Wisconsin's Department of Health Services is forging the details of a plan to change the long term care system. The Office of The Commissioner of Insurance has explained the bulk of the operation of the Integrated Health Agency involves insurance industry activity. The Integrated Health Agencies will be required to have an insurance license.
Insurance regulations will define the standards that will drive the administrative applications that control delivery. The Integrated Health Agency will utilize proven medical benefit standards as a key piece of the administrative authority needed to maintain accepted measures of quality while assuring fiscal integrity.
To stay on schedule the Department of Health Services must submit their brand new insurance style plan to the Joint Finance Committee by April 2016. This is asking for the Joint Finance Committee's permission to submit the brand new waiver proposal to the Centers for Medicare and Medicaid.
This newly created plan with a strong insurance foundation should fall safely within Medicare and Medicaid guidelines- as both are health insurance models. This new plan is expected to fold all existing public programs (Family Care, IRIS, Wisconsin Partnership) in to one mode administering the Medicaid benefit across the entire State of Wisconsin.
Definitions of medical necessity will be instrumental in managing eligibility. The structure of the claims process will require a larger investment on the provider side. Readers are encouraged to watch for DHS to publish their brand new plan as April 2016 comes closer.
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