Lakeland Care District

Questions Frequently Asked by Providers:

Q: 1. How will Family Care affect service providers?
A: The Lakeland Care District is responsible for developing a network of providers suitable to serve members throughout the district, and current county providers may wish to contract with the District. The network will focus on offering needed and covered services for an increasing number of members as waiting lists are eliminated in the transition to Family Care. Contracts will be awarded based on members’ needs and the provider’s qualifications, ability, skill and licensure. In Family Care, members are part of the team that is involved in service decisions and choice of providers.

Q: 2. What will happen to small agencies under Family Care expansion?
A: The Lakeland Care District will need providers of all sizes throughout the region being served. Though the size of an agency would not affect whether or not they could contract with the District, it might affect the kinds of referrals it gets. For example, if a small agency does not have medical staff, then consumers with complex medical needs are less likely to be referred to that agency.

Q: 3. Would Adult Family Homes (AFH) need to be licensed and certified as Family Care expands?
A: Currently, Family Care requirements for licensing and certification are similar to the requirements for facilities serving Waiver populations. State staff is currently addressing who will be responsible for conducting the licensing and certification functions.

Q: 4. What if a provider does not want to be a Lakeland Care District provider?
A: Providers can choose whether or not they wish to contract with the District, and we encourage providers to consider the opportunities available as part of a Family Care District network. Because Family Care is an entitlement for all financially and functionally eligible people, there may be a need for an increased number of providers in the new District.

Q: 5. Will there be enough service providers to meet the increased number of consumers receiving services?
A: The Lakeland Care District is responsible for developing an adequate network of providers. Our planning process includes identifying gaps in services to meet members’ needs and if there are not enough providers, resource and capacity development will be a priority throughout implementation of the District.

Q: 6. Should providers start to add new capacity to accommodate all of the people who will be served by the Lakeland Care District?
A: No, we are not asking providers to expand their capacity at this time. However, we encourage you to begin considering the variety of possibilities available to you as a Family Care provider, which may include adding capacity, expanding services or territory, etc.

Q: 7. Do providers need to bill the Lakeland Care District on a monthly basis?
A: Yes. Because Family Care is a managed care program, agencies will need to submit claims on a monthly basis in order to receive payment. In return, the state requires that Family Care agencies pay the majority of ‘clean’ claims within 30 days.

Q: 8. How will provider rates be set?
A: The District will contract with a variety of providers to serve its members’ needs, and rates are determined by the needs of the members and the cost-effectiveness of the services provided. Each District receives a payment in the form of a per-person, or ‘capitated,’ rate from the state, which it uses to pay for all agency costs, the vast majority of which is services to its members. Funds for provider rates are funded from the capitated rate payments.

Q: 9. Do personal care workers need to work through home-health agencies in order to provide services to Lakeland Care District members?
A: No, personal care workers would not need to be employed by a home-health agency to provide services to Family Care members. A member who chooses to self-direct their care can hire anyone they choose to provide their care, as long as that worker meets the Family Care standards, fits the member’s choice and meets the member’s outcomes.