Bringi ging P g PACE t CE to New Ha Hampshire Liz P Parr rry - - PowerPoint PPT Presentation

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Bringi ging P g PACE t CE to New Ha Hampshire Liz P Parr rry - - PowerPoint PPT Presentation

Sep 04, 2023 259 likes •514 views

Bringi ging P g PACE t CE to New Ha Hampshire Liz P Parr rry Nati tional P PACE Associati tion Outline I. Introduction II. PACE 101 III. State Requirements and Issues IV. Federal Requirements and Issues V. Q&A PACE 101 101

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Bringi ging P g PACE t CE to New Ha Hampshire

Liz P Parr rry Nati tional P PACE Associati tion

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SLIDE 2

Outline

I. Introduction

  • II. PACE 101
  • III. State Requirements and Issues
  • IV. Federal Requirements and Issues
  • V. Q&A
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SLIDE 3

PACE 101 101

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SLIDE 4

What i t is PACE? E?

Seeing PACE Firsthand

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SLIDE 5

What i t is PACE? E?

  • Comprehensive
  • Community Based
  • Coordinated
  • Capitated
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SLIDE 6

PACE b E by the Number ers - What

124 PACE

Organizations

242 PACE Centers

11 Average # Years

Programs in Operation

6

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SLIDE 7

PACE b E by the Number ers - Where re

31

PACE States

19 Operate in Rural Areas

49% of all PACE

  • rganizations operate in 5 States

7

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SLIDE 8

Wher ere e is PACE?

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Who ho Do Does s PACE S E Serve?

  • 55 and older
  • At a Nursing Home Level of Care
  • Able to live in Community, with PACE services
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PACE b E by the Number ers - Who

42,000+ Participants

95% In Home &

Communities

76 Average Participant Age

10

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How D Does es P PACE Op Oper erate? e?

  • PACE Center
  • Primary Care
  • Rehabilitative Care
  • Activities
  • Meals
  • In the Home
  • Transportation
  • Contracted Network:
  • Specialists
  • Hospitals
  • Assisted Living
  • Other
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SLIDE 12

Integ egrated ed Ser ervice De Delivery and T nd Team M Managed C d Care

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SLIDE 13

Ou Outcom

  • mes

es

  • Better care
  • Fewer unmet needs
  • Improved chronic care management
  • Better functional support
  • Longer life
  • Higher Quality of Life
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PACE C E Costs ts

  • Reduces high cost of uncoordinated care
  • Fewer hospitalizations
  • Less ER use
  • Capitated = Predictable
  • PACE rate less than current Medicaid cost
  • No copays
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SLIDE 15

Who

  • Pays f

for PACE CE C Care

  • PACE is a financially capitated program
  • Organizations receive a per member, per month payment

to deliver all the necessary care

  • Breakdown of Participants
  • 90% dually eligible for Medicaid and Medicare
  • 9% Medicaid-only
  • 1% private pay, Medicare-only, other
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Why P y PACE CE i in N New Ha Hampshire?

  • Coordinated care
  • Keeps elders in their homes and their communities
  • Supports family caregivers
  • Reduces costly acute care
  • Takes full responsibility for meeting care needs,

at a predictable monthly cost

  • Supports economic development and provides good jobs
  • Proven model
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State Requirements a and I Issues

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State Pl Plan Am Amendment

  • State must amend its Medicaid Plan to elect PACE as a

voluntary state option

  • The State Plan Amendment (SPA) and provider application processes

can occur simultaneously

  • State must receive CMS approval of SPA before 3-way Program Agreement

can be signed

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State Pl Plan Am Amendment, c con

  • nt.
  • The SPA covers three major components:
  • 1. Clinical and financial eligibility and post-eligibility treatment of income requirements

for PACE enrollees;

  • 2. Medicaid capitated rates and payments (including rate setting methodology); and
  • 3. Procedures for processing Medicaid enrollments and disenrollments in the state’s

management information system

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State R e Role e in PACE D E Devel elop

  • pment
  • Site selection
  • Licensing and certification requirements
  • UPL(s) and Medicaid capitation rate(s)-setting
  • Program eligibility requirements and determination processes
  • Medicaid enrollment and disenrollment systems
  • Medicaid state plan amendment
  • Reviews/submits PACE provider application and participate in provider

application process

  • Participates in 3-way Program Agreement
  • Medicaid contract, if necessary
  • Ongoing oversight and monitoring
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Federal Requirements a and I Issues

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CMS’s R Role e in PACE D E Devel elopmen ent

  • Responsible for development/implementation of federal PACE regulatory requirements
  • Implements Medicare payment methodology
  • Reviews/approves PACE provider applications and SPAs
  • Medicare enrollment and disenrollment systems
  • Participates in 3-way program agreement
  • Ongoing oversight and monitoring
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Medicar are e Par art D D

  • PACE organizations offer Medicare Part D prescription drug coverage
  • Individuals who join a PACE program, will get your Part D-covered drugs

and all other necessary medication from the PACE program

  • Prescription drugs provided under Medicare Part D will be covered in the Medicare

capitation rates paid to PACE organizations and payment for non-Medicare covered

  • utpatient prescription drugs and prescribed over the counter medications covered

in the Medicaid capitation rate

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Qu Ques estion

  • ns?

lizp@npao aonline.org