Provider Meet & GreetDANE COUNTY – OCTOBER 24-26, 2017

Partnering for Success

My Choice Family Care

WHO ARE WE?

AN OVERVIEW OF MY CHOICE FAMILY CARE

My Choice Family CareDEDICATED TO QUALITY, COST EFFECTIVE SERVICES

Experience MattersMy Choice Family Care has been

a Managed Care Organization

since 2000 in Milwaukee County,

one of the State’s pilot Family

Care counties.

Dedicated to Vulnerable Citizens

• Frail Elders

• Adults with Physical Disabilities

• Adults with Intellectual and

Developmental Disabilities

My Choice Family CareGREAT PARTNERSHIPS TO IMPROVE QUALITY OF LIFE

Our recent expansion efforts include:

• Rock County – effective July 1, 2016, Wisconsin Department of Health Services introduced Family Care into this former waiver county.

• Geographic Service Region 2 – My Choice Family Care will be a new MCO within this region effective January 1, 2018.

• Geographic Service Region 3 – My Choice Family Care will be a new MCO within this region effective January 1, 2018.

• Dane County – effective February 1, 2018, the Family Care program will also be expanding into Dane County.

For the past 17 years,

My Choice Family Care

has been administering

the Family Care benefit

package and has served

over 27,300 Members.

MCFC looks forward to

creating new provider

partnerships with those

of you who stand beside

us in our mission of

participation, honoring

choice and providing

quality, cost-effective

supports and services.

My Choice Family CareService regions

My Choice Family Care

Waiver Program

and

Family Care

Similarities

and

Differences

Provider Contracting

HANNAH HARRISPROVIDER RELATIONS & NETWORK MANAGER

Provider Contracting TeamHannah Harris, Provider Relations & Network Manager

Provider Relations & Network Specialists

Diane Baumbach Mary Swanson

Jessica Cullen Randy Westley

Kelli Macon Sheri Wojtowicz

Debora Rieder

**PLEASE SEE THE HANDOUT PROVIDED FOR YOUR ASSIGNED

CONTRACTING REPERSENTATIVE.

Some of the provider services needed include:

CONSULTING SERVICES COUNSELING/THERAPEUTIC SERVICES

*Financial Management

*Housing Counseling EMPLOYMENT/ACTIVITY SERVICES

*Relocation Services *Adult Day Care

*Support Broker *Employment Services

*Prevocational Services

EQUIPMENT & SUPPLIES *Supported Employment

*Adaptive Aids *Vocational Planning and Support

*Comminication Aids

*Personal Emergency Response System MISCELLANEOUS HOME BASED SERVICES

*Specialized Medical Equipment *Home Delivered Meals

*Home Modifications

RESIDENTIAL

*Adult Family Home TRAINING BASED SERVICES

*Community Based Residential Facility *Consumer Education & Training

*Residential Care Apartment Complex *Daily Living Skills Training

*Self Directed Support

TRANSPORTATION *Supportive Independent Living Services

Provider Network Needs

• Contracting is actively calling providers to

introduce MCFC and our mission.

• We are currently accepting applications from

providers for all covered services of the

Family Care program.

• Those interested please contact us or

complete the online application.

• Provider trainings/orientations are tentatively

scheduled for mid November, December and

January. Additional dates and times can be

added if interest exists.

Provider Network EffortsPROVIDER OUTREACH HAS BEGUN

Care Planning and Coordination

KAREN ENGLANDCARE MANAGEMENT ADMINISTRATOR

• The Member is the center of their Interdisciplinary Team (IDT), along with their RN and CM.

• Collaborate to assess, coordinate, and monitor the options available to meet a Member’s health and safety needs and long-term care outcomes.

• IDT staff are responsible to provide on-going care management through regular face-to-face and phone contact.

Care ManagementSUPPORTING MEMBERS TO ACHIEVE THEIR

OUTCOMES

• Providers play a very important role in

Members’ lives and supporting them in

achieving their goals and outcomes.

• It is essential to Member care that the

IDT Staff develop good working

relationships with the staff that provide

care to our Members.

Providers’ Role in Care PlanningCOLLABORATION FOR MEMBER OUTCOMES

• This relationship can only be

successful if there is ongoing

communication between the IDT Staff

and the Member’s supports.

– Ongoing assessment process

– Problem solving

– Monitor quality and contractual adherence

– Evaluate progress on Member outcomes

and continued need for service.

– Assure member satisfaction

IDT and Provider Communication

• The IDT Staff may visit members at

their homes, residential facilities

and/or day and work programs.

• The IDT Staff may review Member’s

records containing:– Individual Service Plan (ISP)

– Progress Notes

– Behavior Support/Intervention Plans and tracking

• Participation in Care Conferences and

Care Planning

• Incident reporting

Coordination with Providers

• Participation in Care Conferences and

Care Planning– Helps ensure an accurate understanding of

Member’s functioning and abilities within the

home and the care and services provided.

• The facility is required to inform the

IDT of all critical incidents, changes in

condition, medical appointments, and

any Member absences from the

facility, including hospitalizations.

Coordination with Providers

(Residential)

Provider Quality

WES ALBINGER

PROVIDER QUALITY MANAGER

• Develop, communicate, and monitor

contract requirements to ensure MCO

compliance with State and to promote

provider quality

• Contract requirements are principally

derived from MCFC’s contract with

State DHS and should be largely

consistent with those you may already

be following for other FC payors

Provider QualityCOMPLIANCE WITH CONTRACT REQUIREMENTS

• Provide technical assistance to network

providers on contract requirements

• Collaboration-Liaison between provider

community and MCO

• Identify areas for growth and expansion

of network to ensure access and

choice to members

• Identify areas for training and other

support to providers

Provider Quality, continued

• Informal resolution process

• Background checks

• Provider Survey

• Training: provider onboarding training

• Provider Advisory Groups

• Member satisfaction surveys

• Provider Newsletter

Provider Quality RECENT AND ONGOING PROVIDER QUALITY INITIATIVES

Provider Portal

MARY JO SAGGIOCLAIMS SPECIALIST

Payment and/

or Provider

Remittance

Advice Sent

Authorization and Payment Process

WPS Process

Claim

According to

Authorization

Provider

Submits Claim

to WPS Via the

Midas Portal

Provider

Submits Claim

to Other

Insurance or

Medicare

Provider

Performs

Authorized

Service

Provider

Receives

Authorization

from MCO

WPS Receives

Authorization

from MCO

Managed Care

Organization

(MCO)

Authorizes the

Approved

Service

Member Needs

Family Care

Approved

Service

Authorizations

1. System:

Provider Portal

2. Login ID and

Password

3. Environment:

Production

4. Login

www.mcfc-midas.com

5 Steps To A Clean Claim

Please visit MyChoiceFamilyCare.org

• Providers Tab

• Become a Provider

• Choose the “Request for Application” link

Quick Link to Request for Application:

https://www.mcfc-midas.com/providerapplication/

Next StepsI’D LIKE TO BECOME A PROVIDER.

WHAT DO I DO NEXT?

Session I – Employment and

Day Services

• My Choice Family Care has a strong

commitment to ensuring all members

have access to community employment

My Choice Family Care

PRE-VOCATIONAL, SUPPORTED

EMPLOYMENT AND DAY

SERVICES

Prevocational Services

PREVOCATIONAL SERVICES ARE THE

PROVISION OF SERVICES INTENDED TO

PREPARE AN INDIVIDUAL FOR PAID

EMPLOYMENT BUT WHICH ARE NON-JOB

SPECIFIC.

• National trend is towards community based services.

• Community Based prevocational services.

• Facility-based prevocational services.

• Members age 18 thru 25 years must have a integrated employment goal to receive facility based services.

• For this age group MCFC will be utilizing prevocational services through DVR.

My Choice Family CarePREVOCATIONAL SERVICES

Supported Employment

SUPPORTED EMPLOYMENT IS THE

PROVISION OF SUPPORT TO MAINTAIN

PAID, COMPETITIVE EMPLOYMENT IN AN

INTEGRATED WORK SETTING TO

INDIVIDUALS WHO, BECAUSE OF THEIR

DISABILITIES, NEED ON GOING SUPPORT

TO PERFORM IN A WORK SETTING.

• Job Development is completed using DVR funding.

• Job Coaching is initially funded by DVR and is transitioned to Long Term Care when member is stable.

• DVR/MCO Transportation funding roles.

• Work Incentive Benefits Counseling

• Post- employment services with DVR

• MCFC CM’s will play an integral role through out the DVR process.

Supported Employment IN COLLABORATION WITH DEPARTMENT OF VOCATIONAL REHABILITATION (DVR)

• Provider to work with MCFC CM.

• JD & JC reports submitted to CM.

• Prevocational services 6-month

progress report & service plan.

• Employment Outcome Data Collection

through PPS System.

• End of the year report.

Provider Expectations REPORTING

• Day center service- provided

traditionally to members with

developmental, intellectual, or cognitive

disabilities geared to help them learn

activities of daily living, community

living skills, and socialization skills in a

controlled environment with their peers.

Day Programming ServicesDEFINED

• Written program statement, or model,

outlining the services, days and hours

of operation, and the goals of their

program.

• Staff shall be trained in the needs and

intervention strategies involved with

members, which include but are not

limited, to developmental, cognitive,

and intellectual disabilities.

Day Programming Services EXPECTATIONS

• Standard Day Service Program

• Medical Assistance Day Program -

• Medical staff required on-site due to Members’ medical needs

- Nursing staff required for medication administration, tube feedings, etc

- Medication management - ordered by primary care provider and not duplicated in-home/residential setting

- Daily Injections

- Bed or chair bound – requires two person assist for re-positioning

- Hoyer transitions

Day Programming ServicesSTRUCTURE

• Behavioral Assistance Day Program

- Elopement risk

- Physical or verbal threats to themselves or others

- Requires physical redirection

- Impulsive behavior – acting out, high volume speaking, etc.

• One to One Assist Day Program

- Behavioral Support Plan and tracking provided by the provider to support need for 1:1

- Persistent self-injurious behavior

- Significant elopement risk

- PICA diagnoses

Day Programming Services Cont.STRUCTURE

Session II - Transportation

• A common carrier, specialized medical

vehicle or other provider who directly

conveys a member and their attendant,

if any, to destinations

• These services enable a member to

gain access to community services,

activities and resources, as specified in

the member’s care plan

• Excludes emergency medical

transportation

Transportation ServicesDEFINED

• Drivers should be easily identified with

company name badges. Company logo

and/or signage on vehicles clearly

visible.

• Vehicles kept clean and in good repair.

• MCFC embraces the Medicaid

requirement of door-to-door service

expected for all rides, SMV and

ambulatory.

• Passenger logs

Transportation ServicesPROVIDER EXPECTATIONS

• Driver background checks, licensed

and insured drivers

• Safe driver and defensive driving

training

• Red Cross or equivalent training in first

aid CPR

• Instruction for the use of lifts, ramps,

and restraint devices

• Comply with DHS Weekly Driver’s

Vehicle Inspection

Transportation ServicesPROVIDER QUALITY

Session III –

Supported Independent living

Scope of Services

Supported Independent Living Service (SIL) is a combination of services to provide assistance to eligible persons in non-regulated settings in order to meet their daily living needs and to insure adequate functioning at home and in the community.

SIL is flexible and member centered, and can be effective across a wide range of support needs.

Members are assessed, and a service plan is developed,

by the member’s IDT, who will consult with the member

and others who have knowledge of the member’s needs

and preferences, such as guardians, family, friends, and

providers).

The SIL Assessment captures many domains of need,

including: Bathing, Dressing, Eating, Mobility, Toileting,

Transferring, Grooming, Meal Preparation, Laundry,

Chores, Budgeting, Medically Oriented tasks, and Mental

and Behavioral Support.

A level of overall assistance is generated which reflects

the type and frequency of assistance the member needs.

Scope of Services

SIL providers play an important, defined

role as described in the member’s care plan. In most cases, SIL providers are one of multiple service providers, including informal/natural supports.

Some activities, although related to independent living, are organized as separate services and are therefore outside the scope of responsibility for the SIL provider.

Scope of Services

Examples include, but are not limited to: transportation, daily living skills training, vocational services, rep payee.

SIL services bear some similarity in scope with Supportive Home Care and Personal Care services.

The selection of specific services is determined by the IDT based on member needs.

Scope of Services

Session IV – Residential Providers

and Services

• Role of Residential Provider

• Compensation

• Payment for Member Absence from

Residential Setting

• Residential Placement of Members

• Residential Scope of Services

Residential Services Overview

A contract with My Choice Family Care

for community residential services

incorporates the services and supports

listed below. This list is not all

encompassing, but a listing of general

categories and examples of costs

typically incurred in each category.

Rates for community residential services

include the following items and supports:

Scope of ServicesIN COMMUNITY RESIDENTIAL SETTINGS ADULT FAMILY

HOME AND COMMUNITY BASED RESIDENTIAL FACILITY

• Physical Space

• Furnishings

• Equipment

• Housekeeping Services

• Building Maintenance

• Grounds Maintenance

• Building Protective Equipment

• Building Support Systems

• Fire and Safety Systems

• Food

• Telephone and Media Access

Physical EnvironmentROOM AND BOARD RATE

• Support and Supervision

• Personal Care, Assistance with Activities of Daily Living

and Daily Living Skills Training

• Activities, Socialization and Access to Community

• Health Monitoring

• Medication Management

• Behavior Management

• Facility Supplies First Aid Supplies - including gauze pads,

blood pressure cuffs, stethoscopes, thermometers, cotton

balls, medication, specimen cups

• Facility Equipment

• Personal Protective Equipment for Staff Use –

including gloves, gowns, masks

• OSHA and Infection Control Systems

• Resident Funds Management

• Transportation

Program ServicesCARE AND SUPERVISION RATE

Go to: www.ewala.org

Affordable Liability Insurance Coverage for

Residential Providers Available Through Wisconsin

Assisted Living Association and M3 Solutions, Inc.

Session V – Behavioral

Health, Personal Care and

Supportive Home Care

• COVERED SHC BENEFITS

• SERVICE REQUIRMENTS

• PRE AUTHORIZATION

• REIMBURSEMENT

SUPPORTIVE HOME CARE SERVICESoverview

BEHAVIORAL HEALTH SERVICEOVERVIEW

• COVERED BH BENEFITSMENTAL HEALTH, AODA (ALCOHOL AND OTHER

DRUG ABUSE), CSP (COMMUNITY SUPPORT

PROGRAMS), IN-HOME THERAPY

• SERVICE REQUIREMENTS

• PRE AUTHORIZATION

• MEDICAID REIMBURSEMENT

• COVERED PC BENEFITS

• SERVICE REQUIRMENTS

• PRE AUTHORIZATION

• MEDICAID REIMBURSEMENT

PERSONAL CARE SERVICESoverview

Session VI – All Other

Services (DME/DMS, Home

Modifications and Other

Therapies)

• COVERED DME/DMS BENEFITS

• SERVICE REQUIRMENTS

• PRE AUTHORIZATION

• MEDICAID REIMBURSEMENT

DURABLE MEDICAL EQUIPMENT & SUPPLIES

overview

• Supervision

• Personal Care, Assistance with Activities of Daily Living

and Daily Living Skills Training

• Activities, Socialization and Access to Community

• Health Monitoring

• Medication Management

• Behavior Management

• Facility Supplies First Aid Supplies - including gauze pads,

blood pressure cuffs, stethoscopes, thermometers, cotton

balls, medication, specimen cups

• Facility Equipment

• Personal Protective Equipment for Staff Use –

including gloves, gowns, masks

• OSHA and Infection Control Systems

• Resident Funds Management

• Transportation

Program ServicesCARE AND SUPERVISION RATE

My Choice Family CareRATE SETTING METHODOLOGY

How are provider rates determined?

What is care under management?

How do costs in Dane County

compare to other Wisconsin Counties?

Partnering with

You to Serve our

Community

THANK YOU FOR

JOINING US TODAY!

We look forward to partnering with you!