The Michigan Legislature's biennial lame-duck session is a time when little-known issues pop up and sometimes sail to the governor's desk with little debate.
That was the case in 2018 when lawmakers put new restrictions on health and human services companies getting into the business of serving the in-home care needs of low-income seniors who are eligible for both Medicare and Medicaid.
The Legislature tightened the rules for a new company to enter the market for PACE (Program of All-Inclusive Care for the Elderly), an alternative for seniors to stay in their homes instead of moving into a skilled nursing facility.
Two years later, a Denver-based company is trying to convince lawmakers to open up just the metro Detroit market for the PACE program, creating first-of-its-kind direct competition for PACE of Southeast Michigan, which is run by Presbyterian Villages of Michigan and Henry Ford Health System.
InnovAge, a for-profit company, is lobbying for passage of Senate Bill 810 to allow it to petition the Michigan Department of Health and Human Services to offer its services in Southeast Michigan; the bill applies only to the metro Detroit market.
"We don't think that a monopoly improves quality," said Beverley Dahan, vice president of government and legislative affairs at InnovAge.
InnovAge operates PACE in-home care programs and senior service centers in Colorado, California, New Mexico, Pennsylvania and Virginia and is expanding into Kentucky and Florida, company CEO Maureen Hewitt said.
The state and federal government pay PACE providers about $3,000 per month for Medicaid-eligible services that keep a senior out of a costlier nursing home. In addition, Medicare pays PACE providers between $2,000 and $2,500 per month for managed health care services for individuals in the PACE program instead of a fee-for-service, Dahan said.
The proposed legislation would require InnovAge or another provider to prove there's unmet need in the market. House Bill 5664 is an identical House version of SB810.
Based on the income criteria of seniors living on less than $25,000 a year in their homes, InnovAge company officials estimate there are some 25,000 dual-eligible senior citizens in metro Detroit and just 3,000 being currently served by PACE of Southeast Michigan.
"There's plenty of room for two providers for PACE in that market," Hewitt told Crain's.
As part of its lobbying pitch, InnovAge company leaders are promising to invest $30 million into the construction of two health and wellness centers in Wayne and Oakland counties, where Medicare-Medicaid dual-eligible seniors could see doctors, get physical therapy, exercise, socialize and be transported from their homes.
The PACE Association of Michigan, which represents the sole providers in 13 regional markets across the state, is lobbying to stop the lame-duck legislation from proceeding.
"What these bills would do is allow the out-of-state corporation to basically change the rules mid-game and basically get to the front of the line," said Stephanie Winslow, executive director of the PACE Association of Michigan.
The 2018 law contains a "pathway" for entering the PACE business, Winslow said, but gives existing providers right of first refusal to submit a plan for expanding services to fulfill unmet need.
"If InnoVage wants to enter the market, they have a pathway to do it," Winslow said. "But they don't want to do that."
InnovAge's legislative effort to "leapfrog" in front of Presbyterian Villages of Michigan and Henry Ford Health doesn't account for spending restrictions MDHHS has put on growth in the program to curtail rising Medicaid costs during the coronavirus pandemic, Winslow said.
"They're claiming that there's unmet need in Southeast Michigan that we're not meeting," Winslow said. "We can't grow any faster and serve more participants than the state will allow us."
InnovAge company officials are trying to appeal to lawmakers that expanding in-home services for seniors is a better alternative to filling up nursing homes, which have been fraught with COVID-19 outbreaks and deaths throughout the coronavirus pandemic.
"With COVID, this is a great program because we have a lot of flexibility to give services in the home as opposed to institutional care," Hewitt said.
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November 15, 2020 at 12:04PM
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Denver company seeks to break 'monopoly' for in-home senior care in metro Detroit - Crain's Detroit Business
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