A relatively small program that provides medical and social services to older adults and enables aging in place is getting its first facelift since 2006. Some of the changes include proposals lawmakers have pushed since 2014.
A new rule proposal from the Centers for Medicare & Medicaid Services (CMS) would update the Programs of All-Inclusive Care for the Elderly (PACE) to modernize the program and improve care to beneficiaries. The proposal also aims to expand the program.
“The goal of this proposal is to strengthen beneficiary protections and provide PACE organizations with more administrative and operational flexibility so they can do what they do best—caring for our nation’s most vulnerable individuals,” Andy Slavitt, acting administrator for CMS, wrote in a statement. “While PACE serves a relatively small number of people today, our proposal is intended to encourage states to further expand these programs.”
PACE provides medical and social services to more than 34,000 older adults in 31 states, enabling them to remain living in the community instead of in institutional care. With about 100 PACE organizations, enrollment in PACE has jumped 60% since 2011, according to CMS.
“The proposed changes would provide greater operational flexibility, remove redundancies and outdated information and codify existing practice,” CMS’ announcement reads.
Specifically, the proposal calls for more flexibility for the interdisciplinary team, allowing them to “participate in more aspects of a participant’s care than is currently the case.” PACE team members are only allowed to perform one role under current rules. The flexibility applies to care access as well, with CMS proposing that non-physician primary care practitioners provide some services to PACE beneficiaries in place of primary care physicians.
CMS also proposes to modify its PACE Program Agreement, the contract between CMS, the state administering agencies and PACE organizations. The change would allow more frequent updates to PACE organizations and improve efficiencies in the development of program agreements.
“Our proposed changes would make PACE regulations and guidance more consistent, transparent and comprehensible,” according to the announcement. “Our proposed changes include clarification to enrollment policies, quality improvement and other requirements for PACE organizations.”
The rule also includes a few specific beneficiary protections:
—Clarity that PACE organizations with prescription drug coverage must be in compliance with Medicare Part D requirements
—Changes to sanctions, enforcement actions and terminations to decrease risk of harm to program participants and hold PACE organizations accountable
—Add language to exclude individuals with convictions for physical, sexual or drug or alcohol abuse from employment in any capacity that could put PACE beneficiaries at risk
The proposed rule will be published on the Federal Register on August 16 and be open for a 60-day public comment period until October 17, 2016.
Written by Amy Baxter