Bill to create all-inclusive, community-based care program for seniors awaits governor’s approval

(Credit: Monkey Business)

The Gist

The Legislature passed a bill this month to create a new long-term care program for seniors that would help them live at home while receiving comprehensive medical care, meals and other community services. If signed by the governor, it’s expected to save the state money on health care costs and decrease emergency room visits and nursing home care for many elderly residents.

What's Happening

House Bill 1078 creates the Georgia Program of All-Inclusive Care for the Elderly (PACE). Part of the state’s medical assistance program, PACE targets people over age 55 who need skilled nursing care and who are dually eligible for Medicaid and Medicare. The program would be managed by the Department of Community Health. 

PACE programs, currently operating in 159 centers in 32 states, usually run out of an adult day health center, offering comprehensive medical and wraparound services including primary care, dental care, physical therapy, social activities, lab and X-ray services and medications through an interdisciplinary team of caregivers. They also provide in-home care services and regular transportation to and from the PACE center.

Sen. Jesse Petrea (Credit: Georgia House)

“This will allow us to help people who need skilled nursing care to remain at home and avoid institutional placement,” said Rep. Jesse Petrea, R-Savannah, who chairs the House Human Relations and Aging committee and is lead sponsor of the bill. “It’s going to give expanded opportunities to serve our aged, blind and disabled people on Medicaid in newer, better and more efficient ways, which is better for both consumers and taxpayers.”

Medicaid is a joint federal and state health care program that assists individuals and families with limited income and resources to access necessary medical services. In Georgia, the federal government pays 60% and the state pays 40% of the cost for most Medicaid-funded services. Medicare is federal health insurance for anyone age 65 and older, and some people under 65 with certain disabilities or conditions. 

Why It Matters

Joint research conducted by the Department of Community Health and the National PACE Association shows that states participating in the program save on average 12% on health care costs for their aged populations, in large part because people participating in the program receive preventive care and case management of their chronic medical conditions, which means fewer hospitalizations and less long-term nursing care.

And while Georgia already has some Medicaid-funded programs providing home- and community-based care, those programs often have a waiting list of a few thousand people. The PACE program does not require a waiver from the Centers for Medicaid and Medicare Services to operate and is not subject to five-year renewals, which makes it easier to implement.

“PACE really is all-inclusive, whatever that person needs,” said Fred Watson, a board member of the Georgia Council on Aging, who said he has studied the program model in other states and strongly supports its implementation in Georgia. “If it’s set up right, it is going to help the poor who struggle to find good medical care, and those not ready for nursing homes,” he said.

The key to the program’s success will be “for the state to set rates that will pay a provider an all-inclusive rate,” said Watson, since the companies operating PACE centers “are taking a risk by agreeing to provide everything a member needs,” including long-term nursing home care at some point. 

Brian Dowd, deputy commissioner of the Department of Community Health, told lawmakers his team has determined the PACE model is well suited to three initial service areas of the state with a large population of Medicaid/Medicare enrollees and senior care service providers who’ve already expressed interest in participating: Savannah/Chatham County, Macon/Bibb County and Fulton and Dekalb counties in metro Atlanta. 

What's Next

The bill has been sent to Gov. Kemp for his review. If enacted, the Department of Community Health will submit an amendment to the state health plan to the Centers for Medicare and Medicaid Services that will include proposed per diem reimbursement rates for providers and areas of coverage in the PACE plan. Once approved, the Department will send out bids and contract with three initial providers to set up the PACE centers. Petrea estimated that this implementation process might take about a year and a half.

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