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Family Care Resource Allocation Decision Method

The "Resource Allocation Decision Method" was developed by the Department of Health Services (DHS) and the Family Care Partnership Program sites. In December 1998, a workgroup of DHS managers and staff developed preliminary guidelines about the circumstances in which a Family Care Managed Care Organization (MCO) could decline to provide a service requested by a member. This was necessary to clarify that consumer preference is not the only determinant of Family Care services, and to provide a methodology for MCOs to balance outcomes with cost. That workgroup developed a draft that has been revised considerably with input from the four Partnership sites. The result is a standardized decision-making process intended to be useful for Partnership sites and Family Care MCOs. MCOs are required to either use the RAD method as their service authorization process, or to use an alternative method that has been approved by DHFS. To date, all MCOs are using the RAD method to authorize services.

In particular, this Resource Allocation Decision Method is intended to:

• Instill Family Care values and consumer outcomes into daily case management practices

• Maximize appropriate resource allocation decisions

• Assure cost-efficiency in all resource expenditures, large and small

• Assure consistency across sites, inter-disciplinary teams, and time

  • This ensures fairness or equity (i.e., like cases are treated alike)

• Facilitate team meetings with steps and questions to guide teams.

  • This increases teams’ efficiency and reduces stress (by providing a clear structure focusing on outcomes)

• Train MCO managers and staff

• Educate consumers and families

  • This demystifies MCO decisions, reduces power struggles and misunderstandings

• Preserve the flexibility and creativity critical to quality and program success

  • A standardized decision process can allow for greater flexibility than specific rules or criteria and is more outcomes-based

• Provide guidelines for hearing officers in the state fair hearing appeal process

The overall approach involves a balancing of outcomes and costs similar to current Wisconsin statutes on "least restrictive environment" given a county’s "available resources." However, the limit of "available" resources is far less clear in a managed care environment than it is in county human services (fee-for-service) funding.

• Informational materials explaining the Resource Allocation Decision ("RAD") method (PDF, 40 KB)
   

• Overview of the Family Care Resource Allocation Decision Method (PDF, 217 KB)
  
  

• Wisconsin Family Care Program Resource Allocation Decision Method (PDF, 216 KB)

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Last Revised:  November 03, 2008