Wis. ForwardHealth Online Handbook, Hospice, Topic #391

The following services are not covered by BadgerCare Plus HMOs or Medicaid SSI HMOs but are provided to members on a

fee-for-service basis as long as ForwardHealth covers the service for the member, and the service is medically necessary:

• Behavioral treatment services (for example, autism services)

• Chiropractic services, unless the HMO elects to provide chiropractic services

• County-based mental health programs, including CCS (comprehensive community services), CRS (Community Recovery

Services), CSP (community support program) benefits, and crisis intervention services

• Dental

Note: HMOs must provide dental services in Milwaukee, Waukesha, Racine, Kenosha, Ozaukee, and Washington

counties.

• Environmental lead investigation services provided through local health departments

• Hub and Spoke Health Home or SUD (substance use disorder) pilot programs (integrated recovery support services)

• Medication therapy management

• Pharmacy services and diabetic supplies

• PNCC (Prenatal care coordination) services

• Physician-administered drugs

Note: The Physician-Administered Drugs Carve-Out Procedure Codes table indicates the status of procedure codes

considered under the physician-administered drugs carve-out policy.

• Residential SUD treatment

• SBS (School-based services)

• Targeted case management services

• NEMT (Non-emergency medical transportation) services

• DOT (Directly observed therapy) and monitoring for TB (tuberculosis)-Only Services

Providers who render any of these services to a BadgerCare Plus or Medicaid SSI HMO member should submit PA (prior

authorization) requests and claims directly to ForwardHealth for coverage.