From Forbes McIntosh, WALA Lobbyist:
At a meeting of the Wisconsin Long-Term Care Advisory Council on January 8, 2013, the Department of Health Services (DHS) provided a summary of the changes to the DHS 2013 Family Care MCO contracts – including a new provision that we reported on previously that stipulates that MCO contracts with “residential” providers remain valid for one year (with some exceptions).
Other changes to the state’s Family Care contract with MCOs include:
- Clarifies the use of “residential care services” only in the following circumstances:
- When member’s long-term care outcomes cannot be cost-effectively supported in the member’s home; or
- When member’s health and safety cannot be adequately safeguarded in the member’s home; or
- When residential care services are a cost-effective option for meeting the member’s long-term care needs.
- Provides simplified definitions of long-term care and personal experience outcomes.
- Adds a $1,000 “Money Follows the Person” (MFP) relocation incentive payment to MCOs for each member who is relocated from an institution into a community setting consistent with federal guidelines. The MCO will submit before December 31 of the contract year a list of members for whom the MCO anticipates a receipt of an incentive payment. The Department will compare the MCO’s list of members to their list of Medicaid members for whom the Department is receiving an enhanced Medicaid match through the MFP program. This will determine the number of relocations to use for calculation the incentive payment to the MCO.
- Adds that DHS will provide an add-on to the capitation rate for members with a nursing home level of care to assist the MCO in the purchase of automated, in-home medication dispensing systems.
- Changes to the grievance and appeals process.
- Click here to read the summary of substantive changes (low-resolution image).