School-Based Services Expansion

REQUIREMENTS: By July 23, 2025: Billing team must attend the mandatory ForwardHealth online information session (9:30–10:30 a.m.) or review the recorded session posted to the ForwardHealth Portal Trainings page. This session will provide detailed billing guidance, allowable procedure codes, and claims submission information. Before August 1, 2025 (start of 2025–2026 school year): - Update billing system to recognize expanded member eligibility criteria: students with IEP, IFSP, 504 Plan, Individualized Health Plan, Behavioral Health Plan, or other medical professional-developed plans with established medical necessity - Credential new provider types in your system: clinically trained mental health professionals, physicians with prescribing authority, dentists, and dental hygienists (all must be employed by or contracted with local education agency) - Ensure documentation templates capture required plan details: medical need justification/disability condition statement, service list, start/end dates, scope, frequency, and duration - Establish process to obtain and retain complete plan documentation per Wis. Admin. Code § DHS 106.02(9); DHS will audit these records and deny/recoup payment for services lacking required documentation Ongoing (Effective 2025–2026 school year): - Bill for newly covered services once procedure codes are released in future ForwardHealth Updates (monitor ForwardHealth Portal and email subscription for 2025–2026 updates) - Verify all school-based service claims include required plan documentation or claims will be denied and previously paid claims may be recouped - Provide providers with documentation checklists to prevent claim denials and sanctions CONSEQUENCES: Failure to maintain required documentation may result in claim denials, recoupment of paid claims, intermediate sanctions, or termination from the Medicaid program.