After six months of capped enrollment on the statewide Program for All-Inclusive Care for the Elderly, a Burlington facility that looks after nearly 140 adults is able to accept new participants again.
“We’re so excited about it,” said Marianne Ratcliffe, executive director of Piedmont Health SeniorCare, which has a facility on Vaughn Road and another in Pittsboro.
Most of the participants in the program live at home and are taken to the facility during the day, where they take part in activities and receive medical services.
From April 1 to Sept. 30, the state’s Division of Medical Assistance imposed a freeze on enrollment at the Burlington facility — and PACE facilities around the state — to “study the growth rate of PACE … and ensure that adequate funds were appropriated” for the next fiscal year to allow two new PACE facilities to open.
Brian Toomey, CEO of Piedmont Health SeniorCare, told the Times-News in June that if enrollment caps and a decreased budget carried over into the next year, the nonprofit would have to close its Burlington facility to pay off debt on its Pittsboro center, which opened in January.
But with the state’s new budget, $52 million in Medicaid funds was approved for PACE programs, now allowing Piedmont Health’s Burlington center to add three new participants each month, and the Pittsboro facility to add six monthly.
Participants in PACE, which is a waiver program through Medicaid and Medicare, are usually dually eligible for both programs, Ratcliffe said.
“Every month for John Smith, we get a capitated payment — one lump sum from Medicare and Medicaid,” Ratcliffe said. “The PACE program is responsible for whatever medical services are needed to keep that senior safe and healthy at home. Whatever happens to that person — if they need cancer treatment, dialysis, to be hospitalized — we get this capitated lump sum payment, and we have the responsibility for caring for that individual, regardless of the scope of services.”
Ratcliffe said the program offers at least a 20 percent savings for the state, with its Medicaid office paying $3,310 per PACE participant each month. As of April, she said, the average long-term monthly Medicaid rate for someone staying in a nursing home was $4,712.
“The PACE model is not saying nursing homes are terrible,” Ratcliffe said. “There is a place for nursing homes. This provides them with an opportunity to age at home.”
Now that the state has approved enough funding to allow the PACE facilities to continue to grow, Ratcliffe said Piedmont Health SeniorCare is grateful to local Republican legislators Sen. Rick Gunn, Rep. Dennis Riddell and Rep. Steve Ross, as well as Dr. Robin Cummings, deputy secretary, and others at the N.C. Department of Health and Human Services for working to secure PACE’s budget.
For more information on Piedmont Health SeniorCare, call the Burlington facility at 336-532-000, or visit its website at www.piedmonthealthseniorcare.org.
By Natalie Allison Janicello / Times-News
Published: Wednesday, October 29, 2014 at 05:26 PM.