Information Courtesy of PACE.
Program of All-Inclusive Care for the Elderly (PACE)
Facts and FAQs
(307) 773-8112 For More Info
Why do we need PACE? Three out of five Wyoming caregivers say they need more help caring for their elderly parents now. Demand will likely increase, as data show the number of age 65+ residents in Wyoming is expected to more than double over the next 10 years.
Will PACE save Wyoming money? Yes. Based on results in other states, PACE will save Medicaid 10 percent vs. traditional fee-for-service reimbursement programs. In Laramie County alone, the anticipated savings is expected to be more than $200,000 per year.
Why? Fee-for-service rewards the overutilization of services – do more to get paid more. Being paid per service encourages the use of high-cost, marginal care rather than proven, less-expensive alternatives. Fee-for-service doesn't cover the time and expense of health care professionals working together, which often results in duplication of tests and services. PACE requires team members to coordinate their care.
Are participants locked into PACE? No. Disenrollment from PACE is solely at the option of the participant, who may choose to enter – or leave – the program at any time. The State Medicaid program will develop rules to ensure that Medicaid benefits are not diminished due to a participant's choice to enroll or leave PACE.
Does PACE increase the number of Medicaid recipients? No. With the enabling legislation, PACE will work within the existing Medicaid program. Current Medicaid recipients who need more care than what is provided by traditional home health services, but do not yet require institutional care would be served by PACE within Medicaid. PACE is the intermediate step between those two existing levels of care.
BEST PATIENT EXPERIENCE
v Comprehensive, person-centered care
v Active patient-family engagement
v Improved satisfaction
BEST PLACE TO PROVIDE CARE
v Provider freedom from traditional restrictions
v Focus on individual needs of clients; strengthens patient/care team relationships
v Coordinated care reduces duplication and errors
v Reduces re-hospitalization rates
PACE is a resource to serve a growing senior population
v PACE is a capitated benefit authorized by the Balanced Budget Act of 1997 to meet the needs of long-term care clients, providers, and payers.
v Following successful CMS demonstration projects in1985-97, the PACE model of care obtained permanent CMS provider status to provide services to Medicaid beneficiaries as a state option.
v 85 PACE organizations in 29 states currently serve over 17,000 clients.
v PACE provides services utilizing the Medical Home Model – integrates and coordinates acute, primary and long-term care plus the benefit of an adult day health center.
v Full range of health, social services, in home assistance – to allow the elderly to AGE IN PLACE
v Traditional healthcare services (primary care; medical specialty services; prescription drugs; emergency services; hospital services; skilled home care; assisted living; and nursing home care
v Plus - Personal transportation (for both urban and rural participants); home care services beyond a skilled need; and any necessary equipment (medical or otherwise) to keep them comfortably and safely in their homes.
v PACE provides a comprehensive, coordinated, multi-disciplinary team approach to personalize care to make sure participants get whatever care they need – patient-centered.
For Laramie County Seniors and their families this means
v Seniors 55 and older who would otherwise need a nursing home level of care can remain in their homes longer with the help of adult day center services and 24 hour access to their PACE team.
v Families and caregivers have support to help them keep their loved ones at home.
v PACE responds to needs and wishes of the elderly to stay in familiar surroundings and supports maximum function.
Learn more about PACE by watching a brief educational video (about 10 minutes) at: http://www.pace4you.org/website/article.asp?id=15
Why We Need A PACE Program
v The current health care model for the frail elderly is fragmented; reactively triggered by acute events; lacks incentives to control cost (overlaps result in repeated tests and medication errors); and has limited access to services essential to maintaining maximum levels of physical, social and cognitive function.
v The care delivery system is already challenged to meet the needs of our seniors and will be over-burdened in the future as Wyoming's senior population is predicted to double by 2030 (U.S. Census Bureau, 2008).
v PACE will not duplicate or replace programs currently in place (Senior Centers, Home and Community Based Services, home care, assisted living, long term care) and, in fact, may contract with existing providers for these services.
v PACE will provide another resource to help meet the needs of the frail elderly in our community.
PACE Participant Eligibility
PACE is an option for Medicare and Medicaid eligible enrollees who are:
v At least 55 years old,
v Living in the PACE service area, and
v Certified as eligible for nursing home care by the appropriate State agency.
v Once selected by the participant, PACE becomes the sole source of services.
v Participants may dis-enroll at any time.
PACE Organization Requirements
v A PACE organization is a public or private organization, approved by Medicaid, that is capable of providing comprehensive medical and non-medical services to PACE participants in exchange for a capitated, risk-based annual payment from Medicaid and Medicare.
v PACE organizations are prohibited from withholding any necessary medical or non-medical services to any participant in order to increase its profit from the capitated payment made by Medicaid.
v PACE organizations are approved, regulated and monitored by both the State Medicaid office and CMS.
v To complete the application and pre-pace activities in 2011
v Obtain PACE certification by June 2012
v Accept the first PACE participants into the program by July 1, 2012 or earlier
v Achieve graduated growth during first 3 years, break even by year 4
v Enabling legislation and revision of State Medicaid Plan
v Planning and coordination with State Medicaid and Regional CMS offices
v Application completed and to Medicaid in August/September
v Medicaid review of application in August – November
v Working with architects on physical space plans
v We will improve the health of frail elderly members of our community
v We will help reduce re-hospitalization rates
v We will be cost efficient
v We will improve patient experiences
v Active patient engagement and satisfaction
v Stronger patient/doctor relationship/medical home