April 2022
Project Category: Enhance Quality Outcomes
Background:
The Program of All-Inclusive Care for the Elderly (PACE) is a benefit that provides all Medicare and Medicaid services to qualified beneficiaries who are 55 and older and meet nursing level of care but choose to receive services in a community setting. All services the participant receives are administered by a certified PACE organization (PO) that is located in the participant’s service area. The PO receives a monthly Medicare and Medicaid capitation, per enrolled participant, but must provide all services to the participant.
The Department contracts with five POs, who operate a total of eleven centers across the State of Colorado to serve PACE enrollees. Each PO provides services in the following CO counties: InnovAge (Adams, Arapahoe, Broomfield, Denver, Jefferson, Larimer, Pueblo, Weld), Rocky Mountain PACE (El Paso), Senior Community Care (Eckert, Montrose), TRU PACE (Boulder, SW Weld), and HopeWest (Mesa).
PACE & ARPA:
Currently, the Department has three major projects focused on improving the PACE program, two of which are supported through the ARPA HCBS funding. The Department is examining services provided under PACE and the type of services people receive to better understand the needs of those who receive PACE services. The Department believes this will help improve services and ensure quality for PACE participants. Second, the Department is developing a regulatory structure for PACE. Currently, PACE oversight includes two state agencies, HCPF and the Department of Public Health & Environment (CDPHE), and our federal partner, the Center for Medicare & Medicaid Services (CMS). For this reason, the Department is looking to streamline surveys of the PACE program and develop necessary regulations to ensure high-quality care. Last, the Department will be identifying key performance metrics to develop a pay-for-performance structure within PACE rates. PACE is paid a capitated rate that covers all Medicaid and Medicare services. To ensure value, the pay-for-performance structure will pay for increases in quality by PACE providers.
How Can Stakeholders Get Involved?
If you wish to be a part of the PACE stakeholder groups or have any questions, please contact the Department at HCPF_PACE@state.co.us.