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PACE: P rogram of A ll-inclusive C are for the E lderly

PACE: P rogram of A ll-inclusive C are for the E lderly . Age and Disabilities Odyssey Conference June 20, 2011 Mary Olsen Baker Aging and Adult Services Division, DHS. Pace philosophy. Provide pre-paid, capitated, comprehensive health care services that are designed to:

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PACE: P rogram of A ll-inclusive C are for the E lderly

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  1. PACE:Program of All-inclusive Care for the Elderly Age and Disabilities Odyssey Conference June 20, 2011 Mary Olsen Baker Aging and Adult Services Division, DHS

  2. Pace philosophy Provide pre-paid, capitated, comprehensive health care services that are designed to: • Enhance the quality of life and autonomy for frail, older adults • Maximize dignity of and respect for older adults • Enable frail older adults to live in their own homes and in the community as long as medically and socially feasible • Preserve and support the older adult’s family unit

  3. Integrated system of care for the frail elderly that is: Community-based Coordinated Comprehensive Capitated The Program of All-inclusive Care for the Elderly is an:

  4. PACE History & Evolution • 1983 – On Lok demonstration • 1986 – PACE replication demonstration • 1997 – Congress established PACE as permanent Medicare provider and Medicaid state option (Balanced Budget Act) • Distinct statutory and regulatory designation as a provider-based entity • Sections 1894 and 1934, Social Security Act • Title 42, Part 460, Code of Federal Regulations

  5. Adults 55 years of age or older and who are: Living in a PACE organization’s service area State-certified as eligible for nursing home level of care Able to live safely in the community with the services of the PACE program at the time of enrollment Who Does PACE Serve (eligibility criteria)?

  6. Pace vs. msho Medicaid, Medicare, and dually eligible seniors 55+ Community settings only Must meet NF level of care Enrollment average 282/site Full risk for unlimited nursing home care Combines all primary, acute and LTC services Based on adult day care center model, which coordinates clinic and LTC Services May enroll private pay Voluntary Enrollment Includes Medicare Part D Medicare frailty adjustor All Medicaid and dually eligible seniors 65+ All settings NF level of care not required Enrollment 38,000 statewide Limited risk for nursing home care for community enrollees Combines all primary, acute and LTC services No adult day care requirement, includes Health Care Home Does NOT enroll private pay Voluntary Enrollment Includes Medicare Part D Medicare frailty adjustor pending under new ACA provisions

  7. PACE Organizations Provide All Medicare and Medicaid covered–services and all medically necessary services which include but are not limited to: • medical care • nursing • physical therapy • occupational therapy • home health care • hospital care • personal care • prescription drugs • audiology • dentistry • optometry • podiatry • speech therapy • respite care • SNF/NH care

  8. Integrated Service Delivery and Interdisciplinary Team Care Interdisciplinary Teams Social Services Pharmacy Home Care Activities Nutrition Primary Care Personal Care Transportation OT/PT

  9. Provider-based model of care which (uniquely) assumes FULL financial RISK for ALL medically needed care Serves exclusively a nursing home eligible population where approximately 90% of individuals live in the community PACE Core Competencies

  10. PACE Core Competencies (cont) • Produces exceptional outcomes: • Participants more likely to have advance care directives and die at home • Very high satisfaction among participants, caregivers, and employees • Reduced hospitalizations and permanent residency in nursing homes

  11. Hands-on interdisciplinary team approach to care management by actual caregivers Continuous process of assessment, care planning, service provision, and monitoring for all needs and services Responsibility for all preventive, primary, secondary, and tertiary care NOT case management! Integrated, Interdisciplinary Team Care

  12. Integration of Medicare, Medicaid and private pay payments by PACE providers Medicare A/B capitation payments risk- and frailty- adjusted for PACE participants (2010 monthly mean = $2063) Medicaid capitated payment amounts based on states’ expenditures for long-term care populations (2010 monthly mean = $3258) Medicare Part D payments based on bid amounts Capitated, Pooled Financing

  13. Minnesota Proposed Preliminary PACE Rates* DUAL Metro 55-64 $3150 65-74 $1829 75-84 $2293 85+ $2863 Non-Metro 55-64$3222 65-74 $1657 75-84 $2129 85+ $2761 NON DUAL Metro 55-64 $4593 65-74 $3700 75-84 $4000 85+ $4527 Non-Metro 55-64 $4525 65-74 $3030 75-84 $3357 85+ $3934 * Rates presented are the “Total Rates After Withhold.” Minnesota preliminary proposed PACE rates are available online at http://www.dhs.state.mn.us/dhs16_59649.

  14. Minnesota 2011 Average MSHO/MSC+ Rates* DUAL Metro 55-64 NA 65-74 $1918 75-84 $2023 85+ $1927 Non-Metro 55-64NA 65-74 $1742 75-84 $1828 85+ $1806 NON DUAL Metro 55-64 NA 65-74 $3204 75-84 $3225 85+ $3274 Non-Metro 55-64 NA 65-74 $2628 75-84 $2673 85+ $2676 * Rates presented are the “Total Rates After Withhold.” Minnesota preliminary proposed PACE rates are available online at http://www.dhs.state.mn.us/dhs16_59649.

  15. Status of PACE (As of January, 2011) • 166 PACE centers, operated by 75 organizations, in 29 states, serving 23,000+ • Between 2005-2010, number doubled • Enrollment grew 20% in 2008, 13% in 2009 • 15 new programs in development “pipeline” • More than 50% of PACE organizations plan to expand in 2011

  16. PACE Census Growth 1996 – 2010

  17. PACE Organizations Nationwide

  18. PACE Start Up Costs And Requirements • Start up costs vary, in general $1 to 5M • Need dedicated adult day center • Market = 30-45 minute driving radius of adult day center with a 10% market penetration can capture approximately 150 enrollees • Sponsor (sophisticated and dedicated) willing to assume full financial risk

  19. PACE Decision Making and Start Up Timeline Phase 1 Preliminary information gathering 6-12 months Phase 3 Final business planning & start up period 6-12 months Board Approval Phase 2 In-depth business planning 6-12 months Board Agreement Phase 4 PACE Provider Status On-going

  20. Purpose Of Minnesota RFP To identify qualified responders who agree to develop a financial and service viable PACE Organization (PO).

  21. Minnesota PACE RFP (cont) • Select up to 3 Organizations • Successful responders must demonstrate an understanding and the ability to meetall service and financial requirements for POs laid out in federal and state regulations

  22. Timeline 6months to respond to RFP (Due 9/30/2011) Estimated times 2 months to evaluate and select (Oct/Nov 2011) 1 month to execute the contract (Dec 2011) 6 months to jointly complete application to CMS At least 3 months for first CMS review At least 3 more months for second CMS review

  23. SUCCESSFUL RFP RespondentsScope of Work • Jointly develop an application acceptable to CMS • Enter into a two-way contract with the State • Implement a PACE Organization • Sustain a functioning PACE site

  24. Minnesota PACE Contacts http://www.dhs.state.mn.us/mnpace Email: Dhs.mnpace@state.mn.us Mary Olsen Baker, Aging & Adult Services (651) 431-2568 Deb Maruska, Special Needs Purchasing (651) 431-2516

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