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 |
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.
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.
Inclusa Announces 2022 Opening of Portage County, WI Non Profit Center
Inclusa will open and operate a Non-Profit Center on the site of their future headquarters located at 2801 Hoover Road in Stevens Point, WI, when they take ownership in early 2022. The center will have leased space available along with common space to allow for collaboration and engagement amongst community members and other non-profit organizations.
Inclusa Announces New Headquarters in Stevens Point, WI
Inclusa has entered into an agreement to purchase Delta Dental of Wisconsin’s current headquarters at 2801 Hoover Road in Stevens Point, WI. Delta Dental will be moving to a new facility in Stevens Point. Inclusa hopes to be moved into their new headquarters by early 2022. For more information: