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401, 2024

Home Health and Nurse Supervisory EVV Soft Launch Information for January 1, 2024

By |January 4th, 2024|Categories: Provider Announcements|Comments Off on Home Health and Nurse Supervisory EVV Soft Launch Information for January 1, 2024

On January 1, 2024, the Wisconsin Department of Health Services (DHS) will implement the soft launch requirements for Electronic Visit Verification (EVV) for home health care services (HHCS) and nurse supervisory visits using the following service codes:

  • Personal Care Nurse Supervisory Visit (T1019 and T1020)
    • Service Code 99509 – Home visit for assistance with activities of daily living and personal care
  • Private Duty Nursing (Independent Nurses and Agency Nurses)
    • Service Code 99504 – Home visit for mechanical ventilation care
    • Service Code S9123 – Non-vent private duty nursing care in home, by Registered Nurse (RN)
    • Service Code S9124 – Non-vent private duty nursing care in home, by Licensed practical nurse (LPN)
  • Non-Private Duty Nursing (Independent Nurses and Agency Nurses)
    • Service Code 99600 – Unlisted home visit service or procedure
    • Service Code T1001 – Nursing assessment/evaluation
    • Service Code T1502 – Administration of oral, intramuscular, and/or subcutaneous medication
    • Service Code T1021 – Home health aide or Certified Nursing Assistant (CNA)
  • Therapy
    • Service Code 92507 – Treatment of speech, language, voice, communication, and/or auditory processing disorder
    • Service Code 97139 – Unlisted therapeutic procedure – Occupational Therapy
    • Service Code 97799 – Unlisted physical medicine/rehab service or procedure – Physical Therapy

For a full listing of all service codes identified for EVV, visit: https://www.dhs.wisconsin.gov/evv/service-codes.htm

Soft launch is the time to learn and use the EVV system without affecting payments! Below are a few resources and supports to assist providers in preparing for EVV.


Resources


Supports

Inclusa is here to support providers with any contract or authorization specific questions as it relates to your contracted services.

  • Contact Provider Relations at 877-622-6700 (select option 2, then option 3) or ProviderRelations@inclusa.org to discuss contract or service-related information.
  • Contact Inclusa’s Home Health Authorizations & Claims Support Team at ACS-SHC-SDS-HomeHealth@inclusa.org or 888-544-9353 (select option 7) to discuss authorization or billing related information.

Wisconsin EVV Customer Care is available to provide support throughout the soft launch transition as it relates to the EVV vendor system. Customer Care is accessible by email at vdxc.contactevv@wisconsin.gov or by phone (in English, Hmong, and Spanish, among other languages) at 833-931-2035 Monday–Friday, 7 a.m.–6 p.m. CT.

Sign up for the DHS email list to receive updates and notifications on training opportunities, policy information, and other important details regarding EVV in Wisconsin.

604, 2023

EVV Hard Launch Information

By |April 6th, 2023|Categories: Provider Announcements|Comments Off on 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.

Resources

Important Reminders

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.

Supports

Wisconsin EVV Customer Care is available to provide support throughout the process. Customer Care is accessible by email at vdxc.contactevv@wisconsin.gov 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:

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.

1208, 2022

Humana to Expand Medicaid Services in Wisconsin with Acquisition of Inclusa, Inc

By |August 12th, 2022|Categories: Uncategorized|Comments Off on 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.

703, 2022

2022 American Rescue Plan Act – Impacted Services

By |March 7th, 2022|Categories: Provider Announcements|Comments Off on 2022 American Rescue Plan Act – Impacted Services

907, 2021

2021 State Directed HCBS Rate Increase – Impacted Service Codes

By |July 9th, 2021|Categories: Provider Announcements|Comments Off on 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:
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
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
907, 2021

DHS Notice – 2021 State Directed Rate Increase for HCBS Providers

By |July 9th, 2021|Categories: Provider Announcements|Comments Off on DHS Notice – 2021 State Directed Rate Increase for HCBS Providers

07/08/2021

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.

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