By Paul Soczynski
Chief Operating Officer
Community Care

Chosen by the state to develop and implement long-term care services for low-income seniors and adults with disabilities, Community Care is now working with many new providers in Kenosha, Ozaukee, Racine, Sheboygan and Washington counties. Many of these providers formerly contracted with the counties, who operated these services. What do these changes mean to providers? Community Care’s chief operating officer Paul F. Soczynski answers some of the most common questions for our readers.

Q: Why is long-term care shifting from the county to Community Care?
A: Historically, county waiting lists for services have consistently outpaced funding available to provide these services. Many frail, elder adults and adults with disabilities have spent years waiting for services. Community Care was chosen by the state to expand long-term care services so these residents would have access to a wider range of home- and community-based care under a managed care format. Community Care’s mission is to help people remain in their homes while making efficient use of limited funds. Counties opted out of providing long-term care service under managed care. Instead they are focusing on serving as the Aging and Disability Resource Center in their county.

Q: Will Community Care cut services to individuals?
A: Our goal is not to cut services, it is to provide the best health and long-term care services based on individual needs and desired outcomes. In the past, there were many distinct funding streams for services. Today, they are streamlined into one funding stream so that services can be provided in the most efficient ways. By giving people access to the appropriate level of community-based care when they need it, we not only provide services where people prefer — in their own homes, we also use taxpayer and public dollars as responsibly as possible.

Q: As a provider, will my rates be cut?
A: We are looking at more efficient ways of doing things. We do not want to short-change enrollees or providers. In trying to provide services to more people, we must find cost-effective approaches that are mutually beneficial for all of us, especially those who depend on our services. There may be rate and rate methodology changes as we review care plans to make them more cost effective while maintaining our commitment to solid member choices and outcomes.

Q: When I have a question about claims, whom should I ask?
A: Community Care offers providers a dedicated customer service representative to help you handle claims easily and efficiently. For help with claims, call Sandy Braun at 414-902-2375. If you have a question about service authorizations you are asked to call the following staff resources: At DDIS, contact Nancy Siegrist at 262-898-2130. At KHDS, contact Jamey Roman at 262-657-7188. In the Community Care Racine or Kenosha offices, contact Laura Moore at 262-484-5090. Please do not call the Care Manager or RN. The staff resources listed above will work with the care management staff to answer your questions and help resolve any problems you have.

Q: I am a service provider that is in the process of contracting with Community Care. How can I get my contract questions answered?
A: We are pleased to offer service providers a dedicated provider relations representative to help you get answers to your contracting questions. For help with contract questions, call Phyllis Salley-Thompson at 414-902-2515.