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Request for Public Comments: Family Care Waiver Amendments

The Wisconsin Family Care program operates under federal authority from the Centers for Medicare & Medicaid Services (CMS) Medicaid Home and Community-Based Services (HCBS) waivers. Waivers give states options to provide Medicaid services in home and community-based settings through managed care. The Wisconsin Department of Health Services (DHS) intends to submit a request to amend the 1915(b) and 1915(c) Family Care waivers. For more information about Medicaid HCBS waivers, please see the CMS website.

1915(b) Waiver Amendment

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

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.

 

Electronic Visit Verification (EVV)

In response to the federal 21st Century Cures Act, the Wisconsin Department of Health Services (DHS) is required to implement electronic visit verification (EVV) for Medicaid-covered personal care services and home health services. DHS has created a dedicated webpage where providers can view all current EVV information. Providers are encouraged to visit the webpage frequently.

Expansion

Learn more about the Family Care and IRIS transition for Dane County.

Enrollment Statistics

Enrollment Report - April 1, 2018

Request for Proposals

Last year, DHS solicited proposals from managed care organizations (MCOs) interested in providing Family Care services in geographic service regions (GSRs) 5 and 6 and facilitating the expansion of the Family Care program into Adams County.

The solicitation for Family Care services in these GSRs has been challenged and is under judicial review. DHS may not proceed with the award of contracts in these GSRs until the judicial review has concluded. DHS anticipates that review will conclude in mid-January 2018.

While that review proceeds, all currently available MCOs in these regions remain under contract with DHS. All aging and disability resource centers (ADRCs) in these regions should continue to provide objective information to members and potential members regarding the program options and MCOs that are currently available in their regions.

In the interim, DHS will work with Adams County to ensure that services continue for those currently enrolled in the legacy waiver programs.

DHS will notify the ADRCs when the judicial review is completed.

Last Revised: May 22, 2018