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available to all Wisconsin Medicaid recipients as outlined in Table 2. Room and board costs are not considered allowable costs for residential treatment service providers unless they qualify as impatient facilities under section 1905(a) of the Act.

Table 2: Wisconsin OUD/SUD Benefits Coverage with Expenditure Authority

SUD Benefits Wisconsin Medicaid Authority Expenditure Authority Outpatient Services State Plan wa Intensive Outpatient Services State Plan wa Medication Assisted State Plan Services provided to individuals Treatment (Individual services covered) in IMDs Residential Treatment State Plan Services provided to individuals Services (Individual services covered) in IMDs Inpatient Services State Plan (Individual services Services provided to individuals covered) in IMDs Medically Supervised State Plan Services provided to individuals Withdrawal Management in IMDs

5.3. SUD Implementation Plan and Health IT Plan. The state's SUD Implementation Plan initially approved for the period from June 7, 2019 through December 31, 2023 (and temporarily extended through December 31,2024) remains in effect for the approval period from October 29, 2024, through December 31, 2029, and is affixed to the STCs as Attachment A. Any future modifications to the approved Implementation Plan will require CMS approval. Failure to progress in meeting the milestone goals agreed upon by the state and CMS will result in a funding deferral. The approved SUD Implementation Plan describes the strategic approach and a detailed project implementation plan, including timetables and programmatic content where applicable, for meeting the following milestones which reflect the key goals and objectives of this SUD demonstration project:

a. Access to Critical Levels of Care for OUD and other SUDs. Coverage of OUD/SUD

treatment services across a comprehensive continuum of care including: outpatient; intensive outpatient; medication assisted treatment (medication as well as counseling and other services with sufficient provider capacity to meet needs of Medicaid beneficiaries in the state); intensive levels of care in residential and inpatient settings; and medically supervised withdrawal management, within 12-24 months of demonstration approval;

. Use of Evidence-based SUD-specific Patient Placement Criteria. Establishment of a requirement that providers assess treatment needs based on SUD-specific, multidimensional assessment tools, such as the American Society of Addiction Medicine (ASAM) Criteria or other assessment and placement tools that reflect evidence-based clinical treatment guidelines within 12-24 months of OUD/SUD program demonstration approval;

Patient Placement. Establishment of a utilization management approach such that beneficiaries have access to SUD services at the appropriate level of care and that the interventions are appropriate for the diagnosis and level of care, including an independent process for reviewing placement in residential treatment settings within 12-24 months of demonstration approval;

. Use of Nationally Recognized SUD-specific Program Standards to set Provider Qualifications for Residential Treatment Facilities. Currently, residential treatment

Wisconsin BadgerCare Reform

Approval Period: October 29, 2024 through December 31, 2029

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