Family Care Program Operations

The links below offer access to communications intended for Managed Care Organizations (MCOs) and key information and tools used most often.

General Information

• 1-2 Bed Adult Family Home Certification Standards
• Being a Full Partner booklet 
• Capitation Rates 
• DHS-MCO Contract
• Enrollment Data
• Family Care Fiscal Resources
• Integrated Employment and Prevocational Services
• Maps:
  • Family Care Geographic Service Regions (PDF)
  • Partnership/PACE Geographic Service Regions (PDF)
• MCO Contact Information (PDF)
• Notice of Action (NOA) and Notice of Denial Forms
• Nursing Home Resources in the Family Care Benefit
• Relocation Manual
• Restrictive Measures
  • Guidelines and Requirements for Use of Restrictive Measures (PDF)
  • Request for Use of Restraints, Isolation, or Protective Equipment as Part of a Behavior Support Plan, F-62607
  • Request for Use of Medical Restraints, F-62608

Communications to MCOs

Family Care Technical Assistance and Resource Series

Training and Technical Assistance for Care Managers

• Self-Directed Supports in Family Care and Partnership: A Best Practice Guide for IDT Staff (PDF)
• Guidelines for Registered Nurse Delegation to Unlicensed Assistive Personnel (PDF)

Third Party Administration (TPA) Claims Processing Services

DHS contracts with Wisconsin Physicians Service Insurance Corporation for third party administration (TPA) services for Family Care MCOs. Services include claims processing, encounter reporting, and other claims processing related services, and the contract period runs through February 25, 2019. MCOs and the vendors are to use the following templates and supporting materials to document the terms and services of the contract.

• Online Statewide Long-Term Care Infrastructure Third Party Administration Contract
• RFP # 1677-DLTC-PM (PDF, issued July 2009)
• Final Claims RFP Master Agreement Template (PDF)
• Amendment to TPA Contract (PDF)
• Memo re: Partnership Pricing and Participating Agreement Template (PDF, 9/7/11)  
• Participating Agreement Template for use by MCOs and TPAs (PDF)
• Participating Agreement Supporting Documents:
  • Implementation/Transition Plan Standards (PDF)
  • Communication Plan Protocols (PDF)
  • Minimum Communication Requirements spreadsheet (Excel)
  • Test Plan Standards (PDF)
  • TPA Training and Technical Assistance Plan (PDF)

Resources

• Encounter Reporting:
  • Reference Materials (User guide, data dictionaries, content edits, etc.)
  • Encounter Reporting Application
• ForwardHealth Portal
• Listserv signup pages: 
  • Division of Long Term Care Memos 
  • Functional Screen