PACE Comments: More Flexibility, Fewer Regulations

Members | February 09, 2017 | by Peter Notarstefano

On Aug. 11, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule (CMS-4168-P) to revise and update regulations from the 2006 Final rule for Programs of All-Inclusive Care for the Elderly (PACE). The proposed rule was published in the Federal Register on August 16, 2016, and public comments are due on Monday, October 17, 2016. LeadingAge reviewed and submitted comments on the proposed rule. 

On Aug. 11, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule (CMS-4168-P) to revise and update regulations from the 2006 Final rule for Programs of All-Inclusive Care for the Elderly (PACE). The proposed rule was published in the Federal Register on August 16, 2016, and public comments are due on Monday, October 17, 2016. LeadingAge reviewed and submitted comments on the proposed rule. 

CMS states that the changes in the proposed rule will strengthen protections for beneficiaries and provide administrative flexibility and regulatory relief for PACE organizations. The proposed rule will also remove redundancies and outdated information, and codify existing practice. 

The proposed rule addresses several program elements including: 

Administrative flexibility and regulatory relief for PACE organizations 

  • CMS is proposing to modify the PACE Program Agreement. 
  • CMS is proposing a more flexible approach to the composition of the interdisciplinary team. 
  • CMS is proposing to allow non-physician primary care practitioners to provide some services in the place of primary care physicians. This change would give PACE organizations flexibility and improve efficiency.

Additional beneficiary protections 

  • Clarifying that PACE organizations offering qualified prescription drug coverage must adopt two key elements of the Part D compliance program in the PACE regulations. Specifically, CMS would require each PACE organization (PO) to develop compliance oversight requirements. Additionally, CMS would require POs to have measures that prevent, detect and correct non-compliance with CMS’s program requirements as well as measures that prevent, detect, and correct fraud, waste, and abuse.
  • Proposing changes to sanctions, enforcement actions, and terminations.
  • Adding language to ensure that individuals with convictions for physical, sexual, or drug or alcohol abuse are not be employed in any capacity where their contact would pose a potential risk to beneficiaries in the PACE program. 
  • CMS is proposing amendments to specifically prohibit POs from using non-employed agents/brokers, including contracted entities, to market PACE programs.

Oversight 

  • CMS is proposing to use technology to enhance efficiencies in monitoring. 
  • Allow CMS the discretion to take alternative actions in the form of sanctions or Civil Monetary Penalties when they are authorized to terminate a PACE program agreement. 

In addition to reviewing the proposed PACE rule, LeadingAge read through the comments that the National PACE Association (NPA)  submitted in response to CMS’ proposed changes and requests for comment.  

In our comment letter, we stated we would like to stress our support for NPA’s recommendations related to the following: 

  • An expanded definition of primary care provider on the PACE interdisciplinary team to include nurse practitioners, physician assistants and community-based physicians in addition to PACE physicians. 
  • Greater flexibility in PACE organizations' use of the PACE center and alternative care settings in response to participants' needs and preferences in order to support choice by PACE participants regarding how and where they would like to participate in activities and access PACE program services while allowing the PACE program to grow more efficiently and more nimbly. 
  • Greater flexibility with regard to how individual IDT members participate in assessments and care planning with the objective of varying the composition of the IDT for individual participants based on their care needs.
  • Allowing PACE organizations to open new PACE centers in approved service areas without having to submit expansion applications.