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Pediatric Palliative Care Center (PPCC) Model

A Proven Pathway for Sustainable Care

The Pediatric Palliative Care Center (PPCC) license is a groundbreaking approach now beginning to take shape in proven state precedents. Minnesota’s Crescent Cove has pioneered the foundational reimbursement licensing and funding structure  which has been further strengthened with the enactment of Mason’s Law in Iowa (2025), the PPCC model creates a single, holistic healthcare license that enables communities to provide:
 

  • Overnight respite for children and families
     

  • Palliative care supports with an interdisciplinary team
     

  • End-of-life/hospice care, integrated with existing hospice agencies
     

For states that adopt this “clean license”, it eliminates the need for multiple, overlapping regulations and gives medically fragile children and their families a trusted place outside of hospital or home where they can receive comprehensive support.

How a PPCC Works
 

  • Flexible use of bedrooms → Each room can be utilized for overnight respite, palliative, or end-of-life depending on needs of children and families in order to be responsive to the ebb and flow of journeys.
     

  • Typical size → Generally +/- 8 children’s bedrooms + up to 3 family suites (the global “sweet spot” for preserving a true home-like environment). Mason’s Law allows up to 12, but most homes have found 8 feels most supportive.
     

  • Interdisciplinary support → Nurses, Child Life Specialists, Social Workers, Chaplains, and Volunteers are included to provide full pediatric palliative care for the whole family, including siblings.
     

  • Special spaces → Enhanced quality of life and expressive therapies through Sensory, art, and music rooms; hydrotherapy pools; accessible playgrounds; memorial and bereavement areas.

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Sustainability Through Medicaid (Crescent Cove Model)

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Crescent Cove’s strategic legislative efforts updated Minnesota licensing laws to allow for holistic overnight respite and pediatric palliative support in a community-based children’s respite and hospice home. They were able to then work with Minnesota Medicaid to establish an ongoing and appropriate reimbursement funding rates for children enrolled in Medicaid based on three levels of care needs:
 

  • Green, Yellow, Red scale → Aligns 24-hour daily rates with level of acuity
     

  • Highest tier (Red) reimbursed at ~$2,000/24-hour day per child

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Generally: 

• 80% of Usage is for Overnight Respite + Palliative Care Supports
 

• 20% for EOL/Hospice Care
 

• Flexible – this ebbs and flows

When a Child/Family Comes for EOL/Hospice

• They are STILL receiving Overnight & Palliative Care Support at the Center

 

(Note: Hospice is specialized component of Palliative Care)

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• A 3rd party “Partner Hospice Agency” comes into the Center to provide the higher-level comfort and medical support

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  (Just like the Hospice Agency would do in a family’s own home or hospital – nothing changes for the healthcare system or billing of hospice care).

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What That Means in Practice
 

For an 8-bedroom PPCC at 60% occupancy (realistically not every room will be occupied every day of the year):
 

  • 1,752 child stays annually (8 rooms × 365 days × 60%)
     

  • $2,000/day reimbursement × 1,752 stays = ~$3.5 million/year in operating revenue

 

This ongoing revenue stream provides the foundation for long-term sustainability.

Beyond Medicaid

Mason’s Law in Iowa established the PPCC license as an opportunity to reframe children and family centered community-based care eligible for all state funding sources, including:
 

  • Medicaid Waivers (1915(c))

  • State Plan Amendments

  • Title V Maternal & Child Health resources

  • Other state healthcare funding streams (similar to residential care or skilled nursing)
     

Future opportunities include partnerships with private insurers and philanthropic support.

Why This Matters

For the first time, communities have a clear and proven path and vision to open and sustain pediatric palliative care homes.
 

  • Local leaders can build with confidence knowing a sustainable model exists.

  • Funders can give with assurance that programs will not be dependent solely on philanthropy.

  • Families will finally have access to a trusted place for respite, palliative, and end-of-life support for their children.


The PPCC model shows: it can be done, it is being done, and it will change what’s possible for families across the U.S.

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