STATE OF WISCONSIN
In 1998, the Department of Health and Family Services submitted two
Medicaid (MA) State Plan amendments to the federal government to establish
Targeted Case Management (TCM) for children in out-of-home care as an MA
covered service for children in all 72 Wisconsin counties. These plan
amendments did not differentiate between TCM provided to children in
out-of-home care who were IV-E eligible or non-IV-E eligible. The federal
government approved the state’s plan amendments in
Therefore, the Department has decided to pursue utilizing the new federal approval to claim federal MA/TCM funding for non-IV-E eligible children in the Child Welfare System. We are in the process of sorting out the federal requirements concerning the MA TCM claim for IV-E eligible children but did not want to delay the state’s ability to begin claiming additional federal reimbursement for the non-IV-E children.
The Department will adjust the Random Moment Time Study (RMTS), which is currently used as the basis for claiming Title IV-E funds, and use it to claim MA TCM reimbursement for the target group of non-IV-E eligible children. By using the RMTS approach rather than the fee-for-service, the State will be able to claim without requiring billing of individual services.
To avoid double billing against federal funds, Wisconsin Medicaid will not reimburse case management providers for case management services provided to children in substitute care after July, 2001, on a fee-for-service basis whether the provider is a county agency or a private vendor contracting with the county. The Department will be issuing instructions through both the Medicaid Provider Update and the DCFS Numbered Memo. As of July 1, 2001, case management services to non-IV-E eligible kids in substitute care will be reimbursed only through the RMTS mechanism.