Bills Would Provide LTC District MCOs Path to Become Insurance Entities
By Forbes McIntosh, Government Policy Solutions, WALA Lobbyist
Five Family Care managed care organizations (MCOs) in Wisconsin issued separate press releases Thursday each praising the state lawmakers who have drafted a bill addressing the ability of long-term care district MCOs to become insurance entities in preparation for Family Care 2.0 in 2017.
Senate Bill 687 and Assembly Bill 856 would allow long-term care districts, which represent four of the eight existing Family Care MCOs, to restructure themselves as a non-stock \ non-profit corporation, use their existing public assets and their contracts with the Department of Health Services (DHS) toward a path of meeting insurance requirements. These MCOs argue this legislation is needed to clarify a pathway for existing organizations to become Integrated Health Agencies (IHAs) in the revised system that will be implemented if and when the DHS Family Care 2.0 Waiver is submitted and approved by the Centers for Medicaid and Medicare Services (CMS).
SB-687 and AB-856 allow the Department of Health Services to contract with a county or long-term care district to operate a care management organization outside the geographic area of that county or long-term care district. The bill specifies that DHS may award contracts to one or more certified entities to operate a care management organization within a county or geographic area. If DHS awards a contract to a long-term care district to operate a care management organization outside the geographic area of the counties that created the long-term care district, the bill allows any county that is newly served by that care management organization to join the existing long-term care district under certain circumstances at the discretion of the long−term care district’s board.
“Because of the frailties of aging or a developmental or physical disability, many people need help accomplishing activities of daily living and caring for their health,” said ContinuUs’ chief executive officer, Teri Buros, in a statement. “Managed Care Organizations administering Wisconsin’s Family Care program have a documented track record of cost-effectively assuring that our clients – we call them members – can live as independently as possible for as long as possible. The legislation introduced by Senator (Howard) Marklein and Representative (Scott) Krug provides a way for ContinuUs’ 300-plus employees, and the employees of our 2,000- plus contracted service providers, to continue our mission of stewardship as we support Wisconsin’s most vulnerable citizens.”