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News & Press: Regulatory

Long Term Care Advisory Council Summary

Wednesday, September 13, 2017   (1 Comments)
Posted by: Sarah Bass
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The Wisconsin Long-Term Care Advisory Council met Tuesday, September 12 in Madison. Below are some highlights of the meeting discussion/presentations:

MCO Pay for Performance:

Beginning in 2018, the Wisconsin Department of Health Services will begin sending out annual satisfaction surveys to Family Care and IRIS participants, taking this duty away from the managed care organizations (MCOs). The survey responses will be benchmarked, and MCO capitation rate payments in the future will be based in part on quality of services as measured by the survey responses. Under the new Pay for Performance, 0.5 percent of capitation payments to MCOs would be withheld by DHS and they would need to "earn back" the 0.5% based on meeting benchmarks in consumer satisfaction/quality for the four questions below. MCOs could receive an additional 0.5 percent "bonus" payment by both meeting the benchmarks and also scoring "exceeding" in the each category. Among the survey questions that will be used in calculating the Pay for Performance incentives:

  • How involved are you in making decisions in your care plan?
  • How often do you get the help you need from your care team?
  • How much does your care plan include the things that are important to you?
  • How well do the services you receive meet your needs?

The questions will be modified slightly to be appropriate for IRIS participants.

The surveys will be sent to all Family Care and IRIS participants beginning in mid 2018, in time for results to be scored and PFP payments out to MCOs by the end of 2018.

MCO 2018 Contracts:

DHS officials also shared with Advisory Council members the preliminary 2018 MCO contract changes. Among the provisions that perhaps led to the most discussion was an expanded definition of marketing to include providers and agents of an MCO. DHS staff said they've heard some cases of providers trying to sway consumers to enroll with the MCO that pays the provider more - and this restriction would help alleviate that. Some council members expressed concern about the difference between "marketing" and "educating," saying that providers should be allowed to inform consumers at a minimum about whether they have a contract with a specific MCO to avoid participants from moving into a facility and later learning that the MCO does not have a contract with that LTC facility.

Next Council Charge Focus:

The Advisory Council discussed the issue of community development and specifically what areas within community development they could next focus on. It was the consensus that transportation was a critical issue - both relating to the consumer/participant and also transportation for the LTC workforce.

Comments...

Andrew Logan says...
Posted Wednesday, September 13, 2017
Providers have no choice but try to steer consumers to the MCO that "pays the best" when we are now reimbursed approximately 65% of private pay rates. This is a crime on the part of the MCO. Care Wisconsin's "tier" system was clearly a bait-and-switch, with ZERO intention of "steamlining the rate setting process" and 100% intention of decreasing reimbursement. When is WALA going to start addressing these issues adequately?

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