Family Care, Partnership, and PACE - What's New!

1915(b) Waiver Amendment (PDF)

Appendix D Spreadsheet (Excel)

DHS will request the following changes to the existing 1915(b) waiver:

1. Clarify that enrollment in a managed care organization (MCO) is mandatory in order to receive Family Care benefits.
2. Establish non-risk payments to MCOs for Indian members who receive services from an Indian Health Care Provider (IHCP).

Enrollment in Family Care continues to be voluntary, but the requirement to join an MCO in order to receive Family Care benefits means that the program is mandatory under federal regulations. DHS is amending the waiver to clarify this policy.

The amendment will also establish non-risk payments to MCOs for services rendered to American Indian members who receive care management to ensure MCOs are not exposed to financial risk for these members.

Please send your comments on the 1915(b) waiver amendment to:

Email: Family Care webmail, Subject: Family Care 1915(b) Waiver Amendment
Standard, unencrypted public email is not considered appropriate for sending confidential information. Please do not send sensitive, personal information such as an account number or Social Security number when corresponding at the email address provided.

Mail written comments to:
Division of Medicaid Services
Bureau of Adult Long Term Care Services, Attn: Family Care 1915(b) Waiver Amendment
P.O. Box 7851
Madison, WI 53707-7851

Comments are due by May 30, 2018.

A paper copy of the 1915(b) waiver amendment can be requested via the mailing or email address listed above.

1915(c) Waiver Amendment (PDF)

DHS will request the following changes to the existing 1915(c) waiver:

1. Pursuant to federal law, modify the care management service definition to allow American Indian Health Care Providers (IHCPs) as a provider for care management for American Indian members.
2. Establish a cost-based reimbursement methodology for IHCPs.
3. Establish safeguards for American Indian members who receive care management and other services from an IHCP to get appropriate choice counseling to help them make fully informed choices about their long-term care services.

DHS is required by federal regulations to include IHCPs as a care management provider choice for American Indian members in Family Care.

To support the financial viability of IHCPs, DHS has chosen to establish a cost-based reimbursement methodology for IHCPs. This will reduce IHCPs’ exposure to financial risk and assist them with cash flow.

Federal regulations require DHS to establish safeguards for members when a care management provider also provides other services. This ensures that members receive conflict-free choice counseling and can make fully informed choices about their service providers.

Please send your comments on 1915(c) waiver amendment to:

Email: Family Care webmail, Subject: Family Care 1915(c) Waiver Amendment
Standard, unencrypted public email is not considered appropriate for sending confidential information. Please do not send sensitive, personal information such as an account number or Social Security number when corresponding at the email address provided.

Mail written comments to:
Division of Medicaid Services
Bureau of Adult Long Term Care Services, Attn: Family Care 1915(c) Waiver Amendment
P.O. Box 7851
Madison, WI 53707-7851

Comments are due by May 30, 2018.

A paper copy of the 1915(c) waiver amendment can be requested via the mailing or email address listed above.