CMS updates PACE program

CMS published its final rule to update the programs of all-inclusive care for the elderly (PACE), which provides comprehensive medical and social services to help keep elderly individuals who qualify for nursing homes in their homes longer.

The update aims to reduce administrative burden and regulatory relief on PACE programs and strengthen protections and improve care for enrollees.

Currently, there are more than 100 PACE programs across 31 states, with 45,000 elderly individuals enrolled. The final rule is the first major update to PACE since 2006, according to CMS.

“At CMS, our top priority remains putting Medicare and Medicaid beneficiaries first by removing unnecessary burdens that get in the way of healthcare providers spending time with their patients,” CMS Administrator Seema Verma said in a statement. “The changes we are making to the PACE program will help to protect our seniors from abuse and neglect.”

One aspect of the final rule allows the interdisciplinary team members to serve two separate roles under certain circumstances to meet the needs of PACE participants. In addition, certain non-physician primary care providers will be allowed to perform some services in place of primary care physicians.

For participants, the final rule ensures that PACE organizations offering qualified prescription drug coverage must comply with the same requirements as Medicare Part D, unless that requirement has been waived. Civil penalties and sanctions can now also be waged against PACE organizations in new enforcement actions to keep programs accountable. The rule also bars convicted criminals with an offense related to physical, sexual or drug or alcohol abuse from employment in PACE programs where they will be in contact with patients and pose a risk.

From an administrative standpoint, the final rule codifies the existing practice of relying on automated review systems to process initial applications for new PACE programs and expansion applications for existing programs. PACE programs will also no longer have to request waivers for some commonly waived provisions.

See the final rule here.