Medicaid Managed Care - U.S. Senate Special Committee on Aging

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CCE's staff consist of a variety of professionals dedicated to working with elderly individuals. Team
members who serve at CCE's adult day health centers include the following
Activity coordinamors.
- Center supervisor.
Dietary personnel.
* Medical records personnel and medical assista.
- Nurse practiticnr.
* Personal care workers.
* Primary care physicians-
- Registered nurses.
Rehabilitation therapists.
* Social workers.
"We provide about 50 percent of the home care [for participants] and contract for the rest,' did CCO's
Chief Executive Officer Kirby Shoaf. "We also contract for specialty physician services, hospital services,
nursing home services, about 40 percent of our trasportasion. and tmany other services"
To be eligible for the CCE program, participants mnst be at least 55 years old, hive long-term health ca
needs, live in Milwaukee County, be <strong>Medicaid</strong> and/or Mecarc eligible, have potential for remaining in
the community with assistance, and aree to receive all servioes fro CCE or provids approved by CCE-
Funding for CCE comcs via monthly capitation payments from <strong>Medicaid</strong> and Medicare for all eligible
enrollees. Most participants who qualify for both <strong>Medicaid</strong> and Medicare pay nothing for the program.
However, those who qualify for just one of these programs, or who fll into certain special categories, pay
a portion of the premium. These funds are then pooled together to achieve mm-dmum eficiSency and
flexibiliry in care planning.
Medicasid pays CCE a monthly, per-person capitsation rate of $2,132 for PACE, while Medicare pays a
monthly race of S1.039. In return for this monthly pretium, CCE is fully responsible for the physical,
psychological, and social care of each patient.
Nationaly. <strong>Medicaid</strong> capitation payments to PACE sites yield state a 5-15 perent savigs relative to their
fcc-for-service expenditures for a comparable ntsing-homt cestified population. Beyond these savings,
PACE offers policy makers a more comprehensive and lers costly alternative to consoructing new nursing
home beds.
Because PACE is a managed cars model that cnrolls only frail older persons, assuring enrollees' quality of
cars is cxtremely important. In 1993, the Community HcalLh Aeccaditoion Progra eviewed five PACE
cites and found the quality and coordination of enrollee care to be 'exceptional " In 1995, the National
PACE AssociadoD received a grant from the Robert Wood Johnson Ponundation to develop standards and
an accreditation mechanism for PACE.
CCO is a sot-for-profit nonstock corporation which provides the following programs in addition to CCE:
Grandfathered CCO Demonstration Program, Comprehensive Community Cre Program, Manitowoc Case
Managemet Program. Elder Abuse Reporting System. Elder Abuse Direct Services, and <strong>Care</strong> Consulting
Services.
Over the past four years, the CCE program has experienced an average anmnal growth rare of 36 percent
and has nearly quadrupled in size. +:
Rprinted sth peirsionfrnr the Mdark 1997 Forward neKetwr.