Family Care, Family Care Partnership, and PACE: Managed Care Organization Contracts
The contracts below explain what’s required of managed care organizations (MCOs). You can view generic versions of contracts on this web page. We customize contracts for each MCO.
Contracts
Family Care and Family Care Partnership contract
2024–2025
- Family Care and Family Care Partnership contract, effective January 1, 2025 (PDF)
- Family Care and Family Care Partnership contract (includes October 2024 and November 2024 amendments), effective January 1, 2024 (PDF)
- Family Care and Family Care Partnership contract (includes October 2024 amendment), effective January 1, 2024 (PDF)
- Family Care and Family Care Partnership contract, effective January 1, 2024 (PDF)
- Substantive changes from prior Family Care and Family Care Partnership contract (PDF)
- October 2024 Amendment (PDF)
- November 2024 Amendment (PDF)
Dual Special Needs (D-SNP) Medicare Advantage Health Plan contract
- Calendar year 2026: D-SNP contract, effective January 1, 2026 (PDF)
- Calendar year 2025: D-SNP contract, effective January 1, 2025 (PDF)
Program of All-Inclusive Care for the Elderly (PACE) contract
2024–2025
- PACE contract, effective January 1, 2025 (PDF)
- PACE contract, effective January 1, 2024 (PDF)
- Substantive changes from prior PACE contract (PDF)
Tribal agreement
Three-Party Agreement Between DHS, Tribal Nation, and Managed Care Organization (PDF)
Materials cited in the current contracts
- Family Care: Standard Definitions of Managed Care Terminology
- Guidelines for Service Dogs in Family Care and Family Care Partnership, P-01048 (PDF)
- MCO Provider Network Adequacy Policy, P-02542 (PDF)
- MCO Training and Documentation Standards for Supportive Home Care, P-01602 (PDF)
- MCO Quarterly Appeal Log, F-02466 (Excel)
- MCO Quarterly Grievance Log, F-02466A (Excel)
- Medicaid Standards for Certified 1-2 Bed Adult Family Homes, P-00638 (PDF)
- Restrictive Measures Guidelines and Standards, P-02572 (PDF)
- Restrictive Measures User Guide, P-02769 (PDF)
- State Reporting Requirements (PDF)
- Template Language MCOs are Required to Use in Grievance and Appeal Materials, F-02619
- Transition of Care Between Medicaid Programs or Between Agencies Within a Medicaid Program, P-02364 (PDF)
Adult Long-term Care Provider Management Project: Medicaid payments to end for providers not self-enrolled through the ForwardHealth Portal
All adult long-term care waiver services providers must enroll with Wisconsin Medicaid through the ForwardHealth Portal right away. Medicaid payments for services delivered in homes or in the community will end in 2026, for providers who do not self-enroll now.
- Most providers should submit a new provider enrollment application on the ForwardHealth Portal to get a Medicaid-issued provider ID.
- Supportive home care agencies with electronic visit verification (EVV)-only provider Medicaid IDs have a quicker process. They’ll convert their EVV-only enrollment to full Medicaid enrollment. It’s called revalidation.
Key resources:
- Providers should visit the Provider Enrollment System for Adult Long-term Care Portal page. You’ll find recorded trainings about how to enroll and information on how to get started.
- Partners should use our toolkits to help spread the word to providers. We’ve created a:
Please note: this requirement does not affect individual self-directed support or participant-hired workers.