HHS Committee Pushes For Further PACE Expansion

A new report from the National Advisory Committee on Rural Health and Human Services could be the first step in further expanding the Program of All-Inclusive Care for the Elderly (PACE) model nationwide.

Specifically, the committee believes that expanding PACE to more rural parts of the U.S. will help close gaps in long-term care.

“[We] believe that PACE exemplifies integrated care and that expansion of the model in rural America would improve the fragmented state of long-term services and supports (LTSS),” the committee wrote in its report. “A holistic approach that truly connects health and human services is unique and an integral aspect of PACE that improves the health and quality of life of rural elders and caregivers.”


Broadly, PACE helps dual-eligible seniors remain in their community through an interdisciplinary approach. More and more home-based care providers have gotten involved as it has gained in popularity.

The PACE model has been around for roughly a half-century, but organizations that offer PACE services are still not widespread. There are currently 150 PACE programs operating 273 centers in 32 states with a number of pending applications across the country.

Of those, only 17 organizations are in areas designated as rural.


PACE gained significant popularity during the pandemic as 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).

Based in Alexandria, Virginia, NPA is an industry advocacy group that focuses on federal and state policies to support the financial viability of the PACE model.

“The commission’s thoughtful assessment of the challenges rural communities face and the role PACE could play in addressing those challenges is a real step forward,” Shawn M. Bloom, president and CEO of NPA, told Home Health Care News in an email. “We know these older adults [in rural areas] face an increased need for care, and yet they are among the most underserved by home- and community-based long-term care options.”

A handful of states are expanding their PACE programs this year. Now, the Department of Health and Human Services (HHS) could soon add even more momentum to the push for expansion.

To expand to some of the harder-to-reach areas of the country, the committee recommended HHS to support a PACE pilot focused on Medicare-only beneficiaries to assess viability in rural areas and figure out how much start-up capital would be needed for sustainability.

The committee also recommended HHS look further into telehealth capabilities for PACE programs and develop a resource guide to promote the model to rural and tribal communities.

Because PACE is the sole source of services, there is a substantial decrease in administrative burden for PACE clinicians, participants and caregivers, the committee found.

The program’s philosophy also falls in line with the shift to a more value-based approach for home-based care.

“Evidence indicating cost savings and improved health outcomes for PACE participants, particularly for individuals who are dual-eligible for Medicare and Medicaid, continues to grow,” the report read.

However, the visibility of PACE in rural areas remains low. Not all states have PACE organizations or approve PACE as a Medicaid option, and the hefty start-up costs are just one of the few barriers that exist when considering national expansion.

Although the recommendations are good news for PACE, there’s still a long way to go.

“These are great recommendations,” Bloom said. “However, as of today, they are only recommendations. Congress and the administration need to act so that PACE is affordable and accessible for older adults in rural areas.”

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