CHEROKEE NATION
Cherokee Elder Care
(PACE)
Melissa Gower, Group Leader
Health Services & Government
Relations
WHAT IS PACE?
•
•
•
Programs of All-Inclusive Care for the Elderly
Provides and coordinates all needed preventive, primary, acute
and long term care services so that older individuals can
continue living in their community.
An integrated system of care for the
frail elderly that is:
 Community-based
 Comprehensive
 Capitated
 Coordinated
WHAT IS PACE?
•
•
•
•
Optional benefit under both Medicare and Medicaid that focuses
entirely on older people who are frail enough to meet their state’s
standards for nursing home care.
Features comprehensive medical and social services that can be
provided at an adult day health center, at home, or an inpatient
facility.
For the majority of participants, this means they continue to live
at home while receiving services, rather than being
institutionalized.
A team composed of a physician, nurse, social worker and other
health professionals assess the participants, develop care plans,
and deliver all services.
PACE
INTERDISCIPLINARY TEAM
Care Needs Assessment, Planning and Delivery
Home Care
Nursing
Social
Services
Pharmacy
Activities
Primary Care
Personal Care
OT/PT/Speech
Nutrition
Transportation
ELIGIBILITY
Participants must meet the following criteria:
• 55 years of age or older
• Live in the PACE service area
• Meet nursing home level of care requirements as determined
by DHS
• Able to live safely in the community at the time of enrollment
• Sign and agree to the terms of the enrollment agreement
SERVICES
•
•
PACE manages all of the medical, social, and rehab
services participants require.
Minimum services:
 Primary care
 Social services
 Restorative therapies
 Personal care/supportive services
 Nutritional counseling
 Recreational therapy
 Meals
 Transportation
 Prescription drugs
SERVICES
•
•
•
Individual PACE sites may offer additional services unique to
their site
Services are generally provided in an adult day health center
setting, but may also be provided in the home or other
therapeutic setting.
The PACE team has contact with most participants on a daily
basis and all participants several times per week, which assists
the team in detecting subtle changes in the participants
condition.
PAYMENT
•
•
•
For participants who have Medicare and Medicaid
eligibility there is not charge for PACE services.
PACE receives a capitated monthly payment per participant
from Medicare and Medicaid.
Persons enrolled in PACE who are not Medicare or
Medicaid eligible may have a monthly premium.
The PACE Model
History
First
Legislation
Authorizing Demonstration
Sites
PACE
Operational
Demonstration
Congress
Authorizes
Permanent
Provider
Status
Publication
of Interim
Final PACE
Regulation
First Program
Achieves
Permanent
PACE Provider
Status
Balanced Budget Act
of 1997, H.R. 2015
Washington, D.C.
1986
1990
1997
(Nov)
1999
(Nov)
2001
The PACE Model
Philosophy
Honors what frail elderly want…




To stay in familiar surroundings
To maintain independence
To maintain function
To maintain cultural connections
WHY IS PACE A GOOD FIT
FOR CHEROKEE NATION?
• Frail elder populations in rural areas are
•
•
at higher risk of institutionalization
Current environment supports service
integration
Emerging flexibility supports adaptation
BENEFITS FOR THE ELDER
•
•
•
•
Keeps elders in their homes, with families and in their
communities.
Provides excellent, comprehensive health care with
consistent health care providers.
Involves the elder and their families in decision
making regarding health care and other lifestyle
choices. (Partnership)
All team approved healthcare costs are covered for
enrollees.
CULTURAL BENEFITS
• PACE does not dictate how the building looks, so it can
•
•
•
reflect the communities’ culture.
By keeping the elder in the community we facilitate
holding on to the culture through their knowledge and
practices.
PACE offers the opportunity for inter-generational
activities.
The PACE site can incorporate cultural activities,
language and art.
CEC ARTWORK
PACE CHALLENGES
TRIBAL OR RURAL COMMUNITIES
• Lack of population density
• Shortage of providers
• Less negotiating power with contract health
•
providers in rural areas vs. urban areas
AI/AN are at higher risk for chronic diseases
PACE INNOVATIONS
TRIBAL OR RURAL
COMMUNITIES
•
•
•
•
•
Use of adjunct sites
Use of new technologies
Expanded populations (disabled, children, Veterans)
Risk sharing/Stop Loss for outliers
Caregiver and health professional mix
PACE ISSUES
TRIBAL SITES
•
•
•
IHS does not recognize an integrated system of care
such as PACE--only its individual components
PACE programs must serve all Medicare/Medicaid,
cannot restrict to tribal citizens
100% FMAP applies to Certain Medicaid Services
PACE ISSUES
TRIBAL SITE
• Being the first PACE in Oklahoma, Medicaid
•
•
plan required amendment
Methodology to determine an “Indian rate” by
the State
Negotiation of PACE services under a selfgovernance or self-determination agreement
for 100% FMAP
Cherokee Nation’s Pursuit of PACE
CHEROKEE NATION
SERVICE AREA
PLANS FOR PACE
DEVELOPMENT
• Cherokee Nation PACE currently serves the population
•
•
•
residing around the Tahlequah area
Eventual service area will be the Tribal Jurisdiction
Service Area (TJSA).
Functions as a traditional PACE program serving all
eligible individuals
Uses strategies developed under the Rural PACE
Expansion grant to address rural areas
PLANS FOR PACE
DEVELOPMENT
• Feasibility study utilized conservative PACE rate,
rather than any expected “Indian” rate
• Cherokee Nation created a governmental agency
specifically to operate the PACE project – Cherokee
Comprehensive Care Agency
Organizational rules under PACE are very
specific and can be burdensome
PLANS FOR PACE
DEVELOPMENT
•
•
Will continue discussions with IHS in order to access
purchasing contracts like 340 b and have coverage
under the Federal Tort Claims Act
While the Nation already maintains provider
contracts for many areas of care, those specifically
needed for LTC must be negotiated, as well as
contracts with IHS as a provider
CHEROKEE ELDER CARE
•
•
•
•
•
New facility construction began April 2007
Opened September 2008
Continuing to work with OHCA and DHS on
processes
Continue conversations with HIS
Enrollment currently at 80, with capacity 135-150
August 2006
August 2008
April 2007
Interested in Learning More About
Establishing a PACE Site in Your
Area?
Phone: 918-453-5554
E-Mail: rick-richards@cherokee.org
Website: http://eldercare.cherokee.org