Medicaid Managed Care - U.S. Senate Special Committee on Aging
Share Embed Flag
Download ePaper

Medicaid Managed Care - U.S. Senate Special Committee on Aging

Medicaid Managed Care - U.S. Senate Special Committee on Aging Medicaid Managed Care - U.S. Senate Special Committee on Aging

aging.senate.gov
from aging.senate.gov More from this publisher
29.07.2013 Views

'Nisconsin ong>Medicaidong> ong>Managedong> ong>Careong> Programs Overview Primary Independent Program tor All Inclusive WrapAround High Cosl Program AFDCIHS Provider ong>Careong> ong>Careong> lor the WI Children Milwauwkea Case ,haracterlstics ong>Medicaidong> Program (I-ong>Careong>) Elderly Partnership Come Firat JWAM) Managemarni HMO (PPP) (PACE) Proaram (CCF) (HCCM) 4tD ol a9t 077 (expnoeItablo i r 1, Ieb1944 J* y,19 1) C urAy CYre I) Elder Car o Danet Apri0 Attach IW7? My IcO7 cplomantallon 198O4 end 1995 and |rromrnb Is enpeold Orgaization, Inc. I Co, bno In Januty atdt ttde 0 I lo te *mi on May Nerntes I d In 199o. in 199) 2 t 197 ) Uat.. 2) Comtnaty Cc. 2) Eld Cafel DOes Oignedldlaolt hoe. in Cmc. Inb. InJeaiy Atilt 1M. t99Q 3iACCESSt o '09am iteWU Al cotltilsr, Mlutlt Couety MUWcUkDe Councy Indopaendot WnI Job Watstrn "Soo0n09 In May __ _ _ _ __ _ 1997.1 _ _ _ _ _ _ _ One PboC Dt In . l.OQ; .ututc Dana County lJUl.ka Ce-nty _ _ _ _ _ _ _ _ _ Slewlde. oclldbrif Deml, Miucclst and one in end Eau Mile Flor"'n , Kewaunee. ond Maritte. DOane Coti Couonts -.9utt debtlpllon It *pptha lo Rcipients ate aeilonod t Rtadents wi linked core cootodnalontt loNd t* pdaay cYC and a n.twolk of Pedo hatl oldody tIdweldea tho Deroc tloc prnold multalyanv. tha t proeides how cooonunltdyb.h d S ame CCIF Btei. rtt9a and Ceooial catew natglag "lo recohD cme mtl and soake. Uooh ptooider t*no, e ol oe b Uhe pjocidMr coometnat ouplot nutdad lo medial end oodal &ni1dmu0.ng home and conmnunkdy Cean sysatem of cantatl cWeochlnldvY healSh 98.C0K. neded by r9cideton Vl Ath cta0n hJIe la conflt9lodllo. drlVfy of hadlth S.0ncmlt 51 pLhcamente ttnhugh Inl bgreod ea tO Ohibdton Oh t Mad diag a HMOW Is tsponsailn CaDr. ericu. dcadbed Modlold wntslan ofd hehe ldl eldetly and emotlonle lor proldng diedcUy reglhtlula. comiphettdvDe poonslttth phyatcal dt1ttbottCeS ISE D). i cola-Un.tlor modtca and dliabillos. covoted .o.Ic.A to paychoodod serkie the entoUad bye nndul-duldpLna-y ogtaw go0l0 Popl Onaton. Ittipoi qualty dl I~p.oc at.co. to GOal Is to Integola tam. Allow ltdery to Two odtots. on. lot Keep cilddn .iltt Some DS CCF Inyfono qUt11ly d1 Cot. through beltot pImnary cto sor0b9s medical and osocl tamaln In cnonTrorIly. aldarly and onD lot SED out ol cOir, and todvco £00985 to aod by c.,ienng -Intce oind irnptouo bood neoovca and phyoltclly Illcbred. Instttlons. tis tltoouh bellot continuty ol odczd namtdcatl home eoD qeotlty. Ccoe.end thDIr ho... by tntegtatao CtU sad fltoonem oiama - lU0d m o ltomnm Clo. Roduco c Cook, nth rciplnt. Reduce coondination a) pondtIg cniomou-ng long Ottm Colao tetolnCe pdeWo3ey oltolralotn cl through batter co00s by tolductg medical Soomlen baed atenIces serleo dol-ey. and Usod lo hInpprop'l1la $o.nkC. sncoagnnnx nad duplticlion ol Reafocaledamueceis Conin atao Dnd mardtzD abiltyof InOsittdloralzaltloattt ftor llont wdllh toduchig aeroone cid Iu dteabted tong Iatn cmot coats. aeDl.. Ino roeain In omuiity butl deS-inleOd 0Noh Coat napproprdate Coe untnocoesay Core. teilonto. toUh own hoto sortces lar o cidkon dia0no&.s. __lh SED. _ itch 20, 19971BHCF/MC Page l of i

Program Characterislics __________ AFDClJiS ong>Medicaidong> ~~HMO Primary Providtr Program (PPP) Independent ong>Careong> (I-ong>Careong>) I_____ Program lor All Inclusive Caoe for the Elderly (PACE) WI Partnership Program Children Come Firsl (CCF) WrapAround Milwaukee (WAM) ______ High Cost Case Managerent (HCCM) lulelodly and Irding Slab tMoclui oure agaocy and Foderal CooerraIenI. SIrdI Modleald ThIs. year research OBRA ol IC66 gave eutcy nd Federal e dcdraoratlron bedrald ItOdllty tr -oarranrntl ( 0161) GCnl ILr,- I ICF Ooant Iom Rs WJ tlWJ F.orrndeon "Ibsidy a 6 ya. Sla lrarrotd I Fourndaon door gn tilllhy. C4HS granl. Nrm agency. A (1016(b) waborm% . 0. Lotb totaIl eor1eri. the Pact mndd. adminbraerJd by Slal. Curr dy liahr lendad continued Iorrugh I ong>Medicaidong> .gcrOy. by DHFS and Du dnl lnxDng by DHFS t10.1gow go Medicadd pay Coplbalsd rabr to PACE slra. Madcrd ravnnus.. Coorry ODallnurm ol of nd WWr u4k lunaE S o. County OtS yptmolenolmnIl obanblOr or Vodunbytory W aolpenl 10 In da Inhdinblyna elorytrx Vobunabry. lacilr0lea Voorlyunty dzip a re fisk.tt -. selected 01 Volunbotry Vaunb.y vast" Vodunlary tbanlaory) codes Mlhi on. Votutry " °' random to taecl~v prodoDpanH10 VWd mandory tor dg10 Flplan~u,1 10 zip codsr YAh bwo or mono partlbcpailng HMOt. Rotpiard may Orbtin on _amplon l cdlarl we Mel. November 1, 009.L 10rn0rg pacSbe. 11g1bl.poprlaU.n AFDC and Ha..y Start rdyloro O11kng In oly codrs BS1d.aobad S1 dIsabled M edeatd dajpirts [r"citlow" who are sadkUng In taauk, duavy ellgiblorlo Fral ldedly. nurdng hb olmgldse eWrObO vd" o we Fiaolidery mid phbykay dslol duallyollgiblo. ChUdor.dodsoont od. Morid raciplenl and crd nt Daen Cldldoradolaor-nl MadoDid 0e or and c=l nl e 1 Non nstlulonoezad (01.' Iending dsclarge) ong>Medicaidong> ebbvaworeooro Courty. Dual delgi1o Medicare and dublly alioda1 Redlonlrr.-tmrl a Co. Hunrman S.,vlona Mbrou Co. frdrid" dr ll pedbclpatbrg Htts. and pansOn smrdled 0Da1 eISvbles re In mrweged es, i eacluded. Exrpion otosl care, or c01 1. a.a. erelor loMl. U.d HIoelhy Sled 1,. r*ciplenl l0ck04n progrrm fol p10 y nanl proqmm are worner, and children BeCcluded. .lose family Iromob 1s3 ndl 185% rd re Medicald and reside Modcae end In Mlukabee County. Moroald. Polorilel Recipnles mwl1 be ellgiblfnouol mwool r S Sldt ated Codn 21 both theInomneOnd and 0...I n1 be nurseng lomb loYal betloon-alb ed. 0.10 elilgiboly Cannol b, enroled In orllilo 1., ong>Medicaidong> oher maneagad care oo roelo p0ng, . lenv of cao criteria lorn n r bhome adbmlaubon or rrarol havna astoolaIl lWne.. or dblllry. Deprtmrent. hslt Hueran Services ' rntrbpalld have sevare Dapedmeral. Molt expendiluro orrollonra dslvbarence hav6esever0 >S25.000 p6r yaOw a. deined rd In HSS emolbnalislulbanco FeciplasnI muel le 107.2, Ms.. Admin. a, dcoied In HSS primary dlagnords In Codo. rnd be .1 107.02, Wb. Adminr one o0 Ihe lergalord rI.n.inorl rIck d1 Code, and be el dagnoesi neorglo, Insallulbenal Imminentl de 01 ol lclde d. rean odrnbsl.ono t lns. l llnon1l hrotlsrAODA povorty I-ol. (e g., CIP, COP. C6P). paycNcIte hoplel. placonr enl 11, chld edmlselon 1 0 peychlolrlc hospilal, daoonosee.) carin001 1hboutlon, or pecornrer In a cN 1d ju,001b correctIon cadn10 bIAUtn.on, or c0plabnt eg. qairenmnl Nogeeo triclone. Undoergeg5. _____________ Age rn aIno r Ago 65 lacily. 6So.adbry * dly ddoloIr o alrl lrl ege 17 orago 10r04 or phy0.10l disability Juvenile correction locit~ly. 91irl toeo 17 ? ____________I__ 1Norg realdol-ona. .-_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ model. _ itch 20, 1997/13-CIF/MC Page 2 of 6 t1

Program<br />

Characterislics<br />

__________<br />

AFDClJiS<br />

<str<strong>on</strong>g>Medicaid</str<strong>on</strong>g><br />

~~HMO<br />

Primary<br />

Providtr<br />

Program<br />

(PPP)<br />

Independent<br />

<str<strong>on</strong>g>Care</str<strong>on</strong>g><br />

(I-<str<strong>on</strong>g>Care</str<strong>on</strong>g>)<br />

I_____<br />

Program lor<br />

All Inclusive<br />

Caoe for the<br />

Elderly<br />

(PACE)<br />

WI<br />

Partnership<br />

Program<br />

Children<br />

Come Firsl<br />

(CCF)<br />

WrapAround<br />

Milwaukee<br />

(WAM)<br />

______<br />

High Cost<br />

Case<br />

Managerent<br />

(HCCM)<br />

lulelodly and Irding Slab tMoclui<br />

oure agaocy and Foderal<br />

CooerraIenI.<br />

SIrdI Modleald ThIs. year research OBRA ol IC66 gave<br />

eutcy nd Federal e dcdraoratlr<strong>on</strong> bedrald ItOdllty tr<br />

-oarranrntl ( 0161) GCnl ILr,- I ICF<br />

Ooant Iom Rs WJ tlWJ F.orrnde<strong>on</strong> "Ibsidy a 6 ya. Sla lrarrotd I<br />

Fournda<strong>on</strong> door gn tilllhy. C4HS granl. Nrm agency.<br />

A<br />

(1016(b) waborm%<br />

. 0. Lotb totaIl<br />

eor1eri. the Pact mndd.<br />

adminbraerJd by Slal. Curr dy liahr lendad c<strong>on</strong>tinued Iorrugh I<br />

<str<strong>on</strong>g>Medicaid</str<strong>on</strong>g> .gcrOy. by DHFS and Du dnl lnxDng by DHFS<br />

t10.1gow go<br />

Medicadd pay<br />

Coplbalsd rabr to<br />

PACE slra.<br />

Madcrd ravnnus.. Coorry ODallnurm ol of nd WWr u4k<br />

lunaE S o. County OtS<br />

yptmolenolmnIl<br />

obanblOr or<br />

Vodunbytory W<br />

aolpenl 10 In<br />

da Inhdinblyna elorytrx Vobunabry. lacilr0lea Voorlyunty<br />

dzip a re fisk.tt -. selected 01<br />

Volunbotry Vaunb.y vast" Vodunlary<br />

tbanlaory) codes Mlhi <strong>on</strong>. Votutry " °' random to taecl~v<br />

prodoDpanH10<br />

VWd mandory tor<br />

dg10 Flplan~u,1 10<br />

zip codsr YAh bwo or<br />

m<strong>on</strong>o partlbcpailng<br />

HMOt. Rotpiard<br />

may Orbtin <strong>on</strong><br />

_ampl<strong>on</strong> l cdlarl<br />

we Mel.<br />

November 1, 009.L 10rn0rg pacSbe.<br />

11g1bl.poprlaU.n AFDC and Ha..y<br />

Start rdyloro<br />

O11kng In oly codrs<br />

BS1d.aobad S1 dIsabled<br />

M edeatd dajpirts [r"citlow" who are<br />

sadkUng In taauk, duavy ellgiblorlo<br />

Fral ldedly. nurdng<br />

hb olmgldse<br />

eWrObO vd" o we<br />

Fiaolidery mid<br />

phbykay dslol<br />

duallyollgiblo.<br />

ChUdor.dodso<strong>on</strong>t<br />

od. Morid raciplenl<br />

and crd nt Daen<br />

Cldldoradolaor-nl<br />

MadoDid 0e or<br />

and c=l nl e 1<br />

N<strong>on</strong> nstlul<strong>on</strong>oezad<br />

(01.' Iending<br />

dsclarge) <str<strong>on</strong>g>Medicaid</str<strong>on</strong>g><br />

ebbvaworeooro Courty. Dual delgi1o Medicare and dublly alioda1 Redl<strong>on</strong>lrr.-tmrl a Co. Hunrman S.,vl<strong>on</strong>a Mbrou Co. frdrid" dr ll<br />

pedbclpatbrg Htts. and pansOn smrdled<br />

0Da1 eISvbles re In mrweged es, i<br />

eacluded. Exrpi<strong>on</strong> otosl care, or<br />

c01 1. a.a. erelor loMl. U.d<br />

HIoelhy Sled 1,. r*ciplenl l0ck04n<br />

progrrm fol p10 y nanl proqmm are<br />

worner, and children BeCcluded.<br />

.lose family Iromob<br />

1s3 ndl 185% rd re<br />

Medicald and reside Modcae end<br />

In Mlukabee County. Moroald. Polorilel<br />

Recipnles mwl1 be ellgiblfnouol mwool<br />

r S Sldt ated Codn 21 both theInomneOnd<br />

and 0...I n1 be nurseng lomb loYal<br />

betlo<strong>on</strong>-alb ed. 0.10 elilgiboly<br />

Cannol b, enroled In orllilo 1., <str<strong>on</strong>g>Medicaid</str<strong>on</strong>g><br />

oher maneagad care<br />

oo roelo p0ng, .<br />

lenv of cao criteria<br />

lorn n r bhome<br />

adbmlaub<strong>on</strong> or rrarol<br />

havna astoolaIl<br />

lWne.. or dblllry.<br />

Deprtmrent. hslt Hueran Services ' rntrbpalld<br />

have sevare Dapedmeral. Molt expendiluro<br />

orroll<strong>on</strong>ra dslvbarence hav6esever0 >S25.000 p6r yaOw<br />

a. deined rd In HSS emolbnalislulbanco FeciplasnI muel le<br />

107.2, Ms.. Admin. a, dcoied In HSS primary dlagnords In<br />

Codo. rnd be .1 107.02, Wb. Adminr <strong>on</strong>e o0 Ihe lergalord<br />

rI.n.inorl rIck d1 Code, and be el dagnoesi neorglo,<br />

Insallulbenal Imminentl de 01 ol lclde d. rean<br />

odrnbsl.<strong>on</strong>o t lns. l lln<strong>on</strong>1l hrotlsrAODA<br />

povorty I-ol. (e g., CIP, COP.<br />

C6P).<br />

paycNcIte hoplel.<br />

plac<strong>on</strong>r enl 11, chld<br />

edmlsel<strong>on</strong> 1 0<br />

peychlolrlc hospilal,<br />

dao<strong>on</strong>osee.)<br />

carin001 1hboutl<strong>on</strong>, or pecornrer In a cN 1d<br />

ju,001b correctI<strong>on</strong> cadn10 bIAUtn.<strong>on</strong>, or<br />

c0plabnt eg.<br />

qairenmnl<br />

Nogeeo tricl<strong>on</strong>e. Undoergeg5.<br />

_____________<br />

Age rn aIno r Ago 65<br />

lacily.<br />

6So.adbry * dly ddoloIr o alrl lrl ege 17<br />

orago 10r04 or<br />

phy0.10l disability<br />

Juvenile correcti<strong>on</strong><br />

locit~ly.<br />

91irl toeo 17 ?<br />

____________I__<br />

1Norg realdol-<strong>on</strong>a.<br />

.-_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ model. _<br />

itch 20, 1997/13-CIF/MC Page 2 of 6<br />

t1

logo

products

Resources

Company

Terms of service
Privacy policy
Cookie policy
Cookie settings
Imprint
Change language
Made with love in Switzerland
© 2024 Yumpu.com all rights reserved

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!