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News & Press: Family Care

Assisted Living Community Alert - Family Care MCO Contracts and Rate Cuts

Wednesday, November 22, 2017   (0 Comments)
Posted by: Sarah Bass
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In response to on-going concerns related to Family Care MCO rate cuts that have been reported by some residential providers who have residents that are enrollees in the MCO Inclusa, representatives of the provider associations met with Wisconsin Department of Health Services officials to voice concerns related to the inadequacy of rates and reported rate cuts by Inclusa. During the meeting, DHS officials indicated that they do not get involved in rate negotiations between providers and MCOs, and that such negotiations are between the provider and the particular MCO organization.

The associations have met with Inclusa on a number of occasions. According to Inclusa representatives, approximately 1,000 assisted living communities, serving 5,900 residents, are under contract with Inclusa. Inclusa has indicated approximately one-half of the residents will receive a rate cut; the other 50% will either see no rate change or an increase. We have requested additional rate details from Inclusa.

 

Wisconsin Assisted Living Association, in cooperation with the state’s other long-term care provider associations, would like to ensure that we give the long-term care provider community a good sense of their options related to contracting with Family Care MCOs moving forward. 

 

 If your facility has reimbursement rate concerns related to a particular MCO, you should seek to elevate your concerns to higher levels within the MCO and immediately request a face-to face meeting to address these concerns. As your facility reviews the rates proposed by the MCO, the associations suggest you take the actions noted HERE, in advance of your meeting, to help you gather data necessary to contest rate cuts proposed by the MCO.

 

If these efforts to contest rate cuts sought by the MCO do not produce results, providers have options, including but not limited to:

  1. Accept the rate that is provided.
  2. Notify the Family Care MCO that your facility will no longer be able to accept future residents.
  3. To the extent consistent with your facility's contractual obligations and other legal requirements, tell the MCO that your facility will review rates on an individual resident (current or prospective) basis and determine your facility’s ability to serve the resident based on the resident’s care and services needs and the rate offered.  In certain circumstances, this may mean initiating discharge notices to residents for which the MCO refuses to provide an adequate rate.  Note: The associations have heard from some members that Inclusa is only willing to deal with providers on an "all or nothing basis."  This policy is stated in the Discharge Clause section of the Inclusa rate-letter. However, depending on your facility's importance to Inclusa, this approach could prove effective.
  4. Terminate, following the proper contractual notice requirements, the contract with the MCO, and indicate that your facility cannot continue to serve as participating provider.

Members with concerns regarding the adequacy of Family Care rates are encouraged to contact their legislators. To find out who are your legislators and their contact information, go HERE and type in your address in the upper right-hand corner. Should you have any questions or comments regarding the above information, please do not hesitate to contact Sarah Bass at sbass@ewala.org or Jim Murphy at jmurphy@ewala.org.


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