Is Family Care a Health Maintenance Organization (HMO)?
Family Care is not a HMO and will not provide health care services. It is a “managed” long-term care program, which means that it provides for coordination and delivery of services to members related to activities necessary for daily living functions, such as eating and bathing. While Family Care is not a HMO, it is classified by the federal Center for Medicare and Medicaid Services (CMS) as a Pre-paid Inpatient Health Plan (PIHP) which means that, in many respects, the program is treated similarly to a HMO. It is classified this way because nursing homes and other institutions that provide long-term care services are included in Family Care’s benefit package. Because it’s considered a PIHP by the federal government, this subjects the program to additional regulatory requirements. Some of these requirements are very beneficial to members including Appeals and Grievance procedures, choice of providers and the option to self-direct supports.
