The Medicare Payment Advisory Commission (MedPAC) endorsed recommendations to improve enrollment, quality data and the payment method for a program that coordinates care for beneficiaries eligible for both Medicare and Medicaid.
The Program of All-Inclusive Care for the Elderly (PACE) is a Medicare program that provides frail individuals age 55 and older, who are still in their homes, comprehensive medical and social services coordinated and provided by an interdisciplinary team of professionals in the community. The program offers an alternative for such beneficiaries having to enter nursing homes and long-term care.
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PACE providers offer a fully integrated model of care, yet enrollment in the program is small and slow, said Christina Aguiar, a MedPAC analyst.
The recommendations are designed "to accurately pay PACE providers for the beneficiaries they enroll, support for growth of this program by expanding enrollment and to pay all integrated programs for dual eligible beneficiaries from the same payment system," she said at the Nov. 3 MedPAC meeting.
The commissioners unanimously approved proposals to pay PACE providers rates based on the Medicare Advantage system for setting benchmarks and quality bonuses by 2015. It also revises the Medicare Advantage risk adjustment system to better forecast risk because it under-predicts costs for complex patients that PACE providers serve.
For 2012, Medicare will spend 17 percent more for PACE enrollees than it would for these beneficiaries if they were to remain in fee for service, Aguiar said. These revisions will "reduce Medicare spending on PACE and better align it with fee-for-service funding levels," she said.
The changes will also allow PACE providers 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," Aguiar said.
Medicare would decrease spending on PACE by less than $1 billion over five years as a result of the changes, she said.
Among the other changes, the advisory commission endorsed elimination of the age limitation by allowing beneficiaries, who were younger than 55 years and certified for nursing home use, to take advantage of the program. PACE providers will also be able to receive pro-rated capitation payments for beneficiaries who enroll after the first of the month and to benefit from outlier protection policies during the first three years of their program to help defray potentially exceptionally high acute care costs from Medicare beneficiaries.
Once Medicare establishes quality measures to evaluate PACE providers, they will be able to take part in the Medicare Advantage quality bonus program. The quality measures will also help beneficiaries choose a program that best fits their needs, Aguiar said.