Department of Health Services Logo

 

Wisconsin Department of Health Services

Partnership Home

Basic Information

PACE Program

Family Care

 

Proposal for Innovative Demonstration Project for Dual Medicaid/Medicare Members - Virtual PACE

Wisconsin is one of fifteen states that received a demonstration grant from the Centers for Medicare & Medicaid Services (CMS) to develop a care coordination and funding model to integrate the care of persons dually eligible for Medicare and Medicaid. Awarded by the Medicare-Medicaid Coordination Office ("Office of the Duals"), Wisconsin's demonstration project is called Virtual PACE.

Stay informed - Sign up for the Virtual PACE listserv 

What's New

Wisconsin’s Virtual PACE Proposal Posted for Public Comment at CMS

On April 26th, 2012, DHS submitted to CMS a proposal called Virtual PACE. As part of the federal review process, CMS has posted Wisconsin’s proposal for public comment. During this time, interested individuals or groups may submit comments to help inform CMS’s review of Wisconsin’s proposal.

To submit comments visit the Integrated Care Resource Center (ICRC) website. (exit DHS)

Public comments must be received by May 31st, 2012 at 5:00 p.m. Eastern Standard Time.

Virtual PACE Proposal to the Centers for Medicare and Medicaid Services (CMS) - April 26th, 2012

DHS has submitted to CMS a proposal called Virtual PACE. In 2011, Wisconsin received a grant from CMS to develop a model program design that would improve the coordination and cost effectiveness of care for individuals eligible for both Medicare and Medicaid.

Governor’s Letter of Support (PDF, 59 KB) 
Read the Virtual PACE Proposal (PDF, 2 MB) 

Public Comments on Draft Proposal

DHS issued a draft proposal on March 16th, 2012 for public comment. The Department collected public comments through online responses, written submissions and town hall forums. The comments DHS received during the 30-day public comment period can be viewed by following the links below, which categorize comments by type of stakeholder.

Previous Updates

  • Virtual PACE Demonstration Draft Proposal for Public Comment - March 16, 2012 (PDF, 360 KB)
    DHS announced the release of a draft proposal for the provision of integrated care to people who are eligible for Medicare and Medicaid. The proposal was issued on March 16th, 2012 for public review. The input received during the review period guided the Department's development of the final proposal submitted to the Centers for Medicare and Medicaid Services (CMS).

  • Stakeholder Advisory Committee - Committee Roster (PDF, 91 KB) 
     DHS is pleased to announce the formation of the Virtual PACE Stakeholder Advisory Committee. The group had its first meeting March 1, 2012, and will continue meeting throughout the planning for the Integrated Care Initiative.

  • Notice of Revised Virtual PACE Implementation Timeline (PDF, 10 KB) 
     Through mutual agreement, DHS and CMS have jointly reached a decision to modify the Virtual PACE demonstration implementation date from July 1, 2012 to January 1, 2013.

  • Data Snapshot - Dual Eligible Members in December 2010 (PDF, 110 KB) 
     A high-level overview of the populations that may be eligible for the Virtual PACE demonstration program. This data is not, by itself, sufficient to reach any program design or cost projection conclusions. 

Stakeholder Engagement and Committees

Online Surveys
To comment on the Virtual PACE program and the Virtual PACE grant submission (PDF, 55 KB) please complete one of the following surveys.

Town Hall Meetings

Planning Grant

Wisconsin recently received a $1 million federal grant to secure federal authority, similar to PACE (Program of All-inclusive Care for the Elderly) authority, for the state to have more flexibility in combining Medicare and Medicaid funding to serve people who have a nursing home or ICF-MR level of care. While PACE is available only in select counties to people age 55 or older, and coordinates services through an adult day care setting, this Virtual PACE pilot program envisions serving younger people in more counties and with greater flexibility in the location where care is provided.

Summary of Virtual PACE Program Proposal (PDF, 67 KB)

The links below are to the DHS and CMS announcement of grant awards and to the proposal submitted by DHS.

Financial Alignment Model

Subsequent to Wisconsin’s receipt of this important planning grant for Virtual PACE, the Office of the Duals collaborated with the Center for Medicare and Medicaid Innovation (the “Innovation Center”) to provide all states with an opportunity to pursue two financial models for better integrating care for dual eligibles. These two models include:

  • Capitated Model: A State, CMS, and a health plan enter into a three-way contract, and the plan receives a prospective blended payment to provide comprehensive, coordinated care.
  • Managed Fee-for-Service Model: A State and CMS enter into an agreement by which the State would be eligible to benefit from savings resulting from initiatives designed to improve quality and reduce costs for both Medicare and Medicaid.

CMS is interested in testing these models across the country in programs that collectively serve up to 1-2 million Medicare-Medicaid enrollees. All programs will be rigorously evaluated as to their ability to improve quality and reduce costs. Meaningful engagement with stakeholders and ensuring beneficiary protections will be a crucial part of developing and testing these models.

In July 2011, CMS released a State Medicaid Directors' letter to describe these two new options. States have an option to pursue either or both of these financial alignment models. As described in the letter, States interested in the new financial alignment opportunities were required to submit a letter of intent (LOI) by October 1, 2011. CMS is offering streamlined approaches for States interested in testing these two models and technical assistance to support necessary planning activities. This information can be found on CMS' website. (Exit DHS)

Wisconsin submitted a Letter of Interest (LOI) in response to this opportunity. This LOI offers Wisconsin another viable pathway to aligning Medicare and Medicaid funding for duals. Letter of Interest from Secretary Dennis G. Smith (PDF,184 KB).

PDF: The free Adobe Acrobat Reader software is needed to view print portable document format (PDF) files. Learn more

Last Revised: May 03, 2012