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What CCS can pay for and who can deliver it: program supports, roles and restrictions
Summary
In a recorded county training, Julie Winter laid out the types of supports CCS can authorize, who may provide them, and the limits ForwardHealth and DHS 36 place on services such as psychotherapy and day treatment.
Julie Winter, the quality control and improvement coordinator shared between Ashland and Bayfield counties, summarized the CCS service menu, who may fill each support, and the limits that Medicaid and DHS 36 place on certain services.
Winter said CCS is "a rehabilitative person centered program" intended for community‑based supports for people with mental health and/or substance‑use barriers and that supports "are meant to be provided in the community and or in the participant's home." That setting and the Medicaid funding stream shape what CCS will authorize.
Why this matters: service choice, clinical scope and billing rules affect whether a participant can keep an existing provider or must change providers and whether agencies must credential or contract to provide certain supports.
Key points on supports and who may deliver them - Service facilitator role: service facilitators coordinate, monitor and assess authorized supports and — per Winter — are the only role that can add or adjust supports on a participant's service plan. They also offer participants a side‑by‑side introduction to a new provider when requested. - Individual skill development and enhancement: the most commonly authorized support in these county programs; side‑by‑side teaching, modeling and cueing for daily‑living and coping skills. Winter said this support "can be provided by any role authorized in CCS," but authorized language on the service plan must clearly tie the support to the person's goal. - Peer support: filled only by certified peer specialists with lived experience and appropriate certification; Winter said peer support is "a mutually empowering relationship" and that non‑certified staff may not be authorized to deliver peer support. - Psychotherapy and day treatment: ForwardHealth requires that outpatient psychotherapy and adult mental‑health day treatment services for a person enrolled in CCS be billed through the CCS program. Winter said counties must try to contract with an established therapist if a participant already has one; if the therapist declines to contract, the participant may have to choose between remaining with that therapist outside CCS or enrolling in CCS and establishing a new therapist through the program.
Natural supports and medical necessity - DHS 36 requires exploration of natural supports first (family, friends, community services); CCS may not bill for supports that replace a natural support that is actively available. - Winter repeatedly emphasized documenting medical necessity: recreational activities can be authorized only if tied to rehabilitative, clinically justified goals (for example, learning coping skills through structured activities).
Choice, contracting and practical effects - When a vendor employs multiple staff, authorizations typically name the vendor and not a specific employee; agency supervisors assign which staff will fill the authorization. - If a provider outside the county is unwilling to contract, Winter said the participant must choose whether to remain with that provider (outside CCS billing) or start CCS with a new provider who contracts with the county.
Ending: Winter pointed providers to the ForwardHealth handbook, the counties' authorization examples and the vendor resources page for template authorizations and redacted examples showing how service facilitators write supports to match DHS 36 definitions.
