Family Care, Family Care Partnership, and PACE: Program Operations for Managed Care Organizations

• 1-2 Bed Adult Family Home Certification Standards
• Being a Full Partner booklet
• Contact Information for Managed Care Organizations (PDF)
• Enrollment Data
• Home and Community-Based Services (HCBS) Settings Rule
• DMS Employment Initiatives: Helping People with Disabilities Find and Keep Jobs
• Maps:
  • Geographic Service Regions, P-01790 (PDF)
  • Partnership/PACE Geographic Service Regions, P-01789 (PDF)
  • Family Care and IRIS Geographic Service Region Reconfiguration Timeline, P-03225 (PDF)
• Resident Relocation Manual
• Checklist for MCOs in the Chapter 50 Resident Relocation Process (PDF)
• Standard Definitions of Managed Care Terminology
• Tribal Members—Long-Term Care Option

• Capitation Rates
• Contract with MCOs
• Cost Share Cap for Medicaid Eligibility Group B Plus
• Developmental Disability Center Rates for Managed Care Organizations
• Direct Care Workforce Funding Initiative Information and FAQs
• Financial Summaries
• Fiscal Information
• Minimum Fee Schedule for HCBS
• Nursing Home Resources
• Rates for Nursing Home Commissions
• State and Federal Requirements

 Adult Long-term Care Provider Management Project: Medicaid payments to end for providers not self-enrolled through the ForwardHealth Portal

All adult long-term care waiver services providers must enroll with Wisconsin Medicaid through the ForwardHealth Portal right away. Medicaid payments for services delivered in homes or in the community will end in 2026, for providers who do not self-enroll now.

• Most providers should submit a new provider enrollment application on the ForwardHealth Portal to get a Medicaid-issued provider ID.
• Supportive home care agencies with electronic visit verification (EVV)-only provider Medicaid IDs have a quicker process. They’ll convert their EVV-only enrollment to full Medicaid enrollment. It’s called revalidation.

Key resources:

• Providers should visit the Provider Enrollment System for Adult Long-term Care Portal page. You’ll find recorded trainings about how to enroll and information on how to get started.
• Partners should use our toolkits to help spread the word to providers. We’ve created a:
  • Toolkit for managed care organizations
  • Toolkit for IRIS fiscal employer agencies
  • Toolkit for IRIS consultant agencies
  • Toolkit for IRIS participants

Please note: this requirement does not affect individual self-directed support or participant-hired workers.

• Family Care and Partnership: Notice of Adverse Benefit Determination Forms
• Medical Remedial Expenses Checklist for Medicaid Long-Term Care Waiver Programs, F-00295 (Word)​

• Guidelines for Service Dogs in Family Care and Family Care Partnership, P-01048 (PDF)
• Immunization Conversation Kit
• MCO Training and Documentation Standards for Supportive Home Care, P-01602 (PDF)
• Resource Allocation Decision (RAD) Process Infographic, P-02705 (PDF)
• Restrictive Measures Guidelines and Standards, P-02572 (PDF)
• Restrictive Measures User Guide, P-02769 (PDF)
• Self-Directed Supports in Family Care, Partnership, and PACE: A Best Practice Manual for Interdisciplinary Team Staff, P-00593 (PDF)
• Technical Assistance and Resource Series for MCOs
• Transition of Care Between Medicaid Programs or Between Agencies Within a Medicaid Program, P-02364 (PDF)

Pay for Performance (P4P) is a system where DHS pays MCOs to achieve goals related to quality. One of these goals, the Community Connections P4P, aims to increase the percentage of members who are engaged in integrated community life, active in civic engagement, and socially connected in their communities in ways that the member chooses. The MCOs created strategic plans to achieve these goals. This P4P aligns with the Long-Term Care Community Inclusion goal in the 2021 Medicaid Managed Care Quality Strategy, P-02156 (PDF).

Strategic Plan Part 1

Part 1 of the Strategic Plan includes two sections.

1. Strategic Plan Responsibilities and Objective
2. Strategic Plan Proposed Measures, Including Measures Research
   • Community Care, Inc. Pay for Performance Strategic Plan Part 1 (Word)
   • iCare Pay for Performance Strategic Plan Part 1 (Word)
   • Inclusa Pay for Performance Strategic Plan Part 1 (Word)
   • Lakeland Care Pay for Performance Strategic Plan Part 1 (Word)
   • My Choice Wisconsin Pay for Performance Strategic Plan Part 1 (Word)

Strategic Plan Part 2

Part 2 of the Strategic Plan includes three sections.

1. Strategic Plan Development
2. Strategic Plan for Community Connections and Changes in MCO Practice
3. Training and Technical Assistance Plan

MCOs start piloting Strategic Plan Part 2 in 2024. After this first pilot year, MCOs will work with DHS to expand on these plans once MCOs and DHS review what was learned in the first year.

• Community Care, Inc. Pay for Performance Strategic Plan Part 2 (Word)
• iCare Pay for Performance Strategic Plan Part 2 (Word)
• Inclusa Pay for Performance Strategic Plan Part 2 (Word)
• Lakeland Care Pay for Performance Strategic Plan Part 2 (Word)
• My Choice Wisconsin Pay for Performance Strategic Plan Part 2 (Word)
• All MCOs Pay for Performance Strategic Plan Part 2 (Word)

• DHS Memos Library
• Electronic Visit Verification
• Encounter Reporting:
  • Long-Term Care Information Exchange System (Reference materials)
  • Encounter Reporting Application
• Family Care Partnership: Drug Carve Out Resources
• ForwardHealth Portal
• Get email updates about DHS programs
• Medicaid Eligibility Handbook
• Nursing Home Reimbursement
• Residency Manual, P-03623 (PDF)
• Request for Proposal
• Wisconsin's Functional Screen
• Wisconsin Long Term Care Advisory Council