Provider Rates

State Directed Rate Increase and American Rescue Plan Increase

As part of a Wisconsin Department of Health Services (DHS) directed rate increase, Managed Care Organizations are required to provide a unit rate increase to eligible provider’s rates for Family Care Partnership covered Home and Community-Based Service (HCBS) services. Providers eligible for the State Directed Rate Increase include adult day care services, daily living skills training, habilitation services, residential care, individual and group supported employment, prevocational employment, vocational futures planning, respite care services provided outside of a nursing home, and supportive home care.

DHS Minimum Fee Schedule

The Wisconsin Department of Health Services (DHS) has created a minimum fee schedule for certain specified adult home and community-based services (HCBS). The schedule is a list of the minimum rates managed care organizations (MCO) can pay providers of certain adult long-term care services in Family Care, Family Care Partnership, and the Program of All-Inclusive Care for the Elderly (PACE). It applies to:

• Supportive home care services:
  • Agency
  • Member self-directed
• Residential facilities:
  • 1–2 bed adult family homes (AFHs)—owner occupied and corporate owned
  • 3–4 bed AFHs
  • Residential care apartment complexes (RCACs)
  • Community-based residential facilities (CBRFs)

MCOs must follow the minimum fee schedule beginning October 1, 2024. DHS has directed that MCOs are NOT directed to set provider rates at the new minimum fee schedule rates and then apply the 2021 state directed rate increase and the 2022 ARPA rate increase to that minimum rate.

MCOs are to implement the minimum fee schedule rates such that effective 10/1/2024 providers’ rates are set to the greater of the minimum rate OR the provider’s pre-10/1/2024 rate, where the pre-10/1/2024 rate already included the 2021 state directed rate increase and the 2022 ARPA rate increase.