CMS NEWS
FOR
IMMEDIATE RELEASE
May 28, 2019
Contact:
CMS Media Relations
(202) 690-6145 | CMS Media Inquiries
CMS Modernizes Care for Frail, Elderly
Individuals Enrolled in PACE
Programs of All-Inclusive Care for the Elderly (PACE) Final
Rule will provide seamless, customized care to meet individual patients’
needs
The
Centers for Medicare & Medicaid Services (CMS) finalized a rule today
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final rule removes redundancies and eliminates outdated information,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.
To
view the final rule (CMS-4168-F), please visit: https://www.federalregister.gov/documents/2019/06/03/2019-11087/medicare-and-medicaid-programs-programs-of-all-inclusive-care-for-the-elderly
For a
fact sheet on the final rule, please visit: https://www.cms.gov/newsroom/fact-sheets/programs-all-inclusive-care-elderly-pace-final-rule-cms-4168-f
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