Provider Forum

Meet & Greet

Partnering for Success

My Choice Family Care

WHO ARE WE?

AN OVERVIEW OF MY CHOICE FAMILY CARE

My Choice Family CareDEDICATED TO QUALITY, COST EFFECTIVE SERVICES

Experience MattersMy 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 CareMISSION AT THE HEART OF OUR WORK

Our Mission Statement

My Choice Family Care respects the

dignity and personal autonomy of each

Member by honoring choice and

providing high quality, cost-effective

services and supports.

My Choice Family CareGREAT 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.

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 CareService regions

Care Planning and Coordination

KAREN ENGLANDCARE MANAGEMENT ADMINISTRATOR

• The Member is the center of their Interdisciplinary Team (IDT), along with their RN and CM.

• Collaborate to assess, coordinate, and monitor the options and services 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.

Care Management

SUPPORTING MEMBERS TO ACHIEVE

THEIR OUTCOMES

• Providers play a very important role in Members’ lives.

• Providers support Members on a daily basis and, often, have a deep understanding of how a support or intervention may impact a Member’s daily life.

• It is essential to Member care that the IDT Staff develop good working relationships with the staff that provide care to our Members.

Providers Role in Care

Planning and Service

Coordination

• This relationship can only be successful if there is ongoing communication between the IDT Staff and the Member’s supports. – Aides the ongoing assessment process,

problem solving, and contractual adherence to ensure Member’s needs and outcomes are met.

– Allows the IDT Staff and the MCO to monitor quality, attainment of Member outcomes, and evaluate Member’s continued need for services and their satisfaction with their supports.

IDT and Provider Communication

• Collaboration between the IDT Staff

and Providers in the following areas will

help to ensure the highest Member

satisfaction along with clear

communication between the teams:

– IDT and Facility coordinate and share care

plan information

– Coordinate a response to Member’s

concerns

– Coordinate communication with involved

family and guardians

Collaboration for Member Outcomes

• The IDT Staff will visit Members in their homes including

residential facilities.

• The IDT Staff may review Member’s chart containing:

– the Individual Service Plan (ISP)

– Progress Notes,

– Medication Administration Record (MAR)

– Behavior Support/Intervention Plans and tracking

– Other documentation pertinent to the Member’s care.

Coordination with

Residential Providers

• 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.

Coordination with

Residential Providers

(continued)

• Questions and Discussion

My Choice Family CarePARTNERING WITH YOU!

Provider Contracting

HANNAH HARRISPROVIDER RELATIONS & NETWORK MANAGER

Provider Contracting TeamHannah Harris, Provider Relations & Network Manager

Provider Relations & Network Specialists

Diane Baumbach Mary Swanson

Jessica Cullen Randy Westley

Kelli Macon Sheri Wojtowicz

Debora Rieder

Contract Services Assistant

Kat Gomez

**PLEASE SEE THE HANDOUT PROVIDED FOR YOUR ASSIGNED

CONTRACTING REPERSENTATIVE.

Some of the provider services needed include:

CONSULTING SERVICES COUNSELING/THERAPEUTIC SERVICES

*Financial Management

*Housing Counseling EMPLOYMENT/ACTIVITY SERVICES

*Relocation Services *Adult Day Care

*Support Broker *Employment Services

*Prevocational Services

EQUIPMENT & SUPPLIES *Supported Employment

*Adaptive Aids *Vocational Planning and Support

*Comminication Aids

*Personal Emergency Response System MISCELLANEOUS HOME BASED SERVICES

*Specialized Medical Equipment *Home Delivered Meals

*Home Modifications

RESIDENTIAL

*Adult Family Home TRAINING BASED SERVICES

*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 Needs

• 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 Network EffortsPROVIDER OUTREACH HAS BEGUN

• Questions and Discussion

My Choice Family CarePARTNERING WITH YOU TO SERVE ROCK COUNTY

Provider Portal

MARY JO SAGGIOCLAIMS SPECIALIST

Payment with

Remittance Advice

Sent

Authorization and Payment Process

WPS

Processes

Claim

According to

Authorization

Provider

Submits Claim

to WPS Via the

Midas Portal

Provider

Submits Claim

to Other

Insurance or

Medicare

Provider

Performs

Authorized

Service

Provider

Receives

Service

Authorization

from MCO

WPS Receives

Service

Authorization

from MCO

Managed Care

Organization

(MCO)

Authorizes the

Service

Member Needs

Family Care

Service

1. System:

Provider Portal

2. Login ID and

Password

3. Environment:

Production

4. Login

www.mcfc-midas.com

This screen

displays MCO

relevant

announcements

and news.

Home

This is where you

will find a variety of

resources and

publications

User Documents

• Questions and Discussion

My Choice Family CarePARTNERING WITH YOU TO SERVE FAMILY CARE MEMBERS!

Provider Quality

WES ALBINGER

PROVIDER QUALITY MANAGER

• 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 QualityCOMPLIANCE WITH CONTRACT REQUIREMENTS

• 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, continuedPROVIDER RELATIONS

• Questions and Discussion

My Choice Family CarePARTNERING WITH YOU TO SERVE ROCK COUNTY

Partnering Together With

You!

Thank you!