PACE Program for Frail Elderly Updated

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  • May 29, 2019
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PACE Program for Frail Elderly Updated

The Programs of All-inclusive Care for the Elderly (PACE) recently got a boost from the Centers for Medicare & Medicaid Services (CMS) final rule that modernizes the program to the “latest standards of in caring for PACE participants.”

PACE Serves 45,000

PACE provides comprehensive medical and social services to certain frail, older folks who qualify for nursing home care but, at the time of admission, can live safely in the community. CMS said more than 45,000 older adults are enrolled in more than 100 PACE organizations in 31 states, and enrollment in PACE has increased more than 120 percent since 2011 as the population ages.
The new final rule is the first major update to the program since 2006 and reflects changes to best practices in caring for the members.
CMS said in a press release the final rule removes redundancies and eliminates outdated information, which will reduce administrative burden on PACE organizations, and allow clinicians and other care providers to focus more of their time on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”,”the release said.

PACE Changes

PACE interdisciplinary teams that provide coordinated care to patients will be able to participate in more aspects of patients’ care, including allowing certain non-physician primary care providers to provide some services in the place of primary care physicians. This allows PACE organizations to operate with greater efficiency, while ensuring they continue to meet the specific needs and preferences of their patients, CMS claimed.
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.

Many PACE participants qualify for both Medicare and Medicaid, CMS said.

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Brad Ericson, MPC, CPC, COSC, is a seasoned healthcare writer and editor. He directed publishing at AAPC for nearly 12 years and worked at Ingenix for 13 years and Aetna Health Plans prior to that. He has been writing and publishing about healthcare since 1979. He received his Bachelor's in Journalism from Idaho State University and his Master's of Professional Communication degree from Westminster College of Salt Lake City.

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