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

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Program for Program Chareolorletice AFDCJHS ong>Medicaidong> Primary Provider Program Independent ong>Careong> (I-ong>Careong>) All Inclusive ong>Careong> for the Elderly WI Partnership Children Come Firsl WrapAround Milwaukee (WAM) High Cool Case - Managamani HMO (PPP) (PACE) Program (COF) (HCCM) CoatnetCtng nutiy HMOs vihoart Any wJrV gheCcrd Jdni venurea CormunlyCate Elder Car at Deco Dane Cj. aul~yimw t MtlsoitaeCounly Convilets e lcensaed by le o Olc l rhe cYtifted prirruuly cues ar~oemsrd betwe Orgaenhonra, Inc., phteudd In th ID the olmreeukGe~sC rtdotih opraltes Co., Inc.tr ekidallt. Sar ces Humarrn ServIca pondirg, Commiselacor of tfelatng spdcite, t ta ror Indeponyendce a Coerunity Cure tar ACCe"S to Ineawmiro The HeO FP, OP. Intonrdati oemuncly oaornet ti IhtEtdy (COE) I hrdependance, In. ruet ersto eetel OtYa, erdl Prie., tVInInr agency, and 1,urmidres. lotiphydoitly ted-erd's sddtttnal net nd kderant Hutnreoa WHO. rn durtod. stundda tar quaey Nurso Prmcttcon . HMO. Elder CGer Optlo In sarlerce, calturad Can be assocateds Dose Gclty. ICoaret tlo sectIlittty. trvolrm wcrl, FO AC arnd Intaparodent LIvtNt capacIty snd LPtIsA hf Woetern oacldIneton at orfoe. Ytabcavirt (CILVVYI) lo both elderty and tea, stralg Yes. Fulltcapltt.t No. Prhary providor Yes. Satetpays a Yea. i5% a Yeas. 5% oat Yes. 15% ot FFS Yes. 95% at FFS No. Cowlttcl niihy rrssrgeerssct tar ott rraadaoel enlcete covered ry seerves S3.00 PMPM and FtS phrotaaon rdat oa wtthed ave rege oat weighted Averaogal "ataot t Mentatotl ti)% ot the Medcotd NH oots plus cool at1 NH cost plus coils al Health Servle cota lot MentlS Healrs SwnAcos Wit tave a cninur ol 5at 0. Medicoid eccopt prnalot care payrrenta net r adtnctul ro FFS cos par rrrnbsc ronoru ae other aore Mdieid sho ric al otaer care. Solvnay proecitlco Deom Co. Ficmunm Ptlwaukee Co. Se.M.ose n 1a S lorkcsaret onioum par rnorAh per coso accepted Int c0ordtnalloe end proctdKt ($553.24 Madcald e ftr t tot fllhree (isOWr063o ayatOrni pcordes paymorri to pronides payment to PopCorn romaine carIer peymao PFMPM lor ypore thn PACE sin enlts.t Mdctd covet con -lo cover the not ra rftlollon. Two CY 097.) asametost task. poymont$2.t31.71 Mexdcaldseoevces. Mradcakd esercc. cpitaelnr rs, onoe Medilcidpaymeonl PPRM borCCEClO t Approdxcotoly $3160 Appronaetely $4,000 tla AFOC, ooe tlo $2285.05 PM PM far CY 97. PM PM tor oombined PMPM tl cotrotnod Healthy Stat Eider Cars br CY '97. 52285856 PMPM ton ctptilloon capIha/on. Captroion rote vanetrs S2131.7t PUPM lor Elder ong>Careong> torCY' 07. by rle regn. Ton CCE t CYS'7. S2,916 PMPM lor rats oiUons dnide the ecart. ACCESS tot CY 07 CtLWdW endiOes S2.504 PMPM tar phyarceily dlablod o66band 3593.3d sypsnl rangaoenrsr ter Fully capIlated lot el FFS payotLe lot at spoechlty end aensaery ma4crd Fuly cayllaled c, ad Fully capilotd epsatotIy end thcough coniltctalt Capilaed for epecltiry and Thtrough coniccnted trraemvnieAth crn Through contmced rangomenaos ith FFS paymrnts tot .tt nrce0aary medicat ther prosn dr ancillary medical .nArca. SpecieSets ancillaty modcotl tatonmonlea wilh coilcor'y mudlcic Done County tor MtH Fil-vatnee Conunly tor 6erices. enmic., covered ry end ER mst obra a ae tacas covord by Moorcald arid srncas covred by norvrcoa FFS itH sorces. FFS the Modicaid roloetal before trio Modicoid i tdcaoe. Irie Modlcrtid paymon3 lor Slt other pomnrl tor at oUier -poarcn. Ireatorg prowruo program. wirh sama noc..rod byn FF3. nacorsary mdlcot 'trvs.-rIcee.. n_ csarory mardcat anch 20, 1997/tHCF/MC Page 3 of 6 "3 1131

Primary Independent Program for All Inclusive WrapAround High Cost Program AFDC/HS Provider ong>Careong> ong>Careong>oortha WI Children Mllwaukee Case Characlterisilcs ong>Medicaidong> Program (I-ong>Careong>) Elderly Partnership Come FIrst (WAM) Managemeni HMO (PPP) (PACE) Program (CCF) (IICCM) cc. bInecqer (0511 nuo.10 0mu ron. PCP prevldco cc Cc.. coorolneton The ooT e ortQo onoiy Cncnlct weinse musl Den County is Milwaukee County Is CM (brn wtl prewide ..pcnsbifIy, wycoin hnpace 10 plitury owe sontaes aslgned b0 eoch has kid osopodblist provide. .1 ceceo irpcnablc br the lispoocflte forn he case nu gaomee rrauo. walmwn oe rd auhaothze. mernbar. Calt ond ilsk fcpro0r drwcdyorc arese a oporalnrd cpwrcaton? "omlcem 108i pa00 care threp ret bno blr apecelly coordhotors colect ari ndMaaginag el pro , netwrork far 6dnl*tbon d Urn edellelve l00ofon Uc r.lpcnpl&e taonred 1o ecsiVgnnce cl PCP o ra,.i eno mweagnoy baco0ll data to cre needled tckie not pncdbd progrmn *nd ploene ned Ihe pc CIA flan ounrmrcrncr referralscuovco Persneoo l pWcrr Pogorow Prtm err to dboily.ol Cm m . l obecnblc lcOr-Ll WI oubonb~ls I cr l 101 clgn o ca tnr speociaty cell, Cars, draples. elleIovroese, delivddre clly by provide ltr Ilnegrated n0acc0nry rtnionla necesry rentOal manago wilhn cod 24 hourur or oo o, Lnmprrlegcn. eondoe necde toe PACE agenoy'. olc delity r end loc1 wlIcas Di Soelih coso 01 dsien lrld perlod ol clogrmncy coe. Oonrsaldcy srwpo &&aasorno UL o30 r ddOcld)ncoy teerobased 0e00 vhllswc brve ro whateer levet eo Was tter rbarral to pooGrarnetarged deaylof olknorll leannltho mrerrneceone.L Wos.. bnlotyreqiedby Irlgdrillty e oby rogornm One lace to case nnereiie. lcd help mernD r cornniuroll, nd In doy piactlikcire .1t Ink tle rer diplal, Le.. Vhe idiplill. L.. lac cor0laci0 t a000 detlctilopniellc, blePCP Csre berm oenlcrc. Scfrne *,beolcaccostlcshe$. " hereo l pflald Inpetlcdlr heeplltl evaryhNliOsmonils Is podaIl phrrncsy, ooerlaolof cbn sorvoo may be .onargsncy cars, rgronor cre, relquired. Exccplon AODA. Isetil hebalth approve or coxtraceld oul (l iC, ouIpaoden therpy, ait olrrnt thoreapy. made ai rlquoel of qnd hoine heasth do dbrvprop cedtoln rmel, Dneposrtlotn) roldainel Irnnleenl resideniral beaknontl recipleft no0 roqur a PCP sorvtce (oS. ER ba PACE mahinns ond Lronmpeulbc foller and haerepautb losler snobn. 01fts020 booedn full control of care, and col aide ore, and cue aido medilca necesitdy. Ireablnei plans cnd cnd inohomo rend In-tonne sndi. dlvery. tboalm ent srvices. Key *-rrh troetmert cervIces. Key lenr. componanur ore aomp-cont ote c -ool ec. dhidol ceoc mnanogmot rd cidol mcnao nonerd. Cens n.ccr, hilorourve crioo, wretndlre doy Ir-Unn I and doy boalment ond schcnool-hed mertol achool-baod rieonl coplent bcentUloc No copoys. 24 hea -oroe hDige No copoys. Core tinevaleioable. co-d-toton elth DeWty 00n10 with cane rrmdclc. tiome cre. Nom . dadory oadt No opuys. Sore. ae Ccr dt 1t -1.oo .tcom Cole coordnolor evne.e. 24 hou0s. ECpeneton Caenpe ho dtcorood day rc- oMon beyond Uhoao ot-red 0t -ervtoer beyond t aondltan chtonoes. phyclotar. In FFS cycle. bro olbered to FFS Epaotslon of serviccos astiongmet Alinos cLanl 10 cloy sysclm. beyond those ottered Eypoalon ot servlicOe at horo Irconrprartlon In FFS Syorem, beyond hone oltoead arortnod and iold tor Allows eonrolee to In FFS system. direory by hre I IUO. slay a0 homnc. A Enrotals may metdloddpgnwy contnog 10us0 Ieem coordnlocos 01100n1 pd-ro coro monletoa healh core. phystcon. A rnldisclptny loarn coordInStes enroloeS thealh core. t irch 20,19971SICF/MC Pago 4 of 6

Program for<br />

Program<br />

Chareolorletice<br />

AFDCJHS<br />

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

Primary<br />

Provider<br />

Program<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 />

All Inclusive<br />

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

Elderly<br />

WI<br />

Partnership<br />

Children<br />

Come Firsl<br />

WrapAround<br />

Milwaukee<br />

(WAM)<br />

High Cool<br />

Case -<br />

Managamani<br />

HMO (PPP) (PACE) Program (COF) (HCCM)<br />

CoatnetCtng nutiy HMOs vihoart Any wJrV gheCcrd Jdni venurea CormunlyCate Elder Car at Deco Dane Cj. aul~yimw t MtlsoitaeCounly C<strong>on</strong>vilets e<br />

lcensaed by le o<br />

Olc l rhe<br />

cYtifted prirruuly cues ar~oemsrd betwe Orgaenh<strong>on</strong>ra, Inc.,<br />

phteudd In th ID the olmreeukGe~sC rtdotih opraltes<br />

Co., Inc.tr ekidallt. Sar ces Humarrn ServIca p<strong>on</strong>dirg,<br />

Commiselacor of tfelatng spdcite, t ta ror Indep<strong>on</strong>yendce a Coerunity Cure tar ACCe"S to<br />

Ineawmiro The HeO FP, OP. Int<strong>on</strong>rdati oemuncly oaornet ti IhtEtdy (COE) I hrdependance, In.<br />

ruet ersto eetel OtYa, erdl Prie., tVInInr agency, and 1,urmidres. lotiphydoitly<br />

ted-erd's sddtttnal net nd kderant Hutnreoa WHO. rn durtod.<br />

stundda tar quaey Nurso Prmcttc<strong>on</strong> . HMO. Elder CGer Optlo In<br />

sarlerce, calturad Can be assocateds Dose Gclty. ICoaret tlo<br />

sectIlittty. trvolrm wcrl, FO AC arnd Intaparodent LIvtNt<br />

capacIty snd LPtIsA hf Woetern<br />

oacldInet<strong>on</strong> at orfoe. Ytabcavirt (CILVVYI)<br />

lo both elderty and<br />

tea, stralg Yes. Fulltcapltt.t No. Prhary providor Yes. Satetpays a Yea. i5% a Yeas. 5% oat Yes. 15% ot FFS Yes. 95% at FFS No. Cowlttcl niihy<br />

rrssrgeerssct tar ott rraadaoel<br />

enlcete covered ry<br />

seerves S3.00<br />

PMPM and FtS<br />

phrotaa<strong>on</strong> rdat oa wtthed ave rege oat weighted Averaogal "ataot t Mentatotl<br />

ti)% ot the Medcotd NH oots plus cool at1 NH cost plus coils al Health Servle<br />

cota lot MentlS<br />

Healrs SwnAcos<br />

Wit tave a<br />

cninur ol 5at 0.<br />

Medicoid eccopt<br />

prnalot care<br />

payrrenta net r<br />

adtnctul ro<br />

FFS cos par<br />

rrrnbsc r<strong>on</strong>oru<br />

ae other aore<br />

Mdieid sho ric<br />

al otaer care.<br />

Solvnay proecitlco<br />

Deom Co. Ficmunm Ptlwaukee Co.<br />

Se.M.ose n 1a S lorkcsaret <strong>on</strong>ioum<br />

par rnorAh per coso<br />

accepted Int<br />

c0ordtnalloe end proctdKt ($553.24 Madcald e ftr t tot fllhree (isOWr063o ayatOrni pcordes paymorri to pr<strong>on</strong>ides payment to PopCorn<br />

romaine carIer peymao PFMPM lor ypore thn PACE sin enlts.t Mdctd covet c<strong>on</strong> -lo cover the not<br />

ra rftloll<strong>on</strong>. Two CY 097.) asametost task. poym<strong>on</strong>t$2.t31.71 Mexdcaldseoevces. Mradcakd esercc.<br />

cpitaelnr rs, <strong>on</strong>oe Medilcidpayme<strong>on</strong>l PPRM borCCEClO t Approdxcotoly $3160 Appr<strong>on</strong>aetely $4,000<br />

tla AFOC, ooe tlo $2285.05 PM PM far CY 97. PM PM tor oombined PMPM tl cotrotnod<br />

Healthy Stat Eider Cars br CY '97. 52285856 PMPM t<strong>on</strong> ctptillo<strong>on</strong> capIha/<strong>on</strong>.<br />

Captroi<strong>on</strong> rote vanetrs S2131.7t PUPM lor Elder <str<strong>on</strong>g>Care</str<strong>on</strong>g> torCY' 07.<br />

by rle regn. T<strong>on</strong> CCE t CYS'7. S2,916 PMPM lor<br />

rats oiU<strong>on</strong>s dnide<br />

the ecart.<br />

ACCESS tot CY 07<br />

CtLWdW endiOes<br />

S2.504 PMPM tar<br />

phyarceily dlablod<br />

o66band 3593.3d<br />

sypsnl<br />

rangaoenrsr ter<br />

Fully capIlated lot el FFS payotLe lot at<br />

spoechlty end aensaery ma4crd<br />

Fuly cayllaled c, ad Fully capilotd<br />

epsatotIy end thcough c<strong>on</strong>iltctalt<br />

Capilaed for<br />

epecltiry and<br />

Thtrough c<strong>on</strong>iccnted<br />

trraemvnieAth crn<br />

Through c<strong>on</strong>tmced<br />

rangomenaos ith<br />

FFS paymrnts tot .tt<br />

nrce0aary medicat<br />

ther prosn dr ancillary medical .nArca. SpecieSets ancillaty modcotl tat<strong>on</strong>m<strong>on</strong>lea wilh coilcor'y mudlcic D<strong>on</strong>e County tor MtH Fil-vatnee C<strong>on</strong>unly tor 6erices.<br />

enmic., covered ry end ER mst obra a ae tacas covord by Moorcald arid srncas covred by norvrcoa FFS itH sorces. FFS<br />

the Modicaid roloetal before trio Modicoid i tdcaoe. Irie Modlcrtid paym<strong>on</strong>3 lor Slt other pomnrl tor at oUier<br />

-poarcn. Ireatorg prowruo program. wirh sama<br />

noc..rod byn FF3.<br />

nacorsary mdlcot<br />

'trvs.-rIcee..<br />

n_ csarory mardcat<br />

anch 20, 1997/tHCF/MC<br />

Page 3 of 6<br />

"3 1131

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