Provider Bulletin | February 2011

Welcome to the February edition of the Provider Bulletin. In this edition you will find useful information about Family Care sustainability, guidelines for supportive home care, and information about the provider advisory committee.

Family Care Sustainability

Many of our valued providers received letters recently outlining reductions in rates effective in February or March, 2011. To ensure sustainability in the Family Care, Family Care Partnership, and PACE programs for 2011 and beyond, it was necessary to make adjustments in the rates we pay to our providers in certain service categories. Rate reductions were based on a percentage decrease or were targeted at providers who had rates that are higher than we typically pay for the same service. Our goals are to achieve sufficient rate reductions to ensure sustainability and to improve the equity between the rates paid to providers for the same type of service. These decisions were not made lightly since we truly value the partnerships we have built with our providers.

Since 2007, Community Care has been working to implement the State’s goals for long term care reform. These goals include both increased access to services and cost effectiveness of the long term care system. Our funding reflects the State’s need to fund all Managed Care Organizations (MCOs) equitably and at the funding level that supports the cost effectiveness achieved by the original Family Care pilot programs, while continuing to protect members’ health and safety and support their personal experience outcomes. Since
2007, Community Care has invested over $13 million of our agency funds operating Family Care. During this period, we have worked diligently to reduce our internal costs. Currently, we have the lowest administrative rate of any MCO and our care management costs are the third lowest of the nine MCOs.

In late December, we received confirmation of our 2011 funding for Family Care and Family Care
Partnership from the State of Wisconsin, Department of Health Services. The impact to Community Care
will be a decrease of approximately $10 million from our 2010 funding and required that we accelerate
our efforts to improve our cost-effectiveness in order to avoid an additional loss of $14 million in 2011,
based on our initial 2011 budget.

Building a sustainable Family Care Program has not been and will not be easy but we owe it to our
members to work together with our providers to find a way to make the program work so that the
services that enable them to achieve their outcomes are maintained.

We are living in very difficult economic times. Community Care is a nonprofit organization that is
dependent on Medicaid funding. We understand that most of our providers are in the same situation and
we encourage providers to respond to rate reductions by finding ways to revise business models or reinvent
organizations so that we can all continue to serve the members who rely on our services. Community
Care staff is willing to meet with any provider who has questions or concerns. We are also available to
work together to identify ways that we might modify or adjust services to make them more cost effective.
Providers may contact Ed Kohl, Family Care Program Officer (414-902-2437) or Matt Moen, Director of Provider Management (414-902-2384) to initiate these discussions.

Electronic Submission of Claims

Community Care encourages all providers to submit claims electronically. Providers who submit claims electronically will receive payment more quickly, usually within 10 days of submission. Claims not submitted electronically will be processed within 30 days.

Currently there are two ways to submit claims electronically: Community Care’s e-forms system or through a traditional clearing house.

Community Care’s payer IDs to submit through a clearing house are:

• Family Care – 60995
  
• PACE & Family Care Partnership - 39126

Please note that e-forms is a special system; it does not mean submitting a claim using e-mail.

Training sessions are held for those who want to learn about e-forms. Upcoming sessions are listed below. Call Greg Russell at 262-953-8500 for additional upcoming training dates and locations.

Provider Advisory Committee

In June, 2010, Community Care convened the first meeting of the Provider Advisory Committee. This
group, chaired by a member of the Community Care Board of Directors, consists of providers representing
a variety of service categories and all the counties served by Community Care. Community Care staff and a
representative of DHS round out the membership. The purpose of the group is outlined below:

• Serve as a communication conduit between the Community Care, Inc. Board of Directors and the
  subcontracted member service organizations and agencies to ensure a smooth flow of appropriate
  financial, quality, utilization and satisfaction information in all directions
  
• Secure provider input in program management of long-term managed care services
  
• Assist Community Care, Inc. in providing managed care programs that support member outcomes in a
  financially prudent way that ensures good stewardship of public funds.
  
• Assist providers in understanding how to work successfully in a managed care system environment
  
• Create a public and transparent process where questions and concerns are openly expressed and
  addressed and where effective problem solving can occur

The Committee meets quarterly; minutes are posted on the website at:

www.communitycareinc.org/ForProviders/provideradvisorycommittee.htm

Pharmacy Newscapsule

The Division of Quality Assurance at Wisconsin DHS publishes a bi-monthly newsletter with information
on new medications, regulation updates, and a consultation corner featuring answers to your questions:

www.dhs.wisconsin.gov/rl_dsl/Publications/PharmJanFeb11.pdf

New Guidelines for Supportive Home Care and Personal Care

Effective January 1, 2011, DHS has issued new guidelines which clearly delineate supportive home care
tasks from personal care tasks. Follow this link to see the entire Technical Assistance document on this
subject: www.dhs.wisconsin.gov/ltcare/Partners/infoseries/tamemo10-12.pdf

Whenever supportive home care or personal care services are considered, our care teams will use the
In Home Assessment Tool to determine the tasks needed to achieve a member’s outcomes. The teams
will then authorize the appropriate level of service.

Please note that Community Care will only contract with licensed Home Health Care or MA-PC certified
agencies to provide personal care. No other agency can provide this service. Agencies are urged to review their contract for new codes and definitions. Any questions can be directed to the Provider Hotline at 866-937-2783.

Residential Scope of Services

All corporate residential providers recently received the Residential Scope of Services document, which will
be effective March 1, 2011. This document outlines Community Care’s expectations for the range of services
that is included in the rate for corporate residential facilities. This document also notes that we will no longer
pay bedhold when a member is temporarily away from the facility. This decision is in keeping with the federal
government’s mandate that public funds not be used to pay for duplicate services. A copy of the Residential
Scope of Services document is available here.

Community Care Provider Management is in the process of developing Scope of Services documents for
other provider types; non-residential providers will be receiving information about Scope of Services
specific to each category of provider in the coming year.

Vacancy List Process & Frequently Asked Questions

When you have a residential vacancy, complete the Residential Vacancy Notification form at:
www.communitycareinc.org/ForProviders/default.htm. Email the form to: ResidentialVacancies@communitycareinc.org. We will list vacancies on our vacancy list for contracted homes only. We cannot guarantee referrals since we are unable to determine how many members will be seeking placements at any given time.

If you are a contracted provider all of your homes must have a contract before we are able to list your
vacancies. If you have questions regarding your contract status you can send an email to: contractinquiries@ communitycareinc.org. Please remember to provide your corporate provider name and the name of each
individual home you are checking on as well as the address of the facility/facilities.

A list of frequently asked questions is available here.

Provider Claims Education Training Schedule

Community Care conducts claims education training to providers on a monthly basis. You are welcome to attend any of the sessions listed below. Current and new non-medical providers are welcome.

Appleton
4435 West Lawrence Avenue
Appleton, WI 54914

• February 25 9:00-11:00am and 1:00-3:00pm

Milwaukee
1555 South Layton Boulevard
Milwaukee, Wisconsin 53215
Room 40

• March 2 9:00-11:00am and 1:00-3:00pm

Waukesha
1801 Dolphin Drive
Waukesha, WI 53186

• March 17 1:00-3:00pm

Call Greg Russell at 262-953-8500 for additional upcoming training dates and locations.