Lakeland Care District

Family Care Terms and Definitions

Acute Care
Health care services provided in a hospital.

Aging and Disability Resource Centers (ADRC)
ADRCs are the first place to go with your aging and disability questions. ADRCs are service centers providing the public with accurate, unbiased information on all aspects of life related to aging or living with a disability.

Benefit Specialist
A person trained to help individuals determine the benefits for which they may be eligible and assist them in receiving those benefits.

Biennial Budget
The State of Wisconsin budgets in two consecutive, one-year increments. Each fiscal year begins on July 1 and runs through June 30 of the following year. The biennial budget period begins on July 1 of the odd-numbered year and ends on June 30 of the next odd-numbered year.

Capitated Rate
Under Family Care, the state pays each local Care Management Organization (CMO) a fixed dollar amount per person, per month for members’ services.

Care Management Organization (CMO)
The CMO is the agency that employs the care managers and nurses who assist Family Care members receiving services through the program. This agency is also sometimes called the Managed Care Organization, or MCO.

Choice
Choice refers to members’ care, support and services based on need, effectiveness, and cost.

Cost Effective
The balance between member outcomes, needs and cost of services.

Entitlement
A service guaranteed to people who meet functional and financial guidelines set by state and federal agencies.

Family Care (FC)
A program delivering long-term care services to qualified frail elderly people and adults with physical and developmental disabilities. To receive Family Care services, members must be both functionally and financially eligible, based on state and federal program guidelines. Based on managed care principles, Family Care was originally piloted in five Wisconsin counties (Fond du Lac, La Crosse, Richland, Portage and Milwaukee).

Family Care Benefits
The list of services and supports provided by the CMO.

Financial Eligibility
Eligibility for Family Care services, as determined by economic support specialists based on Medicaid program guidelines.

Functional Eligibility
Family Care members must be both financially and functionally eligible for program services. Functional eligibility is based upon an applicant’s ability to perform key ‘activities of daily living’ (ADL) such as: bathing, dressing, walking, toileting, eating, meal preparation, housework, shopping, and money management, etc.

Functional Screen
A tool used to assess a person’s needs and abilities, to determine their eligibility for Family Care.

Long Term Care District
A new local governmental unit created for the purpose of operating a Family Care program in a certain geographic region, for example, across a group of counties. Long Term Care Districts are separate and independent from any state or county governmental units.

Lakeland Long Term Care District
The Long Term Care District planned by Fond du Lac, Manitowoc and Winnebago Counties to operate the Family Care program throughout the region

Interdisciplinary Team (IDT)
The group of people who work together to plan care and services for a Family Care member. At a minimum, the team includes the Family Care member, a nurse and a care manager. At the member’s choice it may also include others such as family members or guardians, advocates, friends, providers, physicians, pharmacists, etc.

Long Term Care (LTC)
Services provided to people with conditions such as chronic long-term illness, injury, or disability that require a level of regular support. People typically in need of long term care include the frail elderly and people with significant physical or developmental disabilities.

Include, Respect, I Self-direct (IRIS)
IRIS is a publicly-funded, state-run program that provides eligible individuals with a monthly budget allocation through which they craft and direct a service plan to meet their self-identified outcomes. For more information on IRIS, please contact your local ADRC.

Managed Care
A programmatic approach that balances long term care service needs and costs.

Member
A person enrolled in Family Care who receives services from the CMO.

Personal Outcomes
A Family Care member’s self-identified needs and personal preferences. An example of an outcome would be “I want to live in my own home.” The services provided by Family Care are geared toward achieving each member’s outcomes.

Family Care provides a wide range of services individually tailored for each member. A CMO’s success can be measured by the real-life results people get from the services they receive.

Primary Care
Primary care is the health care received from your primary doctor.

Provider (or Vendor)
Providers or vendors are individuals, agencies, or companies providing services.

Provider Network
The provider network consists of contracted providers that agree to provide services to Family Care members through the local CMO.

RAD (Resource Allocation Decision Method)
The decision making process that uses member’s identified outcomes to develop a member’s care and services plan.

Self-directed Supports (SDS)
An option within Family Care that allows members to self-direct their own services and supports within a predetermined budget. Family Care members who use SDS are responsible for budgeting, purchasing and overseeing the services they receive.

Stakeholders
People or groups with an interest in a certain program or effort. Family Care’s stakeholders include long-term care consumers, providers, family members, local elected officials, advocacy agencies, staff, taxpayers, and the public.

For additional Family Care terms and definitions, click on the following link and scroll to ‘Glossary of Terms’:
http://dhs.wisconsin.gov/ltcare/BeingaFullPartner.htm