Post on 25-Feb-2016
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CHEROKEE NATION
Cherokee Elder Care(PACE)
Melissa Gower, Group LeaderHealth Services & Government
Relations
WHAT IS PACE?• Programs of All-Inclusive Care for the Elderly• Provides and coordinates all needed preventive, primary, acute
and long term care services so that older individuals can continue living in their community.
• An integrated system of care for thefrail elderly that is:Community-basedComprehensiveCapitatedCoordinated
WHAT IS PACE?• Optional benefit under both Medicare and Medicaid that focuses
entirely on older people who are frail enough to meet their state’s standards for nursing home care.
• Features comprehensive medical and social services that can be provided at an adult day health center, at home, or an inpatient facility.
• For the majority of participants, this means they continue to live at home while receiving services, rather than being institutionalized.
• A team composed of a physician, nurse, social worker and other health professionals assess the participants, develop care plans, and deliver all services.
PACEINTERDISCIPLINARY TEAM
Care Needs Assessment, Planning and Delivery
Primary CarePrimary Care
TransportationTransportation
Personal CarePersonal Care
ActivitiesActivitiesHome CareHome Care PharmacyPharmacy
NursingNursing
NutritionNutrition
Social Social ServicesServices
OT/PT/SpeechOT/PT/Speech
ELIGIBILITY
Participants must meet the following criteria:• 55 years of age or older• Live in the PACE service area• Meet nursing home level of care requirements as determined
by DHS• Able to live safely in the community at the time of enrollment• Sign and agree to the terms of the enrollment agreement
SERVICES• PACE manages all of the medical, social, and rehab services
participants require.• Minimum services:
Primary care Social services Restorative therapies Personal care/supportive services Nutritional counseling Recreational therapy Meals Transportation Prescription drugs
SERVICES
• Individual PACE sites may offer additional services unique to their site
• Services are generally provided in an adult day health center setting, but may also be provided in the home or other therapeutic setting.
• The PACE team has contact with most participants on a daily basis and all participants several times per week, which assists the team in detecting subtle changes in the participants condition.
PAYMENT
• For participants who have Medicare and Medicaid eligibility there is not charge for PACE services.
• PACE receives a capitated monthly payment per participant from Medicare and Medicaid.
• Persons enrolled in PACE who are not Medicare or Medicaid eligible may have a monthly premium.
The PACE ModelHistory
First Demonstration
Sites Operational
1986
Legislation Authorizing
PACE Demonstration
1990 1997
Congress AuthorizesPermanent Provider
StatusBalanced Budget Act
of 1997, H.R. 2015
Washington, D.C.
(Nov) 1999
Publication of Interim
Final PACE Regulation
First Program Achieves Permanent
PACE Provider Status
(Nov) 2001
The PACE ModelPhilosophy
Honors what frail elderly want… To stay in familiar surroundings
To maintain independence
To maintain function
To maintain cultural connections
WHY IS PACE A GOOD FIT FOR CHEROKEE NATION?
• Frail elder populations in rural areas are at higher risk of institutionalization
• Current environment supports service integration
• Emerging flexibility supports adaptation
BENEFITS FOR THE ELDER• Keeps elders in their homes, with families and in their
communities.• Provides excellent, comprehensive health care with
consistent health care providers.• Involves the elder and their families in decision making
regarding health care and other lifestyle choices. (Partnership)
• All team approved healthcare costs are covered for enrollees.
CULTURAL BENEFITS• PACE does not dictate how the building looks, so it can
reflect the communities’ culture.• By keeping the elder in the community we facilitate holding
on to the culture through their knowledge and practices.• PACE offers the opportunity for inter-generational activities.• The PACE site can incorporate cultural activities, language
and art.
CEC ARTWORK
PACE CHALLENGESTRIBAL OR RURAL COMMUNITIES
• Lack of population density• Shortage of providers• Less negotiating power with contract health
providers in rural areas vs. urban areas• AI/AN are at higher risk for chronic diseases
PACE INNOVATIONSTRIBAL OR RURAL
COMMUNITIES• Use of adjunct sites
• Use of new technologies
• Expanded populations (disabled, children, Veterans)
• Risk sharing/Stop Loss for outliers
• Caregiver and health professional mix
PACE ISSUESTRIBAL SITES
• IHS does not recognize an integrated system of care such as PACE--only its individual components
• PACE programs must serve all Medicare/Medicaid, cannot restrict to tribal citizens
• 100% FMAP applies to Certain Medicaid Services
PACE ISSUESTRIBAL SITE
• Being the first PACE in Oklahoma, Medicaid plan required amendment
• Methodology to determine an “Indian rate” by the State
• Negotiation of PACE services under a self-governance or self-determination agreement for 100% FMAP
Cherokee Nation’s Pursuit of PACE
CHEROKEE NATION SERVICE AREA
PLANS FOR PACE DEVELOPMENT
• Cherokee Nation PACE currently serves the population residing around the Tahlequah area
• Eventual service area will be the Tribal Jurisdiction Service Area (TJSA).
• Functions as a traditional PACE program serving all eligible individuals
• Uses strategies developed under the Rural PACE Expansion grant to address rural areas
PLANS FOR PACE DEVELOPMENT
• Feasibility study utilized conservative PACE rate, rather than any expected “Indian” rate
• Cherokee Nation created a governmental agency specifically to operate the PACE project – Cherokee Comprehensive Care AgencyOrganizational rules under PACE are very
specific and can be burdensome
PLANS FOR PACE DEVELOPMENT
• Will continue discussions with IHS in order to access purchasing contracts like 340 b and have coverage under the Federal Tort Claims Act
• While the Nation already maintains provider contracts for many areas of care, those specifically needed for LTC must be negotiated, as well as contracts with IHS as a provider
CHEROKEE ELDER CARE
• New facility construction began April 2007• Opened September 2008• Continuing to work with OHCA and DHS on
processes• Continue conversations with HIS• Enrollment currently at 80, with capacity 135-150
August 2006
April 2007
August 2008
Interested in Learning More About Establishing a PACE Site in Your
Area?
Phone: 918-453-5554E-Mail: rick-richards@cherokee.orgWebsite: http://eldercare.cherokee.org