« The Dual Agenda: September 1, 2016 Issue

Noteworthy News

CMS Proposes New Rule on PACE Program

The Centers for Medicare and Medicaid Services has released a proposed rule to update and modernize PACE (Program of All-Inclusive Care for the Elderly). The highly regarded PACE program provides nursing home-eligible dually eligible beneficiaries with medical care and social services that allow them to remain in their homes. Among the changes  being introduced in the proposed rule is one that would allow interdisciplinary care team members to perform more than one role on the care team and another that would allow non-physician primary care practitioners to provide some services in the place of primary care physicians. Comments on the proposed rule are due Oct. 17.

In other PACE news, controversy continues to follow CMS’s decision last year to allow for-profit companies to operate PACE programs. In Colorado, InnovAge – formerly a non-profit PACE operator –converted to for-profit status with the help of private equity investors and is seeking aggressive expansion. Many advocates fear that the profit motive is incompatible with providing high-quality care for low-income people with complex needs.

CMS Proposes Mandatory Bundled Payment Program for Cardiac Care

The Centers for Medicare and Medicaid Services (CMS) has proposed a bundled payment model to a select number of acute care hospitals providing Medicare patients with cardiac bypass surgeries or treatment for heart attacks. CMS plans to randomly select hospitals in 98 metropolitan areas for participation in the initiative and expects to save Medicare $170 million over the course of the five-year program. The cardiac care bundled payment program joins a similar CMS program for lower extremity joint replacements, which is also being expanded to include hip and femur fractures.

Innovative Approaches Multiplying for Improved Care for Older Adults

New initiatives to improve care for older adults are emerging on an accelerating basis across the country. In one example, Oak Street Health in Chicago provides value-based primary care exclusively to older adults in underserved urban areas. The model uses a globally capitated risk-based payment system and partners with non- and for-profits in risk-sharing contracts, serving primarily Medicare Advantage and dually eligible enrollees. Meanwhile, Mount Sinai Hospital in New York City and over 100 other hospitals have developed emergency rooms exclusively for elderly patients. Quieter, less crowded and staffed with providers who have expertise in treating older adults, these geriatric ERs seek to provide better care and keep patients from being admitted to the hospital unnecessarily. Finally, a new initiative spearheaded by labor unions and others called Caring Across Generations seeks to build a movement in support of greater investment in caring for adults as they age. The initiative is focused on keeping older adults in their homes, providing more support for families and creating better jobs for home care workers.

Action Needed to Support Continued Funding for the Money Follows the Person Program

The Money Follows the Person (MFP) Program that helps older adults and people with disabilities transfer out of institutional and into community-based settings is under threat. Unless Congress takes action, the MFP Program will end on Sept. 30. There’s still time to keep MFP alive and you can help by telling your Congressperson to vote to continue to fund this successful program that has helped more than 51,000 people move into a setting of their choice since 2005.

Not only does the program increase independence for seniors and people with disabilities, it has also helped states improve access to home and community-based services (HCBS) and saved states and the federal government money because it costs less to provides these services in the community than it does in an institution.

You can send a letter to your Congressperson through the National Consumer Voice for Quality Long-Term Care website. Simply click here and enter your zip code, add your information and press Submit to send your letter.

Subscribe to

The Dual Agenda Newsletter

Support Our Work:

Donate