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CMS Revamps Team-Based Home Care Program for Elderly Patients

CMS is adding more flexibility to one of its team-based home care programs for seniors in order to support individualized care to Medicare and Medicaid beneficiaries.

By Jennifer Bresnick

- As the nation’s patient population continues to trend older and care coordination becomes increasingly important for participation in value-based care programs, CMS is taking some time to tweak one of its team-based home care initiatives.

Team-based home care programs for Medicare and Medicaid seniors

The Programs of All-inclusive Care for the Elderly (PACE) plan will be getting its first major update in a decade, said Acting CMS Administrator Andy Slavitt in a blog post this week

“The Programs of All-inclusive Care for the Elderly (PACE) is a Medicare and Medicaid program that helps people meet their health care needs in the community in which they live instead of a nursing home or other care facility,” he explained. “The focus is on the participant. A team of health care professionals works to make sure that care is coordinated in the home, the community, and at a PACE center.”

Patients aged 55 and older may be eligible for the team-based home care program, which provides a variety of primary care services, emergency care, occupational and physical therapy, and specialty services.  PACE also provides nutritional counselling, meal delivery, social work, and other home care services that address social and clinical needs.

The changes will bring more individualized, coordinated care to elderly Medicare and Medicaid beneficiaries to help keep seniors in their homes and out of long-term care facilities.

The proposed updates to the program will strengthen caregivers’ abilities to provide more individualized support to participants and meet a broader spectrum of their needs.  Currently, PACE caregivers must operate within the limits of a certain pre-defined role.  The changes would allow each caregiver to take on more responsibilities to address the specific needs of each beneficiary.

CMS would also like to expand the use of non-physician providers within the program by allowing other qualified professionals to administer certain services that are currently only provided by primary care physicians.

“This proposal will help the program reflect the latest advances in caring for frail elders and changes in the use of technology. The goal of this proposal is to strengthen beneficiary protections and provide PACE organizations with more administrative and operational flexibilities so they can do what they do best – caring for our nation’s most vulnerable individuals,” Slavitt said.

“While PACE serves a relatively small number of people today, our proposal is intended to encourage states to further expand these programs.”

PACE is only available in a handful of states that support the program under their Medicaid benefits.  CMS officials hope that additional states will adopt the approach to team-based home care as public and private payers employ new strategies to help patients manage chronic diseases, avoid preventable hospital admissions, and remain in the comfort of their homes as they age.

“Over the last six years, since the onset of the Affordable Care Act, we have been taking significant steps to care for more people, care for them better, and make health care more affordable,” Slavitt wrote. “But for us to be successful, we need to work hand-in-hand with patients and their families, physicians and clinicians, and other actors to support new approaches to care. Team-based models that put the individual in the center, like PACE, will be a vital part of the fabric of our system.”

“We must work hard to support these approaches so our country can continue to provide our people with the care they need in the years ahead.”

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