The Wisconsin Medicaid program intends to make the first bonus payments in 2019 on its pay-for-performance initiative for Family Care managed physical, mental, and long-term services and supports (MLTSS) plans. The initiative launched in 2018. The state Department of Health Services (DHS) intends to require the Family Care and Family Care Partnership Medicaid managed care organizations (MCOs) to implement and complete a pay-for-performance initiative based on results of a member satisfaction survey to be administered during the third quarter of 2018. Over the next several years, DHS intends to add more pay-for-performance initiatives for the Family Care and Family Care Partnership plans.
Family Care is a capitated Medicaid managed care program for the delivery of all Medicaid long-term care services. Members enrolled in Family Care may be eligible at a Wisconsin Medicaid nursing home-certifiable level of care or at a non-nursing home level of care. One of these functional levels of care is required as a condition of eligibility.
Family Care Partnership is a capitated integrated Medicaid and Medicare managed care program that, in addition to the Family Care long-term care benefits, provides managed health care benefits, and all applicable Medicare Advantage Special Needs Plan and Medicare Part D prescription drug benefits. All members enrolled in Partnership have a Wisconsin Medicaid nursing home-certifiable level of care, which is required as a condition of eligibility. As a fully integrated program, all supports and services – whether Medicare or Medicaid benefits – are delivered through the Partnership model design identified in this contract.
According to the 2018 Wisconsin Family Care DHS-MCO Contract last updated in July 2018, all MCOs will have 0.5% of their calendar year 2018 capitation rate withheld to be returned based on the MCO’s performance on the member satisfaction survey. The aggregate value of this withhold is estimated at $10 million. The Family Care pay-for-performance initiative began on January 1, 2018. In the third quarter of 2018, DHS sent the member satisfaction survey to a sample of each MCO’s members. The pay-for-performance criteria will be based on four questions that are part of the survey. The questions assess the following:
- Member access to services
- Member participation in the care planning process
- Member satisfaction with care plan/team
- Member satisfaction with services
Benchmarks have been set for 2018. The MCO contract document did not mention the name of the entity that conducted the survey. DHS will notify the MCOs about the benchmarks before the survey is distributed. The evaluation will be complete in the 4th quarter of 2018.
The MCO will receive one fourth of the 0.5% withheld from the capitation rate for each survey question in which they meet the minimum performance standard set by the Department. MCOs that meet the minimum performance standards for all four questions will earn back all of the 0.5% withheld from the rate and will earn a 0.125% performance enhancement to their rate for each targeted performance benchmark they meet. Payments under this section will be made by December 31, 2019.
A link to the full text of “2018 Wisconsin Family Care DHS-MCO Contract” may be found in The OPEN MINDS Circle Library at www.openminds.com/market-intelligence/resources/091518wifamilycarecontract.htm. See page 289 for the section about the pay-for-performance initiative.
A link to the full text of “Wisconsin DHS Memo To Family Care MCOs About CY 2018 Managed Long Term Care Pay For Performance” may be found in The OPEN MINDS Circle Library at www.openminds.com/market-intelligence/resources/100417wifamilycarep4pmemo.htm.
A link to the full text of “Wisconsin DHS Medicaid Draft Managed Care Quality Strategy” may be found in The OPEN MINDS Circle Library at www.openminds.com/market-intelligence/resources/021518wifamilycaremco.htm.
OPEN MINDS last reported on this topic in “Wisconsin Awards Family Care LTSS MCO Contracts,” which published on May 14, 2017. The article is available at https://www.openminds.com/market-intelligence/news/wisconsin-awards-northern-expansion-contracts-family-care-ltss-mcos-issues-procurement-final-county/.
OPEN MINDS last reported on this topic in “Wisconsin Rebids Family Care Managed Long-Term Care Plans In Two Geographic Service Regions,” which published on May 13, 2018. The article is available at https://www.openminds.com/market-intelligence/news/wisconsin-rebids-family-care-managed-long-term-care-plans-in-two-geographic-service-regions/.
For more information, contact:
- Wisconsin Department of Health Services, Post Office Box 7850, Madison, Wisconsin 53707-7850; 608-266-1683; Email: DHSMedia@dhs.wisconsin.gov; Website: https://www.dhs.wisconsin.gov/news/
- Annette Cruz, Vice President of Public Policy & Advocacy, Leading Age Wisconsin, 204 South Hamilton Street, Madison, Wisconsin 53703; 608-255-7060; Fax: 608-255-7064; Email: info@LeadingAgeWI.org; Website: http://www.leadingagewi.org/
