On May 28, The Centers for Medicare & Medicaid Services (CMS) released the final rule for Programs of All-Inclusive Care for the Elderly (PACE), the first major update to the program since 2006. According to CMS, the final rule strengthens protections and improves care, as well as updates the program to provide greater administrative flexibility and regulatory relief for PACE providers.

PACE provides comprehensive medical and social services to certain frail, elderly individuals who qualify for nursing home care but can still live safely in the community at the time of enrollment, a majority of whom are dually eligible for both Medicaid and Medicare. There are currently over 100 PACE organizations across 31 states, with more than 45,000 older adults enrolled, an increase of 120 percent since 2011.

The new rule:

• Clarifies that PACE organizations offering qualified prescription drug coverage must comply with Medicare Part D prescription drug program requirements unless waived;
• Allows PACE team members to serve more than one role on the team under certain circumstances to better meet seniors’ needs and removing the requirement that members of the IDT must serve primarily PACE participants;
• Allows certain non-physician primary care providers to provide primary care services;
• Strengthens CMS’s ability to sanction and require civil money penalties to ensure quality care and protection from harm;
• Eliminates the need to request waivers for most commonly waived rule provisions, such as allowing a community-based physician to serve as the primary care provider on the team, allowing greater flexibility and efficiencies in delivering primary care to participants; and,
• Adds 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 contact with patients would pose a potential risk.

The rule will be published in the federal register on June 3, 2019 and will go into effect 60 days after official publication. The AHCA Reimbursement Policy team will send out additional resources for you and your staff, including details of the final rule requirements and opportunities for providers under these new rules.

Additional Resources
PACE Final Rule
CMS PAC website