The Waivers Service Rates Initiative will modify the existing rate-setting methodology for fee-for-service 1915(c) waiver services, including Children’s Long Term Supports (CLTS), the Community Options Program (COP), and the Community Integration Program (CIP). This initiative does not require changes to the Children's Community Options Program (CCOP), Family Care, or Include, Respect, I Self-Direct (IRIS) programs.
The federal Centers for Medicare & Medicaid Services (CMS) have directed the State of Wisconsin to create a uniform rate-setting methodology for most waiver services. The current practice, in which individual counties or waiver agencies set rates directly with providers, will no longer be allowed by CMS. The Department of Health Services (DHS) must implement a new uniform methodology to set provider rates for HCBS beginning January 2018.
CMS outlined the following guidelines to be used when creating the statewide rate-setting methodology:
- The waiver must describe the rate-setting methodology used for each waiver service.
- The waiver must describe how the state exercises financial oversight to ensure that rates are determined and paid in accordance with a uniform methodology that ensures consistent rate structure for each specific service.
- The waiver must describe how the state solicits public comment on rate determination methods.
- The waiver must describe how information about payment rates is made available to waiver participants.
- The waiver must describe whether this rate determination method is used for determining self-directed budgets or if some other method is used and applied consistently to each waiver participant.
Services Included in Rates Initiative
- Adult Day Care
- Adult Family Home
- Case Management
- Community Based Residential Facilities
- Children's Foster Care/Level 5 Exceptional Foster Home (DHS has requested CMS approval to exempt from rate-setting)
- Community Integration Services
- Consumer Education and Training
- Counseling and Therapeutic Services
- Daily Living Skills
- Day Services
- Financial Management Services
- Housing Counseling
- Nursing Services
- Prevocational Services
- Specialized Transportation
- Supported Employment
- Supportive Home Care
- Training for Unpaid Caregivers
Services Exempt from Rates Initiative
- Adaptive Aid (Vehicle)
- Adaptive Aid (Other)
- Communication Aids
- Consumer-Directed Supports
- Home-Delivered Meals
- Home Modifications
Personal Emergency Response Systems
- Relocation Services/Housing Start-up
- Residential Care Apartment Complex
- Specialized Medical and Therapeutic Supplies
Information for Stakeholders
- Letter to Providers - Letter sent at the end of October to long-term care providers about this initiative.
- Webinar for Providers - Webinar explains the purpose, history, and process for creating and implementing the new uniform rate methodology being created by this initiative.
- Provider Survey - This survey was created to obtain feedback from providers regarding long-term care provider rates. We encourage providers affected by this initiative to take the survey. Your feedback is important to us.
Keep Me Posted
All other interested parties are asked to sign up here to receive email updates about this initiative. The Department will notify you when additional details are available.