Age and Disabilities Odyssey ConferenceJune 20, 2011

Mary Olsen BakerAging and Adult Services Division, DHS

PACE:Program of All-inclusive Care for the Elderly

PACE PHILOSOPHYProvide 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 ProvideAll 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 TeamsSocial Services

Home CarePharmacy

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$182975-84$229385+ $2863

Non-Metro 55-64$322265-74$165775-84$212985+ $2761

NON DUAL Metro 55-64 $4593

65-74 $370075-84 $400085+ $4527

Non-Metro 55-64 $452565-74 $303075-84 $335785+ $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$191875-84$202385+ $1927

Non-Metro 55-64NA65-74$174275-84$182885+ $1806

NON DUAL Metro 55-64 NA

65-74 $320475-84 $322585+ $3274

Non-Metro 55-64 NA65-74 $262875-84 $267385+ $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 Census Growth 1996 – 2010

PACE Organizations Nationwide

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 1Preliminary information

gathering

6-12 months

Phase 1Preliminary information

gathering

6-12 months

Phase 4PACE Provider Status

On-going

Phase 4PACE Provider Status

On-going

Phase 2In-depth business

planning 6-12 months

Board Agreement

Phase 2In-depth business

planning 6-12 months

Board Agreement

Phase 3Final business planning

& start up period 6-12 months

Board Approval

Phase 3Final 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

TIMELINE6 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 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

Minnesota PACE Contacts

http://www.dhs.state.mn.us/mnpace

Email: Dhs.mnpace@state.mn.usMary Olsen Baker, Aging & Adult Services

(651) 431-2568Deb Maruska, Special Needs Purchasing

(651) 431-2516