[Congressional Record Volume 143, Number 52 (Monday, April 28, 1997)]
[Extensions of Remarks]
[Page E760]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                      INTRODUCTION OF LEGISLATION

                                 ______
                                 

                         HON. WILLIAM M. THOMAS

                             of california

                    in the house of representatives

                         Monday, April 28, 1997

  Mr. THOMAS. Mr. Speaker, I am pleased to introduce today, along with 
Mr. Cardin, Mr. Bilirakis, and Mr. Stark, the Programs of All-inclusive 
Care for the Elderly [PACE] Act of 1997. Our bill would provide 
coverage of PACE under the Medicare Program and establish PACE as a 
Medicaid State option.
  As many know, PACE is a quality, cost-effective long-term care 
program that was pioneered by On Lok Senior Health Services in San 
Francisco, CA. The PACE program is a fully-capitated acute and long-
term health care program in which all covered services are provided 
through a single organization or a single provider of care, including 
not only the long-term care services and inpatient hospitalization, but 
physician services, nurses, physical, occupational and recreational 
therapists, social workers, dieticians, home health aides and medical 
equipment suppliers. PACE programs receive capitation payments from 
Medicare and Medicaid, and in the case of individuals who are not 
eligible for Medicaid, private individuals. These payments provide 
payers savings relative to their expenditures in the traditional 
Medicare, Medicaid, and private payer systems. Finally, PACE programs 
are unique in that they assume total financial risk and responsibility 
for all acute and long-term care without limitation.
  PACE evolved in response to problems which exist in the current long-
term care system, a system that is biased toward institutional care, 
leads to discontinuity and duplication in the provisions of services, 
and affords little control over utilization of services and costs. 
These problems can lead to fragmented care, repeated and lengthy 
hospital stays, family stress, premature nursing home placement, and 
impoverishment.
  By expanding the availability of community-based long-term care 
services, tightly integrating all aspects of their enrollee's care, and 
emphasizing preventive and supportive services, PACE programs have 
substantially lowered the utilization of high-cost, inpatient services. 
In turn, dollars that would have been spent on hospital and nursing 
home care services are used to expand the availability of community-
based care which, again reduces the need for higher-cost institutional 
care. As a result, PACE enrollees are able to remain at home and enjoy 
a better quality of life.
  The PACE Coverage Act of 1997 offers an alternative to traditional 
long-term care which has been proven effective--both in terms of 
quality and cost. While we recognize that PACE is not the only solution 
to problems facing frail, older Americans, it is one solution that has 
withstood the test of time and the scrutiny which comes with being 
visible. On Lok, the first of the PACE programs, has been in existence 
since 1972 and began offering the full spectrum of PACE services in 
1983. In 1986, Congress authorized demonstration waivers for up to 10, 
later 15, organizations seeking to replicate the achievements of On Lok 
in San Francisco. These programs have accumulated more than six decades 
of experience. Based on the success of these pioneers, it is time to 
make PACE programs available to eligible Medicare and Medicaid 
beneficiaries on a broader scale.
  The purpose of our bill is to make this important alternative 
available across the Nation. It is also urgently needed. As mentioned, 
15 demonstration sites were authorized. Far more than that number are 
now waiting in the wings to serve our frail elderly citizens. By 
establishing qualified programs as providers, we also will facilitate 
the ability of the private sector to insure these services and to 
contract with PACE programs on behalf of individuals who would benefit 
from this type of care. Again, this, of course, would be voluntary. 
What we are doing here is providing another significant resource.
  As we examine the needs of the elderly, we need to look for ways to 
move beyond existing programs to make coordinated care networks a 
permanent competitive options for all beneficiaries, and the PACE model 
provides a strong foundation for us on which to build.

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