Independent Reviews of Family Care
External Quality Review
Reports
| Independent Assessment
External Quality Review
Effective July 1, 2002, the Department contracted with
MetaStar (Exit DHFS) to conduct external
quality review (EQR) activities for the Family Care program. On an
ongoing basis, EQR
activities evaluate the quality of the services that are arranged for
or provided to Family Care enrollees or potential enrollees under the
contract the Department has entered into with CMOs, resource centers
and enrollment consultants. The goal of EQR activities is to gain an
understanding of how each CMO is or is not meeting the needs of its
enrolled population, how each RC and the enrollment consultant program
is meeting the needs of potential Family Care enrollees, and how
differences in State and CMO, RC or enrollment consultant approaches
are affecting outcomes. The EQR activities are very similar
to the quality assurance activities that the Department has previously
conducted.
These activities include review of internal quality programs at both
CMOs and RCs, quality site visits, monitoring implementation of
contract standards, member-centered plan reviews, and member outcome
interviews. These external quality review activities are performed
consistent with DHFS requirements, and with applicable Medicaid
provisions under the Balanced Budget Act of 1997, managed care
provisions, and Centers for Medicare and Medicaid Services (CMS)
protocols for use in external review of Medicaid managed care organizations and
pre-paid health plans. EQRO Request
for Proposals (PDF, 374 KB) Annual
External Quality Review Reports,
Submitted by MetaStar, Inc.
Independent Assessment
Effective September 16, 2002, the Department contracted
with the Innovative Resource
Group (IRG) to conduct an independent assessment of the Family Care
program during the first two years of the Family Care waiver, as required
by CMS. Working in collaboration with MetaStar, the external quality
review organization for Family Care, IRG will produce one report in late
2003 that will examine how Family Care has affected access to, quality of,
and cost-effectiveness of long-term care services, in comparison to other
systems of long-term care delivery in Wisconsin. The Department will
submit the independent assessment with its application to CMS for renewal
of the Family Care waivers.
PDF: The free Acrobat Reader® software
is needed to view and print portable document format (PDF) files. Learn
more.
Last Revised: June 10, 2008 |
