From 2019-2024, MCOs in Wisconsin had a yearly opportunity to participate in an incentive for quality relating to assisted living communities (ALCs) in their network. MCOs contracted with WI DHS, Division of Medicaid Services (DMS) to improve quality for residents residing in Wisconsin ALCs. Participating MCOs received an incentive payment for each member living in an ALC that met at least 1 of the following sets of criteria:
Incentive 1 Criteria
Managed Care Incentive Certification - Wisconsin Department of Quality Assurance (DQA)
Incentive 2 Criteria
Managed Care Incentive Certification - DQA
Managed Care Incentive Certification - WCCEAL Participation
Managed Care Incentive Certification - WCCEAL Falls Rate
In 2024, a third incentive was added. Participating MCOs earned a weighted portion of an incentive payment based on collectively increasing the statewide average of ALCs that satisfy the follow set of criteria:
Incentive 3 Criteria
New in 2024
Has at least one MCO member residing in the setting
Managed Care Incentive Certification - WCCEAL Participation
Managed Care Incentive Certification - DQA
Have a standing of good regulatory compliance from DMS:
Licensed for three years.
Have no enforcement action in the last three years.
Have no substantiated complaints in the last three years.
Is compliant with the Home and Community-Based Services settings rule.
Managed Care Incentive Certification - WCCEAL Participation
Is a member of Wisconsin Coalition for Collaborative Excellence in Assisted Living (WCCEAL) in good standing.
The ALC's WCCEAL status for the 4th quarter of the calendar year must be in good standing (New Member, Regular Member, Gold Member).
MCOs are required to provide the list of ALCs that are part of their network during the MCO Update Period each quarter. The list of ALCs for the 4th quarter of the calendar year will be used when determining incentive eligibility.
Managed Care Incentive Certification - WCCEAL Falls Rate
Has a rate of less than three falls with injury per 1,000 occupied bed between January 1 and December 31, as documented by WCCEAL. A fall with injury means a fall that results in an injury requiring medical treatment.
The ALC's falls with injury rate is determined by averaging the rates submitted in their Quality Improvement (QI) Variables for the calendar year (at least 1 submission for the year is required).
