CMS Approves Alexian Brothers Community Services St. Louis For Health Care Program For Frail Elderly

The U.S. Centers for Medicare and Medicaid Services (CMS), in cooperation with the Missouri Department of Social Services, today approved a request by Alexian Brothers Community Services St. Louis, in St. Louis, Mo., to become the first provider under the permanent program of comprehensive care that allows frail elderly people to live in their communities.

The Program of All-Inclusive Care for the Elderly (PACE) is 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.

"We are pleased to have our first permanent PACE program, and it is our hope that other PACE programs will follow Alexian Brothers' lead," 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. Alexian Brothers Community Services St. Louis 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 between state and federal agencies, providers and foundations during the pilot project phase."

CMS, an agency within the U.S. Department of Health and Human Services which administers Medicare and Medicaid, is the former Health Care Financing Administration.

Alexian Brothers Community Services St. Louis is operated by the Alexian Brothers Health System. The plan joined the PACE demonstration program in August 2000 and now serves about 120 beneficiaries with an average age of 77. Most beneficiaries in the Alexian plan are eligible to receive services under both the Medicare and Medicaid programs.

PACE began as a demonstration project in San Francisco and currently has 25 sites in 13 states. A regulation published Nov. 24, 1999, implemented legislation establishing PACE as a permanent part of the Medicare program and includes provisions that enable demonstration sites to convert to permanent status.

PACE is available only in states that have chosen to offer the program under Medicaid. To be eligible for PACE, a person must be 55 or older, live in the service area of a PACE program and be certified as eligible for nursing home care by an appropriate state agency. Enrollment is voluntary, then PACE becomes the sole source of services for Medicare and Medicaid beneficiaries who choose to enroll. PACE offers and manages all the medical, social and rehabilitative services enrollees need to preserve or restore their independence, to remain in their homes and communities, and to maintain their quality of life.

A team of doctors, nurses and other health professionals assesses the participant's needs, develops care plans and provides services for total care. Generally, services are provided in an adult day health center setting, but may also include in-home and other referral services that enrollees may need, such as medical specialists, laboratory and other diagnostic services, and hospital care. If a participant needs to be placed in a nursing home, PACE provides that service and maintains care by regular evaluation and monitoring of the beneficiary's condition.

A PACE program receives a fixed monthly payment per participant from Medicare and Medicaid. The amounts are the same during the contract year, regardless of the services a participant may need. Persons enrolled in PACE may also have to pay a monthly premium, depending on their eligibility for Medicare and Medicaid.