CMS Issues Final Rule to Improve PACE Program for Frail and Elderly

On May 28, the Centers for Medicare and Medicaid Services (CMS) issued a final rule to improve and modernize the Programs of All-Inclusive Care for the Elderly (PACE). The rule is the first major change to the program since 2006. CMS expects that the changes will help incorporate current best practices in the care rendered to frail and elderly patients. CMS issued a press release and a fact sheet summarizing the rule.

The final rule promotes a flexible approach with respect to the composition of the interdisciplinary team that is tasked with caring for PACE patients by allowing individuals to serve in more than one role on the team. This will allow key individuals that are involved in a patient’s care to participate in more aspects of care and help PACE organizations effectively tailor treatment plans for the patient’s individualized needs. The rule also allows certain non-physician healthcare providers to be more involved in treatment plans and to provide certain services in lieu of a physician, which will provide more flexibility and efficiency for PACE organizations.

The final rule also includes certain protections with respect to the quality of care provided to patients. It clarifies that PACE organizations must comply with Medicare Part D rules and regulations when offering prescription drug coverage, unless they receive an explicit waiver of these requirements. The rule also prohibits PACE organizations from employing individuals who were convicted of a crime relating to physical, sexual, or drug or alcohol abuse if such employment would require the individual to have contact with PACE patients. CMS will hold PACE organizations accountable for providing high-quality care and protecting patients from harm and abuse.

Under the final rule, PACE organizations will be subject to sanctions and monetary penalties if they fail to meet the requirements of the PACE rules and regulations.