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Frequently Asked Questions (FAQs) Q: How is this going to serve people better? A: The long-term goal is to provide more services to more people in a cost effective manner and to create an entitlement to services in the community that currently only exists in nursing homes Q: Wisconsin has been viewed as a leader among states with regard to community-based care as a long-term care option. Why is there a need for reform? A: There are waiting lists for community-based services statewide due to lack of funding, and there is an entitlement (guaranteed funding) for services provided in institutions—such as nursing homes.Based on the experience of Family Care and Wisconsin Partnership Program more non-institutional services can be purchased for more people in a managed care environment, thereby diminishing waiting lists and allowing people to remain in the community rather than more restrictive settings, such as nursing homes. Q: What will be different in a different system? A: No matter what changes, we are committed to the goal of local access to a variety of high quality, consumer-focused services targeted to assist eligible individuals to remain in a setting of their choice and achieve the highest level of self-sufficiency and quality of life. Q: How can “consumer choice” and “cost-control” be goals? Aren’t they mutually exclusive? A: One of the goals of implementation will be to develop a broader network of providers from which consumers can select services.However, in order to provide more services in a cost neutral manner, there must be some attention made to coordinating care.In order to eliminate waiting lists and subsequently reduce costs, the FPCMC region and its endorsed care management organizations, will strive to provide the best quality services to the all eligible people in a cost effective manner. Q: What are resource centers and how do they fit in a reformed system? A: Resource centers are the one-stop, county-run, local access point for consumers seeking information and/or services for their long-term care needs. Resource Centers provide options counseling and enroll consumers in public programs such as Family Care and Family Care Partnership. Q: How is this going to affect family members? A: Families will remain actively involved in care planning when managed care starts.The individual enrolled in the program or the client’s legal guardian must approve care plans and can provide feedback on the effectiveness of the care plan. Q: When would consumers get off the waiting list? A: The state goal is to have the waiting lists eliminated within 2 years of managed care implementation in each county.It is important to keep in mind that the requirement of cost-neutrality for both the counties and the state remains a part of this goal and will impact the timeline. Q: If I am on a waiting list, when can I expect to begin receiving services? A: The state asked eacy county to asses their waiting list and prepare a system to move eligible people on the waiting list to Family Care overa a 24-month period. Implementation of Family Care in the FPCMC region began in early 2008. Q: How many options and choices will consumers have to choose from? A: It is anticipated that in a managed care environment there will be a broader network of providers and a larger service array from which to select the set of services individuals require to meet their health and safety needs.Network development is a part of the planning process.In some FPCMC counties, there will be two care management organizations to choose from and/or some sort of program under development that gives consumers choices. Q: Will this initiative address services for children? A: No, not at this time. Q: What about people with mental health problems? Are they included? A: Care plans for elders and adults with physical and developmental disabilities who also have mental health issues will incorporate meeting their mental health needs.Care for individuals with primary diagnoses of mental illness will not be included in the long –term care managed care system under development. Q: Can a Family Care member live in a nursing home and receive community-based services, as is the case with the waivers? A: The member will plan care with the interdisciplinary team based on the desired outcomes of the member. Q: Is enrollment in Family Care going to be voluntary? A: The State’s goal is to provide long-term care services through a managed care system that is most effective and cost efficient.The other options for people will be institutions or using Medicaid card services, which have some limitations for people with long-term care needs. Q: What does the capitated rate mean to me as a consumer? A: The capitated rate is the monthly amount the state pays to the Care Management Organization (CMO) for each person enrolled in the program.The CMO is responsible for providing all benefits and services to the participants in the program that help them meet their desired outcomes. Q: Does the capitated rate mean that my loved one will not be able to receive “quality of life” services? A: No.The idea behind the current reform effort is to make available an entitlement to services in the community that currently exists only in institutionalized settings, but to do so in a planned, member-centered, quality and cost effective way. Q: What services are people waiting for on the waiting list? A: Primarily, long-term care services such as home care and personal care and some mental health services that could be provided in the community. Q: Will my severely handicapped adult child be afforded the support to live independently in the community, as others have been able to do under the waiver programs? A: Since this reform is focused on creating an entitlement to community-based services that currently exists only for institutions, it is believed that more services can be purchased in a community-based setting in a managed care environment.This should allow for more opportunities to live in the community rather than less. Q: Under long-term care reform, will the services that I now receive be reduced? A: When the current client transitions to a Family Care program, their current care plan moves with them. Then through the normal review of the needs and desired outcomes for the individual, care plans will be discussed. Any changes to the care plan would be made through discussions with the client or the client’s guardian and the interdisciplinary team overseeing and coordinating care. Q: What if my current care plan and services are self-directed? A: Self-directed supports are a part of the Family Care and Partnership programs being implemented in the FPCMC counties.
Questions Frequently Asked by Governmental
Agencies and Their Staff:
Q: How can the goal of increasing service array, eliminating waiting lists, and providing better services be obtained while maintaining cost neutrality for both the state and county systems? A: The State has estimated the eventual cost of managed care expansion and feels the expansion can be done in a cost neutral manner.It is based on some assumptions including the estimated number of people that will be enrolled, the total current cost of Medicaid to these enrollees, and the amount of revenue already available to support the needs of these individuals.This information is being used during the planning process and these assumptions will be relied upon unless or until they are deemed inaccurate. Q: Will county staff lose their jobs as a result of managed care implementation? A: Counties and their private partners are working together to create a system where the existing county staff would be a part of the new care management system.While there are no guarantees, all FPCMC partners are intent on keeping the relationships between current case managers and clients intact and serving the overall care of residents in FPCMC counties. Q: What happens to the tax levy and community aids dollars that counties have invested in the long-term care system once managed care is implemented? A: This matter will be worked out within each county as managed care implementation is planned.There are also on-going discussions between the state and the Wisconsin Counties Association and the state and the Wisconsin County Human Services Association.As it stands now, counties will be expected to leave the amount of their 2005 tax levy and community aides contributions to long-term care in the funding of services.There are on-going discussions to eventually have the state “buy out” counties to the same level as the original Family Care counties had, which was 22% of their community aides.While this is being resolved, county partners are focusing on moving forward in order to eliminate waiting lists and serve more people more effectively. Q: What will the role of Human Service Department management staff in the reformed system? A: Each county will decide what supervisory and management staff will be needed for their subcontracted long-term care services and which staff are moving to the ADRCs or other roles in the county. Questions Frequently Asked by Providers:
Q: How will this initiative affect service providers? A: Part of the challenge in developing this initiative will be to establish a network of providers.All current providers in each county are being offered the opportunity to be part of that network by contracting with the care management organization. Providers will offer needed and covered services for existing clients and an increasing number of clients as waiting lists are eliminated. Q: Will there be enough service providers to meet the increased number of consumers receiving services? A: If there are not enough service providers, resource and capcity development will be a priority in the implementation of long-term care reform by the care management organization. Q: How will provider rates be set? A: In the first year of managed care implementation, care management organizations will work with counties to set rates, since providers will need to maintain a contract with counties for those clients still on the waivers and will need to establish a contract with the care management organization for those clients in managed care. Questions Frequently Impacting All Stakeholders:
Q: Isn’t this going to cost extra money, and where is the money coming from?
A: In estimations provided by the State, savings generated in the new system through the management of long-term care and the integration of primary and acute care into the system will allow for cost neutral expansion allowing more clients to be served. Q: If there are savings, where are they going to come from? A: Savings will be achieved through enhanced coordination and management of existing plans and services, plus the integration of acute/primary care with long-term care.Currently, services are provided both under the waivers and via Medicaid card services.One of the goals of long-term care reform is to integrate the two into one health care system that focuses on proactive care meant to prevent or reduce the amount of overall spending. Q: If I have more questions, how do I have them answered: A: There will be on-going opportunities for communicating and asking questions.A web site has been developed and is updated regularly.It is http://www.familypartnershipltc.org/cms/. There are also meetings held by the coalition on the third Wednesday of the month at the Administration Building in Juneau in Dodge County.The meetings generally run from 9:30 to noon.Please, check the web site before attending to be sure the meeting will be held.The meetings are open to the public and public input is sought at the start and end of each meeting. Q: Who were the partners during the planning and implementation phases of Family Care in our region? A: The planning partners include public and private parties including: Columbia County
Dodge County
Green Lake County
Jefferson County
Marquette County
Ozaukee County
Sauk County
Sheboygan County
Walworth County
Washington County
Waukesha County
Waushara County
Care Wisconsin, Inc.
Community Care, Inc.
Lutheran Social Services of Wisconsin and Upper Michigan, Inc.
Q: What is the status of Family Care implementation in 2009? A: FPCMC completed the planning and roll-out phases of long-term care reform by Sept. 1, 2008 for all counties except Walworth County, which is scheduled to start Family Care in mid-2009. All other counties have now opened Aging & Disability Resource Centers, to provide information and assistance to all citizens and enrollment for eligible individuals in Family Care. The Family Care programs – Family Care and, in several FPCMC counties, Family Care Partnership – are now provided by the care management organizations, Care Wisconsin and Community Care. Within the first six months of operation, all current waiver clients in each county transitioned to Family Care. After the six months, the waiver programs have closed in each county. In addition, starting at the same time, eligible individuals on the waiting lists began enrolling in Family Care, a process scheduled over a 24-month period. At the end of two years, the goal is to eliminate waiting lists. Also, at the end of August 2008, FPCMC transitioned from a regional planning and implementation group to a coalition composed of counties and care management organizations, with a focus on operational matters.
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