Provider Meet & Greet DANE COUNTY – OCTOBER 24-26, 2017 Partnering for Success
My Choice Family Care WHO ARE WE? AN OVERVIEW OF MY CHOICE FAMILY CARE
My Choice Family Care DEDICATED TO QUALITY, COST EFFECTIVE SERVICES Experience Matters My Choice Family Care has been a Managed Care Organization since 2000 in Milwaukee County, one of the State’s pilot Family Care counties. Dedicated to Vulnerable Citizens • Frail Elders • Adults with Physical Disabilities • Adults with Intellectual and Developmental Disabilities
My Choice Family Care GREAT PARTNERSHIPS TO IMPROVE QUALITY OF LIFE Our recent expansion efforts include: • Rock County – effective July 1, 2016, Wisconsin Department of Health Services introduced Family Care into this former waiver county. • Geographic Service Region 2 – My Choice Family Care will be a new MCO within this region effective January 1, 2018. • Geographic Service Region 3 – My Choice Family Care will be a new MCO within this region effective January 1, 2018. • Dane County – effective February 1, 2018, the Family Care program will also be expanding into Dane County.
My Choice Family Care Service regions For the past 17 years, My Choice Family Care has been administering the Family Care benefit package and has served over 27,300 Members. MCFC looks forward to creating new provider partnerships with those of you who stand beside us in our mission of participation, honoring choice and providing quality, cost-effective supports and services.
My Choice Family Care Waiver Program and Family Care Similarities and Differences
Provider Contracting HANNAH HARRIS PROVIDER RELATIONS & NETWORK MANAGER
Provider Contracting Team Hannah Harris, Provider Relations & Network Manager Provider Relations & Network Specialists Diane Baumbach Mary Swanson Jessica Cullen Randy Westley Kelli Macon Sheri Wojtowicz Debora Rieder **PLEASE SEE THE HANDOUT PROVIDED FOR YOUR ASSIGNED CONTRACTING REPERSENTATIVE.
Provider Network Needs Some of the provider services needed include: CONSULTING SERVICES COUNSELING/THERAPEUTIC SERVICES *Financial Management EMPLOYMENT/ACTIVITY SERVICES *Housing Counseling *Relocation Services *Adult Day Care *Support Broker *Employment Services *Prevocational Services EQUIPMENT & SUPPLIES *Supported Employment *Adaptive Aids *Vocational Planning and Support *Comminication Aids MISCELLANEOUS HOME BASED SERVICES *Personal Emergency Response System *Specialized Medical Equipment *Home Delivered Meals *Home Modifications RESIDENTIAL TRAINING BASED SERVICES *Adult Family Home *Community Based Residential Facility *Consumer Education & Training *Residential Care Apartment Complex *Daily Living Skills Training *Self Directed Support TRANSPORTATION *Supportive Independent Living Services
Provider Network Efforts PROVIDER OUTREACH HAS BEGUN • Contracting is actively calling providers to introduce MCFC and our mission. • We are currently accepting applications from providers for all covered services of the Family Care program. • Those interested please contact us or complete the online application. • Provider trainings/orientations are tentatively scheduled for mid November, December and January. Additional dates and times can be added if interest exists.
Care Planning and Coordination KAREN ENGLAND CARE MANAGEMENT ADMINISTRATOR
Care Management SUPPORTING MEMBERS TO ACHIEVE THEIR OUTCOMES • The Member is the center of their Interdisciplinary Team (IDT), along with their RN and CM. • Collaborate to assess, coordinate, and monitor the options available to meet a Member’s health and safety needs and long-term care outcomes. • IDT staff are responsible to provide on-going care management through regular face-to-face and phone contact.
Providers’ Role in Care Planning COLLABORATION FOR MEMBER OUTCOMES • Providers play a very important role in Members’ lives and supporting them in achieving their goals and outcomes. • It is essential to Member care that the IDT Staff develop good working relationships with the staff that provide care to our Members.
IDT and Provider Communication • This relationship can only be successful if there is ongoing communication between the IDT Staff and the Member’s supports. – Ongoing assessment process – Problem solving – Monitor quality and contractual adherence – Evaluate progress on Member outcomes and continued need for service. – Assure member satisfaction
Coordination with Providers • The IDT Staff may visit members at their homes, residential facilities and/or day and work programs. • The IDT Staff may review Member’s records containing: – Individual Service Plan (ISP) – Progress Notes – Behavior Support/Intervention Plans and tracking • Participation in Care Conferences and Care Planning • Incident reporting
Coordination with Providers (Residential) • Participation in Care Conferences and Care Planning – Helps ensure an accurate understanding of Member’s functioning and abilities within the home and the care and services provided. • The facility is required to inform the IDT of all critical incidents, changes in condition, medical appointments, and any Member absences from the facility, including hospitalizations.
Provider Quality WES ALBINGER PROVIDER QUALITY MANAGER
Provider Quality COMPLIANCE WITH CONTRACT REQUIREMENTS • Develop, communicate, and monitor contract requirements to ensure MCO compliance with State and to promote provider quality • Contract requirements are principally derived from MCFC’s contract with State DHS and should be largely consistent with those you may already be following for other FC payors
Provider Quality, continued • Provide technical assistance to network providers on contract requirements • Collaboration-Liaison between provider community and MCO • Identify areas for growth and expansion of network to ensure access and choice to members • Identify areas for training and other support to providers
Provider Quality RECENT AND ONGOING PROVIDER QUALITY INITIATIVES • Informal resolution process • Background checks • Provider Survey • Training: provider onboarding training • Provider Advisory Groups • Member satisfaction surveys • Provider Newsletter
Provider Portal MARY JO SAGGIO CLAIMS SPECIALIST
Authorization and Payment Process Provider Provider Provider Submits Claim Receives Performs to Other Authorization Authorized Insurance or from MCO Service Medicare Provider Submits Claim Managed Care Member Needs to WPS Via the Organization Family Care Midas Portal (MCO) Approved Authorizes the Service Approved WPS Process Service WPS Receives Claim Authorization According to from MCO Authorization Payment and/ or Provider Remittance Advice Sent
Authorizations
www.mcfc-midas.com 1. System: Provider Portal 2. Login ID and Password 3. Environment: Production 4. Login
5 Steps To A Clean Claim
Next Steps I’D LIKE TO BECOME A PROVIDER. WHAT DO I DO NEXT? Please visit MyChoiceFamilyCare.org • Providers Tab • Become a Provider • Choose the “ Request for Application ” link Quick Link to Request for Application: https://www.mcfc-midas.com/providerapplication/
Session I – Employment and Day Services
My Choice Family Care PRE-VOCATIONAL, SUPPORTED EMPLOYMENT AND DAY SERVICES • My Choice Family Care has a strong commitment to ensuring all members have access to community employment
Prevocational Services PREVOCATIONAL SERVICES ARE THE PROVISION OF SERVICES INTENDED TO PREPARE AN INDIVIDUAL FOR PAID EMPLOYMENT BUT WHICH ARE NON-JOB SPECIFIC.
My Choice Family Care PREVOCATIONAL SERVICES • National trend is towards community based services. • Community Based prevocational services. • Facility-based prevocational services. • Members age 18 thru 25 years must have a integrated employment goal to receive facility based services. • For this age group MCFC will be utilizing prevocational services through DVR.
Supported Employment SUPPORTED EMPLOYMENT IS THE PROVISION OF SUPPORT TO MAINTAIN PAID, COMPETITIVE EMPLOYMENT IN AN INTEGRATED WORK SETTING TO INDIVIDUALS WHO, BECAUSE OF THEIR DISABILITIES, NEED ON GOING SUPPORT TO PERFORM IN A WORK SETTING.
Supported Employment IN COLLABORATION WITH DEPARTMENT OF VOCATIONAL REHABILITATION (DVR) • Job Development is completed using DVR funding. • Job Coaching is initially funded by DVR and is transitioned to Long Term Care when member is stable. • DVR/MCO Transportation funding roles. • Work Incentive Benefits Counseling • Post- employment services with DVR • MCFC CM’s will play an integral role through out the DVR process.
Provider Expectations REPORTING • Provider to work with MCFC CM. • JD & JC reports submitted to CM. • Prevocational services 6-month progress report & service plan. • Employment Outcome Data Collection through PPS System. • End of the year report.
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