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 CMS Puts Updated Rule in Place for PACE Participants, Organizations

In its first major update to the Programs of All-Inclusive Care for the Elderly (PACE) initiative since 2006, the Centers for Medicare & Medicaid Services (CMS) released a final rule that the agency said would give PACE providers greater administrative flexibility and regulatory relief.

PACE furnishes comprehensive medical and social services to certain frail, elderly individuals who qualify for nursing facility care but can still live safely in the community at the time of enrollment. Most of those who take part are dually eligible for both Medicaid and Medicare.

CMS said there are currently more than 100 PACE organizations across 31 states, with some 45,000 older adults enrolled, which marks an increase of 120 percent since 2011.

The final rule removes redundancies and eliminates outdated information, which will reduce administrative burden on PACE organizations, allowing clinicians and other care providers to focus more of their time on patients and less time on paperwork, the agency said.

“This rule also finalizes several operational flexibilities for PACE organizations that will improve care and access for individuals enrolled in PACE,” CMS said. As an example, PACE interdisciplinary teams (IDT) that provide coordinated care to patients will be able to participate in more aspects of their patients’ care, including allowing certain nonphysician 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 agency said.

The final rule includes the following modifications:

--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 under certain circumstances to better accommodate seniors’ needs and remove the requirement members of the IDT must serve primarily PACE participants;

--Allows certain nonphysician primary care providers to provide primary care services;

--Strengthens CMS’ 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 and will go into effect 60 days after official publication. A CMS fact sheet is available at

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