Senate Likely to Vote Next Week on Medicaid Reforms

Even though the Senate could not pass legislation to overhaul the Affordable Care Act and reform Medicaid earlier this year, Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA) continued to work on the issue. Over the last several months the senators refined their existing proposal and sought additional supporters.

The latest version has gained steam and the cosponsorship of Sens. Dean Heller (R-NV) and Ron Johnson (R-WI). Similar to other legislative proposals considered by the Senate and the House, the Graham-Cassidy bill would institute a per-capita funding cap for Medicaid, which is gravely concerning to NPA. PACE is particularly vulnerable if Medicaid cuts are enacted, given that 99 percent of participants are Medicaid beneficiaries (90 percent dual-eligible, 9 percent Medicaid-only). Under a per-capita cap funding methodology, the higher needs of PACE participants and the associated higher costs are not taken into account by the federal government. Therefore, state Medicaid programs may decide the funding level is insufficient to sustain PACE going forward.

The Senate Finance Committee plans to hold a hearing on the bill on Monday, Sept. 25, with a vote by the full Senate expected to occur later next week. The window of opportunity for the Senate to act on this legislation is narrow, as the ability to consider the Graham-Cassidy bill under the special budget reconciliation rules, which allow for passage of the bill with a simple majority of senators, expires on Sept. 30.

Urge your senators to vote against the Graham-Cassidy bill. Take action now to protect Medicaid funding.

For more information, contact Francesca Fierro O'Reilly, vice president of Advocacy.

Post-Election and PACE

NPA has developed a post-election member update to provide information on the key policy issues of concern to PACE organizations.

At-Risk Medically Complex PACE Pilot Development

NPA worked with a group of PACE organizations, consumers and policy organizations to develop a framework for an at-risk medically complex pilot population. The At-Risk Medically Complex Pilot Framework addresses the following components of a pilot for this population:

  • eligibility criteria,
  • service delivery,
  • payment and
  • quality indicators.

NPA and the workgroup members strongly believe that a pilot guided by this framework holds great potential for improving the quality of life and quality of care experienced by individuals who are at risk of needing a nursing home level of care. Through better coordinated care that promotes well-being and slows health decline, the PACE organizations in the pilot can delay the need for nursing home care. For many, this also will delay their need to have their care paid for by state Medicaid programs.

NPA has provided the pilot framework to the Centers for Medicare & Medicaid Services (CMS) and encourages CMS to use its PACE pilot authority to conduct a pilot for the at-risk medically complex population.

NPA Webinar on PACE Pilots

NPA, along with a number of disability community stakeholders, hosted a webinar titled "PACE Pilots: A New Era for Individuals with Disabilities" about the Adapted PACE Protocol on Aug. 24.

The PACE Innovation Act of 2015 provides the Centers for Medicare and Medicaid Innovation (CMMI) the authority to develop PACE pilots for new populations. In anticipation of the pilots, NPA and a number of disability community stakeholders have completed work on the Adapted PACE Protocol, which builds on the current PACE program design and adapts it to address the needs and concerns of younger people with disabilities.

The webinar addressed the potential pilot populations being served under the PACE Innovation Act of 2015, the Adapted PACE Protocol and next steps. Speakers included Peter Fitzgerald, executive vice president of Policy and Strategy at NPA; Esme Grant, of the American Network of Community Options and Resources; Laura Weidner, of the National Multiple Sclerosis Society; and Sarah Meek, of the Lutheran Services in America Disability Network.

You can view the webinar and the accompanying slide presentation.

Legislative Advocacy

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PACE Innovation and Growth

NPA works with Congress to promote PACE innovation and growth.

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