Provider Meet & Greet DANE COUNTY OCTOBER 24-26, 2017 - - PowerPoint PPT Presentation

Provider Meet & Greet

DANE 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 Care

DEDICATED TO QUALITY, COST EFFECTIVE SERVICES

Experience Matters

My Choice Family Care has been a Managed Care Organization since 2000 in Milwaukee County,

• ne 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 Care

GREAT 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

• ver 27,300 Members.

MCFC looks forward to creating new provider partnerships with those

• f you who stand beside

us in our mission of participation, honoring choice and providing quality, cost-effective supports and services.

My Choice Family Care

Service regions

My Choice Family Care

Waiver Program and Family Care Similarities and Differences

Provider Contracting

HANNAH HARRIS

PROVIDER RELATIONS & NETWORK MANAGER

Provider Contracting Team

Hannah 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 Efforts

PROVIDER OUTREACH HAS BEGUN

Care Planning and Coordination

KAREN ENGLAND

CARE 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
• ptions 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 Management

SUPPORTING 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 Planning

COLLABORATION 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 Quality

COMPLIANCE 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
• f 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 SAGGIO

CLAIMS SPECIALIST

Payment and/

• r 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 Steps

I’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 Care

PREVOCATIONAL 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 Services

DEFINED

• Written program statement, or model,
• utlining the services, days and hours
• f 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 Services

STRUCTURE

• Behavioral Assistance Day Program
• Elopement risk
• Physical or verbal threats to themselves
• r 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 Services

DEFINED

• 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 Services

PROVIDER 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 Services

PROVIDER 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
• ne of multiple service providers,

including informal/natural supports. Some activities, although related to independent living, are organized as separate services and are therefore

• utside 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 Services

IN 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 Environment

ROOM 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 Services

CARE 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 SERVICES

• verview

BEHAVIORAL HEALTH SERVICE

OVERVIEW

• COVERED BH BENEFITS

MENTAL 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 SERVICES

• verview

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

• verview

• 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 Services

CARE AND SUPERVISION RATE

My Choice Family Care

RATE 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!