CMS Finalizes Rule to Update and Modernize PACE
June 2019 ~
CMS, on May 28, released a new final rule to “update and modernize” the Programs of All-Inclusive Care for the Elderly (PACE) program, based upon best practices in caring for frail and elderly individuals.
PACE provides comprehensive medical and social services to the elderly in need of increased medical care and supervision, who qualify for nursing home care but, at the time of enrollment, can still live safely in the community. According to CMS, the provisions under the rule target redundancies and administrative burdens, seeks to allow greater flexibility in creating interdisciplinary teams, as well as the addition of patient protections.
The rule also includes important clarifications to enrollment policies, quality improvement, and other requirements for PACE organizations, resulting in more consistent, transparent, and comprehensible regulations and guidance.
Revisions and updates to the PACE program under the final rule include strengthening protections and improving care for participants and providing administrative flexibility and regulatory relief for organizations.
Strengthening Protections and Improving Care for PACE Participants
According to the Fact Sheet, CMS plans to establish a more flexible approach to the composition of the interdisciplinary team that is central to the coordinated care that participants receive from PACE organizations.
In addition, in order to expand access to PACE, CMS is finalizing a number of other flexibilities, including allowing certain non-physician primary care providers to provide some services in place of primary care physicians. The agency states this will allow PACE organizations to operate with greater efficiency while ensuring they continue to meet the needs and preferences of participants.
The rule also includes 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 for providing quality care and protect PACE participants from harm; 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.
Providing Administrative Flexibility and Regulatory Relief for PACE Organizations
The final rule codifies the agency’s existing practice of relying on automated review systems for processing initial applications to become a PACE organization and expansion applications for existing PACE organizations.
Additionally, the final rule will modify the PACE regulations to eliminate the need for PACE organizations to request waivers for a number of the most commonly waived provisions. These changes are intended to reduce the burden and improve efficiency for PACE organizations, state administering agencies, and CMS notes the fact sheet.
The Final Regulations will become effective on August 2, 2019.