WASHINGTON, D.C. – Programs of All-Inclusive Care for the Elderly, or PACE, provide comprehensive community-based care to Medicare beneficiaries age 55 and over who meet the criteria for a nursing home level of care but want to live at home.
Research shows that PACE participants are healthier, spend more time living at home, are hospitalized less, and live longer than those receiving care through other programs.
Although the older adults served by PACE are frail and medically complex, 95 percent live at home in their community and enjoy a high quality of care and a high quality of life, testified Cheryl Wilson, CEO of St. Paul’s Senior Services, in San Diego, at a hearing June 7 by the Health Subcommittee of the House Ways and Means Committee.
Currently, 233 PACE centers serve more than 40,000 participants in 32 states. Congress approved legislation creating PACE as a permanent provider in 1997, and PACE providers have developed innovations over the past two decades to help speed the expansion of the PACE model of care. The National PACE Association is working with Congress to update the PACE statute and regulations to allow the innovative model to grow faster and work more effectively.
“While CMS has issued a proposed rule that would provide PACE with more operational flexibility, it has yet to implement this rule in its final form. As a result, PACE organizations face operational and administrative requirements that constrain growth,” said Wilson, of St. Paul’s Senior Services, which has operated a PACE program in San Diego since 2008. The program has over 600 participants, and a new PACE center is under development.
PACE providers would like to see a number of innovations supported in the updated regulations, such as the utilization of community locations to deliver some services outside of the PACE center and home. They also would like to have the flexibility to use nurse practitioners and community physicians and to be able to customize their interdisciplinary teams around the needs of each participant.
In 2015 Congress passed the PACE Innovation Act, which encourages Medicare to allow providers to develop pilot programs so that a broader range of individuals can benefit from the PACE model.
“CMS can support PACE growth by implementing the pilot authority provided by Congress to allow PACE to serve new populations with similar needs and medical complexities to the population currently served,” Wilson said.
By expanding PACE to serve other medically complex individuals who are at risk of nursing home placement, such as those with physical mobility limitations or complex medical and functional support needs, more people will benefit from the increased quality of care and quality of life provided by the PACE model and be able to continue living at home.
Expanding PACE makes sense for states concerned about fiscal pressure to hold down Medicaid costs. Studies have shown that PACE costs states 16 percent less for Medicaid-eligible individuals enrolled in the program than those with similar needs in traditional Medicaid.
“PACE continues to operate based on the fundamental principle that it is preferable in terms of quality of life, quality of care, and costs to public and private payers for PACE-eligible individuals to be served in the community whenever possible,” Wilson said.
The National PACE Association works to advance the efforts of Programs of All-Inclusive Care for the Elderly. PACE programs coordinate and provide all needed preventive, primary, acute and long-term care services so older individuals can continue living in the community. The PACE model of care is centered on the belief that it is better for the well-being of seniors with chronic care needs and their families to be served in the community whenever possible. For more information, visit www.NPAonline.org.