Presentation on theme: "Age and Disabilities Odyssey Conference June 20, 2011 Mary Olsen Baker Aging and Adult Services Division, DHS PACE: P rogram of A ll-inclusive C are for."— Presentation transcript:
Age and Disabilities Odyssey Conference June 20, 2011 Mary Olsen Baker Aging and Adult Services Division, DHS PACE: P rogram of A ll-inclusive C are for the E lderly
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
The Program of All-inclusive Care for the Elderly is an: Integrated system of care for the frail elderly that is: Community-based Coordinated Comprehensive Capitated
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
Who Does PACE Serve (eligibility criteria)? 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
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 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 PACE vs. MSHO
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
Integrated Service Delivery and Interdisciplinary Team Care Interdisciplinary Teams Social Services Home Care Pharmacy Nutrition OT/PT Primary Care Transportation Personal Care Activities
PACE Core Competencies 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
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 PACE Core Competencies (cont)
Integrated, Interdisciplinary Team Care 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!
Capitated, Pooled Financing 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
DUAL Metro 55-64$3150 65-74$1829 75-84$2293 85+$2863 Non-Metro55-64$3222 65-74$1657 75-84$2129 85+$2761 NON DUAL Metro 55-64$4593 65-74$3700 75-84$4000 85+$4527 Non-Metro55-64$4525 65-74$3030 75-84$3357 85+$3934 Minnesota Proposed Preliminary PACE Rates* * 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.
DUAL Metro 55-64NA 65-74$1918 75-84$2023 85+$1927 Non-Metro55-64NA 65-74$1742 75-84$1828 85+$1806 NON DUAL Metro 55-64NA 65-74$3204 75-84$3225 85+$3274 Non-Metro55-64NA 65-74$2628 75-84$2673 85+$2676 Minnesota 2011 Average MSHO/MSC+ Rates* * 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.
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
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
Phase 1 Preliminary information gathering 6-12 months Phase 1 Preliminary information gathering 6-12 months Phase 4 PACE Provider Status On-going Phase 4 PACE Provider Status On-going Phase 2 In-depth business planning 6-12 months Board Agreement Phase 2 In-depth business planning 6-12 months Board Agreement Phase 3 Final business planning & start up period 6-12 months Board Approval Phase 3 Final business planning & start up period 6-12 months Board Approval PACE Decision Making and Start Up Timeline
Purpose Of Minnesota RFP To identify qualified responders who agree to develop a financial and service viable PACE Organization (PO).
Minnesota PACE RFP (CONT) Select up to 3 Organizations Successful responders must demonstrate an understanding and the ability to meet all service and financial requirements for POs laid out in federal and state regulations
TIMELINE 6 months 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
SUCCESSFUL RFP Respondents Scope 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
Minnesota PACE Contacts http://www.dhs.state.mn.us/mnpace Email: Dhs.email@example.com Mary Olsen Baker, Aging & Adult Services (651) 431-2568 Deb Maruska, Special Needs Purchasing (651) 431-2516