ARPA 5% HCBS Rate Increase
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This document governs a proposed 5% Medicaid rate increase for a broad set of home and community-based services (HCBS) to be effective January 1, 2022, affecting Medicaid fee-for-service, managed care, IRIS, Children's Long-Term Support, Family Care and related programs and providers.
A 5% rate increase for specified HCBS service categories effective January 1, 2022.
Funding for the 5% increase is supported by ARPA HCBS FMAP-related funds available through March 2024.
Coverage and Implementation Criteria
Coverage and implementation criteria for 5% HCBS increase
Covered when ALL of the following apply:
ALL of the following
Programs
- BadgerCare Plus
- SSI Managed Care
- Children's Long-Term Support
- Family Care
- Family Care Partnership
- Medicaid fee-for-service state plan services
- IRIS
- PACE
ALL of the following
ANY of the following
- Adult day care services
- AODA
- AODA day treatment
- Assistive technology/communication aid
- Care management for Care4Kids
- Targeted Case Management
- Consultative clinical and therapeutic services for caregivers
- Consumer-directed supports (self-directed supports) broker
- Consumer education and training
- Counseling and therapeutic
- Environmental accessibility assessments
- Financial management services
- Habilitation services (daily living skills training and day habilitation resources)
- Home-delivered meals
- Home health services
- Housing counselling
- Medication therapy management
- Mental health day treatment
- Mental health services
- Nursing (in home)
- Occupational therapy (in home)
- Personal care
- Physical therapy (in home)
- Prenatal Care Coordination
- Prevocational services
- Residential care
- Residential substance use disorder treatment
- Respiratory care
- Respite
- Self-directed personal care
- Skilled nursing services (RN/LPN)
- Speech and language pathology services (in home)
- Substance Use Disorder Counseling
- Supported employment - individual employment support
- Supported employment - small group employment support
ALL of the following
- Department will increase the Medicaid fee-for-service and Children's Long-Term Support fee schedules for all eligible services for dates of service effective January 1, 2022.
- Managed care entities are required by contract with the Department to increase their provider rates for the eligible services by 5% for dates of service effective January 1, 2022.
- The IRIS program is eligible for the 5% increase; the Department will meet with IRIS stakeholders to plan implementation of that increase.
Eligible Codes and Funding Window
| Adult day care services | Adult day care services |
| AODA | AODA |
| AODA day treatment | AODA day treatment |
| Assistive technology/communication aid | Assistive technology/communication aid |
| Care management for Care4Kids | Care management for Care4Kids |
| Targeted Case Management | Targeted Case Management |
| Consultative clinical and therapeutic services for caregivers | Consultative clinical and therapeutic services for caregivers |
| Consumer-directed supports (selfdirected supports) broker | Consumer-directed supports (selfdirected supports) broker |
| Consumer education and training | Consumer education and training |
| Counseling and therapeutic | Counseling and therapeutic |
Provider Rate Implementation Actions
Implement 5% rate increase for eligible HCBS
Increase Medicaid fee-for-service and Children's Long-Term Support fee schedules for all eligible services for dates of service effective January 1, 2022; ensure managed care entities increase provider rates by 5% via contractual requirements; participate in IRIS implementation planning so IRIS providers receive the 5% increase.
- Department will increase Medicaid FFS and Children's Long-Term Support fee schedules for eligible services effective Jan 1, 2022.
- Managed care entities are contractually required to increase provider rates for eligible services by 5% effective Jan 1, 2022.
- IRIS program is eligible for the 5% increase; Department to meet with IRIS stakeholders to plan implementation.
Definitions and Eligible Service Categories
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