EVV Hard Launch Information
On May 1, 2023 the Wisconsin Department of Health Services (DHS) implemented the hard launch of the Electronic Visit Verification (EVV) system for hands-on cares for the following Service codes:
- T1019 and T1020 – Personal Care services; per 15 minutes and per diem
- S5125 and S5126 – Attendant Care services; per 15 minutes and per diem
Claims will be denied for dates of service on May 1, 2023 and thereafter, if EVV requirements are not followed. Below are a few resources, reminders, and supports to assist impacted providers.
- New to EVV Flyer: a great introduction to the required system, outlining steps to get started.
- What is EVV Flyer: a brief overview of the system and where to learn more.
- Wisconsin Electronic Visit Verification: a brief video focusing on the basics of EVV.
- EVV Fundamentals: a 30-minute training video about EVV and where to find resources.
- DHS EVV Training Page: a resource page on how to train workers and agency administrators.
- DHS EVV Website: a singular location to access these and all EVV related resources.
- EVV Provider Billing Facts: a resource from Wisconsin Physicians Service (WPS), Inclusa’s Third Party Administrator (TPA) (claims processor), providing guidance to support the claims and billing process.
EVV Visit Key Needed: Workers are required to check in/out using an EVV system at the start and the end of each visit. Claims without an EVV Visit Key will be denied. The EVV Flyers above provide further details regarding the EVV Visit Key.
No Date Span Billing: Claims for the related services must be submitted separately for each date of service. Claims submitted using date span billing will be denied. The WPS EVV Provider Billing Facts link above provides further details and helpful tips regarding claims and billing.
Date Span Example: A member received services on 14 dates in the month of May. Date span billing is when a date span of 5/1/2023–5/31/2023 is submitted for total units (days) and total charges. Instead, submit each day separately with units and charges on 14 individual claim lines.
Wisconsin EVV Customer Care is available to provide support throughout the process. Customer Care is accessible by email at firstname.lastname@example.org or phone at 833-931-2035 Monday–Friday, 7 a.m.–6 p.m. CT.
Inclusa Authorization and Claims Support Team is available to provide support with authorization and claims:
- Supportive Home Care/Personal Care – contact ACS-SHC-SDS-HomeHealth@inclusa.org or 1-888-544-9353, option 7.
- Community Supported Living – contact ACS-Residential-CSL-NH@inclusa.org or 888-544-9353, Option 6.
Inclusa Provider Relations Team is available to provide support with contracting questions. Please contact your local Program Manager, ProviderRelations@inclusa.org, or 877-622-6700, option 2, then option 3.
Humana to Expand Medicaid Services in Wisconsin with Acquisition of Inclusa, Inc
We are excited to announce that Humana has agreed to purchase substantially all of Inclusa’s assets. This acquisition will allow us to create a model of care that provides industry-leading support for members across the health care continuum.
“Since our founding in 2000, the mission of Inclusa has been to maximize health outcomes for our members by proactively partnering with others to build vibrant and inclusive communities in Wisconsin that offer people dignity, choice, and connections,” said Mark Hilliker, Inclusa chief executive officer. “I am proud of the success we have achieved and look forward to the greater impact our team can have as part of Humana.”
This partnership upholds the continuity of Inclusa’s culture and locally-rooted legacy, while expanding its contribution within Humana’s national Medicaid platform. Thank you for joining us in this exciting opportunity.
Press Release: Humana Inc. – Humana to Expand Medicaid Services in Wisconsin with Acquisition of Inclusa, Inc.
We will share more information as it becomes available.
2021 State Directed HCBS Rate Increase – Impacted Service Codes
Family Care HCBS Inclusion Logic
|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|
|104.00||Supportive Homecare – Daily|
Procedure Codes Not Covered
|S5120||Chore Services, per 15 min|
|S5121||Chore Services, per day|
Covered Supported Employment Codes
|114.00||Vocational Futures Planning & Support|
|615.10||Supported Employment- Integrated|
|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:
SERVICE NOT INCLUDED IN PROGRAM FEE, per diem
|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|
Supported Employment Codes Covered
|H2025||Supp Employ Coaching, hour|
|T2014||Prevocational services; per diem|
|T2015||Prevocational services; per hour|
|T2038 HJ||Voc Futures Planning|
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 DHSLTCFiscalOversight@dhs.wisconsin.gov if you have any general questions about the 2021 State Directed Rate Increase.
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.
FOR IMMEDIATE RELEASE
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.org.
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.