Wisconsin Department of Health Services
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Cost ReasonablenessReturn to the Community Recovery Services Home Page Initial Cost Approval ProcessThe Department of Health Services administers the state’s Medicaid program. The Division of Mental Health and Substance Abuse Services (DMHSAS) performs a gatekeeper role in its review and approval of certifications and recertifications for the CRS Medicaid benefit. Inherent in the approval process is a review of the service type, rates, and units of service being requested for eligible consumers. The type and quantity of services must be consistent with the consumer’s assessed needs. The requested rate for services must be reasonable per the definitions in the state’s Allowable Cost Policy Manual (ACPM). In the event that a requested rate (county/tribal cost) exceeds the posted Medicaid Fee Schedule (MFS) for the service(s) requested , DMHSAS will approve such rate up to 100% of the MFS. Actual county and tribal costs which exceed 100% of the MFS may be captured during the cost reconciliation process provided they meet the reasonableness tests specified in the ACPM. Counties and tribes are encouraged to bill state Medicaid at the rate approved for each eligible consumer if such flexibility exists within their current data system. In the event that such flexibility does not exist within the current data system, counties and tribes are encouraged to establish an internal fee that represents the average of the approved rates for each CRS service type, not to exceed the MFS. Last Revised: May 20, 2011 |