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News & Press: Family Care

MCOs Distribute MOU/Addendum for Direct Care Workforce Payments - Clarification and FAQs Given

Wednesday, June 6, 2018   (0 Comments)
Posted by: Sarah Bass
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On your behalf,  WALA sent a note to DHS and the stakeholders on 6/6/18 expressing our concerns on a number of issues in the contracts/MOU you have received from the MCOs. Complete text here with responses from DHS in red italics. 

 

WALA has heard from several of our members who now have received either a contract Addendum or Memo of Understanding from the following MCOs:
  • iCare
  • Inclusa
  • Care Wisconsin
We completely understand why DHS provided specific language to the MCOs and we appreciate your intent to maintain consistency in the process with all the MCOs.  But to be honest, we were surprised DHS did not seek input from the Direct Care Workforce Funding work-group. Our collaboration has enabled us to communicate with our membership on what to expect with the funding but when our members received the contract addendum and memos of understanding from the MCOs, it raised concerns and confusion since other stakeholders were not informed or consulted so we could communicate with our members about this timely process. 
 
We have the following concerns and would like more clarification on the following items:
  • Contract Addendum/Memo of Understanding between Providers and MCOs -  We are concerned that this acts as an additional contract obligation and is called differently with each MCO.  It appears that some of the language varies between MCOs.  Could we get a copy of the language DHS provided to the MCOs?  RESPONSE: https://ewala.org/resource/resmgr/news/DCW_MCOProviderAgreementAdde.pdf
  • The second concern (numbering based on the attached Inclusa June 1, 2018 provider agreement - each MCO seems to have provided the info in different formats) is in section b., ii.  "Provider must complete making payments to Direct Care Workers by the following deadlines:..." These payment deadlines to caregivers were never discussed in our meetings. Many providers give out incentives at different times throughout the year and this does not allow for much flexibility.  How can we incorporate the necessary flexibility so providers can best meet the needs of their caregivers? RESPONSE: We've been working with the understanding that the intent of this initiative is to get cash in workers' paychecks as soon as possible. We have placed deadlines on both the MCOs and the providers to meet this intent. 
  • Further clarification is needed for part b., v. “The Direct Care Workforce payments paid to Provider for a particular quarter shall be recouped:... "

    • To clarify: a provider who received payments of greater than $1,000.00 AND did not complete the survey and attestation are the only ones who will have payments recouped? Correct? RESPONSE: Correct.
    • Is there any situation in which a provider would not receive funding? RESPONSE: There are a number of situations based on the attached contract language. Some situations include if the provider did not receive payments from an MCO in quarter 1, the provider only provided self-directed services, and the provider does not return the contract to the MCO by the deadline to receive quarter 1 payments.
    • Where did the $1,000 threshold come from? To our knowledge, this was not discussed at the work-group level. RESPONSE: Providers that do not complete the survey and attestation will have the direct care workforce funding they received recouped by the MCOs. However, we acknowledge that there is a point at which the amount of funding recovered would not justify the amount of work involved. $1,000 per quarter was the maximum amount the Department was comfortable excluding from recoupment.
    • Many providers are not seeing the word AND at the end of v, 1 and only see v.2 about payment threshold of $1,000 and are reading that they can only receive up to $1,000/quarter. We do not interpret it that way - what is your intent? Yes, providers are adults and are responsible for reading the text, but this misreading has made many go ballistic that there is a $1,000 per quarter maximum.  RESPONSE: Providers can receive more than $1,000 per quarter. There is no ceiling to the amount providers can receive. The intent of the provision is that amounts less than $1,000 will not be recouped even if the provider does not complete the attestation and survey.
    • If we had seen this language, we would have suggested the addition of  “The Direct Care Workforce payments paid to Provider for a particular quarter shall be recouped WHEN THE FOLLOWING TWO CONDITIONS ARE MET:  …..“
      • Was this your intent? This would have saved a lot of heartburn and many questions. 
    • Does this language imply that providers that would have a payment of less than $1,000.00 (but more than $25) would automatically get payment - even if they did not complete the survey or attestation?RESPONSE: Providers that do not complete the survey and attestation by the initial deadlines in the contract are forfeiting all future direct care workforce payments, regardless of the amount of funding they received. If the provider does not meet the initial survey and attestation deadline, they have until 9/13/2019 to submit a survey and attestation to avoid have the funding they did receive recouped. Providers that received less than $1,000 will not have their funding recouped even if they do not complete a survey and attestation by 9/13/2019.
  • What happens if the member doesn't get an attestation or survey? Who does a provider contact and what is the protocol for that since not returning the survey has such consequences?  Many members are concerned that this could get lost in the shuffle and they will pay the penalty. RESPONSE: MCOs will be asked to send the survey and attestation link to providers when they notify them that the providers should expect the payments. Once the attestation and survey are published, they will also be posted to the FAQ site on the DHS website.
  • There is also concern about the timing from MCO to the providers. The DHS language states when DHS will get the monies to MCOs but not when MCOs pay providers. If I recall correctly, in our meetings we discussed a 15 day turnaround which was later revised to 30 days.  But we are not seeing this timeframe in the documents we have seen.  Can this get included? RESPONSE: MCOs have until 8/15/2018 to distribute the first payment. For all other payments, MCOs have one calendar month following the Department’s distribution. For example, MCOs have until October 31st for the payment we make in September of 2018.
  • We would think that the importance of this for providers would be recognized since providers do not yet have official word yet when this will occur. How can they plan not knowing this since they have already paid the caregivers? Again, much heartburn from some providers. 
  • What is the status of the FAQs? These will help alleviate confusion with providers. The clock is ticking and providers still do not know what DHS expects us to know in the FAQs, only what was sent by the MCOs. With the deadline now set by these letters, providers are still uninformed. When can providers expect them? RESPONSE: Today. https://www.dhs.wisconsin.gov/medicaid/ltc-workforce-funding-faq.htm

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