Based on the DHFS' "preliminary views" on LTC redesign, the Department strongly desires to utilize MCOs as the primary vehicle to deliver LTC in the future. That being the case, WAHSA advocates that all MCOs participating in the State's redesigned LTC program must have:

• Experience in contracting for or directly providing LTC services.
• The capacity to assume financial risk.
• The ability and willingness to provide or contract for the full range of necessary LTC Services. (The MCO would not be required to serve all long term care client groups if the organization does not have the expertise to do so.) The MCO must offer at least two choices of providers within each provider group (e.g., adult day care, nursing home, home health, personal care staff, etc.).
• Demonstrated expertise in QA monitoring and improvement, including a data system in place to evaluate contract performance and client satisfaction.
• The responsibility for case management.
• A governance structure that assures meaningful representation by members of the community, clients and families.
• The ability to respond timely to emergency situations.
• Demonstrated ability to internally and externally advocate on behalf of the client.
• Written protocols for care/service plan development, grievance procedures, appeals, and evaluations.
• An independent audit report provided annually to the DHFS which would include full disclosure of the MCO's revenues and expenditures, changes in ownership and related party transactions.

Again, the LTC Managed Care Organization Program would operate in accordance with the "Common Core Elements" identified in this paper. WAHSA assumes any entity (not-for-profit, for-profit, or governmental) which is able to meet the requirements listed above and adhere to the common core elements could be an MCO under the state program. Enrollment in a LTC MCO would become mandatory only if there are at least two MCOs within a client's community which offer services to that client group. Otherwise, enrollment would be strictly voluntary. In these instances, the client either could utilize the voucher option or participate in the fee-for-service system (presumably this system would offer fewer service options). Within the MCO program, enrollees generally would be free to choose a care/service plan if the cost of this plan does not exceed the client's capitation rate (determined by the client's individualized comprehensive assessment).