SHELLEY HANSEN-BLAKE, PRESIDENT CAPOW EXECUTIVE DIRECTOR, REM WISCONSIN Wisconsin Family Care.

Slides:



Advertisements
Similar presentations
What It Means for HCS Participants & Their Families Hill Country Community MHMR Center March 23, 2010 Changing from HCS Case Management to Service Coordination.
Advertisements

1 Wisconsin’s FAMILY CARE: ADVOCACY and APPEALS Betsy Abramson, Disability Rights Wisconsin Family Care Ombudsman Program Manager
Presented by: Melissa O. Picciola, Equip for Equality June 27, 2012.
Essential Elements of a State Rebalancing Effort Susan Reinhard, RN, PhD Senior Vice President AARP Public Policy Institute Rhode Island, May 28, 2009.
Key Findings from the Family Care Implementation and Outcomes Study Lisa Alecxih February 13, 2004.
The Department of Medical Assistance Services Barbara R. Seymour, BSW, HCCS 1.
FLORIDA SENIOR CARE Improving Medicaid Services for Florida’s Seniors Beth Kidder Chief, Bureau of Medicaid Services Agency for Health Care Administration.
1 Wisconsin Partnership Program Steven J. Landkamer Program Manager Wisconsin Dept. of Health & Family Services July 14, 2004.
1 Family Care (report 11-5) Legislative Audit Bureau January 2012.
Programs of All-Inclusive Care for the Elderly (PACE) Oklahoma Health Care Authority (OKHCA)
DSAW Family Services, Inc.. DSAW Leadership Norms DSAW Team Leadership Norms Everyone does and should bring enthusiasm to the work we do. We must all.
Core Values For a Good Long Term Care System Persons with disabilities and their families are entitled to maximum feasible choice/participation in selecting.
National Governor’s Association Winter Meeting 2008 Health & Human Services Committee Presentation by: William A. B. Ditto, MSW, LSW Director New Jersey.
Department of Medical Assistance Services Virginia Elder Rights Coalition Kristin Burhop and Elizabeth Smith December 5,
ETHICS AND DISABILITY Susan Fox Project Director Institute on Disability/UNH May 23, 2006.
Connections to Community Living
1 Georgia Division of Aging Services Overview of Programs.
How the Budget Bills Affect People with Disabilities April 2011 Distributed by.
Washington State Team May, 2015 Ed Holen, DDC Shannon Manion, DDA Debbie Roberts, DDA Community of Practice: Supporting Individuals with Intellectual/Developmental.
IRIS: Include, Respect, I Self-Direct Self-Determination Conference Wisconsin Dells November 9, 2010.
Essential Elements of Self-Determination In Wisconsin Excerpts from: SDS Stakeholders Seminar October, 24, 2006 Wisconsin Dells Updated for: SDS Network.
Managed MaineCare Initiative Discussion with the Stakeholder Advisory Committee 7/15/10 9/10/
January 25, 2011 Georgia Behavioral Health Caucus Community Care Joseph Bona, MD, MBA Chief Medical Officer DeKalb Community Service Board.
UPDATE NOVEMBER 10, 2011 Money Follows the Person Rebalancing Demonstration.
Presented by: Dean Choate- IRIS Participant, Patty Branton- Support Broker & Sue LeGault- CSP From Family Care to IRIS & Beyond!!!! Self-Directed Support.
Montana Community Choice Partnership Money Follows the Person (MFP) Demonstration Grant Stakeholder Advisory Council Meeting March 10, 2015.
Ken Collins, LMSW, Deputy Director Intellectual Disabilities Services Division Mental Health Mental Retardation of Harris County 1.
Stephanie Hull MGA Conference Chief, Long Term Services and Supports June 7, 2012 Maryland Department of Aging.
Balancing Incentive Program and Community First Choice Eric Saber Health Policy Analyst Maryland Department of Health and Mental Hygiene.
The Challenges of the Medicaid Modernization Mandate – Part 1 Joel L. Olah, Ph.D., LNHA Executive Director Aging Resources of Central Iowa Iowa Assisted.
1 NAMD: Moving Past the Hype: Real World Payment Reforms in Virginia November 8, 2011 (2:15-3:45 p.m. session) Cindi B. Jones, Director Virginia Department.
Overview of Steps Needed to Develop Partnerships
Sustainability of PBS Implementation: State-wide Planning in Kansas March 27, 2008 Rachel Freeman University of Kansas.
Managing Care in Wisconsin Donna McDowell, MSS, Director Bureau of Aging & Disability Resources Division of Long-Term Care Dept. of Health Services ASA.
DBHDS Virginia Department of Behavioral Health and Developmental Services Improving Discharge Processes Updates on Waiver Changes Heidi Dix Assistant Commissioner.
1 South Carolina Medicaid Coordinated Care and Enrollment Counselors Programs.
Terence Ng MA, Charlene Harrington, PhD Department of Social & Behavioral Sciences University of California, San Francisco 3333 California Street, Suite.
Overcoming provider resistance to Cash & Counseling and other self-directed care programs: A toolkit for States National Home And Community Based Services.
MassHealth Managed Care for Older Members and Members with Disabilities Lori Cavanaugh Director of Purchasing Strategy NASHP Annual Conference October.
SW 644: Issues in Developmental Disabilities The Wisconsin Children’s Long-Term Support Service System: Where We’ve Been, Where We Are, and Where We’re.
Janet Grant CareSource Management Group Executive Vice President Business Development and Regulatory Affairs Medicaid Conference September 24, 2008 Contracting.
ALTCI Actuarial Study — Final Results September 14, 2005.
December 20, A Brief Overview: Real Choice and Independence Plus Systems Change Grants Connect the Dots Meeting December 20, 2004.
1 Developing a Framework for an Early Intervention System of Care NECTAC/ ITCA Finance Seminar May 22, 2006.
Section 1115 Waiver Implementation Plan Stakeholder Advisory Committee May 13, 2010.
“Reaching across Arizona to provide comprehensive quality health care for those in need” Our first care is your health care Arizona Health Care Cost Containment.
Frye 1 Judith Frye Director, Center for Delivery Systems Development Wisconsin Department for Family and Health Services.
Wisconsin’s “Elder Boom” Kitty Rhoades, Secretary Department of Health Services.
Provider Topics for MCO’s and OLTL  Topics for MCO’s o Safe and Orderly Discharges for NF Residents o Medical Assistance Eligibility o Administrative.
Performance Position July Delivering the right care, at the right time, in the right place CONTEXT Ambulance service significant activity increase.
NC Council of Community Programs Presentation to Stakeholder Engagement Group October 26, 2015.
September 20, “Real Choice” in Flexible Supports and Services A Pilot Project Kim Wamback, UMMS Center for Health Policy and Research (Grant Staff)
D IVISION OF S ENIOR & D ISABILITIES S ERVICES D IRECTOR D UANE M AYES.
Transition to Reform in Wisconsin Donna McDowell, Director Bureau of Aging & Disability Resources Department of Health Services D. McDowell1.
{Insert Program Name} Working Together For Self-Directed Personal Assistance {Insert your name, date]
Core Values For a Good Long Term Care System Persons with disabilities and their families are entitled to maximum feasible choice/participation in selecting.
SW 644: Issues in Developmental Disabilities Wisconsin Council on Children’s Long- Term Supports Building a Family Support System for Children and Youth.
1 CHOICES FOR CARE Blazing the Trail to Real Choices Joan K. Senecal, Commissioner Vermont Department of Disabilities, Aging and Independent Living
UPCOMING STATE INITIATIVES WHAT IS ON THE HORIZON? MERCED COUNTY HEALTH CARE CONSORTIUM Thursday, October 23, 2014 Pacific Health Consulting Group.
Wisconsin Department of Health Services Family Care in Wisconsin Presented by: Kristen Felten, MSW, APSW Office on Aging June 14 th, 2011.
Oregon: A Leader in Long-Term Care Reform Kathy Wilson, MS, MBA University of Massachusetts Boston American Public Health Association Conference November.
Aging and Disability Resource Center of Western Wisconsin Long Term Care Options Counseling Peggy Herbeck October 1, 2008.
Board of Health Proposed 2011 Public Health Budget October 29, 2010 Dr. David Fleming Director and Health Officer.
MassHealth Restructuring Update Jeff Keilson June 7, 2016.
Upcoming Changes in Dane County system
Upcoming Changes in Dane County System
CALIFORNIA FOUNDATION FOR IDEPENDENT LIVING CENTERS STATEWIDE MEETING
CES Locality working and enabling communities
How the budget and Budget Repair Bill Supports for People w/ Disabilities SC Date.
Wisconsin Medicaid Informational Series
Presentation transcript:

SHELLEY HANSEN-BLAKE, PRESIDENT CAPOW EXECUTIVE DIRECTOR, REM WISCONSIN Wisconsin Family Care

Wisconsin Family Care Goals CHOICE – Give people better choices about the services and supports available to meet their needs. ACCESS – Improve people's access to services. QUALITY – Improve the overall quality of the long- term care system by focusing on achieving people's health and social outcomes. COST-EFFECTIVENESS – Create a cost-effective long-term care system for the future.

Enrollment Data September ,034 Members Three Programs: Family Care, PACE & Partnership 10 Care Management Organizations  May provide single program or combination of one or more programs Family Care (Long-Term Care): 33,292 (1935 TG unknown)  Developmental Disability: 12,072  Frail Elder: 14,670  Physical Disability: 4,615  Acute & Primary Care through traditional MA Card Services PACE & Partnership: 4,742 (80% Elder & Physical disability)  Combines acute/primary care with long-term care

IRIS: Include, Respect, I Self-Direct Goals of IRIS:  INCLUDE – Wisconsin elders, adults with physical disabilities and adults with developmental disabilities who are Medicaid eligible are included in communities across Wisconsin just like everyone else. IRIS can help participants remain connected to others.  RESPECT – You choose where you live, what relationships you build, where you work, and how actively you participate in your community.  I SELF-DIRECT – IRIS is a self-directed option in which you creatively use your monthly budget allocation to help meet your individual long-term care needs. You decide what is important to you. IRIS Enrollment: 4590 ( )

WI Family Care: The Good …. Entitlement Program:  Eliminate Waiting Lists  53 of 72 WI Counties participate Consolidate Regional Resources  Levels availability of service through economies of scale  10 MCOs vs. 72 Counties Consumer Choice  ADRC Eligibility & Benefit Counseling  Maintain consumers at home longer (60% in home) Cost Savings:  Pilot Counties achieved $452 PMPM Medicaid savings  Innovative Service Models blend consumer choice with savings

Family Care Case Mix Shift

WI Family Care: The Bad … Pilots were not representative of expansion regions  Case Mix: PMPM $1800-$2800 FE & PD; $2900-$4600 DD No standard provider rate setting methodology  Each MCO has it’s own, frequent changes in the formula  Long-Term Care Functional Screen not meant for rate setting Provider rate reductions tied to MCO saving targets  DD providers sustained rate cuts from 7% - 35%  Cuts occur multiple times in one year; in consecutive years, and shortly after admission of new consumers Lack of Uniform Processes  Billing Systems, Contract language, and program standards Economic Recession derailed services across the board

WI Family Care: The Ugly … Consumer Choice Restrictions  More housemates due to cost savings, moves to different homes or providers for less costly options, reduced community inclusion  Single MCO in most areas; IRIS resources insufficient for demand Inadequate and confusing appeal process (consumer) No appeal process for provider  If rate is inadequate to serve the individual, discharge is only recourse  Provider network shrinking due to inability to survive at reduced rates Concern about quality, oversight, and continuity Rapid Expansion without adequate resources for MCOs  Inexperienced Care Managers; lack of team process  Shift of case mix to high need individuals with developmental disabilities  Individuals with I/DD last target group to enter; acuity measures unproven

WI Family Care: The Ugly … Expansion MCOs sustainability is at risk  Insufficient funds for high need clients Enrollment cap in the midst of statewide roll out  Emergency enrollment process provides safety net  As attrition occurs, new individuals can be enrolled Operating dual service systems for past decade  Several high population regions continue “legacy” waivers  Regions in midst of roll out unable to carry out full implementation Re-Establishment of Waiting Lists  Matured MCOs (pilots) had eliminated waiting lists  Expansion areas partially cleared waiting lists  Anticipated Waiting List will grow to 16,000 by 2013

WI Family Care: The Pretty? … Purpose of enrollment cap is to stabilize FC Commitment by Stakeholders Provider opportunities to develop innovative service models for high cost populations DHS to reconvene rate setting initiative/project Fresh outlook in new administration  “right amount, right time, right service, right place”  “Family Inclusiveness” model  Access ADRC sooner for “light touch” support  Avoid “Breaking Point” enrollment  More services in the “Shallow End” vs. “Deep End”

WI Family Care: The Pretty? … Legislative and DHS pledge to maintain an open process and seek public input  Take the time to study problems and develop sound solutions Develop & Implement additional practices to minimize waste, fraud and abuse of funds Develop further outcome and quality measures Provide technical assistance to MCOs and share best practices between organizations We are in this together for the long haul … and have the mutual will to succeed!