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Click
here
to view a printable version of the frequently asked questions (FAQs) on this page.
Milwaukee County held four Family Care Expansion Provider
Forums from April to May of 2008. These Forums provided an
opportunity for service providers to discuss proposed changes in
the delivery of County-administered long-term support services;
find out the questions and concerns that service providers have;
and to gather input from service providers for the planning
process.
Click
here
for a printable version of the PowerPoint that was presented at
the Forums. This presentation covers the following topics:
- What is Long-Term Care Today.
- The Milwaukee County Long-Term Care Reform Project.
- Proposed Expansion of Family Care.
- Family Care Goals / Expected Outcomes.
- How Family Care Works / What Services Are Included.
- Frequently Asked Questions (FAQs).
Below are some of the more frequently asked questions (FAQs)
raised at the Forums, along with answers.
Click on the heading or the individual questions that you would like to see
answers for.
INTRODUCTION
FAMILY CARE EXPANSION
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Question: Has Family Care expansion already been
approved?
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Question: When is it expected that the Disability
Resource Center (DRC) would be operational?
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Question: Would there be more than one County-run Care
Management Organization (CMO) under Milwaukee County’s
expanded Family Care model?
-
Question: In addition to the County’s Care Management
Organization (CMO), what are some of the other managed care
options that people would have access to if Family Care is
expanded?
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Question: Would the consumer get to choose which Care
Management Organization (CMO) to enroll in?
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Question: If a consumer currently receives Waiver
services through Disabilities Services Division (DSD), would
they automatically be eligible for the expanded Family Care
program?
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Question: If Family Care is expanded, what would happen
to an individual enrolled in the County’s expanded Care
Management Organization (CMO) when they turn 60 years old?
FAMILY CARE BENEFIT
PACKAGE
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Question: What services would be included in the Family
Care benefit package?
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Question: Under Family Care expansion, would persons
with disabilities who wish to work be able to do so?
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Question: Would recreation services be part of the
expanded Family Care benefit package?
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Question: Would respite care be a benefit that is
covered under Family Care expansion?
FAMILY CARE FUNDING
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Question: Would existing Community Options Program
(COP), Community Integration Program (CIP 1A/1B and CIP II),
and COP-Waiver funding be rolled into the funding for the
expanded Family Care program or would funding remain
separate?
-
Question: Where is the new money coming from to fund
Family Care expansion?
FAMILY CARE
SERVICE PROVIDERS
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Question: Who gets to be a service provider in the
expanded Family Care program?
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Question: Would providers need to be able to serve all
persons age 18 and older under Family Care expansion?
-
Question: Would providers contract with each Care
Management Organization (CMO) individually?
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Question: Would personal care workers need to work
through home-health agencies in order to provide services to
Family Care members?
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Question: What would happen to small agencies if Family
Care is expanded?
-
Question: Would Adult Family Homes (AFHs) need to be
licensed and certified if Family Care is expanded?
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Question: What if a provider does not want to be a
Family Care service provider?
FAMILY CARE CAPACITY
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Question: Would the expanded Family Care program include
additional Care Management Units (CMUs)?
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Question: Should providers start to build new houses and
add more beds to their operations, in order to accommodate
all of the new people that would be coming into the
long-term care (LTC) services system?
FAMILY CARE RATES
AND BILLING
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Question: How would rates for Family Care service
providers be determined?
-
Question: Would Disabilities Services Division (DSD)
service providers’ rates increase under Family Care
expansion?
-
Question: Would current Disabilities Services Division (DSD)
service providers continue to bill through Title 19 if they
become part of the expanded Family Care provider network?
-
Question: Would the expanded Family Care program
continue to use electronic payments?
-
Question: Under Family Care expansion, would 1-2 bed
Adult Family Homes (AFHs) that contract with the County’s
Care Management Organization (CMO) need to bill on a monthly
basis?
FREQUENTLY ASKED QUESTIONS
Milwaukee County held four Family Care Expansion Provider Forums
from April to May of 2008. These Forums provided an opportunity
for service providers to discuss proposed changes in the
delivery of County-administered long-term support services; find
out the questions and concerns that service providers have; and
to gather input from service providers for the planning process.
The following includes some of the questions that were
asked at the Provider Forums, with answers.
Answer: No. In order for Family Care to be expanded to adults
with disabilities between the ages of 18-59, the County Board
and the State Department of Health and Family Services (DHFS)
need to determine whether or not Family Care expansion would be
viable for Milwaukee County. The County needs to have approval
to expand the current Care Management Organization (CMO), which
is operated by Milwaukee County Department on Aging (MCDA) and
serves functionally and financially eligible individuals age 60
and older in Milwaukee County. The County also needs to submit a
Disability Resource Center Application to DHFS and have it
approved. MCDA currently operates an Aging Resource Center for
persons age 60 and over. If DSD’s DRC Application is approved,
Milwaukee County would have a certified Aging and Disability
Resource Center (ADRC). The County Board has agreed that the
County can submit the DRC Application and begin negotiating
programmatic and funding issues with the State.
Answer: The anticipated start date for the DRC is during the
first quarter of 2009. It is planned that the County’s expanded
Care Management Organization (CMO) would start enrolling persons
with disabilities between the ages of 18-59 within six months
after the DRC is operational.
Answer: No. The current proposal anticipates that the existing CMO would expand to serve eligible individuals 18 years old and
older.
Answer: At this point, it is not entirely clear what all of the CMO options would be under Family Care expansion. However, it is
anticipated that in addition to the Milwaukee County Family Care
CMO, iCare and Community Care, Inc. would also respond to the
State Department of Health and Family Services (DHFS) Request
for Proposals (RFP) for CMOs. The County is not aware of any
other entities that are interested in responding to the State’s
RFP at this time. The State decides, through its RFP process,
which entities can operate a CMO in Milwaukee County.
Community Care, Inc. may offer an integrated Partnership model
and / or a Family Care CMO and iCare may offer an integrated
managed care model under Family Care expansion. Integrated
managed care models include long-term support services as well
as acute and primary care services, like medication and
physician services. The County’s CMO would not offer acute and
primary care services, but the Interdisciplinary Team (IDT),
which consists of the Family Care member, a registered nurse
(RN), and care manager, would help the consumer coordinate these
services.There would also be a Self-Directed Supports Waiver (SDS) option
available upon Family Care expansion.
Answer: Yes. The consumer would meet with an Options Counselor
from the Aging and Disability Resource Center (ADRC) who would
explain all of the available options and help the individual
choose a CMO. Once the consumer has chosen a CMO, they would
then become part of an Interdisciplinary Team (IDT), which
includes no less than a registered nurse (RN) and a care
manager. The Team, which includes the member, would decide what
services would be most appropriate in meeting the member’s needs
and desired outcomes.
Answer: Most of the time, people who are eligible for Waiver
services like Community Options Program (COP) and Community
Integration Program (CIP) are also eligible for Family Care.
Each individual that currently receives Waiver services through DSD, however, would go through the Aging and Disability Resource
Center (ADRC) and meet with an Options Counselor. The Options
Counselor would administer the Functional Screen to re-determine
functional eligibility. Financial eligibility would be
determined by the Economic Support Division (ESD). If a person
is Medicaid (MA) eligible, and passes the Long Term Care
Functional Screen, they would be eligible for Family Care.
Answer: Currently, Milwaukee County Department on Aging’s (MCDA’s)
Family Care program serves individuals that are 60 years old and
older who have physical disabilities, developmental disabilities
and frailties of aging. However, if Family Care is expanded, the
CMO would serve eligible persons 18 and older, throughout their
lifetime, though those services may change as they age.
Therefore, if Family Care is expanded, a person turning age 60
would remain enrolled in the CMO, as long as they continue to be
functionally and financially eligible.
Answer: The Family Care benefit package includes long-term
support services like residential services, employment services,
work and day services, etc. All of the services that are offered
in the current Disabilities Services Division (DSD) Waiver
programs would be offered in the Family Care program. In
addition, the Family Care benefit includes several services not
currently provided by Medicaid (MA) Waivers including Medical
Assistance Personal Care (MAPC), Nursing Home and other services
currently paid by Title 19.
Answer: Yes. The expanded Family Care program would provide
enhanced employment opportunities, particularly for individuals
transitioning from the school system.Milwaukee County Department on Aging’s (MCDA’s) provider network
would need to be expanded to accommodate the needs of the
expanded younger population.
Answer: Family Care members receive services based on their
preferred outcomes and needs. If recreation services are a
cost-effective alternative to a service that is covered in the
Family Care benefit package, and it meets an individual’s
outcomes, then the recreation services would be available to the
member.
The Interdisciplinary Team (IDT), which consists of at least the
Family Care member, a registered nurse (RN) and care manager,
can be flexible in determining what services would be most
appropriate for the member. One of the Care Management
Organization’s (CMO’s) tasks is to find providers that offer the
services that are requested by Family Care members.
Answer: Respite is a Family Care benefit. If respite is needed
to meet a member’s needs and desired outcomes, then it would be
included in that individual’s care plan.
Answer: If Family Care is approved for expansion in Milwaukee
County, all Medicaid (MA) Waivers that Disabilities Services
Division (DSD) currently administers, would no longer be
available in Milwaukee County. Funding would transition to
Family Care once individuals have been transitioned from the
Waivers. According to the current planning assumptions,
Milwaukee County would transition the 2,500 Waiver clients into
Family Care within the first year of expansion.
Answer: There is new money coming from the State and from the
reallocation of funds from other long-term care (LTC) programs,
including Medicaid (MA) Waiver programs like Community Options
Program (COP), Community Integration Program (CIP) and the Brain
Injury Waiver (BIW), as well as some MA “card” services such as
institutions and personal care. Family Care combines all the
Federal, State, and County funds associated with these programs.
Answer: Once Family Care is expanded, providers interested in
being in the Family Care provider network would go through an
application process. Milwaukee County Department on Aging’s (MCDA’s)
website lists minimum requirements that Family Care service
providers must meet in order to be included in its provider
network.
Answer: It would be very important for providers to serve
individuals that they have experience serving. Providers would
not be asked to take on a group of individuals that they have no
experience working with. Contracts would be based on the
provider’s qualifications, ability, skill, and license to take
on certain populations.
Answer: Yes, each CMO would have its own provider network and
providers would need to contract with each CMO individually.
Providers would need to examine the various CMO options,
including the benefit packages and target populations served, to
determine which CMO, if any, it wants to contract with. The
County’s expanded CMO would serve all eligible individuals over
age 18. It is conceivable that the other CMOs would serve
individuals with disabilities under the age of 60, as well.
Answer: No, personal care workers would not need to be employed
through a home-health agency to provide services to Family Care
members. A Family Care member who chooses to self-direct his /
her care, either by enrolling in the Self-Directed Supports (SDS)
Waiver or a Care Management Organization (CMO), can hire anyone
to provide care that he /she chooses, regardless of whether or
not they are affiliated with an agency, as long as that worker
meets the Family Care standards, fits with the member’s choice,
and meets the member’s outcomes.
Answer: Changes are not anticipated for small agencies under
Family Care expansion. The County’s expanded Care Management
Organization (CMO) would need providers of all sizes. Though the
size of an agency would not effect whether or not the agency
could contract with the County’s expanded CMO, it might
determine the kinds of referrals it gets. For example, if a
small agency does not have medical staff, then consumers with
complex medical needs would probably not be referred to that
agency.
Answer: Family Care requirements for licensing and certification
are similar to the requirements under Disabilities Services
Division’s (DSD’s) current Waiver programs.
Answer: Providers can choose whether or not they want to
contract with a Care Management Organization (CMO). However,
Milwaukee County Department on Aging (MCDA) encourages providers
to look at the long-term opportunities of being in a Family Care
provider network. Because Family Care will be an entitlement for
all financially and functionally eligible individuals 18 years
old and older in Milwaukee County, there may be a need for an
increased number of providers.
Answer: Milwaukee County Department on Aging (MCDA) currently
contracts with about 26 agencies for care management services.
If Family Care expands to serve individuals with disabilities
between the ages of 18-59, additional care managers and CMUs may
be needed. Some CMUs may provide services for all persons 18 and
older and some may be age-specific or based on unique
population-specific needs.
Answer: No, the County is not asking providers to build homes or
add beds to their operations, at this time.
One of the questions on the Disabilities Services Division (DSD)
Application, which was sent to existing providers, was whether
or not providers were interested in expanding their operations
and how many additional consumers they could accommodate. DSD
and Milwaukee County Department on Aging (MCDA) are currently
working on figuring out who would enroll in County’s expanded
CMO, in order to get a sense of how many, and what kind of
providers, would be needed.
Answer: Rates are, in part, determined by the Medicaid (MA)
budget that the State Department of Health and Family Services (DHFS)
approves and also by the average cost of service for all Family
Care members enrolled in a Care Management Organization (CMO).
Each CMO receives a payment, or capitated rate, from the State.
The CMOs distribute the money to providers to provide services
for their members.
Answer: Currently, DSD pays some providers more than Milwaukee
County Department on Aging (MCDA) and it pays some providers
less than MCDA. The County would work with providers to identify
differences in rates, in order to ensure a smooth transition for
providers from the current Waiver programs into the Family Care
program. DSD cannot guarantee that providers would be paid their
current rate; some providers would not see a change in their
rates, some providers’ rates would go up, and some would go
down. Because the County is still in a planning phase to expand
Family Care, specific rates are not yet known. If rates appear
as though they would not be sufficient, the County Board and
County Executive would not go forward with expansion.
Answer: No, providers would not bill for Family Care benefits
through Title 19. Instead, providers would bill through a Third
Party Administrator (TPA). Milwaukee County Department on
Aging’s (MCDA) current Care Management Organization (CMO) has a
contract with WPS to act as its TPA.
Answer: Yes, electronic payments would continue, and, in the
future, Milwaukee County’s Care Management Organization (CMO)
will require that everyone use this system. According to
Milwaukee County Department on Aging (MCDA), providers who file
electronically are paid up to 90% of billings within 30 days;
though, most providers usually receive payment within 10 days.
Answer: Yes. In order to receive payment, providers would need
to submit claims on a monthly basis.
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