Below you will find a list of available service categories, and a summary of what they cover.
Adaptive Aids-General and Vehicle
Adaptive aids are devices, controls or appliances that enable persons to improve or maintain their abilities to perform activities of daily living, participate in typical home and community activities, control their environment and prevent institutionalization. Adaptive aids facilitate independence and may decrease the need for attendant care and reduce the risk of institutionalization. Allowable adaptive aids are items or devices that meet the objectives described in this definition. The list below contains examples of the items or services that may be allowable. The list is instructive and not intended to be an all-inclusive description of allowable items, devices or services. To effectively respond to new technology, items or devices that are not specifically described below may be allowed when it is demonstrated that the item or device will accomplish the purpose and objective of this service and meet an assessed need.
- Van/vehicle lifts, lift/transfer units (manual, hydraulic or electronic), standing boards/frames
- Wheel chairs, walkers and other assistive mobility devices
- Control switches, pneumatic devices, including sip and puff controls
- Portable ramps, over the bed tables, hygiene/meal preparation aids
- Environmental control units, electronic control panels, adaptive security systems, door handles and locks
- Prosthetic devices
- Computer and necessary software
Adult Day Care
Adult day care services are the provision of services for part of a day in a non-residential group setting to adults who need an enriched social or health-supportive experience or who need assistance with activities of daily living, supervision and/or protection. Services may include personal care and supervision, light meals, medical care, and transportation to and from the day care site. Transportation between the member's place of residence and the adult day care center may be provided as a component of adult day care services. The cost of this transportation is included in the rate paid to providers of adult day care services. Meals provided as part of adult day care may not constitute a "full nutritional regimen" (3 meals per day).
Adult Family Home 1-2 Beds
An adult family home is a place in which the operator provider care, treatment, supports or services above the level of room and board for up to two adults. Services typically include supportive home care, personal care and supervision. Services may also include transportation and recreation/social activitie, behavior and social support, and daily living skills training.
**For information regarding additional available 1-2 Adult Family Home providers, please call our Toll free number and request to speak with an AFH Coordinator at 877-785-6266.
Adult Family Home 3-4 Beds
An adult family home is a place in which the operator provider care, treatment, supports or services above the level of room and board for up to two adults. Services typically include supportive home care, personal care and supervision. Services may also include transportation and recreation/social activity, behavior and social support, and daily living skills training.
**For information regarding additional available 1-2 Adult Family Home providers, please email CLI-AFHQuestions@inclusa.org
**For information regarding available Respite providers, please email CLI-AFHQuestions@inclusa.org
Alcohol and Other Drug Abuse Day Treatment
Alcohol and Other Drug Abuse (AODA) day treatment service is a medically monitored, and non-residential substance abouse treatment service which consists of r egularly scheduled sessions of various modalities, such as individual and group counseling and case management, provided under the supervision of a physician. Services are providerd in a scheduled number of sessions per day and week, with each patient receiving a minimum of 12 hours of counseling per week.
Alcohol and Other Drug Abuse Services
This service provides a combination of medical and AODA services provided by state-certified programs. Specific services include individual, group, and family therapy and educational programming specific to medial aspects of AODA diagnosis and treatment.
Care Management/Support and Service Coordination
Care management/support and service coordination is the provision of service to locate, manage, coordinate and monitor all Inclusa program services and informal community supports provided to eligible members and to assure that services are provided in accordance with program requirements. This service is intended to insure the Family Care program member’s health and safety by enabling the member to receive a full range of appropriate services and supports consistent with his/her assessed needs in a planned, coordinated, efficient and cost effective manner. While these general guidelines apply to all care management/support and service coordination provided, the service activities may be target group or age-specific. This service includes assistance with establishing financial, functional and all other aspects of Family Care eligibility. Service may also include assisting the member to access medical, social and natural supports and services. Beyond plan development and service coordination activities, the interdisciplinary staff role includes the primary responsibility to assure member health and safety.
Communication Aids/Interpreter Services
Communication aids are those devices or services necessary to assist persons who have hearing, speech or vision impairments or a language barrier to effectively communicate with family, friends, caregivers, service providers, medical professionals or the community at large. Allowable communication aids include devices that assist the member to achieve the defined objective of this service. Examples of allowable items or devices are listed below. The list is illustrative and not all-inclusive. To effectively respond to new technology, additional items or devices not specifically named may be allowed when it is demonstrated that the item or device will accomplish the objective of this service and meet an assessed need.
Communication aids may include:
- Assistive listening devices
- Telecommunication equipment
- Low vision magnification equipment
- Braille writing equipment
- Augmentative communication devices
- Visual fire alarm systems
- Direct selection communicators
- Alphanumeric, scanning or encoding communicators
- Speech amplifiers
- Cellular phones, personal pager systems, telephone answering machines
- Interpreter service
- Computers and necessary software
Community Based Residential Facility
A Community Based Residential Facility (CBRF) is a state licensed facility where five or more unrelated adults reside, in which care, treatment or services above the level of room and board but not including nursing care are provided to residents as a primary function of the facility (DHS 83.03).
Community Support Program
Community Support Program (CSP) services include medical and psychosocial / rehabilitative services, enabling the member to better manage the symptoms of his/her illness, to improve independence, and to achieve effective levels of functioning in the community. Services include: assessment, evaluation, and treatment planning. Additionally, family, individual, and group psychotherapy, medication administration and monitoring are included. CSP also provides 24-hour crisis intervention; ongoing psychiatric and psychological evaluation; case management, ongoing monitoring and service coordination; and Clozapine management.
Consultative Clinical and Therapeutic Services for Caregivers
The purpose of consultative services is to improve the ability of unpaid caregivers and paid direct support staff to carry out therapeutic interventions. Clinical and therapeutic services assist unpaid caregivers and/or paid support staff in carrying out the member's treatment/support plans, are not covered by the Medicaid State Plan and are necessary to improve the member's independence and inclusion in their community. The service includes assessments, development of home treatment plans, support plans, intervention plans, training and technical assistance to carry out the plans and monitoring of the member and the caregiver/staff in the implementation of the plans. This service includes the provision of training for caregivers/staff that are or will be serving members with complex needs (beyond routine care). For example, when an individual with complex needs is relocating from one of the State Centers for the Intellectually Disabled, this service could be used to train caregivers/staff on the behavioral support plans necessary for community integration. This service may also include consultation with service providers and potential providers to identify providers that can meet the unique needs of the member and to identify additional supports necessary for caregivers to perform therapeutic interventions. Excludes training in member self-advocacy or caregiver advocacy on behalf of a member, which are covered under consumer education and training.
Consumer Education and Training
The provision of educational services to help the member develop self advocacy skills, exercise civil rights and acquire the skills needed to exercise control and responsibility over their other supportive services. Educational services may include individualized tutoring and instruction, and instructional materials. Covered expenses may include enrollment fees, books and other educational materials and transportation related to participation in training courses, conferences and other similar events that address the objectives of this service category.
Counseling and Therapeutic Resources
Services included treat a personal, social, behavioral, cognitive, mental or alcohol or drug abuse disorder. Services are usually provided in a natural setting or service office. Services include: counseling to assist in understanding capabilities and limitations or assist in the alleviation of problems of adjustment and interpersonal relationships, recreational therapy, music therapy, nutritional counseling, medical and legal counseling, and grief counseling.
Day services programs provide regularly scheduled, individualized skill development activities to members. Services are typically provided in a non-residential setting. Program goals may include developing/enhancing member skills for social interaction, communication, or community integration. Day services must have a training component providing service above the level of supervision. Services are typically provided four or more hours per day, up to five days per week outside the home of the member. Services may occur in a single physical environment or multiple environments or in the community at large.
Daily Living Skills Training
Daily living skills training services provide education and skill development or training to improve the member’s ability to independently perform routine daily activities and effectively utilize community resources. Services are instructional, focused on skill development and are not intended to provide substitute task performance. Daily living skills training may include skill development in:
- Personal hygiene
- Food preparation
- Home upkeep/maintenance
- Money management
- Accessing and using community resources
- Community mobility
Durable Medical Equipment
Durable medical equipment (except hearing aids and prosthetics) includes iron lungs, oxygen tents, hospital beds, and wheelchairs (which may include a power-operated vehicle that may be appropriately used as a wheelchair) used in the patient's home (including an institution used as a home), whether furnished on a rental basis or purchased, and includes blood-testing strips and blood glucose monitors for individuals with diabetes.
Financial Management Services
Financial management services are services that assist members and their families to manage service dollars. This service involves a person or agency paying service providers after the member, guardian or family authorizes payment to be made for services included in the member’s approved individualized service plan. Financial Management Services providers, sometimes referred to as fiscal intermediaries, are organizations or individuals that pay bills for personnel costs, tax withholding, worker’s compensation, health insurance and other taxes and benefits appropriate for the specific provider consistent with the individual’s ISP. The Financial Management service provider or fiscal intermediary serves at the request of the agency and is made available to the member to insure that appropriate compensation is paid to providers of services. This service also includes paying bills authorized by the member or their guardian, keeping an account of disbursements and assisting the member ensure that sufficient funds are available for needs.
Home Delivered Meals
Home delivered meal services include the provision of meals to members who are at risk of institutionalization due to inadequate nutrition. Home delivered meal costs include the purchase and planning of food, supplies, equipment and labor, as well as the transportation costs associated with the delivery of one or two meals per day to the member’s home. Members provided with home delivered meals may be unable to plan, prepare or obtain nutritional meals without assistance or may be unable to manage a special diet recommended by their physician. Generally these meals are provided in the member’s home. This service does not constitute a full nutritional regime.
The term “home health services” means the following items and services furnished to an individual, who is under the care of a physician, by a home health agency under a plan (for furnishing such items and services to such individual) established and periodically reviewed by a physician, which items and services are provided on a visiting basis in a place of residence. Services may include part-time or intermittent nursing care provided by or under the supervision of a registered professional nurse, as well as physical or occupational therapy or speech-language pathology services.
Home modifications are those services that are designed to assess the need for, arrange for and provide modifications and/or improvements to a member’s residence that address a need identified to improve health, safety, accessibility, or provide for the maximization of independent functioning. Home modifications may include the materials and services needed to complete the installation of specific equipment, the modification of the physical structure, or the reconfiguration of essential systems within the home. Home modifications are generally permanent fixtures/changes to a physical structure.
The provision of services to members is to provide people with comprehensive guidance on housing opportunities available to meet their needs and preferences. This may include guidance on how a member may gain access to available public and private resources available to assist the person to obtain or retain safe, decent, accessible, and affordable housing and avoid institutionalization. Housing Counseling includes planning, guidance and assistance in accessing resources related to:
- Home ownership, both pre and post purchase
- Home financing and refinancing
- Home maintenance, repair and improvements including abating environmental hazards
- Rental counseling, not including any cash assistance
- Accessibility and architectural services and consultation
- Weatherization evaluation and assistance in accessing these services
- Lead based paint abatement evaluation
- Low income energy assistance evaluation
- Access to transitional or permanent housing
- Accessibility inventory design
- Health and safety evaluations of physical property
- Debt /credit counseling
- Homelessness and eviction prevention counseling
Medical supplies include items necessary to maintain the participant’s health, manage a medical or physical condition, improve functioning or enhance independence. Allowable items or devices may include incontinence supplies, wound dressings, IV or life support equipment, orthotics, nutritional supplements, vitamins, over the counter medications and skin conditioning lotions/lubricants. Additionally, allowable items may include books and other therapy aids that are designed to augment a professional therapy or treatment plan.
Mental Health Services
**Not inpatient or physician provided
Services available under this benefit include: evaluations, assessments, testing, group, and family psychotherapy, collateral contacts, and psychiatric medication management.
Mental Health Day Treatment Services
Mental Health Day Treatment Services include a combination of medical, mental health, occupational therapy, and other services provided by state-certified day treatment programs. Specific services include individual and group occupational therapy and psychotherapy, medication management, symptom management, psychosocial rehabilitation services, and nursing services.
A nursing home is normally the highest level of care for older adults outside of a hospital. Nursing homes provide what is called custodial care, including getting in and out of bed, and providing assistance with feeding, bathing and dressing. However, nursing homes differ from other senior housing facilities in that they also provide a high level of medical care. A licensed physician supervises each patient’s care and a nurse or other medical professional is almost always on the premises. Skilled nursing care is available on site, usually 24 hours a day. Other medical professionals such as occupational or physical therapists are also available. This allows the delivery of medical procedures and therapies on site that would not be possible in other housing.
Nursing services are those medically necessary, skilled nursing services that may only be provided safely and effectively by a nurse practitioner, a registered nurse, or a licensed practical nurse working under the supervision of a registered nurse. The nursing services provided must be within the scope of the Wisconsin Nurse Practice Act and are not otherwise available to the member under the Medicaid state plan. Nursing services may include periodic assessment of the member’s medical condition when the condition requires a skilled nurse to identify and evaluate the need for medical intervention or to monitor and/or modify the medical treatment services provided by nonprofessional care providers. Services may also include regular, ongoing monitoring of a member’s fragile or complex medical condition as well as the monitoring of a member with a history of noncompliance with medication or other medical treatment needs.
*In all settings except inpatient hospital
Occupational therapy based on engagement in meaningful activities of daily life (as self-care skills, education, work, or social interaction) especially to enable or encourage participation in such activities despite impairments or limitations in physical or mental functioning.
Personal care services are medically oriented activities related to assisting a recipient with activities of daily living necessary to maintain the recipient in his or her place of residence in the community. These services shall be provided by a provider certified under s. DHS 105.17 and by a personal care worker employed by the provider or under contract to the provider who is supervised by a registered nurse according to a written plan of care. The personal care worker is limited to performing only those tasks and services as assigned for each recipient and for which he or she has been specifically trained.
Personal care services include:
- Assistance with bathing
- Assistance with getting in and out of bed
- Teeth, mouth, denture and hair care
- Assistance with mobility and ambulation including use of walker, cane or crutches
- Changing the recipient’s bed and laundering the bed linens and the recipient’s personal clothing
- Skin care excluding wound care
- Care of eyeglasses and hearing aids
- Assistance with dressing and undressing
- Toileting, including use and care of bedpan, urinal, commode or toilet
- Light cleaning in essential areas of the home used during personal care service activities
- Meal preparation, food purchasing and meal serving
- Simple transfers including bed to chair or wheelchair and reverse
- Accompanying the recipient to obtain medical diagnosis and treatment
Personal Emergency Response System Services
A personal emergency response system is a service that provides immediate assistance in the event of a physical, emotional, or environmental emergency through a community based electronic communications device. This service can provide a direct link to health professionals, enabling the user to secure an immediate response by the activation of an electronic communications unit in the member’s home. Allowable items under this service may also include a cellular telephone and cellular service used when a conventional PERS system is not feasible.
Pre-vocational services are the provision of services to teach an individual the skills necessary to succeed in employment. Services occur over a defined period of time and involve training and the provision of opportunities for experiences that enhance basic work-related skills. Training is intended to teach individuals concepts necessary to effectively perform a job in the community and may include following directions, attending to tasks, task completion, appropriate responses to supervisors/co-workers, attendance/punctuality, problem solving, safety and mobility training. Work-related skills include reporting to work on time, taking proper sanitary measures, wearing appropriate clothing, acting in a manner that is appropriate to the situation and other skills necessary for successful employment. Services include supervision and training. The focus is on general habilitative rather than specific employment goals.
**In all settings except inpatient hospital
Physical therapy involves the treatment of disease, injury, or disability by physical and mechanical means (as massage, regulated exercise, water, light, heat, and electricity).
Residential Care Apartment Complex (RCAC)
Residential care apartment complex (RCAC) means a place where five or more adults reside and which consists of independent apartments, each having an individual lockable entrance and exit. Each unit will have a kitchen, including a stove or microwave oven (of at least 1000 watts), an individual bathroom, sleeping and living areas. The RCAC may provide to residents of the place, not more than 28 hours per week of supportive, personal and nursing services.
An RCAC does not include a nursing home or a community based residential facility, but may be physically part of a structure that is a nursing home or community based residential facility (DHS 89.13 (1). To be an allowable setting, the facility or a distinct part of the facility must be state certified as an RCAC.
RCAC services means services provided by an RCAC, either directly or under contract, to meet the needs identified in a tenant’s service agreement, to meet unscheduled care needs or to provide emergency services 24 hours a day (DHS 89.13 (2). In addition to supportive, personal and nursing services provided directly by the RCAC, other persons or agencies may also provide services directly or under arrangement with the RCAC, that supplement but do not supplant those provided by the facility.
Relocation related services (106.01) include the payment of certain costs associated with relocating from an institution. Costs may include the initial fees to establish utility service or the purchase of essential items and services needed to establish a community living arrangement.
Relocation related housing start up services (106.03) includes person-specific services, supports or goods that may be arranged, scheduled, contracted or purchased, and that will be put in place in preparation for the member’s relocation to a safe, accessible community living arrangement. There is no institutional length of stay requirement that must be met in order to access this service.
Several resources are available through Inclusa for relocation services. All relocation services are coordinated through the Member’s Inclusa Social Worker.
Respite Care: non-institutional and institutional settings
Respite care services are those services provided to a member on a short-term basis, to relieve the member’s primary caregiver(s) from care demands.
Respite care services may be provided in a residential setting, institutional setting, the home of the member, or in another community setting not described above.
**For information regarding available Respite providers, please contact one of our Residential Coordinators directly
Speech and Language Therapy Services
**In all settings except inpatient hospital
This service includes the treatment of problems with communication because of congenital causes, accidents, or illness. Speech and language therapists are allied health professionals who have special training in this field.
SDS Support Broker
An individual who assists a member in planning, securing and directing self-directed supports. The services of a support broker are paid for from the member’s self-directed supports budget authority. Support brokers are subject to criminal background checks and must be independent of any other waiver service provider. A support broker shall be knowledgeable of the local service delivery system and local community-integrated services and resources available to the member. A support broker shall also be knowledgeable of the typical kinds of needs of persons in the member’s target group.
The member and interdisciplinary team staff are responsible to assure that a support broker selected by the member has the appropriate knowledge.
- Excludes the cost of any direct services authorized and obtained by a consumer through an SDS plan, which is paid for and reported under the appropriate service definition.
- Excludes the cost of fiscal agent services, which is paid for and reported as financial management services.
A provider of this service must have knowledge of the unique needs/preferences of the participant and the service system.
Supported Employment Services
Supported Employment is the provision of assistance to facilitate the employment of a member in an integrated work setting. These services include job development aimed at developing a position in a community job or a carved out portion of an already existing position.
Members using this service may need ongoing support to maintain employment. Specific services include vocational/ job-related assessment, job development, referral, on-the-job support and coaching, education or training and transportation. Other support services including services not specifically related to job skill training may also be provided based on the needs of the specific member served.
Supportive Home Care
Supportive Home Care (SHC) is the provision of a range of services for members who require assistance to meet their daily living needs, ensure adequate functioning in their home and permit safe access to the community. Supportive home care services include:
- Personal Services
- Assistance with activities of daily living such as eating, bathing, grooming, personal hygiene, dressing, exercising, transfer and ambulation;
- Assistance in the use of adaptive equipment, mobility and communication aids;
- Accompaniment of a member to community activities;
- Assistance with medications that are ordinarily self-administered;
- Attendant care;
- Supervision and monitoring of members in their homes, during transportation (if not done by the transportation provider) and in community settings;
- Reporting of observed changes in the member’s condition and needs; and
- Extension of therapy services. "Extension of therapy services" means activities by the SHC worker that assist the member with a PT, OT or other therapeutic treatment plan. These activities may include assistance with exercise routines, range of motion exercises, standing by during therapies for safety reasons, having the SHC worker read the therapist's directions, helping the member remember and follow the steps of the exercise plan or hands on assistance with equipment/devices used in the therapy routine. It does not include the actual service the therapist provides.
- Household Services
- Performance of household tasks and home maintenance activities, such as meal preparation, shopping, laundry, house cleaning, simple home repairs, snow shoveling, lawn mowing and running errands;
Assistance with packing and general house cleaning when a member moves
Specialized Transportation - Community (all non-medical)
Community Transportation is the provision of services or items which permit an individual to gain access to community services, activities and resources. This service may consist of items such as tickets or other fare media or services where the provider directly conveys a member and her or his attendant, if any, to destinations.
Transportation Provided by a Specialized Medical Vehicle (SMV) or common carrier to and from a location at which the recipient receives a Medical Assistance (MA) covered service on that day. Transportation services also may include lodging, meals and mileage reimbursement. Lodging and meal reimbursement and are only authorized when Medicaid services are required out of the area.
Vocational Futures Planning
Vocational Futures Planning service is a member directed, team based comprehensive employment readiness service that supports Inclusa members to obtain, maintain or advance in employment. Vocational futures planning service may consist of the following activities:
- Identification of the barriers to work, including an assistive technology pre-screen and, if required, an in-depth comprehensive assessment including any barriers that may be present as a result of stigma associated to a particular disability or aging group.
- Benefits analysis
- Career exploration
- Job seeking support
- Ongoing support