LIFE PITTSBURGH IN PITTSBURGH, PA. APPROVED FOR HEALTH CARE PROGRAM FOR FRAIL ELDERLY
The Centers for Medicare & Medicaid Services (CMS) and the Pennsylvania Department of Public Welfare have approved a request by LIFE Pittsburgh in Pittsburgh , Pa. , to become a provider under a permanent program of comprehensive care that allows the frail elderly to live in their communities.
LIFE (Living Independence For the Elderly) Pittsburgh 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 LIFE Pittsburgh offer the care and services that many frail, older Americans need to live in their communities instead of nursing homes," HHS Secretary Mike Leavitt 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."
LIFE Pittsburgh began operating as a Long Term Capitated Assistance Program under an agreement with Pennsylvania ’s Medicaid program and has become a productive, ongoing effort that will now be reimbursed effective May 1, on a permanent basis, by the two health care programs. This is the result of a relationship formed among state and federal agencies, providers and foundations during the pilot project phase. LIFE Pittsburgh has the capacity to serve up to 250 beneficiaries.
Most beneficiaries in the plan are eligible to receive services under both the Medicare and Medicaid programs. The LIFE Pittsburgh operates two PACE centers - at 1 Parkway Center in the Greentree area and at 1200 Reedsdale St. in North Shore , both in Pittsburgh . Joann Gago is LIFE Pittsburgh ’s executive director.
"We are pleased that LIFE Pittsburgh is offering PACE in the city of Pittsburgh ," CMS Administrator Mark McClellan, M.D., Ph.D. 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.”
In PACE, 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 in November 1999, implemented legislation establishing PACE as a permanent part of the Medicare program.
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.
With the new Pittsburgh site, PACE currently has 33 sites in 18 states. Pennsylvania has two other plans operating in Philadelphia and McKeesport .
Further information about PACE is available on the CMS Web site at http://www.medicare.gov/nursng/alternatives/pace.asp.