MedPAC Approves Recommendations For PACE Improvement

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The Medicare Payment Advisory Commission (MedPAC) has endorsed recommendations to improve enrollment in, along with quality data and the payment method for, the Program of All-Inclusive Care for the Elderly (PACE).

PACE is a Medicare program wherein beneficiaries age 55 and older who are eligible for Medicare and Medicaid alike, remain in their own homes, and are defined as “frail” receive comprehensive medical and social services coordinated and provided by an interdisciplinary team of local professionals. It was designed as an alternative to nursing homes and long-term care.

At a MedPAC meeting held last week, MedPAC Analyst Christina Aguiar said that participation in the program is limited and slow despite the fully integrated model of care provided under the program umbrella. She noted that the recommendations endorsed by MedPAC are intended to accurately pay PACE providers for the beneficiaries they enroll, as well as to ensure payment of all integrated programs for “dual eligible” beneficiaries from the same payment system and to support the growth of the program by expanding enrollment.

MedPAC commissioners unanimously approved proposals to pay PACE providers rates based on the Medicare Advantage system for setting benchmarks and quality bonuses by 2015. Next year, Medicare will spend 17% more for PACE enrollees than it would on such beneficiaries were they to remain in a fee-for-service program, according to Aguiar.

As a result, she said, Medicare spending on PACE will decrease and will become better aligned with fee-for-service funding levels.

Additionally, in line with the endorsed recommendations, PACE providers will be permitted to participate in Medicare Advantage quality bonus programs and make the repayment for PACE more consistent with Special Need Plans (SNP)-based integrated care programs.
Beneficiaries who are younger than 55 years and certified for admission to a nursing home may also avail themselves of the program. Pro-rated capitation payments for beneficiaries who enroll in the program after the first of the month will be issued to PACE providers.

The latter will also be protected by outlier protection policies during the first three years of their participation in the program to help defray potentially exceptionally high acute care costs from Medicare beneficiaries.

Once Medicare has formulated quality measures to evaluate PACE providers, these providers will have the option to participate in the Medicare Advantage quality bonus program.