The Centers for Medicare & Medicaid Services (CMS) and the Colorado Department of Health Care Policy and Financing have approved a request by Total Longterm Care Inc. in Denver, Colo., to become a provider under a permanent program of comprehensive care that allows the frail elderly to live in their communities.
Total Longterm Care Inc. is part of the Program of All-inclusive Care for the Elderly (PACE), an optional benefit under Medicare and Medicaid that focuses entirely on older people who are frail enough to meet their state's standards for nursing home care. The program brings together all the medical and social services needed for someone who otherwise might be in a nursing home.
"PACE programs such as Total Longterm Care offer the care and services that many frail, older Americans need to live in their communities instead of nursing homes," Health and Human Services Secretary Tommy G. Thompson said. "Under President Bush's New Freedom Initiative, we are working to help all Americans with disabilities live more independently and participate more fully in community life."
Total Longterm Care joined the PACE demonstration program in 1991 and now serves about 645 beneficiaries. Most beneficiaries in the plan are eligible to receive services under both the Medicare and Medicaid programs. The plan operates PACE centers at 200 E. 9th Ave. and 3202 W. Colfax Ave. in Denver, at 550 E. Thornton Parkway in Thornton, Colo., and 610 Garrison St. in Lakewood, Colo. David Reyes is Total Longterm Care’s president and chief executive officer.
"We are pleased to have another permanent PACE organization," CMS Administrator Tom Scully said. "PACE gives frail people covered by Medicare or Medicaid the opportunity to live at home close to their loved ones, while also receiving the care they need. Total Longterm Care has become a productive, ongoing effort that will now be reimbursed, on a permanent basis, by the two health care programs. This is a result of the successful relationship forged among state and federal agencies, providers and foundations during the pilot project phase."
A team, including a physician, registered nurse, therapists and other health professionals, assesses the participant's needs, develops a comprehensive plan of care and provides for total care. Generally, services are provided in an adult day health center, but also may be given in the participant’s home, a hospital or long-term care facility in a nursing home.
PACE is available only in states that have chosen to offer the program under the Medicaid state plan. To be eligible for PACE, a person must be 55 or older, live in the service area of a PACE organization, be able to live safely in the community and be certified as eligible for nursing home care by the state.
Enrollment is voluntary, and once enrolled, PACE becomes the sole source of all Medicare and Medicaid covered services, as well as any other items or medical, social or rehabilitation services the PACE interdisciplinary team determines an enrollee needs. If a participant requires placement in a nursing home, PACE is responsible and accountable for the care and services provided and regularly evaluates the participant’s condition.
PACE began as a demonstration project in San Francisco. A regulation published Nov. 24, 1999, implemented legislation establishing PACE as a permanent part of the Medicare program and included provisions that enable PACE demonstration sites to convert to permanent status.
A PACE organization receives a fixed monthly payment from Medicare and Medicaid for each participating beneficiary, depending on their Medicare and Medicaid eligibility. The payments remain the same during the contract year, regardless of the services a participant may need.
Further information about PACE is available on the CMS Web site at http://www.medicare.gov/nursng/alternatives/pace.asp.