Medicaid Managed Care Advisory Committee Presentation

MEDICAID MANAGED CARE ADVISORY COMMITTEE MEETING

NOV 10, 2021

Department of Medical Assistance Services

Virtual Meeting Notice

DMAS is conducting this meeting electronically via Webexdue to the declared emergency related to the COVID-19 pandemic. Please mute your line if you are not speaking. This meeting will be recorded for administrative purposes.

The slides will be emailed to all participants that registered for this Webex.

Live captions of this meeting are available:

https://www.streamtext.net/text.aspx?event=HamiltonRelayRCC-1110-VA3100

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Committee Members – Roll Call

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Name Agency

Alison Land (Commissioner) Department of Behavioral Health & Developmental

Services

Clark Barrineau Medical Society of Virginia

David Brown Department of Health Professions

Denise Daly Konrad (on behalf of Debbie Oswalt) Virginia Healthcare Foundation

Doug Gray Virginia Association of Health Plans

Duke Storen (Commissioner) Department of Social Services

Gayl Brunk VA Association of Centers for Independent Living

George Graham Virginia PACE Alliance

Committee Members – Roll Call

Name Agency

Holly Sluder Lake Country Area Agency on Aging

Holly Puritz, MD American College of Obstetricians and Gynecologists

Hunter Jamerson Virginia Academy of Family Physicians

Jennifer Faison Virginia Association of Community Services Boards

Jennifer Fidura Virginia Network of Private Providers

Kathy Harkey National Alliance on Mental Illness - VA

Kathy Miller Virginia Department of Aging and Rehabilitative Services

Kelly Walsh-Hill Virginia Interagency Coordinating Council

Lanette Walker Virginia Hospital and Health Care Association

Laura Forlano, DO Virginia Department of Health

Marcia Tetterton Virginia Association for Home Care and Hospice

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Committee Members – Roll Call

Name Agency

Raziuddin Ali, MD Board of Medicaid Assistance Services

Rufus Phillips Association of Free Clinics

Samuel Bartle, MD American Academy of Pediatrics

Sara Cariano Virginia Poverty Law Center

Steve Ford Virginia Health Care Association – Virginia Center for

Assisted Living

Tracy Douglas-Wheeler Virginia Community Healthcare Association

Teri Morgan Virginia Board for People with Disabilities

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Questions

Committee members – please type questions into the chat or use the raise hand feature. These questions will be answered by the presenter after each agenda item.

Members of the public – we will take questions from the public at the end of the meeting as time allows. Please hold your questions.

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Agenda

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Welcome

Managed Care Programs Update

Project BRAVO

Deputy of Administration Update

EQRO Managed Care Compliance Review

Program for All-inclusive Care for the Elderly

Committee Feedback

Public Comment

WELCOME

Virginia Medicaid

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1 in 5 Virginians

1.9 million members

1 in 3 births

30,000 pregnant individuals

800,000 children

Medicaid Expansion, 2019

745,000 adults

Virginia Medicaid has two managed care programs and six health plans

Managed Care Update

• December 1st Contract Changes:

BRAVO

Doulas

Minor changes

• PRSS

New enrollment process coming soon

• Dental New adult dental

services implemented July 1st

118,000+ claims (72,522unique members)

40 dentist in active credentialing

• GA Studies Mobile Vision CMHRS Termination Home Visiting

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Managed Care Update

• Maternity Focus CMS approved Doula SPA 4th in nation Goal to begin enrollment

January 2022• Connections and Outreach

Reaching out to OB/GYNs for input

Sending notices re: 60 day postpartum clarification

• Child Health

EPSDT training coming soon

Foster Care Affinity Group with focus on timely access to care

Infant Well-Child Affinity Group with focus on improving well-child visit rates and quality

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Managed Care Update

• DMAS is implementing a 12.5 % temporary rate increase for specific waiver services, behavioral health services, home health services, and other identified services for dates of service from July 1, 2021-June 30, 2022. The Medicaid Memo includes eligible procedure and revenue codes.

• DMAS issued a Request for Proposal to help with administering the $1000 payment to agency-directed and consumer-directed personal care attendants. Payments will be made in early 2022.

DMAS – American Rescue Plan Act funding

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Managed Care Update

• DMAS is determining a process for payments of the $5 Nursing Facility Per Diem. We anticipate making quarterly payments throughout the year to meet the September, 2022 deadline in the Appropriations Act.

DMAS – American Rescue Plan Act funding cont’d

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Questions from committee members?

BRAVO UPDATE:ENHANCED MEDICAID SERVICES IN 2021 AND BEYOND

November 2021

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Enhanced Behavioral Health Services for VirginiaProject BRAVO

Implement fully-integrated behavioral health services that provide a full continuum of care to Medicaid members. This comprehensive system will focus on access to services that are:

Vision

Quality care from quality

providers in community

settings such as home,

schools and primary care

Proven practices that are

preventive and offered in

the least restrictive

environment

Better outcomes from best-

practice services that

acknowledge and address

the impact of trauma for

individuals

Encourages use of services

and delivery mechanism that

have been shown to reduce

cost of care for system

High Quality Evidence-Based Trauma-Informed Cost-Effective

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Behavioral Health Redesign for Access, Value and Outcomes

Current Continuum

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-Lack of evidence-based services

-Reliance on intensive services for acute

problems- Service definition and rate structures do not support best practice

The North StarBehavioral Health Services Enhancement

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Project BRAVO went LIVE 7/1/2021

• 3 Enhanced Services LIVE now:

• 6 Enhanced Services LIVE 12/1/2021

What does this mean?

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Assertive Community Treatment

MH Partial Hospitalization

Program

MH Intensive Outpatient

MultisystemicTherapy

Functional Family

Therapy

Mobile Crisis Teams

Community Stabilization

23 Hour Crisis Stabilization

Residential Crisis

Stabilization

Project BRAVO went LIVE 7/1/2021

• 3 Enhanced Services LIVE now:

Intended System Impacts:

• Provide a more flexible, robust rate for PACT teams that would compensate for actual cost of service and support fidelity to the model

• Add in a missing stair-step in the continuum of intensive facility-based supports

• Strengthen options for diversion and step-down from psychiatric hospitalization to address the bed crisis

• Increase options for team-based care that includes both licensed and unlicensed providers

What does this mean?

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Assertive Community Treatment

MH Partial Hospitalization

Program

MH Intensive Outpatient

Successes and Lessons Learned So Far

Success!

• We did this together during a pandemic and workforce crisis on a condensed timeline!

• Unprecedented collaboration with stakeholders through use of WebEx

• ACT = 41 Teams enrolled (1 new team at Fairfax CSB)

• MH-IOP = 4 new programs enrolled (1 adult, 3 youth)

• MH-PHP = 52 new programs enrolled (40 adult, 12 youth)

Lessons Learned

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• Accreditation / Medicare Certification is an area where providers would appreciate more time and support; trainings helped!

• Reducing duplicative processes and paperwork is harder than you may think, but if you work together and listen you can find solutions: The story of the ACT 30 Day ISP

• Individual consultation with providers during transition is a helpful tool to move us towards our goals together

• Don’t give up, even when there is a global pandemic and funding is frozen…

Project BRAVO Next Steps

• Phase 2 BRAVO 12/1/21:

Crisis Services Implementation

Multisystemic Therapy

Functional Family Therapy

• DMAS does not hold any authority to enhance any additional services at this time*

988

Legislation

STEP-VA Crisis Work

Project BRAVO Crisis

Services Roll Out

Marcus Alert

Continued Close Collaboration with DBHDS

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* Exception is Behavioral Therapy and 2021 budget language mandates implementation of new ABA Codes

High Level Implementation Progress:Phase 2

In P

rogr

ess

CEBP Repository Development

MCO Resolutions Panel

MST-FFT Consultations

Nea

r C

om

ple

te

Dashboard Finalization

State Plan Approval (submitted)

System Changes

MCO Readiness Reviews

Co

mp

lete

d

Rate Setting

Policy Development

Provider Bulletins on Codes and Rates

Stakeholder Engagement

Public Comment Period and Integration into policy manuals

MCO Training on MST-FFT

Service Authorization Development

Provider Manual Trainings

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December Implementation Information

• MST and FFT are both evidence based practices that require certification through treatment developers

• The Center for Evidence-Based Partnerships is developing a shared online repository where these certifications as well as other cross-system practice information can be stored

• Crisis Service Transformation is going to be progressive and we should all expect challenges in this process Workforce complications

Coordination of Regional Hubs and the Call Center

New Services and Networks of Providers

Keep in mind…

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BRAVO: Future Directions

Consideration of System Functioning

and Stakeholder Perspectives

Budget Decision Package Proposals

Governor’s Proposed Budget

General Assembly Session

Final Budget (Authority & Funding)

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BRAVO: Future Directions

• Youth Services Widespread concern of impact on youth isolated and without regular

community contacts Therapeutic Day Treatment and Pandemic Impacts School-Based Services Opportunities / Free Care Expanding reimbursement for Evidence-Based Practices High Fidelity Wraparound / Coordinated Specialty Care

• Integrated Care The pandemic has underscored the relationship between physical and

behavioral health Emphasis on integration of BH into primary care to support programs

like Virginia Mental Health Access Program Integration into Long Term Care facilities to support our aging

population and acknowledge geriatric needs

Stakeholder and System Needs/Priorities

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Thank you for your partnership, support and participation.

Additional Questions?

Please contact [email protected]

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Questions from committee members?

DEPUTY OFADMINISTRATION

UPDATES

SARAH HATTON

Federal Flexibilities

• When the Executive Orders in Virginia ended on 06/30/2021, some flexibilities at the state level ended and some remained due to their affiliation with the Federal COVID 19 PHE and Maintenance of Effort.

• The remaining federal flexibilities remain in place until the PHE expires; the most recent extension of the PHE occurred on October 18th for another 90 days.

• DMAS will continue to monitor for updates to the PHE extension and CMS plans for unwinding.

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ELIGIBILITY AND ENROLLMENT UNWINDING UPDATES

New Federal Policy Updates

• CMS initially issued guidance in December 2020. The August 13 State Health Official letter outlines updated policies, but signals that more detailed guidance will be available in the future.

• The August 13 updates did not indicate if the federal PHE will be extended. The Department of Health and Human Services (HHS) previously indicated that it

expects the PHE to continue through the end of 2021. The most recent renewal of the PHE is scheduled to expire on 01/16/2022.

• Major updates to policies for unwinding federal Medicaid continuous coverage requirements include: An Extended timeframe to complete pending eligibility and enrollment

redeterminations from six months to 12 months States must complete a new redetermination for individuals who were

determined ineligible during the PHE prior to the termination of eligibility.

On August 13, the Center for Medicare and Medicaid Services (CMS) provided updated guidance to support states for the eventual end of the Federal Public Health Emergency (PHE). The guidance is intended to minimize burdens for Medicaid beneficiaries and limit coverage disruptions.

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Enrollment by Covered GroupSince the start of the Federally declared Public Health Emergency, the Virginia Medicaid program has gained over 350,000 new members. The Commonwealth now has over 1.9 million residents enrolled in Medicaid coverage.

Group End of SFY 2020(6/30/2020)

End of SFY 2021(6/30/2021)

SFY 2022 to Date(As of 8/15/2022)

Aged Individuals (65 or Older) 78,968 80,810 81,347

Caretaker Individuals 121,484 142,128 144,899

Expansion Individuals 435,995 562,530 575,546

Pregnant Individuals 20,258 25,558 26,977

Children 712,836 777,727 785,747

Disabled or Blind Individuals 149,178 152,487 152,774

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Expected Redetermination

Coverage Group Number of Members Impacted

Manual Annual Renewals (those who did not successfully complete the ex parte renewal process)

Overdue Cases: 425,414Overdue Members: 728,150

Individuals who Turned Age 19/21/26

Individuals who Turned Age 65

Pregnant Individuals who Reached the End of Postpartum Period

Individuals in Breast & Cervical Cancer Protection Treatment Act (BCCPTA) or Expansion Coverage who Began Receiving Medicare Coverage

Individuals who Reported a Change in Circumstances Requiring a Redetermination

Unknown

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Data through November 2021

Known Individual Member Changes by Change Type

Attained Age 19/21/26

40%

Attained Age 6517%

End of Postpartum Period

30%

Receiving Medicare13%

MEMBER COUNT

The chart below reflects DMAS/DSS known changes that have occurred within the member population since the beginning of the Federal PHE declaration in March 2020. Other changes may have been reported by the member, such as a change in household size; the total count for this type of change is unknown.

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Data through November 2021

New “Medicaid Combined Partial Review Process” Batch Run

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New VaCMS Automation Post-PHE

• New VaCMS automation will now include:

BCCPTA/Expansion individuals with Medicare

PG women in Medicaid and CHIP that meet their postpartum period

Individuals aging out of current coverage group to include individuals

who turned ages 19, 21, 26, and 65.

• During the batch run VaCMS will re-evaluate enrollees for other covered

groups, authorizing approvals and closures

• VaCMS will send necessary documentation for enrollees to complete and re-

evaluate them for other covered groups

• New automated tools to assist local agencies workers with caseload

management

Continued Redetermination During the PHE

• Ex Parte Renewals: July 2020 through June 2021 – 53% of the overall member population successfully

ex parte renewed. [This success rate includes populations that are not able to be renewed in the ex parte process such as a majority of the Aged, Blind, or Disabled (ABD) coverage groups.]

According to Ex Parte Renewal Trends:

• On average, we expect the following to continue: 80% of MAGI enrolled members successfully ex parte review

53% of all enrolled members successfully ex parte review

The majority of the remaining members will receive a renewal packet

• Currently the automated ex parte renewal process does not send renewal packets. This part of the process was paused during the PHE and will resume at the end of the PHE when full redeterminations are required.

When CMS signaled to states that the federal PHE would be extended through the end of 2021, DMAS made the decision to turn the ex parte renewal process “back on.” This process only takes action on enrollments that can be approved for continued coverage for another year.

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Phased Unwinding Approach

Phase TimingCurrent Number of Members Impacted

Description

I Pre-End of PHE – one large batch run, then ongoing monthly

~39k Members, first run scheduled for Nov 2021

Run cleanup auto-batch to reassign individuals who have reached the end of their postpartum period with income below 138% of FPL to new coverage group; Expansion or LIFC. No adverse action to be taken. Keep special monthly run ongoing through end of PHE.

II Pre-End of PHE– one large batch run

Unknown Ex Parte Clean Up Run: Re-run ex parte to redetermine any individuals who may have previously fallen out of the ex parte run who may now successfully complete their renewal process.

III End of PHE –ongoing; could be up to 12 months

Unknown Member reported changes to DSS. Certain changes will need to be worked to redetermine eligibility. These changes include changes such as changes in household size.

IV End of PHE 644,394 Members* Renewals – cases will be renewed on a rolling basis throughout 12 month period allowed by CMS.

38 *Renewals due through November 2021

Considerations

• Uncertainty as to when PHE will end CMS has stated that states should still expect 60 days notice prior to HHS

announcing the end date of the PHE The Build Back Better plan may change the directive and timeline for resuming

normal operations

• The full official unwinding guidance from CMS has not been received Solution: The team has worked on bucketing populations effected so the

timeline can be built around the populations and focuses on using existing automated processes to assist with work volume

• Member contact information may be out of date Solution: DMAS is prepared to begin a campaign through direct mailing and

digital outreach as soon as the PHE end date is announced

• Inability to predict how many members will lose coverage no knowledge of the number of reported changes that have been made during the PHE such as changes in household status. DMAS closely monitor any closures or reductions in coverage closely to ensure

appropriate actions are being taken to protect all eligible members from losing coverage

DMAS has identified multiple areas where information is still unknown as well as potential challenges that may be faced in the unwinding process.

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Unwinding Outreach

• Planned Outreach Action:

Direct member mailing

• Post cards planned for pre-PHE distribution

• Quarterly mailings to households with renewals due

Digital outreach

Updates to the Cover Virginia website

• Eligibility Worker Reinforcement

DMAS contractors

• Renewals, changes, and applications

• Application Assistance

To include renewal assistance

Targeted messaging for aged, blind, and disabled (ABD) populations

DMAS is currently working through an outreach plan to ensure members are provided with information, next steps, and needed actions to prevent unnecessary coverage closures and reduce churn.

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Collaboration with Health Plans

• Outreach Direct mailings

• What members need to do now that the PHE has ended

• How to report changes and provide updated information

Digital communication: text, email, websites

• Collaboration to ensure up to date addresses and phone numbers Data exchange

• Reminders to members to complete their renewal Importance of completing renewal

Ways to complete the renewal process

DMAS is partnering with the health plans in multiple collaborative efforts to reduce the risk of members losing coverage and to provide needed information and education at the end of the federal PHE.

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In order to ensure consistent messaging to members and coordinate timing of any outreach, DMAS coordinates language approval and scheduled delivery of mailings/digital/telephonic outreach.

Pathway for Medicaid Enrollment for Afghan Evacuees

• DMAS is coordinating with HHS, State Department and base leads to prioritize Medicaid applications for pregnant individuals, new mothers/newborns and their families

• Medicaid applications counts to date -

• Resettlement coordination – focusing on health care education and care coordination

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Location # of Applicants

Crowne Plaza 136

Ft Pickett 654

Quantico 341

Ft Lee 68

FAMIS PC

Total Enrollment as of 10/31/2021: 3,141 FAMIS PC members have received coverage through this new group – 2,989 are within the Medicaid income limit and 152 within the CHIP/FAMIS income limit

As of 10/1/2021

• At least 562 newborns are now receiving Medicaid or FAMIS coverage as a result of a parent receiving FAMIS PC.

• FAMIS PC individuals range from ages 13 to 47.

• The Northern Region has nearly three-quarters of the Commonwealth’s current enrollment of FAMIS PC. Additionally, 15% live in the Central Region.

• Over half of the FAMIS PC population is receiving coverage in their 3rd trimester of pregnancy while at least 15% are still in their first trimester.

• New FAMIS PC enrollment for the month of September averaged 41 per day.

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Thank you for your time today!

Questions?

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Commonwealth of VirginiaDepartment of Medical Assistance Services

CY 2021 Operational Systems Review of Compliance With Medicaid Managed Care

Regulations

November 2021

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Operational Systems Review (OSR) Presentation Content

• OSR Overview

• OSR Standards

• OSR Process

• OSR Results

• OSR Summary

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OSR Overview

• The Department of Medical Assistance Services (DMAS) contracted with Health Services Advisory Group, Inc. (HSAG), to conduct a full OSR of the CCC Plus and Medallion 4.0 managed care organizations (MCOs) as required by 42 CFR 438.358(b)(3)

• The review encompassed all federal standards and DMAS-related MCO contract requirements

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OSR Overview, cont.

• The OSR standards were derived from the requirements as set forth in the Department of Human Services, Division of Health Care Financing and Policy Request for Proposal No. 3260 for Managed Care, and all attachments and amendments in effect during the review period of July 1, 2020, through June 30, 2021.

• HSAG followed the guidelines set forth in CMS’ EQR Protocol 3. Review of Compliance With Medicaid and CHIP Managed Care Regulations: A Mandatory EQR-Related Activity, October 20191-to create the process, tools, and interview questions used for the SFY 2020–2021 OSR.

1- Department of Health and Human Services, Centers for Medicare & Medicaid Services. Protocol 3. Review of Compliance With Medicaid and CHIP Managed Care Regulations: A Mandatory EQR-Related Activity, October 2019. Available at: : https://www.medicaid.gov/medicaid/quality-of-care/downloads/2019-eqr-protocols.pdf. Accessed on: Nov. 1, 2021.

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OSR Standards Reviewed

• Standard I—Enrollment and Disenrollment• Standard II—Member Rights and Confidentiality• Standard III—Member Information• Standard IV—Emergency and Poststabilization Services• Standard V—Adequate Capacity and Availability of Services• Standard VI—Coordination and Continuity of Care• Standard VII—Coverage and Authorization of Services• Standard VIII—Provider Selection• Standard IX—Subcontractual Relationships and Delegation• Standard X—Practice Guidelines• Standard XI—Health Information Systems• Standard XII—Quality Assessment and Performance Improvement• Standard XIII—Grievance and Appeal Systems • Standard XIV—Program Integrity• Standard XV—EPSDT Services

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OSR Standards Reviewed – CCC Plus

CCC Plus Number of Elements

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Standard#

Standard NameNumber of Elements

I Enrollment and Disenrollment 7

II Member Rights and Confidentiality 7

III Member Information 21

IV Emergency and Poststabilization Services 12

V Adequate Capacity and Availability of Services 18

VI Coordination and Continuity of Care 9

VII Coverage and Authorization of Services 20

VIII Provider Selection 5

IX Subcontractual Relationships and Delegation 4

X Practice Guidelines 3

XI Health Information Systems 6

XII Quality Assessment and Performance Improvement 6

XIII Grievance and Appeal Systems 29

XIV Program Integrity 12

XV EPSDT Services 8

Total Number of Elements 167

OSR Standards Reviewed – Medallion 4.0

Medallion 4.0 Number of Elements

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Standard

#Standard Name

Number of

Elements

I Enrollment and Disenrollment 7

II Member Rights and Confidentiality 7

III Member Information 21

IV Emergency and Poststabilization Services 12

V Adequate Capacity and Availability of Services 15

VI Coordination and Continuity of Care 8

VII Coverage and Authorization of Services 19

VIII Provider Selection 5

IX Subcontractual Relationships and Delegation 4

X Practice Guidelines 3

XI Health Information Systems 6

XII Quality Assessment and Performance Improvement 6

XIII Grievance and Appeal Systems 29

XIV Program Integrity 12

XV EPSDT Services 8

Total Number of Elements 162

OSR Process (May-October 2021)

Time Period of Review: July 1, 2020 to June 30, 2021• Conducted an MCO kick-off webinar

• Provided 30 days for MCOs to submit documents as evidence of compliance for desk review

• Allotted 30 days for HSAG to conduct desk review

• Performed desk review of denials, grievances, appeals, and subcontractor agreements sample case files

• Held two-day virtual review of each MCO, with follow up for document submission

• Submitted initial summary reports and OSR full reports to DMAS

• Offered MCO technical assistance sessions for corrective action plan (CAP) development

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OSR Process: Desk Review

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Note: Approximately 1,200 case files and subcontractor agreements were reviewed during the desk review process.

July 1, 2021:

MCOs submitted all requested evidence of

compliance

and

universe files for case file reviews (service

authorization denials, grievances, appeals,

subcontractor agreements)

July 8, 2021: HSAG provided MCOs with the sample selection for the case file reviews

July 14, 2021: MCOs submitted the complete case files

July 30, 2021: HSAG conducted a desk review of MCO-submitted case files and evidence of compliance

• HSAG conducted a virtual Webex OSR audit that included an opening session, interview sessions for each standard, and an exit conference

• The HSAG subject matter expert (SME) auditor led the interview sessions for which the auditor had completed the desk review

• MCO SMEs participated in each interview session

• DMAS staff were available during each interview session

OSR Process: Virtual Review

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• Opening Session

• Interview Session

• Case File Review Discussion

• Closing Session

OSR Process: Virtual Session Components

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OSR Process: Evaluation Review

• HSAG SME Review Team

– Two auditors assigned to each standard

– Same auditors reviews the standard for each MCO

– During the process, results are compared and any difference in findings are resolved by the auditors

• After the virtual sessions, any remaining follow up is reviewed by the auditors for final determination

• Finding is either Met or Not Met for the elements and a score is calculated for overall compliance with the Standard

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OSR Results: Program Scoring

• Overall, the MCOs scored well– Medallion 4.0 Overall Average MCO Score: 93.1%

– CCC Plus Overall Average MCO Score: 91.5%

• Five of six MCOs for both programs considered strongly compliant with federal and state regulations, scoring greater than 90% in their overall scores

• Considerations– Time period of review during COVID-19 pandemic

– First full CCC Plus compliance review since program implementation

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Top Standards of Non-Compliance

• Adequate Capacity and Availability of Services

• Subcontractual Relationships and Delegation

• Grievance and Appeals Systems

• EPSDT Services

Top Standards of Full (100%) Compliance

• Emergency and Poststabilization Services

• Provider Selection

• Practice Guidelines

• Health Information Systems

• Program Integrity

• Coordination and Continuity of Care

OSR Results: Standards

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Note: While the standards may have been similar across the board, the individual elements that the MCOs did not meet varied from plan to plan.

OSR Overall Summary

• On average, both Managed Care Programs demonstrated strong compliance with federal and state regulations

• Corrective action plans are in process to bring any Not Met elements to compliance

• DMAS will work with HSAG and the MCOs to strengthen those identified areas of non-compliance, including

– Strengthening contracts

– Updates to policies or procedures

– Enhance monitoring and oversight opportunities

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Questions

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Questions from committee members?

PACE: The Best Kept Secret in Healthcare

Introduction to a Program of All-inclusive Care for the Elderly

What is PACE?

• Programs of All-Inclusive Care for the Elderly (PACE) serve seniors with chronic care needs by providing access to the full continuum of preventive, primary, acute and long-term care services.

• PACE programs take many familiar elements of the traditional health care system and reorganize them in a way that makes sense to families, health care providers, and the government programs and others that pay for care.

What Can PACE Do For You:• For consumers, PACE provides:

• Caregivers who listen to and can respond to their individualized care needs• The option to continue living in their community as long as possible• One-stop shopping for all health care services

• For health care providers, PACE provides:• Capitated funding arrangement that rewards providers who are flexible and

creative in providing the best care possible• The ability to coordinate care for individuals across settings and medical

disciplines• The ability to meet increasing senior demands for individualized care and

support services

• For those who pay for care, PACE provides:• Cost savings and predictable expenditures• A comprehensive service package emphasizing preventive care that is usually

less expensive and more effective than acute care• A model of choice for older individuals focused on keeping them at home and

out of institutional settings

Who Can Enroll in PACE & How?• Eligibility Requirements:

• 55 and older• Live in a PACE service area• Qualify for nursing home level of care according to VA guidelines

• Need assistance in 5 of 7 ADLs

• Be able to live safely in the community at the time of enrollment• Safety is determined by Interdisciplinary Team assessment prior to enrollment

• PACE Referrals Come From:• Primary Care Providers• Dept of Social Services/APS• Hospital Case Management• Home Health Companies• Low-income Sr. Housing Complexes• Anyone in the Community!!

What Services are Included with PACE?

• Delivering all needed medical and supportive services, a PACE program is able to provide the entire continuum of care and services to seniors with chronic care needs while maintaining their independence in their home for as long as possible.

• Services include the following:• Adult day care that offers nursing; physical, occupational and recreational

therapies; meals; nutritional counseling; social work and personal care;• Medical care provided by a PACE physician familiar with the history, needs and

preferences of each participant;• Home Health care and personal care;• All necessary prescription drugs;• Social services;• Medical specialties, such as audiology, dentistry, optometry, podiatry and

speech therapy;• Respite care; and• Hospital and nursing home care when necessary

PACE and COVID

• Many programs have switched to a hybrid model, offering more services in homes. These include• Home and virtual visits by IDT members (providers,

therapist, social work, etc.)

• Virtual activities programing

• Increasing aide visits

• Social distancing in the centers and on PACE vehicles to still provide services for high-risk patients

• Increased usage of telemonitoring

Questions from committee members?

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Committee Feedback

DMAS COMMITTEE

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Public Comment

DMAS did not receive public comment in writing in advance of the meeting.

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Questions from the public or committee members

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Thank you for your participation!