April 14, 2026 · AGING AND OLDER ADULT SERVICES · 12,369 words · 14 speakers · 84 segments
Good morning. I'm Chairwoman Madden from the 115th Legislative District, and I'd like to call this informational meeting of the House Aging and Older Adult Services Committee to order. Please be aware that this meeting is being recorded and members and guests should silence their cell phones and electronic devices. I'd like to remind members of the public watching at home that our members serve on multiple committees, which often requires them to juggle various obligations. Occasionally, committee members may overlap, so don't be surprised if you see members coming and going during the meeting.
For attendance today, can we have each committee member present and say their name and the district they represent? Good morning. I'm Representative Shelby Labs. that represent the 143rd legislative district in Bucks County.
Good morning, Representative Marla Brown. I represent District 9, and that's Lawrence County.
Good morning, Representative Nikki Rivera. I'm in House District 96 in Lancaster City, Mannheim Township, and East Petersburg Borough.
Good morning, everyone. Lindsay Powell, representative for the 21st District in Allegheny County.
Good morning, Gary Day, Lehigh County, the 187th District.
Okay. Today's informational meeting is on the live program, and we only have 90 minutes.
Wait, you didn't introduce yourself. I'm a cameo appearance here. Representative Eric Nelson, Westmoreland County.
Yep, and we appreciate you standing in today, Chairman. And online we have Chairman Steve Mentzer, and we have Representative Marcel. As I mentioned, we only have 90 minutes for this action-packed three-panel hearing on the LIFE program, which I'm very excited about. And our first panel today brings us back a friend of the committee, Juliette Marsala, who serves as the Department of Human Services Deputy Secretary for the Office of Long-Term Living.
So that's mine.
Yes, go ahead.
Good morning. Chair Madden, Chair Menser, and members of the House Aging and Older Adult Service Committee, thank you for allowing the Department of Human Services to provide testimony about the Living Independence for the Elderly Life Program. I'd like to thank you for the opportunity to kind of share how proud we are of our life program. The life program is known nationally as the Program for All-Inclusive Care for the Elderly, or PACE, which was established by CMS as a permanent entity within the Medicare program and enables states to provide PACE services to Medicaid beneficiaries as a state plan option. Operationally, the PACE program is unique as it is a three-way partnership between the federal government, the state, and the PACE organization. And PACE is a managed care program allowing older Pennsylvanians and people with disabilities to live independently in the community. So DHS is committed to providing more opportunity and supports that allow aging Pennsylvanians and people with disabilities to live in their community allowing older Pennsylvanians to age in place and providing greater independence and choice that people deserve Life is an option for adults with disabilities to live independently in the community while receiving services that meet their health, social, and personal needs. The Life Program is an alternative option to Community Health Choices Program. Life is designed for individuals age 55 and older, assessed as eligible for nursing facility level of care, and who live in a life service area and can be safely served in the community by the life provider. So Pennsylvania has a long and very proud history of providing life services. In 1998, Pennsylvania became one of the first states in the nation to offer life programs, and we have been a leader ever since. According to National PACE Association's latest PACE in the States report, Population Data, Pennsylvania has one of the highest per capita program enrollment in the nation. There are 200 PACE programs nationwide, and 9% of those programs are in Pennsylvania. Pennsylvania has 18 providers operating 57 centers across 54 counties in Pennsylvania. We are a national leader in the number of operating centers. We serve approximately 9% of the nation's enrollment, with over 8,000 Pennsylvanians served last year. Pennsylvania was also the first state to implement the Consumer Assessment of Healthcare Provider and Systems CAHPS Survey, which is a standardized survey tool developed by the Agency for Healthcare Research and Quality and Centers for Medicare and Medicaid Services to measure the consumer experiences of life provider organizations. And so, as you've heard, we are very, very proud to be a national leader. The LIFE program is unique in its three-way partnership between CMS, the state, and the life provider organizations, LIFE POs. CMS depends on DHS as the single point of contact on all state-related requirements. So unlike fee-for-service health care programs, life providers have a capitated payment system in the form of per-month rates. Funding for the life providers come from four main funding sources, Medicare Parts A, B, and D, Medicaid, and then also available to private pay. CMS sets the Medicare Part A, B, and D rates, and the state sets the Medicaid rates in accordance with CMS guidelines and the funds allocated by the General Assembly. The majority of Pennsylvanians enrolled in a LIFE program are duly eligible for both Medicaid and Medicare services, so LIFE provider payments oftentimes are a bundle of the Medicare Part A, B, D, and Medicaid. LIFE provides fully integrated managed long-term care, acute care, behavioral health, and home and community-based supports. The model is based on the interdisciplinary team working with the participant and family to develop a care plan tailored to meet their needs. Some of the services provided under life include adult day services, dental care, lab and x-ray services, optometry services and eyeglasses, podiatry, pharmaceuticals, personal care, medical and non-medical transportation, as well as recreational and socialization activities, social services, durable medical equipment, behavioral health services, emergency care, and meals. It really is the most integrated long-term care program we offer for those who meet the eligibility requirements. So as federally required the LIFE program must provide all needed medical and supportive services where Medicare and Medicaid benefit limitations and conditions relating to amount duration scope of services deductibles copayments coinsurance and other cost sharing do not apply DHS is committed to ensuring the LIFE program is presented to all eligible individuals as a valuable option for Pennsylvanians. DHS has worked with the life providers and their representative associations, Pennsylvania Life Provider Alliance, PALPA, and LeadingAge PA, to create DHS's informational material that includes a thorough description of the life program and presents the life program as an alternative long-term care enrollment option for all individuals who are eligible, regardless if they are newly seeking services or already enrolled in existing programs like community health choices. DHS and the CHC managed care organizations are required to inform all eligible individuals about life on an annual basis. So enrollment in life. In May 2021, DHS began statewide implementation of streamlining life program enrollments through its partnership with the independent enrollment broker, or the IEB. The IEB is responsible for providing educational information and unbiased choice counseling about CHC and life programs to potential participants. If an applicant is interested in the life program, the IEB sends the applicant's information to the appropriate life provider for follow-up. Since its statewide enrollment implementation, the IEB has generated an increase in new referrals to the Pennsylvania life providers, amounting to a 6% increase in the life providers' enrollment growth. Enrollment into the life program includes an in-home visit assessment with the IEB to provide that choice counseling, a functional eligibility determination assessment completed by an independent assessment entity, Aging Well Pennsylvania, along with a physician's certification to determine clinical eligibility if an active determination is not on file. The financial eligibility determination is made by the county assistance office. A safe-to-serve assessment is completed by the life provider, and a signed enrollment agreement is established between the applicant and the life provider. These processes are in place in accordance with federal requirements for our managed care programs. The life enrollment process is important to ensuring program integrity and meeting conflict-free provisions, as outlined in the federal regulations. Since the implementation of CHC, DHS annually mails a life flyer to those CHC participants otherwise eligible for the life program, informing them about the program and their ability to switch to the program if they so choose. DHS closely monitors the education and enrollment of individuals for the LIFE program through Act 40 of 2018, which requires the department to issue a report at the end of each quarter that tracks the enrollment of eligible individuals in long-term care service programs, including managed care organizations and LIFE programs by county. Additionally, as required by Act 54 of 2022, the department has been issuing a report at the end of each quarter that tracks life program outreach, communications, and trainings. In 2024, the life program had a 1.8 increase in their total census While 2025 showed life program growth to be stagnant DHS has seen an increase in disenrollments from the life program over the last five years Some of the top disenrollment reasons provided by participants include admission to a nursing facility, despite it being a covered service in the LIFE program, choosing another Medicaid program or Medicare plan, choosing another Medicaid provider or dissatisfaction with the program. We've included our annual rate of enrollment growth versus disenrollment growth as a table within the testimony so that you can see both the percentage increase of enrollment growth since year, starting from year 2021 through year 2025. And you'll see that there are ebbs and flows with enrollment growth percentage with some years being as high as 16.74 percent in enrollment growth to what we're trending now, which is more of a decrease in enrollment growth. And you'll also see in disenrollments, percentages of disenrollments annually, some as high as 39.6% and or less this year. One concern we often hear is that applicants wish to stay with their primary care provider or current network of providers, which is much easier to do within CHC provider networks versus the life program's interdisciplinary team model and smaller contracted provider networks, though some life providers do encourage folks to keep their primary care physician and allow for that. Another challenge is federal regulation that limits enrollment, the enrollment window to the first of the following month and requires applicants to be safe to serve in the community, which requires the life providers to deny enrollment into their programs if they determine they cannot meet the individual's needs safely in their home, ultimately redirecting those individuals into CHC. But we've had many investments. DHS remains committed to working with life providers and CMS on the development of innovative approaches that would allow us to offer life program services statewide. Over the past several years, DHS has been working to expand life program services across the Commonwealth. So to date, as you know, life services are being provided in 54 counties in Pennsylvania, and 60 out of the 67 counties in the Commonwealth are assigned to a life provider. DHS is able to offer the life program to over 90% of Pennsylvania's life-eligible population in its current 54-county service area. In September of 2025, we issued a notice of solicitation in Pennsylvania in our bulletin to expand the LIFE program to serve the remaining 12 unawarded counties, which at the time included Adams, Bradford, Carbon, Center, Huntington, Monroe, Pike, Potter, Sullivan, Susquehanna, Tioga, and Wayne counties. On October 10th, we assigned the Center Carbon Monroe and Pike County Life Services areas to Life Northwestern PA and Adams County to Albright Life, allowing readiness and implementation activities to begin effective immediately. So we are very excited about that expansion. The awards were based on the evaluation of interest that we received in response to our September 13th published notice. And the expansion of life northwestern Pennsylvania and all bright life into these counties offers the most comprehensive approach to serving those adults and advancing the life program in Pennsylvania. So our next steps for the eight remaining unassigned and inactive counties remain under consideration. We're still trying to get there to get every single county covered. In recent fiscal years, the life program providers received a 2% appropriation increase effective July 2021, a 1% appropriation increase effective July 2023, and another 1% increase effective January 2025 to support enrollment growth. DHS has been working with the life providers to evaluate the rate-setting process for life. DHS is aware of a request to evaluate the LIFE rate-setting methodology to make it more aligned with the rate-setting methodology in CHC. Particularly, the CHC rates must be actuarially sound and include an evaluation of the encounter data from the CHC MCOs. Currently, DHS does not receive Medicaid encounters on the long-term services and support services provided by the LIFE programs. As required in federal regulations, the PACE benefit package must include all Medicaid-covered services as specified in the state's approved Medicaid state plan. And given that the entire life population is clinically eligible for nursing facility-based care, like those enrolled in CHC, long-term services and supports are a crucial component of program costs. This lack of comparable data precludes OLTL from setting life capitation rates in the same manner as the Community Health Choices capitation rates. Therefore, receiving Medicaid and counter data is essential to moving forward to an alternative rate-setting process and allowing DHS to gain a more comprehensive accounting of the services that life participants receive and how the program funds are utilized. So in response to this request, DHS has been working diligently in collaboration with our life providers to lay the foundation for a life program-specific rate-setting process, which requires the standardization and validation of both the financial and encounter data. The collection of Medicare encounter data is now in full production. The submission and review of standardized financial reporting is underway, but upon initial analysis, DHS is finding underreporting of service utilization. The final and most integral step is the collection of Medicaid encounter data, and the kickoff for this initiative was held by us in May of 2024. In July of 2025, we began receiving test submissions from most of the life providers and continue our commitments to work collaboratively with the life providers on this initiative. We allowed for a pause in submissions to give providers more time to build and or enhance their data systems to better accommodate automatic submissions, and we plan to resume collecting submissions in August of this year. To support the life providers' progress towards submitting Medicaid encounter data, In October of 2024, DHS developed and announced a funding opportunity under an approved American Rescue Plan Act, or ARPA, Home and Community-Based Services Spending Plan, that provided funds to life providers to strengthen services provided under the life program. The purpose of the funding opportunity was to implement quality improvement projects by the life providers that are focused on supplementing activities in a manner that improves and strengthens the quality of services provided. 16 of the 18 life providers applied for and received a total of million in funds which were required to be spent by September of 2025 So as we continue to partner with life providers to develop a final Medicaid encounter data dictionary and allow time for providers to make system changes for their data, we look forward to this work continuing. In addition, there are new investments in life that I'm excited to talk about. Pennsylvania's Rural Health Transformation Plan, or RHTP, includes propelling the LIFE program model into some of our most rural counties. And this expansion in north and eastern Pennsylvania advances our goal to increase access to fully integrated care for individuals who are duly eligible for Medicare and Medicaid or individuals who are Medicaid only that meet the criteria. The RHTP also includes a technology-forward expansion of integrated behavioral health services and telehealth-enabled care at existing life centers across Pennsylvania. This initiative is designed to bridge care gaps for rural seniors by delivering whole-person wraparound services that address both physical and mental health needs. Additionally, in the last few months, DHS has begun collaborating with the Pennsylvania Department of Aging to ensure information and education on the LIFE program is provided to individuals who contact the Pennsylvania LINC for assistance. We have done training with them prior to this morning. This is part of a broader effort under the Pennsylvania Departments of Aging, Aging Our Way plan. Pennsylvania LINC is a part of a nationwide effort to help people with disabilities and older adults who need help with activities of daily living find information and connect to support and services in their communities through the Aging and Disability Resource Centers. Finally, by learning from other states' success and pace in life, DHS is evaluating allowing multiple life providers to operate in shared service areas as a strategy to further strengthen and expand the life program networks and increase program enrollment. Currently, Pennsylvanians contemplating life programs do not have a choice of life providers, given there is only one life provider operating in any given service area zip code. In comparison, Pennsylvanians enrolled in community health choices currently choose from among three managed care organizations, and duly eligible participants, Medicare and Medicaid participants, can choose between 12 Medicare Advantage options in addition to their CHC-MCO. So we hope this expansion of providers will help to provide that additional choice. So in conclusion, as evidenced throughout this testimony, the department recognizes the value and benefit of the model of care delivered by the LIFE program and is committed to leading the program forward and expanding access to its services to all eligible Pennsylvanians. DHS performs ongoing monitoring of the LIFE providers in tandem with CMS and has more recently increased its on-site auditing activities for early improvement detections and opportunities to the betterment of the program. We hold quarterly meetings with all LIFE providers and their associations, which provides an open forum for discussion about program issues, questions, concerns, updates, and serves as a vehicle for collaboration on joint initiatives. We continue to look at all opportunities to further develop, expand, and move the needle with the LIFE program from our continual work with providers, to further streamlining the enrollment process along with the IEP and the county assistance offices to being the first state to implement the HCBS CAHPS survey to our life participants We are committed to continuing our work on all of the life program initiatives presented here today and look forward to future opportunities for program quality improvement and expansion. So thank you very much for allowing me to share all of that. I know it was a lot this morning.
Well, we greatly appreciate your time and we greatly appreciate the information. I would like to mention that Representative Mike Jones has joined us online, and Representative Lisa Borowski is here with us. No one has any questions? Okay. So I have a couple questions. You touched on it a little bit, but could you share a little more information, elaborate a little bit more on the rate-setting process, and does the department negotiate rates with providers, and do you feel they are adequate for the level of services that are being provided?
through life? So the rate setting process for life in Pennsylvania is currently under what we consider a sort of amount that would otherwise be spent or an AWOP, right? That is the sort of litmus test for whether or not the rates are appropriate. And so the way the life provider rates are set are, you know, first starting with the appropriations and the direction from the General Assembly as to how much should be allocated to that. Within our budgets, we put forward what we think is reasonable to the cost to carry the program forward with the anticipation and goal of additional enrollments and what that cost of those additional enrollments would be. And then the amount that would otherwise be spent process really shows does it fall within reasonableness of the comparison programs. And so as long as it stays within that amount that would otherwise be paid, it is considered reasonable. There's a lower bound amount and an upward bound amount, and I think currently right now it's hovering around 58%. Okay.
And can you share exactly how long it takes to enroll in the LIFE program?
So our current numbers show that it takes 21 days to enroll in the program.
Okay. And I know this doesn't have a direct bearing, but I think it does have an indirect bearing. Can you comment on the recent PA Commonwealth Court decision regarding the re-procurement of the Community Health Choices Program and how this will indirectly impact the LIFE Program and seniors in the CHC Program?
I have no comment on the CHC RFA Program. It remains in a blackout, so I apologize for that.
No worries. Any other questions? Representative Powell?
Thank you so much for your testimony. Could you talk a little bit more about the Rural Health Transformation Plan? I represent the city of Pittsburgh, so it's not so much affecting our constituents, but obviously our duty here is to ensure that all older adults across the Commonwealth are able to access programs and resources that are dedicated to them. Could you talk a little bit how you've reformatted that program to make it more approachable and accessible to older adults in more rural parts of our Commonwealth?
Yeah, so when we looked at, in particular, when we looked at the opportunity for the Rural Health Transformation Program, one of the pieces that we put in there under the aging population is looking at how we increase the integration of services particularly for older adults who are duly eligible So as you heard a person who is duly eligible could have a Medicaid plan and then a Medicare plan and a Medicaid Advantage plan. It could be with multiple different places. And so in order to really increase that integration of services, that opportunity for an older adult to get all of their services at one place, not have to worry about all this disparate number of payers, we decided that one of the best investments to do that for us in the Office of Long-Term Living was to focus on can we expand the life program into these counties that have no life services. And so that's why we're really excited about being able to partner with All Bright Life and Northwest, who are very good at serving rural communities to help them expand into more rural counties and provide services that were never there before for the LIFE program.
Representative Day?
Thank you, Madam Chair. Thank you for being here today for this important informational hearing. The user and their family have a decision to make. whether to be in a life program or community health choices. From the department's perspective, how would you lay out there? I mean, you just did in all your comments, but how would you lay out there in a sentence, two or three sentences, educate the user and their support network who help them make decisions? Why would they choose life? What is that perfect user that would really benefit from the LIFE program?
Yeah, so the LIFE program is very unique. It's a center-based program. So an individual can go to a LIFE center and get everything they need in one place. They can join the adult day services, get socialization and recreation, and see their clinician all in the same place with transportation that's provided for them. So if someone is really looking for that ease of that one-stop place where they can have all their sort of medical and many of their social needs met, that would be a great person to consider the LIFE program. But LIFE isn't just at the center. It is also a program that provides home support. So they really are with the person both in their own home and at the center where they can get the convenience of receiving all their services in one place. So our family is in the same situation with different family members where we're working to maintain their life, right? Keep them at home. The Life Program does that. It also helps when you're running to all these different appointments all over the place. You centralize it in one location. Yep.
And the one in the Lehigh Valley works fairly well. I would like to see more people be able to use it. So the numbers staying, you know, I think it's only down less than a percent. But still, I would rather see them increasing by 4%, 5%, or 6% a year or even higher because I think it is, I think it helps the individual, their support network, who gets very strained throughout the system as well, and also helps the Commonwealth taxpayer by making things more efficient and more organized for everybody to stay at home and stay in their community. So thank you for your testimony today.
I appreciate it.
Thank you, Madam Chair.
Thank you, Representative Day. Before we go on to Chairman Nell, And I want to mention that Representative Schlegel and Representative Benham have joined us. Chairman?
Thank you, Madam Chair. I wanted to start on the marketing side. You mentioned in the testimony, because we have about maybe 8,000 total participants, several million seniors would be eligible. the order because it seems once an applicant is interested in the life program, then they begin to send them information. It seems like there's a lot of benefit from the life program, but I don't know that seniors are really aware. Is there a way that we might be able to enhance, you know, getting the word out so that people are, that seniors and families of seniors are aware of these opportunities. Because if first a person has to ask and then they begin to receive the information, it makes it tough for them to realize it's on the radar.
Yeah, that's a very good point. Life providers are able to do health fairs in their community, connect with different provider events. It would be great if every representative, if you have a senior health fair, invite your local life provider to be showcased there. That's why we have that partnership with the Department of Aging. Oftentimes older adults connect with the Department of Aging before they even hear about any of the Medicaid programs. And so that's why that partnership and collaboration with the Department of Aging is so critical, to get that information into the hands of the PA-Link choice counselors, where many families connect to them, into the hands of the AAAs, where many of the older adults connect to for valuable information. And so highlighting it as part of the PA link is part of that strategy to increase that awareness before they even get to the Pennsylvania Independent Enrollment Broker. In addition, we have been working on training all of the PA MediCounselors. Those are the individuals that support older adults when they pick their Medicare plan because the life providers are a Medicare plan. And so we're ensuring that all the PA Medi counselors are aware of life and offer that up and make sure that they understand it and make sure that they understand when they're reviewing Medicare Advantage plans that if someone enrolled in life chooses a Medicare Advantage plan, they are disenrolled. And we want to make sure folks are aware of that because there's a lot of advertising that we see on Medicare Advantage, right, on TVs during certain stages of the year. You can't look at the news without seeing a Medicare Advantage plan advertisement. So we want to make sure that folks aren't confused because we have seen a number of individuals that are disenrolled because they pick a Medicare Advantage plan and then realize, oh, my goodness, what did I do, and then we have to try and work to reverse it. So all of those different prongs of awareness are currently in action.
My last question is two parts. I appreciate the opportunity to enhance the marketing side of it. I'm always nervous when I heard you mention increased reporting requirements for providers, something that we often hear that there's an enormous amount of reporting and documentation. So can you touch on the additional burden of the extra reporting requirements if there has been any pushback from providers and then the underreporting of services component which was a very interesting finding So more services are being provided that aren necessarily being billed for I know two different areas, but just want to hit that.
Yeah. So because they receive a capitated rate, it's not that the service isn't being billed for because they do all the services under the sort of bundled payment. It's more about them being able to kind of really show and celebrate their work so that when they are coming forward to say that they need more funds, that it's really evident in the data of what they're providing and what those costs are and what Pennsylvanians are receiving for each of those taxpayer dollars. So the reporting of the data for the majority of providers, it's been very, very collaborative and very supportive. Every provider is at a different place with their technology and their data systems and their encounter collection, which is why the ARPA funds were so critical to help folks kind of elevate their reporting capabilities. And so in order to be kind of on par with community health choices, is there's sort of a baseline of reports that are necessary to do good evaluation of funds and spend and service provision and quality. And that's what we want to also make sure Pennsylvanians can be assured of, is that they're getting quality services from quality providers, and they can trust that. And so that's underlying much of the reason for the data collection, both justifying the funds and the spend and letting them capture all of the beautiful work that they're doing to keep Pennsylvanians healthy, and also allowing us to ensure and showcase that quality as well.
Thank you, Deputy Secretary, for always coming and sharing your knowledge and your time with us. We greatly appreciate it. Okay, panel two. Okay. Panel two, we have Chuck Quinnen, Rosina Blocker. Chuck is the Senior Vice President and Chief Government Affairs Officer of Leading PA, Leading HPA. Rosina. Hi, Rosina. Family Director for Innovage in Philadelphia. Rob McQuillan, Statewide Director for One Senior Care. Mark Gusek, President and CEO of Lutheran Foundation for Long-Term Living. and Mike, I'm not even going to pronounce your last name, Executive Director, PA Life Providers Alliance. Thank you all for being here. We appreciate your time.
Good morning, Chairwoman Madden, Chair Mencer, members of the House Aging and Older Adult Services Committee. My name is Chuck Quinnen, and I serve as the Senior Vice President of Government Affairs for LeadingAge PA. Thank you for the opportunity today to speak on behalf of our life provider members. Leading HPA represents more than 420 mission-driven providers across Pennsylvania's aging services ecosystem. Our members span the full continuum of aging services, including life providers, nursing homes, assisted living residences, personal care homes, affordable housing, and as we like to say, anywhere older adults reside or receive services and supports. The LIFE program is a proven alternative to Community Health Choices, or CHC. At its core life insurers older adults receive the right care at the right time in the right setting Research consistently shows that this model is associated with lower hospitalization rates reduced hospital stays reduced caregiver burden and enhanced quality of life for its participants Just as importantly, life is a cost-effective model of care. For every individual who receives care through life instead of CHC, the state Medicaid budget saves over $39,000 each year. This translates into roughly $300 million in annual Medicaid savings for the Commonwealth. In many ways, life reflects exactly where health care policy is headed nationally. As policymakers increasingly prioritize value-based care, care coordination, and reduced utilization, life has already been delivering on these goals for decades through prevention-focused, coordinated, whole-person care that improves outcomes while lowering costs. Despite its demonstrated value, Life Medicaid payment rates have not kept pace with rising operating costs. Without action, we risk weakening a program that delivers both strong outcomes and meaningful savings. To stabilize the program and ensure better predictability, there's an urgent need for increased investment, which is why we're advocating alongside PALPA for setting Life Medicaid reimbursement rates at a minimum of 60% of the AWOP. or the amount that would otherwise be paid for similarly situated individuals under CHC. This would require approximately a little over $19 million in annualized state funding in the fiscal year 26-27 budget and still provide a 40% savings to the state while ensuring better stability for the life program. In addition to increasing funding for life rates, continued efforts are needed to improve both awareness and access to the program. We are pleased that the Pennsylvania Long-Term Care Council has committed this year to launching a public awareness campaign for the LIFE program as part of the Aging Our Way PA plan and look forward to our ongoing partnership in that effort. However, as you'll hear today from this panel, limited awareness of and barriers to accessing the LIFE program necessitate a multifaceted approach. We commend this committee in the House for passing House Bill 1894, which seeks to ensure that older adults eligible for long-term services and supports receive clear information about the LIFE program as an alternative to CHC so they can make fully informed decisions about their care. Thank you, Chairs Madden and Menser, for your leadership on this important legislation. Finally, we urge the Commonwealth to examine barriers that unnecessarily restrict access to life services, including the need to implement solutions that would allow life to serve more seniors in additional settings such as personal care homes. In addition, as you'll hear from others on the panel, we must also create more efficient enrollment processes so that older adults have better and more timely access to the LIFE program. As Pennsylvania's older adult population continues to grow, we must ensure our policies support innovative, cost-effective, community-based care models that preserve independence. The LIFE program is a critical component of Pennsylvania's aging services ecosystem. And like every part of that continuum, it helps support and stabilize the broader network of care. We cannot allow this proven and valuable program to weaken due to inaction. Thank you once again for the opportunity to testify today. We are eager to collaborate with this committee and the Pennsylvania General Assembly in our ongoing efforts to support LIFE providers and ensure that older adults can access this valuable option when they need it Thank you Thank you and we just going to let all of the panel testify before we open it up to questions
Rosina, am I saying your name right?
Yes, ma'am. Good morning. Hi, my name is Rosina, and I'm the center director for two of the life centers in Pennsylvania. So Innovate Life is a life program that serves portions of the city of Philadelphia. A typical day in the LIFE program would start with our interdisciplinary team meeting. We meet every morning to discuss participant care, socialization. We coordinate care. In this meeting, we will go over any admissions or discharges from the previous day. We also go over the participants' social, medical, psychological needs, as well as discuss anything else that's related to the participants in this meeting. Once this meeting is completed, the participants will then start to come into the center. A day looks like our transportation brings them in from home. They come in. They have a light breakfast in our day center. During that time, we are still in the midst of our meeting. We do our care planning every six months. And during this meeting, we discuss the participants' plan of care. Once the participants come in, they can participate in activities such as crafts, arts, entertainment, and sensory activities. Our recreation staff and our life specialists, they are CNAs, they lead the participants in these activities. During this time, they also are able to see clinic staff for scheduled appointments, any acute needs that arise, and any medical management that is needed at that time. This includes seeing their primary care provider and the nurses that work in the clinic. The participants also have the opportunity to meet with their social workers who can assist with benefits management, counseling, and also, again, care coordination. They also can meet with our registered dietician who can go over any dietary needs, and they can assist them with any nutritional counseling that may be needed at that time. The participants also are able to work with our therapists. We have a gym in our centers, so it's a full gym, and they are able to work and come in and be able to perform any activities that they need during that day. They can walk in. We also include, we have speech, podiatry, optometry, and we also have behavioral health services on site. So participants, again, be able to come in, see the eye doctor, see the dentist, see the podiatrist, or if they have any mental health needs, they are able to speak to our behavioral specialist who is also on site. The participants would then have a full hot lunch. Then we also, for instance, if they don't like the lunch that is served that day, we do offer alternatives in the sense that they can also have something else if they don't like the main meal that we are serving for the day. They can then participate in our activities in the afternoon. They do flower making. We have entertainment that comes in. They make candles. So anything that they would like to do, we try to foster it around what they want versus what we want. So, again, they can participate in any activities at that time. And after that, they will start to go home. And, again, provided by us, our transportation, we take them home. And we do provide home care, and we do have after-hours nurses as well for anything that's needed after-hours.
You're welcome. Thank you for letting me. Of course. We appreciate the information. Rob?
Good morning, Chair Woodman, Madden, Ranking Member Nelson, committee members. My name is Rob McQuillan. I'm the Vice President of Operations for Life Northwest Pennsylvania, and thank you for the opportunity to speak with you today. I want to talk about an opportunity in Pennsylvania where policy, fiscal responsibility, and patient care are fully aligned, and that is improving access to the Life program. LIFE, which everyone hopefully knows by now is an acronym, the Living Independence for Elderly, serves some of the most vulnerable citizens. These are individuals who are nursing home eligible, often managing complex medical and social needs. LIFE allows them to remain at home, in their communities, while receiving coordinated, comprehensive care. This is not just a program. It is a proven model that delivered better outcome. First, I want to touch upon the impact of health outcomes. Life is designed to manage the whole person. It brings together interdisciplinary care, proactive monitoring, and strong community connection. The result is fewer hospitalizations, fewer emergency events, and a significantly reduced need for institutional care. That allows Pennsylvanians to age with dignity at home where they want to be. However, delays in access are creating risk for Pennsylvanians. Our numbers indicate that it takes on average in Pennsylvania 34 days for a participant to enroll in a life program. That's nearly two weeks longer than neighboring states of Kentucky and Ohio where I have personal experience in operating, where those enrollment dates from inquiry to enrollment are closer to 22 to 23 days. For a frail senior, that delay can mean the difference between stability and decline, remaining at home or ending up in the emergency department, the hospital, or being admitted to a nursing facility. Second is the impact on cost and the importance of long-term thinking. Life is not only a proven model of care, it is also the most cost-efficient care. The average cost per life participant in the Commonwealth of Pennsylvania is approximately $54,000, compared to $86,000 for other models being delivered by the Commonwealth. That's roughly, for every life participant, a savings of $32,000 per year per individual. With approximately 8,000 participants currently enrolled in Pennsylvania, expanding access to life not only improves care, it meaningfully reduces the financial burden to the Commonwealth. But the real opportunity here is not within a single budget cycle. It is how we think about long-term fiscal responsibility. Too often, decisions are made year to year. But programs like life change the trajectory of cost over time. By preventing hospitalizations, stabilizing chronic conditions, and delaying even avoiding nursing home placement, life reduces high-cost utilization across multiple years, not just one. While other states are expanding access and improving outcomes, growth in Pennsylvania has stalled. We have expanded access sorry when we have expanded access to life we are not just improving care we are bending the cost curve for the future And when scaled those long services can be substantial to the Commonwealth This is a rare opportunity where doing the right thing for people also aligns with the Commonwealth's long-term fiscal goals. While historically many things in the Commonwealth of Pennsylvania have been favorable in working with the state and local governments for the life program, there are two areas that we suggest that could be evolved to meet the new situations or the new conditions. First is to allow life providers to conduct their own functional eligibility determinations, commonly known as the FED. Today, the process from inquiry to medical eligibility determination can take anywhere between 18 to 20 business days, approximately three weeks. And that often involves multiple entities making contact with the individual and asking them questions about their condition and their environment. In contrast, Life Northwest Pennsylvania can complete a community assessment within one to two business days. Other states have already addressed this by allowing the LIFE or the PACE provider, their staff to be trained on how to do the functional determination tool, which significantly reduces the amount of time to enrollment and improved participant outcomes.
Second is the modernization of how eligible seniors are informed about and connected with the LIFE programs. Individuals who are medically and financially eligible for long-term services are not consistently or directly connected to life providers. By ensuring that those individuals are shared with the life programs, we enable direct outreach, education, and faster engagement, helping seniors make informed decisions and access to care sooner. Pennsylvania has been a leader in supporting seniors to live independently at home. But today, that leadership is at risk, not because the model doesn't work, but because of the barriers to access. We have an opportunity to take a longer view, improve the health outcomes, strengthen families and communities, and make smarter, more sustainable financial decisions, all at the same time. The question is not whether life works. The data and experience are clear that it does. The question is whether we are willing to act in a way that sets the Commonwealth up for long-term success. Because when we expand access to life, we are not just improving a program, we are improving the lives and investing in a stronger future for Pennsylvania. Thank you for your time.
Thank you, Rob. I'd like to mention that Representative Carroll has joined us. Mark, you're next.
Thank you, Madam Chair. My name is Dr. Mark Usek. I am currently the president and CEO of the Lutheran Foundation for Long-Term Living, which actually was formed as a result of being the CEO of Life Northwestern Pennsylvania. I joined into this Life program back in about 2005, 2006, and Pennsylvania was certainly a leader in the program at that time. There was tremendous growth, a lot of excitement, a lot of help from the administration and legislatively. Seemed to slow a bit start to slow a bit and flatten a bit I say around 2012 started to see some barriers and using the term loosely some pushback The data that I've seen shows that the enrollment has dropped off in the last three or four years when you compare it to national. And I've prided myself over the years of being one of the guys that doesn't come into the administration or doesn't come to the legislative body to ask for money. I've always come and ask for access. Because I'm not a believer of doing more with less. I'm a believer of doing more with more. And that more is access to participants to get more participants into the program so that they can be served properly. I started this quest for access way back in, I'd say, 2016, 2017, and went through a lot of gyrations with us. Lots of opinion letters were written at the request of the administration at the time, actually. And we got pretty close at one point. I think it was around 2019 we got pretty close. of the state actually, I still have the flow chart somewhere, where the state actually was going to allow us to touch each individual that called in to the, at the time, it was either the IAB because they were just rolling out CHC, or it would have been to the local area agency on aging, that we would have been able to actually get the name of the person and their contact information. Now, there were rules around that, pretty significant rules to protect from scamming and prohibitive marketing practices. And I remember Governor Wolf at one time even loved the idea that we had our cell phones programmed properly. We were going to send out pictures of the individuals coming to see them. And then, of course, COVID hit. We lost our traction. And so here we are again. Here I am again asking for access to the individuals. Access to the individuals will allow the proper education for that individual in what the life program has to offer. I can tell you I have personally listened to telephone calls with the IEB describing not only the life program but the other programs to individuals. It's heartbreaking. When the elderly person is calling in, they can't hear, they don't understand. The people on the IEB are trained by a PowerPoint presentation. it's pretty heartbreaking. Face-to-face is the way to educate them. A phone call should be the first point of contact to say, yes, here's what's coming. The idea of would you like to talk to a live program is actually an opt-in. That should not be an opt-in. Originally, that was just going to be a letter sent saying a live program will be contacting you. because participants who are asking for medical assistance and help, they need to be educated in all their options. They also need to know what they're eligible for. The only way to know to be eligible for life, not the only way, I'm sorry, but one of the main ways is to do a community assessment. That community assessment should be done so that the participant knows if they are eligible for life. This way they can make fully informed decisions. There been talk that you know being able to reach out to the participant directly is a prohibitive marketing practice because it predatory marketing I can tell you in the same CMS document that says that later in that document specifically states that an unsolicited call from somebody like a friend a doctor a social worker is allowed But if that person says, no, I'm not interested, then we have to walk away. But that's okay. That's what our job is. And that's where the programs need to police themselves and others. The other thing on the functional eligibility determination, the Fed, over the years, the Fed is a tool, and that's all it is. The life programs help people through that process. When the Fed says they are not nursing facility clinically eligible, NFCE, there's an appeal process. We have helped many people through that appeal process. We have won 98% of those appeals. That tells me that either the information is bad that they're getting or the process is broken. We shouldn't be winning 98% of the appeals. Again, I'm an advocate of access, absolute advocate of access. And legislative action apparently is what it's going to take to get that access. It's not a HIPAA violation. I have opinion letters on that that have been distributed to previous administrations. And, I mean, just think about it. Again, I'm the guy that's not asking for money. I'm actually here to give you money. And that is, with 8,000 people right now, if we were to just simply double that, just double that, we would save the state a quarter of a billion dollars for nothing other than letting us call somebody up once. That's all we're asking for. Thank you.
Thank you so much for your testimony, Mark. Mike?
Good morning. Appreciate the opportunity to testify. Mike Curiel-Ason, Executive Director of the Pennsylvania Life Provider Alliance. You'll have to spell that phonetically for me. That might have to do that after the hearing. You've already heard a lot about the value of the LIFE program, both by Deputy Secretary Marsala as well as the providers here on this panel. So I won't belabor that point, but just to reiterate the fact that LIFE is the only fully integrated program of long-term services and supports. Medicare, Medicaid, behavioral health, physical health, all integrated, provided, and coordinated by the provider under one roof. That's extremely valuable for individuals that currently have to navigate your typical managed care environment, as all of us, I'm sure, can attest to. The interdisciplinary team, amazing. I hope you all have the opportunity to see that firsthand. A lot of you have. From the moment that participant is picked up by the van driver, that van driver can assess whether or not it takes the participant a little extra time to get to the door or is limping. and that can be communicated to the center director. When that individual arrives at the day center, they can be directed to the physical therapist or the nurse to see, is something off? When the participant sits down for their meal, maybe they're not eating right, according to how they normally will eat a meal. That is, again, an opportunity for intervention. That's what this program is all about. It's all about intervention. It's all about preventative services and avoiding more costly services, and that is why it's such a cost-efficient, effective, and valuable program. Secondly, with respect to the regulations, the rate process for the life. Again, it's somewhat complicated, but really what the state's actuary does, because the life program is federally required to cost less than the alternative, right? So the state has to do that calculation. The state's actuary, Mercer, currently does that calculation of what it costs to otherwise care for this population, all right? The life rate has to be less than that. Right now we're 56% of what otherwise would be paid, 56%. The same services to the same population, we're 56% of what CHC plans are paid. And the CHC then also has to coordinate with behavioral health MCOs, the MAT transportation program, which is a fee-for-service program, the Medicare DSNIP plan, and the Medicaid plan. So there's multiple people involved in that, multiple entities, and we're 56% of what they're currently getting paid. To put that into a little context, back in FY10-11, we were 87%. 87% were now 56%. Over that 15-year period, the cost of what it otherwise costs to provide care to that population has grown cumulatively 75%. the life rate has grown 11.5%. Again, same services that are eligible to be provided to this population. 75% growth in the alternative program, which is what is actuarially required in order to sustain care to that population, 11.5% for the life rate. So continued investment in the life program not only makes sense, but it's needed to sustain the program and the provider's ability. to provide this integrated care. Another point I just wanted to make is on, to Rob's point, allowing life providers to perform the functional eligibility determination. Currently that's done under contract with Aging Well, which is subsidiary of the Pennsylvania Association of the AAAs. Those individuals are trained on the administration of the FED, which is a screening tool. It's a series of questions that are asked You certainly can question whether or not that's a robust enough process to screen individuals for clinical eligibility. But it is an objective tool where an individual is trained to administer it. It requires a visit into the participant, as does the IEB doing an initial visit, and then the life provider assessing whether or not they're safe to serve in the community. That's three visits. By allowing life providers to administer that same objective screening tool and be trained on it, we're cutting it down to two visits, which is more convenient for the individual, number one. Number two, it can be done in a conflict-free manner because aging well can still have oversight over the determinations that are made by the life provider. We're not looking to supplant aging well. We're looking to supplement them. This is going to be especially important given that the IFO projects that over the next five years, the percent of the population age 80 and over is supposed to grow 22 percent, 22% growth in the next five years. So allowing life providers to perform the FED, it allows for capacity flexing. It allows to make sure that we have enough individuals that are trained to administer the tool and that can get into the participant's home and assess whether or not they're clinically eligible for the life program. A variety of other states already do this as Rob mentioned New York New Jersey Virginia Kentucky California Ohio Michigan They all have a mechanism that allows PACE organizations to perform the level of care assessment and also have an oversight mechanism to monitor conflicts of interest. So you can effectively monitor conflicts of interest while still allowing these PACE organizations, these life providers to perform the FED. All those other states already provide that. Why not Pennsylvania? So again, I want to leave time for the third panel and any questions, but really appreciate the opportunity to testify. Appreciate the partnership with policymakers. Again, as Chuck alluded to, House Bill 1894. We need to do everything we can to ensure that individuals are being counseled about life as an option and consideration of rate increase. But again, it really goes back to the enrollment process and just streamlining that process as much as possible, given federal rules and given the length of time it takes for somebody to get through the process in Pennsylvania. So thank you very much.
Thank you, Mike. Thank you all for your testimony. I have a couple of questions, simple questions. How many days do people go to life? Anybody can answer that. Rosina?
Oh, sorry. Thank you. It depends on the participant. It's their preference. They can go one day a week. They can come five days a week. It's all based on what they want at this time. Okay. So here's another question anybody can answer.
How come you guys don't let them go to their primary care physician? You want that one?
I yield. Thank you.
That is not a barrier to this program. Initially, when the programs first started out, there were pretty tight rules on the primary care physician, very, very tight. It did make it very difficult. But now, with the allowance of being able to use various extenders and other primary care physicians, it essentially gets handled as a service request by them. What happens, though, is once the participant joins the program and learns that they can see that their doctor, their primary care physician, the life primary care physician, the same day that they're there, they kind of migrate away from their primary care physician. But if they love their primary care physician, the programs will work with them. And, you know, let's be honest. Sometimes when you change your insurance plan, if your primary care physician isn't in the program, you've got to change. But we've been able to overcome that barrier, and I can assure you it's not a barrier. If it's a barrier, it's going to be an individual barrier, not a cumulative barrier. Thank you so much.
Do we have any other questions? Oh, we do. Representative Schlegel.
Thank you, Madam Chair. Just to continue on with Chair Madden's question, What types of procedures must an individual go through to better ensure that they'll be able to keep their primary care physician?
So I can speak for Life Northwest Pennsylvania. Actually, when an individual is interested in enrolling in our program, and one of the questions that we ask of them is, do you want to keep your primary care physician in the community? We see that as a benefit, not only for the participant, but also for our interdisciplinary team. Many of these primary care physicians have worked with this individual throughout the course of their life or many many years and they have a history with this person And they can help us better understand that individual needs their medical conditions past procedures whatever it may be So for us in our program, simply asking that question up front and including that primary care physician and the discussion of what the team sees, and then scheduling those visits for that participant with their primary care physician so that that provider in the community is still involved in their care. Thank you very much.
Thank you. Rep. Nelson?
Quick questions because we still have another panel. Yes, we get one more panel. So some quick questions. Really, the proposed legislation, the changes and what has been implemented in other states, is that a state-level legislation or is it federal? How do we bridge that gap? Like specifically, what would the legislation be enabling or need to enable at the state level?
Sure. So there's a couple different enrollment initiatives that you heard. But with respect to the allowing life providers to perform the functional eligibility determination, it can be done administratively. But without administrative support, it can be done at the state level. So some states have done it administratively. They've adopted administrative policies to allow it. Other states, like Virginia, they've codified that in statute that would allow the PACE organization and the life provider to perform that functional eligibility determination. Again, there's checks and balances on all of those processes in terms of monitoring to ensure that there's no conflict of interest associated with the screening tool. Yeah, and that's the, I think, so legislation that would enable direct access and also to do the assessments.
That's right.
That's right. Anything we can do to ensure that the individual is being appropriately counseled about the program. So whether that be life providers performing that counseling or just ensuring that the IEB is doing that by requiring that the individual sign an attestation, which is an unfortunate step, but it's a needed step because at this point we just don't know the robustness of the counseling that's occurring of individuals with respect to the life program. But clearly when you look at enrollment growth, it doesn't seem to be happening at a level that I think we would all like to see.
And, Chuck, I know we're quick on time, but the 60% of AWAP that you had mentioned, is that legislatively fiscal code in the budget, bureaucratically?
How does that – Yeah, that's how you'd effectuate that change in one of the code bills. And as you heard from Mike, they're currently reimbursed at about 56%, having dropped from a high of close to 90%. So it comes to a fairness equity standpoint. And I would say, you know, there's needs across the system, but with our growing population of older adults and more folks we could serve in life, as you've heard today, it's a minimal investment in the state budget.
Thank you so much. Representative Day?
Thank you, Madam Chair. Mr. Gusick, you had talked about a formula that I have in my mind and kind of zeroed in right on the bullseye of what I'm looking at here as far as the benefit. The gentleman to your right, Mr. Shiri Ellison. Mike. Is that the correct mic? I shouldn't have dove into that. But you had talked about an increase, and I think he just talked about an increase of 4%, it sounds like, in reimbursement. But you had talked about the increase would come from allowing more eligible So I think that definitely step one Step 1B would be an increase in the reimbursement amount
So what is the formula? The nursing home eligible and income eligible would give us a number of Pennsylvanians that it's estimated to be that could be total universe that could be in the life. Is that correct? Is that correct the way I'm saying that? Nursing home and income eligible? Yeah. So clinically and financially eligible. Clinically and financially eligible. If we were to double the current census.
I know.
You had said going from eight, and it's actually $320 million, not $225. So it's actually, I'll make your argument better for you.
Thank you, Representative.
And I just did 40, and actually it would be more than 40,000. It would be 44,000. So it would be even more than that.
But what is that number of do we know the estimated number of Pennsylvanians that would be income eligible, financially eligible, and clinically eligible?
Ballpark, statistically, estimate. So in looking at the latest report by the Office of Long-Term Living, the data dashboard, so you look at to the extent that they're not enrolled in the life program, they're receiving services through CHC. Right. Right. So looking at that CHC population, that's nursing facility clinically eligible, whether they're receiving care within the nursing facility or in the home community-based setting, it's 197,000 or so people. There's about 202,000 that are NFI, non-nursing facility eligible. There's about 197, almost 200,000 individuals. And there's also a population beyond the 197,000 that are just not being served. That's right. Right?
Yep.
Okay. So, but we'll use the $197,000. So, to go from $8,000 to $16,000 is just a drop in the bucket, right? Now, I know our friends that provide CHC, we don't need to eliminate them.
Absolutely not.
We need to leave the choice there, right? It's going to be good for some of those folks to stay there and that process we can go through. But what would be that number? Have you guys thought about it, the $197,000? Where should we be? Is it 10%? Is it 19,000, more than what you suggested? Is it 50%? You know, what is that number? I think it's closer to the 30% level myself. The program is not for everybody. That's why it should be a choice. Billions of dollars in your budget that it could be. Billions.
All right. The only other thing I'm going to ask you guys, and I'll work with you and other members of our committee on this, but the only other thing I'm going to ask you is in light of all the fraud that is being talked about, whenever a legislator moves to expand a program or change the rules, we all look at this as we want it to go to the people we intended for. So please, you guys are in the position to be the experts to come up with what those brackets are, those rules are, to keep us and keep this money going in the right. Let's not just open it doors open because it's obvious financially what to do here. But please bring forth also in your advice and how you maintain it for that at least two checkpoints, not just one, at least two. And we don't need five. That's too many. That's too bureaucratic too many things but two or three at the most and bring those forwards share it with both our chairman Thank you madam chair. I'm sorry for the time and I appreciate it. No worries. You guys have homework
All right, so let's have our third panel, please. Thank you all Thank you all so much for your valuable and insightful testimony. We appreciate you. Georgia Goodman, the Director of Medicaid Policy for leading HPA and Liz Perry, Vice President of State Policy at the National PACE Institution. Come on up. No pressure, we gavel in in 10 minutes. No take your time, we'll stay. We'll stay. Thanks so much.
Thank you. Thank you. Thank you Thank you. Thank you.
Excuse me, is your microphone on? Is there a little green dot?
Oh now it green Oh I have like one sentence left Yes sort of I wouldn do that to you Renewing Pennsylvania's commitment to life providers through education to contractors and community partners coupled with financial investment in program expansion will benefit the state, older adults, and communities served by life programs. Thank you so much for your time today and your ongoing commitment to improving benefits and services for older Pennsylvanians. Thank you.
Good morning. Hello, my name is Liz Perry, and I'm the Vice President of State Policy at the National PACE Association, the trade association for more than 200 PACE organizations across the country. I appreciate the opportunity to be here with you today to share some of the best practices NPA has observed across the country related to access, payment, and opportunities to strengthen federal oversight for PACE and the Pennsylvania Life Programs. An enrolling in life program should be as seamless as possible for older adults who urgently need long-term care. Simply put, it should be just as easy to enroll in PACE as it is to enter a skilled nursing facility. These individuals often have complex medical, functional, and social needs, and even short delays in enrollment can lead to hospitalization, caregiver burnout, or premature and more costly nursing home placement. That is why easing access to PACE and Life must remain a shared priority for state policymakers. One of the most effective ways to streamline enrollment is by allowing life programs to conduct their own level of care assessment using state approved criteria and appropriate oversight. In states that rely on a separate contractor we often see unnecessary delays at the very moment individuals need services most. Because participants may only enroll in life on the first day of the month, even a delay of a few days in completing the assessment can push enrollment into the following month, further delaying access to needed care. Of the 33 states plus the District of Columbia that offer PACE, more than half already allow PACE organizations to conduct initial level of care assessments with appropriate state oversight. In those states, the process tends to be far more efficient, allowing individuals to enroll more quickly and begin receiving timely, coordinated care. In one state that recently made this change, wait times for assessments dropped by 72%. The interdisciplinary team that makes life programs so unique are already structured to evaluate medical, functional, cognitive, and psychosocial needs, and they are well-positioned to complete these assessments efficiently and accurately. But streaming enrollment is only one side of the access equation. Sustainable access also depends on payment policies that recognize the unique structure and risk of the life model. Medicaid capitation rates that are stable, transparent, and developed using actuarial principles are critical to the long-term sustainability of life programs. Life programs are provider-based, fully integrated care models that assume full financial risk for a highly complex population, and rates must reflect that reality. Rates must be comprehensive, recognizing the full range of services life programs provide across primary care, long-term services and supports, therapies, transportation, and institutional risk. States should clearly share how participant acuity and frailty are reflected in the rate base. Just as importantly, rates should be adjusted when underlying cost factors used in the rate calculation increases. As noted earlier, federal law requires that pace or life rates be below the amount that would otherwise be paid. As the previous panel noted, that's about 56 percent in Pennsylvania. On average, we see that at 12 percent. So pace rates usually are 88 percent of what the state's paying. So Pennsylvania is an outlier. Transparency in the rate setting process is equally essential. Rate setting works best as a partnership. Consistent with federal guidance, state should share the data, assumptions, and draft methodologies underlying proposed rates and provide a meaningful forum for life programs to ask questions and offer feedback before rates take effect Adequate rates support not only existing programs but also the development of new programs and the responsible stewardship of state resources Finally, continued progress depends on a strong federal-state partnership and effective oversight. The National PACE Association has been actively engaged with federal partners to improve regulatory clarity, strengthen program integrity, and ensure oversight frameworks reflect how PACE operates today. Life programs already operate under a robust federal oversight and quality requirements, including regular CMS audits. At this time, NPA welcomes continued discussions about developing a more uniform set of pay-specific quality measures that are meaningful, actionable, and appropriately tailored to the unique population served while avoiding unnecessary administrative burden. When states streamline pathways into the program, ensure rates are adequate, and partner with federal stakeholders to strengthen the model, more older adults can access comprehensive community-based care at the right time in the setting that they overwhelmingly prefer, their homes. Thank you for your time this morning. Thank you so
much. And leadership knows that we're still here, so there's time for a couple of questions, short questions, if anybody has any. Okay. Keep that green light going. George, It's good to see you back in Pennsylvania again. You know, from a national perspective, you touched on the reimbursement rate percentage difference, but we're really interested in how has the ethics been or the accountability when we talk about level of care assessments, being able to reach out. I mean, I completely agree that we want that faster timeline for in-processing, but is there a conflict of interest if we eliminate that firewall?
So all of the states that currently allow the PACE organizations to do level of care assessments, it is still a state oversight. So states are still reviewing those level of care assessments to ensure that they're accurately filled out and submitted properly. So in one state, Michigan, for example, all the long-term care providers fill out the same form. It gets uploaded. If, let's say, an HCBS waiver program says this person doesn't meet it, but then a PACE organization says they do for some reason, that immediately gets flagged for the state to review. So there's still a lot of oversight in ensuring that things are being done appropriately, even when PACE organizations have that ability to do the level of care assessment.
That's great. And the marketing, so that people are aware, are they in other states when people are being informed about community health choices, is there a more direct relationship between how someone learns of the program? because it seems like we're one step behind in our current structure.
A lot of states do have what we would call options counselors who are offering perspectives on all the different long-term care options, and NPA believes that that information should be accurate, comprehensive, fully robust, so that individuals are receiving all of the information, not just about pace or life, but to make sure that they're understanding the various programs that are out there for them and choosing the one that is right for them. And I will say it varies. I don't know if there's an ideal state at this point that does it just great. But I think there are different ways to ensure that option counselors are well-trained so that they understand the various programs out there and are able to communicate it in a way that older adults or their family members really understand what programs they're enrolling into.
Thank you. I have one quick question. How does PA rank given the rates?
I would have to double-check. And we are actually still collecting our 2026 rates. So can I get back to you on that just to get the most accurate data information because rates have definitely changed in the last year across the country?
I would definitely appreciate that. So I would just like to say to all the testifiers, thank you so much. Thank you for giving us a wealth of information to consider. In the short time that I have been the Chairwoman of Aging and Older Adult Services, I have learned that Pennsylvania endeavors to do the best that they can by their seniors, right? And we just need these tweaks, and we need to fine-tune things so that everybody can have access to the program that best fits them. And I thank you all for your time. And we are adjourned. Get on the floor, everybody. .