Fact Sheets

Programs of All-Inclusive Care for the Elderly (PACE) Final Rule (CMS-4168-F)

Programs of All-Inclusive Care for the Elderly (PACE) Final Rule (CMS-4168-F)

On May 28, 2019, the Centers for Medicare & Medicaid Services (CMS) is finalizing a rule to update and modernize the PACE program. This rule—the first major proposed update to the Programs of All-Inclusive Care for the Elderly (PACE) since 2006—reflects updates based upon best practices in caring for frail and elderly individuals.

PACE provides comprehensive medical and social services to certain frail, elderly individuals who qualify for nursing home care but, at the time of enrollment, can still live safely in the community. The majority of participants served by PACE are dually eligible for both Medicare and Medicaid. More than 45,000 older adults are currently enrolled in more than 100 PACE organizations in 31 states, and enrollment in PACE has increased by over 120 percent since 2011.

The final rule revises and updates the requirements for the PACE program under Medicare and Medicaid, including:

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

The changes will provide greater operational flexibility, remove redundancies and outdated information, and codify existing practice.

Strengthening protections and improving care for participants

We are establishing a more flexible approach to the composition of the interdisciplinary team that is central to the coordinated care that participants receive from PACE organizations.  Previously, team members could only serve in one role on the team. Now, one individual can fill two separate roles on the team under certain circumstances to better meet participants’ needs and participate in more aspects of a participants’ care. This will strengthen the ability of PACE organizations to provide more seamless and tailored care to their participants.

In addition, in order to expand access to PACE, we are finalizing a number of other flexibilities, including allowing certain non-physician primary care providers to provide some services in place of primary care physicians. This will allow PACE organizations to operate with greater efficiency, while ensuring they continue to meet the needs and preferences of participants. The rule also includes important patient protections including:

• Clarifying that PACE organizations offering qualified prescription drug coverage must comply with Medicare Part D prescription drug program requirements unless the requirement has been waived;
   
• Implementing changes related to PACE enforcement actions, including sanctions and civil money penalties, to strengthen CMS’ ability to hold PACE organizations accountable for providing quality care and protect PACE participants from harm; and
   
• Adding language to help ensure that individuals with a conviction for a criminal offence relating to physical, sexual or drug or alcohol abuse or use will not be employed by a PACE organization in any capacity where their contact with patients would pose a potential risk.

Providing administrative flexibility and regulatory relief for PACE organizations

The final rule codifies CMS’ existing practice of relying on automated review systems for processing initial applications to become a PACE organization and expansion applications for existing PACE organizations. In addition, the final rule will modify the PACE regulations to eliminate the need for PACE organizations to request waivers for a number of the most commonly waived provisions. These changes will reduce burden and improve efficiency for PACE organizations, state administering agencies, and CMS.

The rule also includes important clarifications to enrollment policies, quality improvement, and other requirements for PACE organizations, resulting in more consistent, transparent, and comprehensible regulations and guidance.

To view the final rule, please visit: https://www.federalregister.gov/documents/2019/06/03/2019-11087/medicare-and-medicaid-programs-programs-of-all-inclusive-care-for-the-elderly

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