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Wisconsin Family Care Implementaton Process Evaluation : Final Report III

November 2002

Wisconsin Legislative Audit Bureau
Lewin contact: Lisa Alecxih

This third implementation report for the Wisconsin Legislative Audit Bureau regarding the Family Care program serves as an update to The Lewin Group's August 2001 report. It notes the progress made in implementing the Family Care model in the pilot counties, as well as issues the State and the counties will need to address as program expansion is considered.

Client Area: State and Local Governments
Expertise Area: Center on Aging and Disability


Home and Community-Based Services in Seven States

April 2002

DHHS, Centers for Medicare and Medicaid Services
Lewin contact: Lisa Alecxih

As part of a CMS-funded study, case studies were conducted in Alabama, Indiana, Washington, Wisconsin, Maryland, Michigan, and Kentucky to assess the major features of the home and community-based services system for older people and younger adults with physical disabilities in each State. The case studies analyzed the financing of services; administrative systems; eligibility, assessment, and case management structures; the services provided, including consumer-directed home care and group residential care; cost-containment efforts; and quality assurance. The role that Medicaid plays in home and community-based services is a major focus of the study.

Client Area: Federal Government
Expertise Area: Center on Aging and Disability, Medicaid and CHIP


Long-Term Care Insurance: An Assessment of States' Capacity to Review and Regulate Rates

February 2002

AARP Public Policy Institute
Lewin contact: Lisa Alecxih

For an AARP Public Policy Institute issue paper, Long-Term Care Insurance: An Assessment of States' Capacity to Review and Regulate Rates, The Lewin Group conducted a survey of state insurance departments' current practices relating to the regulation of long-term care insurance rates and assessed their ability to effectively regulate premiums for the long-term care insurance market. Several reports in the last decade question the adequacy of state regulatory efforts, citing insufficient regulatory efforts to protect consumers and chronic shortages of staff and resources. In addition, large increases in rates by some companies raise concerns about state efforts to ensure accurate pricing for long-term care insurance. Large rate increases, or a series of rate increases over time, could: (1) threaten consumers' ability to continue paying for coverage; and (2) erode confidence in the products being offered by the industry. The paper presents findings from the survey and ratings of states' current pricing review practices, as well as recommendations.

Client Area: Associations
Expertise Area: Center on Aging and Disability


Wisconsin Family Care Implementation Process Evaluation Report II

August 2001

Wisconsin Legislative Audit Bureau
Lewin contact: Lisa Alecxih

In its second report for the Wisconsin Legislative Audit Bureau regarding the Family Care program, the Lewin Group notes that since its first report in November 2000, the Department of Health and Family Services and the pilot counties made considerable progress in implementing Family Care. Based on information through June 2001, the pilot counties demonstrated different stages of program processes, capacity, and enrollment. In January 2002, the counties will implement a final program element, an independent enrollment broker, as proposed by the Department and approved by the federal government. The report points out a number of areas that need to be addressed as the pilots continue, including outreach, provider relations, care management, quality assurance, and cost.

Client Area: State and Local Governments
Expertise Area: Center on Aging and Disability


Characteristics of Caregivers Based on the 1996 Panel of the Survey of Income and Program Participation

January 2001

DHHS, Administration on Aging
Lewin contact: Lisa Alecxih

This issue brief, supported by the Adminstration on Aging, examines caregivers providing regular assistance to individuals with a disability or long-term health problem of all ages in 1998. It is intended to provide the Aging Network with general socio-demographic information about its potential target populations as a background for designing and implementing caregiver support services around the National Family Caregiver Support Program.

Client Area: Federal Government
Expertise Area: Center on Aging and Disability


Case Study Reports on Home and Community-Based Services

December 2000

DHHS, Centers for Medicare and Medicaid Services (CMS)
Lewin contact: Lisa Alecxih

The Centers for Medicare and Medicaid Services contracted with The Lewin Group, and its subcontractors, the Urban Institute, the University of Minnesota, Mathematica Policy Research, Inc., and the MEDSTAT Group, to design and implement a study of the impact of Medicaid home and community based services programs on quality of life, quality of care, utilization and cost. The research project is studying the financing and delivery of services to older and younger people with disabilities in seven states and the Medicaid financing and delivery of services for individuals with mental retardation and developmental disabilities (MR/DD) in six states.

Client Area: Federal Government
Expertise Area: Center on Aging and Disability, Medicaid and CHIP


Wisconsin Family Care Implementation Process Evaluation Report

November 2000

Wisconsin Legislative Audit Bureau

Family Care is an innovative, system redesign experiment designed to improve Wisconsin?s long-term care (LTC) system. Family Care creates two new community organizations, a Resource Center (RC) to provide one-stop shopping for information and assistance in obtaining services, and a Care Management Organization (CMO) to help arrange and manage services. The program also introduces managed care principles to control escalating costs. If the program achieves its goals, the new long-term care system will provide elderly and adult individuals with physical or developmental disabilities with greater access to flexible services that promote independence and facilitate a higher quality of life. The Wisconsin Legislative Audit Bureau contracted with The Lewin Group to evaluate the Family Care pilot program. This report completes the first stage of the project, which was a process evaluation. The second stage will be the development of an impact evaluation, which will assess the extent to which the pilot projects are meeting the stated goals of Family Care. The final stage of the evaluation will assess the benefits and costs of the program This report contains background information on the Family Care program as a whole, as well as evaluative information on the development of each pilot project. The report also contains a glossary of terms and a research methodology section that demonstrates the contacts made in the five pilot counties?Fond du Lac, La Crosse, Milwaukee, Portage and Richland?in order to assess the current status of the Family Care program.

Client Area: State and Local Governments
Expertise Area: Center on Aging and Disability


Review of the Medicaid 1915(c) Home and Community Based Services Waiver Program Literature and Program Data

June 2000

DHHS, Health Care Financing Administration (HCFA)
Lewin contact: Lisa Alecxih

This report reviews literature and provides a brief summary of current program statistics for the Medicaid 1915(c) Home and Community-Based Services (HCBS) Waiver program. The review is limited to literature specifically related to the 1915(c) waiver program and focuses on two categories of programs that constitute the majority of recipients and expenditures: programs serving aged individuals and individuals under age 65 with physical disabilities (A/D); and programs serving individuals with mental retardation or developmental disabilities (MR/DD). The document addresses the following six areas: History of the waiver program; Current program characteristics; The role of care management and consumer direction; Issues related to quality of care and life in HCBS waivers; Cost control mechanisms; and Evaluations of cost savings associated with the waiver program.

Client Area: Federal Government
Expertise Area: Center on Aging and Disability, Medicaid and CHIP


A Survey of Employers Offering Group Long-Term Care Insurance to Their Employees

June 2000

DHHS, Office of the Assistant Secretary for Planning and Evaluation (ASPE)
Lewin contact: Lisa Alecxih

This report presents findings from a survey of employers offering long term care (LTC) insurance to their employees. The survey found that the employer LTC insurance market provides greater access to coverage than the individual LTC insurance market by providing opportunities to avoid extensive medical underwriting. Employers identified simplicity of plan design (most importantly, limiting the number of choices employees face) and employee education as factors critical to the success of a LTC insurance offering.

Client Area: Federal Government
Expertise Area: Center on Aging and Disability


Implications of the Medicare Home Health Interim Payment System of the 1997 Balanced Budget Act

March 1998

National Association for Home Care
Lewin contact: Lisa Alecxih

The Medicare Home Health Interim Payment System (IPS) raises concerns for beneficiaries and providers. A temporary plan proposed until HCFA develops a home care PPS, the IPS may cause the number of home health agencies (HHAs) exceeding the Medicare cost limits to more than double and the published cost limits to decrease 21% on average overall. HHAs may operate without knowing the per-beneficiary limits for up to 6 months of the initial IPS cost reporting period. Strategies developed by HHAs to cope with this reduction may include increasing the proportion of low-end users with fewer visits and restraining costs per visit and number of visits per beneficiary. Some of these strategies could have considerable consequences for high-use home health clients.

Client Area: Associations
Expertise Area: Center on Aging and Disability, Medicare

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