CRS: Providers

The Department of Health Services (DHS) offers technical assistance and support to county agencies participating in the Community Recovery Services (CRS) Program.

Policy and requirement changes

The following changes took effect July 1, 2018.

Review ForwardHealth Update 2018-17 for all Medicaid policy changes. (PDF)

Billing and Wisconsin Medicaid cost reporting (WIMCR)

  • Community Living Supportive Services can only be billed on a periodic basis (15 minute units).
  • Costs of direct service, direct support, and overhead will be entered into WIMCR.

Documentation requirements

  • The following documents need to be updated and sent electronically to DCTS every 12 months after meeting in-person with the consumer:
    • Cover letter, which includes:
      • Consumer’s name
      • Medicaid ID number
      • Type of requested CRS service
      • Date of the service plan signature
      • Identification of initial enrollment, annual recertification, or discharge
    • Mental Health/Alcohol and Other Drug Abuse Functional Screen
    • Assessment
    • Service plan, with the following information:
      • Demographics
      • Financials
      • Outcomes (consumer goals, objectives, interventions)
      • Signatures
    • Support plan(previously referred to as a “crisis plan”) with the client’s answers to these questions:
      • What am I like when I feel great or when I am well?
      • What triggers will increase my symptoms and what triggers will decrease my symptoms?
      • What are some early warning signs for when I need someone else to intervene?
      • How do I want someone to intervene?
  • The following documents need to be updated and kept in the consumer’s file every six (6) months after meeting in-person with the consumer for review during the CRS annual monitoring visit:
    • Assessment
    • Service plan
  • The following documents no longer need to be sent to DCTS as of July 1, 2018:
    • Proof of financial eligibility (for example, screen shot of consumer’s ForwardHealth page)
      • Consumers are no longer required to have a countable income at or below 150 percent of the federal poverty level.
      • Consumers need to be eligible and enrolled in a full-benefit BadgerCare Plus or Medicaid plan.
      • Member enrollment issues are the primary reason claims are denied.
      • Providers should always verify a member's enrollment before providing services to reduce claim denials.
      • Verifying a member’s enrollment provides an opportunity to determine enrollment for the current date (since a member's enrollment status may change) and to discover any limitations to the member's coverage.
  • Formula to Determine Amount of Income Available to pay for Room and Board in Substitute Care, F-20920
    • Counties should always verify that a member’s room and board costs are separate from cost of care and supervision.
    • Medicaid payments cannot be made for room and board including the cost of building maintenance.
  • Approval letters from DHS will no longer list an approved rate and approved units. The rate and units will continue to be based on the consumer’s level of need.
  • It is still required that counties include the cost of CRS services in the documentation they send to DCTS every 12 months.

Provider progress notes

  • All providers need to document services provided on a periodic basis. This means a unit of time (minutes, hours, and/or number of units) needs to coincide with a written note.
  • Example periodic note: Staff asked if Jon wanted to go on an outing to Walmart and he said yes. Jon appeared agitated that another housemate was going with and I encouraged Jon to use his coping skill of writing in his journal. He wrote in his journal and we talked about his frustration with this housemate. Jon reported that he feels this housemate picks on him and that he didn’t want to go on the outing anymore. Staff discussed additional coping skills with Jon and assessed for safety. (signed Jane Doe, 1:00-1:30 p.m. OR 2 units)

Provider trainings

  • The ForwardHealth Update states that all CRS program staff must be qualified to provide CRS and meet training curriculum standards developed by DHS and DCTS.
  • The training standards are listed in DCTS Action Memo 2018-10. (PDF)

 

Service definitions

Use these definitions when preparing the outcomes form to indicate the services for the CRS consumer and who will be providing these services.

Community living supportive services

This service covers activities necessary to allow individuals to live with maximum independence in community integrated housing. Activities are intended to assure successful community living through utilization of skills training, cueing and/or supervision as identified by the person-centered assessment.

Community Living Supportive Services consist of meal planning/preparation; household cleaning; personal hygiene; reminders for medications and monitoring symptoms and side effects; teaching parenting skills; community resource access and utilization' emotional regulation skills; crisis coping skills; shopping; transportation; recovery management skills and education; financial management; social and recreational activities; and developing and enhancing interpersonal skills. Tasks such as meal planning, cleaning, etc., are not done for the individual, but rather they are delivered through training, cueing, and supervision to help the participant become more independent in doing these tasks.

These e services available in a variety of community locations that encompass residential, business, social, and recreational settings. Residential settings are limited to an individual’s own apartment or house, supported apartment programs, adult family homes (AFH), residential care apartment complexes (RCACs), and community-based residential facilities (CBRFs) of from 5 to 16 beds (inclusive). The type of residential setting needed is agreed upon in the person-centered assessment. Individuals needing services in a CBRF setting are those whose health and safety are at risk without 24-hour supervision. Payment is not made for room and board including the cost of building maintenance.

The services provided will not be duplicative of other State Plan services, including but not limited to personal care and transportation.

Peer support services

Individuals trained and certified as peer specialists serve as advocates, provide information, and peer support for consumers in outpatient and other community settings. All consumers receiving peer support services will reside in home and community settings.

Certified Peer Specialists perform a wide range of tasks to assist consumers in regaining control over their own lives and over their own recovery process. Peer specialists function as role models demonstrating techniques in recovery and in ongoing coping skills through:

  • Offering effective recovery-based services
  • Assisting consumers in finding self-help groups
  • Assisting consumers in obtaining services that suit that individual’s recovery needs
  • Teaching problem solving techniques
  • Teaching consumers how to identify and combat negative self-talk and how to identify and overcome fears
  • Assisting consumers in building social skills in the community that will enhance integration opportunities
  • Lending their unique insight into mental illness and what makes recovery possible
  • Attending treatment team and crisis plan development meetings to promote consumer's use of self-directed recovery tools
  • Informing consumers about community and natural supports and how to utilize these in the recovery process
  • Assisting consumers in developing empowerment skills through self-advocacy and stigma-busting activities

Learn more about Wisconsin's Peer Specialist Employment Initiative.

Supported employment services

This service covers activities necessary to assist individuals to obtain and maintain competitive employment. This service may be provided by a supported employment program agency or individual employment specialist. This service follows the Individual Placement and Support (IPS) model recognized by SAMHSA to be an evidence-based practice. This model has been shown to be effective in helping individuals obtain and maintain competitive employment.

The core principles of this supported employment approach are:

  • Participation is based on consumer choice. No one is excluded because of prior work history, hospitalization history, substance use, symptoms, or other characteristics. No one is excluded who wants to participate.
  • Supported employment is closely integrated with mental health treatment. Employment specialists meet frequently with the mental health treatment team to coordinate plans.
  • Competitive employment is the goal. The focus is community jobs anyone can apply for that pay at least minimum wage, including part-time and full-time jobs.
  • Job search starts soon after a consumer expresses an interest in working. There are no requirements for completing extensive pre-employment assessment and training or intermediate work experiences (like pre-vocational work units, transitional employment, or sheltered workshops).
  • Follow-along supports are continuous. Individualized supports to maintain employment continue as long as the consumer wants assistance.
  • Consumer preferences are important. Choices and decisions about work and support are individualized based on the person’s preferences, strengths, and experiences.

The service covers supported employment intake, assessment, job development, job placement, work related symptom management, employment crisis support, and follow-along supports by an employment specialist. It also covers employment specialist time spent with the individual’s mental health treatment team and vocational rehabilitation (VR) counselor.

This service does not include services available as defined in S4 (a) (4) of the 1975 Amendments to the Education of the Handicapped Act (20 U.S.C. 1401(16), (17)) which otherwise are available to the individual through a state or local educational agency and vocational rehabilitation services which are otherwise available to the individual through a program funded under S110 of the Rehabilitation Act of 1973 (29 U.S.C. 730).

 

Medicaid information and forms

Memos and handbooks

Provider registration forms

Cost reasonableness

The Division of Care and Treatment Services (DCTS) performs a gatekeeper role in its review and approval of certifications and recertifications for CRS. 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, DCTS 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.

Registering for access to state's eligibility systems

CRS service providers should obtain access to two state information systems: Functional Screen Information Access (FSIA) and the Program Participation System.

Access to these systems is obtained through the Web Access Management System (WAMS). Obtain a WAMS ID.

Functional Screen Information Access (FSIA)

Wisconsin's automated functional screen is used to document functional eligibility for several state benefits, including CRS.

Steps to obtain access:

  1. Obtain a WAMS ID
  2. Visit the Human Services System Gateway
  3. Select FSIA-Access Request.
  4. Complete the fillable form
  5. Submit the fillable form to your agency's information security officer for processing

Program Participation System (PPS)

After completing the consumer's individual service plan packet, the final step for the care manager is to register the consumer into PPS. PPS provides the linkage to the state's Medicaid system. Through PPS, the care manager requests enrollment into CRS. The process is a simple, but requires access to PPS.

Steps to obtain access:

  1. Obtain a WAMS ID
  2. Visit the Human Services System Gateway
  3. Select PPS-Access Request
  4. Follow steps to complete and submit paper request form to your agency's information security officer

A county or tribe may wish to consider having only one key staff member designated for PPS registration duties. If so, it should be a staff member who has access to the functional screen, which will be needed to create the consumer's account in PPS.

Incident reporting

Purpose

DHS is required by the Centers for Medicare and Medicaid Services (CMS) to ensure the health, safety, and welfare of CRS participants. This is done in partnership with local Medicaid agencies, service providers, guardians, and family members. The state uses incident reports to identify statewide or regional patterns and trends, which allow the development of interventions to decrease the likelihood of re-occurrence of such incidents. Thank you for your cooperation with the incident reporting process.

Process

Incident reporting is always a person-specific process. If an incident involves or affects multiple CRS participants, a separate report must be submitted for each participant affected by the incident.

The process begins when the Medicaid agency, service provider, guardian, or family member observe, learn, or discover an event or situation that conforms to the definition of an incident. Providers, guardians, or family members must inform Medicaid agencies of such incidents and Medicaid agencies must both notify and report the event and the response to the assigned state contact as specified in the instructions.

Forms

Quality review process

Guidance on the development of Individual Service Plan (ISP) packets.

Client rights

Please provide these brochures to all CRS consumers.

Contact the DHS Client Rights Office with questions about client rights and the grievance procedure.

Discharge information

DHS guidance on CRS discharges

Trainings

Person-centered planning

 

Last Revised: January 15, 2019