CMS Modernizes Care for Frail, Elderly Individuals Enrolled in PACE


On May 28, 2019, the Centers for Medicare & Medicaid Services (CMS) finalized a rule to update and modernize requirements for the Programs of All-Inclusive Care for the Elderly (PACE).

The PACE program provides comprehensive medical and social services to certain frail, elderly individuals who qualify for nursing home care but, at the time of enrollment, can still live safely in the community. The policies finalized in this rule reflect the latest standards in caring for PACE participants – many of whom are “dually eligible” for both Medicare and Medicaid – and will strengthen patient protections, improve care coordination, and provide administrative flexibilities and regulatory relief for PACE organizations.

“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,” said CMS Administrator Seema Verma. “The changes we are making to the PACE program will help to protect our seniors from abuse and neglect. This rule strengthens the PACE program by offering a more flexible and adaptable approach to the coordinated care that patients receive from PACE organizations, which will allow care teams to provide seamless, better-tailored care to individual patients.”

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. This final rule is the first major update to the program since 2006 and reflects changes to best practices in caring for frail and elderly individuals, informed by stakeholder input and our experiences in administering the program.

The final rule removes redundancies and eliminates outdated information, which will reduce administrative burden on PACE organizations, and allow clinicians and other care providers to focus more of their time on patients and less time on paperwork. This rule also finalizes several operational flexibilities for PACE organizations that will improve care and access for individuals enrolled in PACE. For example, PACE interdisciplinary teams that provide coordinated care to patients will be able to participate in more aspects of their patients’ care, including allowing certain non-physician primary care providers to provide some services in the place of primary care physicians. This will allow PACE organizations to operate with greater efficiency, while ensuring they continue to meet the specific needs and preferences of their patients.

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;

  • Implementing changes related to PACE enforcement actions, including sanctions and civil money penalties, to strengthen CMS’ ability to hold PACE organizations accountable and protect individuals enrolled in PACE from harm;

  • Increasing transparency and simplifying the regulations for PACE organizations – changes that will help clarify enrollment policies and requirements for quality improvement; and

  • Adding language to help ensure that 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.

Questions? Could you benefit from support as you care for an elderly loved one who is still living at home? Kimbrough Law can help. Just give us a call at 706.850.6910.

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