New PACE program would seek younger dual eligibles


The Centers for Medicare & Medicaid Services is soliciting feedback on a five-year program that would expand the Program of All-Inclusive Care for the Elderly to younger dual eligibles and keep them out of nursing homes.

The new model would target dual eligible beneficiaries over age 21 with mobility-related disabilities who would need a skilled nursing facility but are currently ineligible for PACE, according to a CMS Request for Information published late last month.

The “Person Centered Community Care” (P3C) model would “support enhanced community integration for people with disabilities and offer a targeted, appropriate balance between medical care and the broader range of supports younger people with mobility-related disabilities may require to maximize independence,” the RFI states.

However, CMS first wants both technical and pragmatic feedback from states and providers on the new model. For example, it wants to know how states would seek flexibility in modifying eligibility criteria. Other questions in the RFI range from enrollment to payment methodology. CMS also  is seeking feedback on measuring quality outcomes, including functional status and readmission measures, which reflects a long-standing goal at reducing trips to the hospital.

“There is strong evidence that the PACE model of care is effective at reducing inpatient hospitalizations,” the agency noted.

Comments should be sent by Feb. 10 electronically in PDF form to MMCOcapsmodel@cms.hhs.gov