CFCO PACE Workgroup Meets
On August 17th the Department of Health (DOH) convened the second Managed Care Community First Choice Option (CFCO) Program of All-Inclusive Care for the Elderly (PACE) Workgroup meeting. During the meeting DOH reviewed issues identified during the first meeting and provided a status report of their work towards implementing CFCO and the guidance that they are developing for plans. The PACE Workgroup is one of five managed care CFCO workgroups and is charged with identifying CFCO implementation issues that are unique to PACE. In addition there are several workgroups that are focused on CFCO implementation in the fee-for-service environment.
DOH provided a list of issues that were identified by PACE Workgroup participants during the first meeting which Department staff have been discussing internally. These include concerns about:
- the breath and scope of CFCO given that PACE already offers a very robust catalog of services;
- preserving the role of the PACE center as the focal point of service delivery;
- rate updates reflecting the new services being done in a timely manner and in a way that adequately recognizes added costs;
- service authorizations and dynamics when a participant disagrees with plan determinations;
- contracting and credentialing with service providers, especially low volume, non-medical services such as vehicle modification;
- social transportation concerns;
- risk and financial exposure a plan might have related to vehicle and home modifications;
- impact of new patient centered plan requirements including obtaining required signatures;
- Administrative Law Judge (ALJ) familiarity with CFCO rules.
The social transportation benefit remains a concern in all workgroup discussions with participants stressing the need for clear, specific, universal guidance that specifies the limitations of the benefit. A DOH internal workgroup is developing draft guidance that includes a template for service authorization.
DOH is also developing person-centered service plan guidance that will outline the components that are required in the plan and include a template that plans may use if they wish (non mandatory). The guidance is broader than just CFCO because recent federal regulations include service planning requirements that DOH is implementing as well. This draft guidance will be shared for input once ready. DOH also anticipates developing other service-specific guidance and is developing CFCO provider credentialing guidance.
While DOH is planning on providing ALJs training on CFCO services and rules, they are holding off until the services are brought into the plan benefit. In response to participant comments DOH clarified that they have been engaged in a broader initiative to provide training to ALJs on managed care.
The third round of managed care CFCO workgroup meetings will include additional stakeholders including consumer advocates and waiver service provider representatives. Because the PACE workgroup deals with operational issues that are less directly relevant to these stakeholders and given the challenges of facilitating a productive discussion of this expanded group, the PACE workgroup will no longer have scheduled meetings but will hold ad-hoc meetings as needed to ensure PACE-specific issues are resolved. PACE is represented on the other workgroups and PACE workgroup members are invited to transfer to any of the other four workgroups by contacting DOH.
Contact: Darius Kirstein, email@example.com, 518-867-8841