Organizational Capacity
Centralized Model
The Wisconsin Family Care program is an example of a model where most administrative functions are housed within a single unit of government. In this state, the administrative structure is located within the long-term care (LTC) division of the state’s Department of Health Services to administer its Family Care program. The LTC division previously administered the state’s fee-for-service LTC programs (including home and community based waivers, nursing facilities and other state plan services) and was instrumental in re-designing both the delivery system and staff infrastructure to better meet the needs of frail elders and adults with developmental or physical disabilities. Today, the division has a core team responsible for each of its four contracted MLTSS contractors, which includes a contract administrator, a member care specialist, quality specialist, and an individual responsible for fiscal oversight. The division director is responsible for program operations, including contract negotiation, policy direction, and interfacing with other agency leads within the Department of Health Services, state insurance, which regulates Family Care managed care contractors, and local Aging and Disability Resource Centers who are responsible for enrollment. In addition to the program director and core teams assigned to each MLTSS contractor, Family Care is supported by:
- information specialists who oversee the program’s encounter data reporting system and functional screening database;
- quality management staff who work with the External Quality Review contractor to assess quality and implement improvement projects; and
- an external fiscal agent responsible for rate setting and financial reporting.
While Wisconsin was advantaged by having seasoned staff with expertise in long term care populations and supports, transitioning to a managed care delivery system required substantial training of in-house staff and the LTSS provider community which oftentimes was the applicant to serve as the MLTSS contractor. Wisconsin’s experience underscores the expertise needed to define and impose standards of quality and operations on both the delivery and oversight systems of MLTSS programs.
