Reimbursement changes made to comply with CMS

In order to comply with federal requirements, the Mississippi Division of Medicaid (DOM) is changing the way it reimburses for targeted case management for children with serious emotional disturbance (SED), known as Wraparound, and ancillary behavioral health services. In the process DOM is increasing the reimbursement rate for Wraparound while enhancing Medicaid beneficiaries’ choice of providers.

Earlier this year the federal Centers for Medicare and Medicaid Services (CMS) directed DOM to modify reimbursement for Wraparound case management to comply with federal rules. Previously, those services were billed along with ancillary therapeutic services at a bundled, all-inclusive rate. However, CMS indicated that DOM must separate Wraparound from the ancillary support services, such as medications or psychiatric treatment. These changes, which take effect July 1, will prevent the loss of federal matching funds and ensure continued access to community services.

And to mitigate the transition, DOM has created an individual billing code for Wraparound at an enhanced rate of $1,200 per month to encourage more providers to offer Wraparound services. Providers will then be able to bill for the individual therapeutic services separately or bill a bundled rate for Intensive Community Outreach and Recovery Team (ICORT) which includes select therapeutic services.

These changes will increase Medicaid beneficiaries’ freedom of choice by allowing them to receive Wraparound case management and other therapeutic services from different providers. Beneficiaries may also choose to receive Wraparound and therapeutic services from the same provider.

By aligning with CMS’ conflict-free case management requirements, these changes will also increase transparency, ensuring that services billed are the actual services provided.

“When the federal government decided not to pay its share of Medicaid funding for certain behavioral health services, the Division of Medicaid had to find a solution that would preserve access to care for Medicaid beneficiaries but would not leave Mississippi taxpayers holding the bag for the program’s full cost,” said Drew Snyder, executive director. “This solution complies with federal directives, qualifies for federal matching funds, increases provider reimbursement for Wraparound services, and offers more options for children and their families. We are grateful to the Medicaid providers who have delivered services previously and look forward to our continued partnership in the future.”

Published June 15, 2021