The PACE Program Receives its First Update Since 2006

CMS finalized a rule to update and modernize the PACE program. This rule is the first major proposed update to the Programs of All-Inclusive Care for the Elderly (PACE) since 2006.

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.

A major source of trouble for PACE organizations was the previous rule that stated that team members could only fill one role at a time – hamstringing interdisciplinary teams (IDTs). Since the average PACE member has more than one medical condition and requires assistance with multiple activities of daily living, this prior restriction significantly limited a PACE center’s ability to provide care in an efficient, cost-effective manner. The new rule eliminates this restriction, allowing PACE organizations much greater flexibility.

The new rule also permits non-physician medical providers, such as nurse practitioners (NP) and physician assistants (PA), will be allowed next year to take the place of primary care physicians (PCP) in providing some services for PACE participants. Although CMS historically granted waivers for individual PACE providers that wanted to use NPs and PAs to provide services, eliminating a needless administrative burden is always welcome.

The rule also finalizes 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.
  • Strengthening CMS’ ability to hold PACE organizations accountable through sanctions and civil monetary penalties.
  • Clarifying enrollment policies and requirements for quality improvement.
  • Preventing 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.

Click here to read the official press release from CMS.