Proposal for Innovative Demonstration Project for Dual
Medicaid/Medicare Members - Virtual PACE
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)
Sign up for the Virtual PACE listserv
 Notice
of Revised Virtual
PACE Implementation Timeline (PDF, 10
KB)
Data
Snapshot - Dual Eligible Members in December 2010 (PDF, 110
KB)
Town Hall Meetings
101
KB)
Friday, November 11, 2011 - La
Crosse, WI (PDF, 63
KB)
Thursday, November 10, 2011 -
Amherst, WI (PDF, 62
KB)
The links below are to the DHS and CMS announcement of grant awards and
to the proposal submitted by DHS.
Online Surveys:
To comment on the Virtual PACE program and the PACE
grant submission (PDF, 55 KB) please complete one of the following
surveys.
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. Wisconsin’s effort is now
several months into the planning stage. Recent activity included a Town
Hall forum on October 12, 2011, where interested parties were able to
share their vision for a reformed delivery system. Several more similar
forums will be established in the near future.
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).
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Last Revised: February 17, 2012
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