Care Resource Allocation Decision Method
The "Resource Allocation Decision Method" was developed by
the Department of Health Services (DHS) and the Family Care Partnership Program sites. In December 1998, a workgroup of
managers and staff developed preliminary guidelines about the
circumstances in which a Family Care Managed Care Organization (MCO)
could decline to provide a service requested by a member. This was
necessary to clarify that consumer preference is not the only determinant
of Family Care services, and to provide a methodology for MCOs to balance
outcomes with cost. That workgroup developed a draft that has been revised
considerably with input from the four Partnership sites. The result is a
standardized decision-making process intended to be useful for Partnership
and Family Care MCOs. MCOs are required to either use the RAD method as
their service authorization process, or to use an alternative method that
has been approved by DHS. To date, all MCOs are using the RAD method to
In particular, this Resource Allocation Decision Method is intended to:
Instill Family Care values and consumer outcomes into daily case
Maximize appropriate resource allocation decisions
Assure cost-efficiency in all resource expenditures, large and small
Assure consistency across sites, inter-disciplinary teams, and time
Facilitate team meetings with steps and questions to guide teams.
Train MCO managers and staff
Educate consumers and families
Preserve the flexibility and creativity critical to quality and
Provide guidelines for hearing officers in the state fair hearing
The overall approach involves a balancing of outcomes and costs similar
to current Wisconsin statutes on "least restrictive environment"
given a county’s "available resources." However, the limit of
"available" resources is far less clear in a managed care
environment than it is in county human services (fee-for-service) funding.
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May 03, 2013