The new proposed rule for Programs of All-Inclusive Care for the Elderly released on Aug. 11 by the Centers for Medicare & Medicaid Service supports PACE growth, improved access to the program, and increased opportunities for innovation.

The new proposed rule for Programs of All-Inclusive Care for the Elderly released on Aug. 11 by the Centers for Medicare & Medicaid Service supports PACE growth, improved access to the program, and increased opportunities for innovation.

PACE is an innovative model of care that centers around an interdisciplinary team of professionals that provide and coordinate all needed care and services to keep enrollees — all of whom qualify for nursing home care — living in the community as long as possible. Each team works from a PACE center that provides adult day care services, primary care, physical and occupational therapy, transportation, and opportunities for social interaction.

“The National PACE Association has been working with our PACE members and CMS to identify changes to the PACE regulation that would lead to the greater growth, access and innovation of the PACE model of care,” said Shawn Bloom, NPA president and CEO. “We are encouraged that the proposed rule takes significant steps in that direction.”

One of the major changes in the proposed regulation is to provide PACE organizations more flexibility in how programs constitute and use the interdisciplinary team.

“With more than 30 years of experience delivering care, PACE organizations are leaders in the use of highly effective interdisciplinary teams,” Bloom said. “Current regulations require a one-size-fits-all approach to meeting the needs of enrollees. The proposed regulation will allow PACE interdisciplinary teams to function on a more individualized basis.”

The new regulation would allow for a core set of interdisciplinary team members to conduct the semi-annual assessment of enrollees. Other team members would be brought in as needed for individual needs. This change will allow PACE organizations to better focus their resources in areas that have the greatest impact on enrollee care and quality of life.

The proposed rule also would allow community physicians to be involved in the interdisciplinary team, opening the door for greater continuity of care as a senior enrolls in PACE.

“By providing more options for how the team delivers primary care, PACE organizations will have more flexibility in customizing care delivery based on individual needs,” Bloom said.

The proposed regulation also changes the way CMS would monitor PACE programs. Instead of relying on frequent in-person inspections, CMS will acknowledge the internal compliance and continuous quality improvement efforts of PACE organizations and use multiple sources of data to monitor them. On-site visits will focus on those programs with greater needs, which NPA strongly supports.

“Since our beginning as a demonstration program, a continuous quality improvement approach has been part of the PACE model,” Bloom said. “In fact, because we are financially responsible for all needed care, including hospital and emergency room visits, a focus on quality is essential to the success of PACE.”

One goal not advanced by the proposed rule is to make it easier for PACE to provide services in a greater range of settings throughout the community.

“The PACE center will always be a focal point for the PACE team,” Bloom said. “However, in order to support our enrollees’ desire to live as independently as possible, PACE operates throughout the community. From the PACE center to the home, from providing transportation to access to specialty care, PACE is a fully integrated system of care and services that is not confined to one place. Providing more flexibility to PACE organizations in developing alternative care settings where a subset of services would be provided away from the center would provide opportunities for faster PACE growth and greater access and efficiency, while offering enrollees more choice in how their care is provided.”

CMS is accepting comments on the proposed rule until Oct. 17. During the coming weeks, the National PACE Association will work with PACE providers to look closely at the proposed rule and offer additional comments to improve the rule when it is finalized.

“We appreciate the direction CMS is taking with this proposed rule and their openness to hearing feedback from the PACE community,” Bloom said.