CMS Proposes Major Update to PACE Program

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The Centers for Medicare & Medicaid Services (CMS) propsoed a rule on Thursday to update and modernize the PACE program.

The Programs of All-Inclusive Care for the Elderly (PACE) is a Medicare and Medicaid program that provides comprehensive medical and social services that enable older adults to live in the community instead of a nursing home or other care facility. More than 34,000 older adults are currently enrolled in about 100 PACE organizations in 31 states, and enrollment in PACE has increased by over 60 percent since 2011.

The proposed rule would revise and update the requirements for the PACE program under Medicare and Medicaid, including:

  • Strengthening protections and improving care for beneficiaries; and
  • Providing administrative flexibility and regulatory relief for PACE organizations

The proposed changes would provide greater operational flexibility, remove redundancies and outdated information, and codify existing practice. The proposed rule will publish at the Office of the Federal Register on August 16, 2016 and public comments are due on October 17, 2016 after a 60-day comment period.

Programs of All-Inclusive Care for the Elderly (PACE) (CMS-4168-P)

Strengthening protections and improving care for beneficiaries

We are proposing a more flexible approach to the composition of the interdisciplinary team that is central to the coordinated care participants receive from PACE organizations in order to allow the team to better meet beneficiaries’ needs. Team members would be able to participate in more aspects of a participant’s care than is currently the case, which would strengthen the ability of PACE organization to provide more seamless care and better tailor care to individual participants. Currently, team members can fulfill only one role on the care team.

In addition, in order to expand access to PACE, we are proposing a number of other flexibilities, including allowing non-physician primary care practitioners to provide some services in the place of primary care physicians. This would give PACE organizations flexibility and improve efficiency, while ensuring that PACE organizations continue to meet the needs and preferences of participants. Additional beneficiary protections we are proposing include:

  • Clarifying that PACE organizations offering qualified prescription drug coverage must comply with Medicare Part D prescription drug program requirements;
  • Proposing changes to sanctions, enforcement actions, and terminations to strengthen CMS’ ability to hold PACE organizations accountable and decrease the risk of harm to PACE participants; and
  • Adding language to ensure that individuals with convictions for physical, sexual, or drug or alcohol abuse are not be employed in any capacity where their contact would pose a potential risk to beneficiaries in the PACE program.

Providing administrative flexibility and regulatory relief for PACE organizations

We are proposing to modify the PACE Program Agreement, which is the contract between CMS, state administering agencies, and PACE organizations. The changes would permit more frequent updates of information crucial to PACE organizations while streamlining and making more efficient the development of Program Agreements.

Our proposed changes would make PACE regulations and guidance more consistent, transparent, and comprehensible. This proposed rule—the first major proposed update to the PACE program since 2006—would allow CMS to codify guidance and to reflect updates to best practices in caring for frail and elderly individuals. Our proposed changes include clarifications to enrollment policies, quality improvement, and other requirements for PACE organizations.

To view the proposed rule, please visit: https://www.federalregister.gov/public-inspection. CMS welcomes comments on the proposed rule. Comments are due 60 days after the proposed rule publishes in the Federal Register.

For more information on PACE, please visit: https://www.medicare.gov/your-medicare-costs/help-paying-costs/pace/pace.html.

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