Why PACE Will Be A Bigger Piece In The Long-Term Care Puzzle In 2023

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In the new year, a number of states will expand their Program of All-Inclusive Care for the Elderly (PACE) efforts.

PACE has been touted not only as a major opportunity for home-based care providers, but also a risk- and value-based program that actually works for seniors when done right.

During the height of the pandemic, it became more visible than ever because of those results. PACE enrollees contracted COVID-19, or died as a result of the virus, at one-third the rate of nursing home residents, according to data from the National PACE Association (NPA).


But even with this forward movement, there are still a number of actions that will need to take place to further accelerate PACE availability and participation.

“I think PACE really showed the value it had by being really centered on providing care to each one of its enrollees in a unique way,” Robert Greenwood, senior vice president of communications and member engagement at NPA, told Home Health Care News.

PACE footprint grows

The PACE model’s success is slowly beginning to result in more programs in more states, according to Greenwood.


“Our relative success, and being able to provide care under very difficult circumstances, really threw a new light on PACE and what [the model] is able to do,” he said. “I think states looking to meet the growing needs of long-term care services in their states in the future really see PACE in a new light, and are more interested in supporting providers that want to develop PACE organizations.”

States such as Illinois, Maryland, Ohio, New Jersey and Louisiana are expanding PACE. Illinois is especially notable because it currently does not have any PACE organizations.

In general, the PACE model has been around for roughly 50 years, but organizations offering these services are still not widespread. In total, 148 PACE programs operate 273 centers across 32 states and serve about 62,000 individuals.

Overall, eight providers were selected to go forward with PACE development in Illinois, according to Greenwood.

“It’s very exciting that Illinois will go from having no PACE programs to potentially eight PACE programs in the next couple of years,” he said. “Another state not too far away is Ohio. It’s a state that had one PACE program that’s been very successful. We were able to work together with providers to also get the state to issue some RFPs to open up PACE in different markets around Ohio.”

PACE expansion roadblocks

Despite PACE’s growing footprint, there are still barriers that need to be lifted in order for PACE to truly scale.

A report from the Bipartisan Policy Center (BPC) outlined a number of recommendations aimed at expanding the geographic reach of PACE and enrollment.

One of the BPC’s key recommendations was that the Centers for Medicare & Medicaid Services (CMS) should start accepting applications on a monthly basis instead of on quarterly one.

“I think everybody would agree, we want to be able to submit applications more frequently,” Jade Gong, founder and principal of consulting firm Jade Gong & Associates, told HHCN. “Having to lock down in a building that you’re not going to use for two years is a very expensive proposition.”

Some states require that PACE programs hire staff in order for them to have a Readiness Review, which would put them on the final path to opening.

“We’re going six to nine months out to staff up a program, and that’s quite a pre-operational loss,” Gong said. “It’s not inconsiderable.”

CMS only allows the PACE organizations to submit one service area expansion (SAE) application at a time. The report calls for CMS to allow PACE organizations that have completed their trial audit period to submit multiple SAE applications per application cycle.

“If you’re already an organization that’s successful, and operating — the question is, why can’t I open multiple centers?” Gong said.

Additionally, PACE programs are not allowed to market in a service area during the approval process, even if the state has already indicated its approval of the PACE organization to serve that area.

The report recommends that CMS allow established PACE organizations that are growing their geographic service areas or adding a new PACE site to market their program earlier in the application process.

“These are things that you should be allowed to do if, indeed, we want these programs to scale,” Gong said.

Looking ahead, NPA is estimating that up to 30 PACE organizations could open up shop this year.

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