don’t have their phone number, please call Inclusa’s toll free number at 1-877-622-6700 or TTY 711 for assistance.  You can also contact us on via our website here:

Question: Are resources available to help get telephone service?

Answer: The Lifeline program offers discounts on phone service, including no-cost cell phone plans. The Wisconsin Public Service Commission (PSC) administers the program in Wisconsin. Information about Lifeline is available at:

​​​​​​​Residents are directed to contact a telephone service provider to apply. The list of providers that offer lifeline service can be found at

Question: I had a Lifeline phone at one time, but it has been lost/stolen/damaged. How do I report this and get a new phone?

​​​​​​​Answer: The federal rules require the providers of the “free phone” (prepaid, wireless Lifeline) to de-enroll a customer if they have not used their phone for 30 days or more. Contact the Commission’s Consumer Affairs line. They can check on enrollment and contact the carrier on your behalf.

  • The Commission Consumer Affairs phone number is (800) 225-7729 or (608) 266-2001. The line is open Monday through Friday, from 7:45 a.m. and 4:30 p.m.
  • The Consumer Affairs team will call an interpreter if a customer needs assistance in a different language.

Question: How many free minutes a month should Lifeline customers receive?

​​​​​​​Answer: As of December 2019, Lifeline phone carriers were required to provide a minimum of 1000 free minutes per month to Lifeline customers.

If the you do not receive 1000 minutes, let your CRC or HWC know right away and they will assist you.

2020-04-23T22:37:50+00:00April 23rd, 2020|Uncategorized|

COVID-19 Status Updates

Inclusa continues to follow the guidance of the federal Centers for Disease Control and Prevention (CDC) and the Wisconsin Department of Health Services (DHS), alongside local public health agencies across Wisconsin. Providers licensed by the State of Wisconsin should continue to watch for operations guidance in relation to COVID-19 from the Wisconsin Department of Health Services (DHS) Division of Quality Assurance (DQA).

The DHS and CDC websites are updated regularly as circumstances are changing and evolving. Also be sure to connect with your local health department, the first line of contact for situations that impact your community’s health.

In addition, the following are the most recent memos issued by DHS:

2020-03-23T15:41:08+00:00March 23rd, 2020|Front Page News|
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