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Final PACE Rule Aims for Increased Flexibility

When the Programs of All-Inclusive Care for the Elderly (PACE) Final Rule becomes effective on Aug. 2, 2019, PACE Organizations (POs) will be able to select physician assistants or nurse practitioners to serve in the primary care provider role on an Interdisciplinary Team (IDT). Community-based physicians will also be able to serve on an IDT without the PO seeking a waiver, and other team members will not be precluded from being on an IDT even if they primarily serve non-PACE individuals. These are among the provisions included in the first major update to federal regulations governing PACE that the Centers for Medicare and Medicaid Services (CMS) published on June 3rd. They were proposed in 2016 and mark the first revisions to the regulations since they were published in 2006.

While the composition of the IDT remains the same (with the flexibility of allowing extenders to fill the primary care provider role on the team), specified members of the team would be able to determine whether all members of the team were required during reassessment. The regulations also permit remote technology (e.g., teleconference) to be used during reassessments under certain circumstances. Initial assessments would need to be scheduled in a way to ensure that a plan of care is completed for a participant within 30 days of their enrollment.

State and CMS program audits would be less frequent for established POs that CMS deems to be at less risk of non-compliance. Although CMS decided against implementing some of the originally proposed compliance provisions, the regulations do call for POs to adopt a compliance oversight program to promptly respond to, investigate, and correct potential non-compliance and fraud, waste, and abuse. POs that offer qualified prescription drug coverage must comply with Medicare Part D prescription drug program requirements, while CMS is provided with greater flexibility to impose remedies short of termination such as monetary penalties.

The regulations also provide some flexibility to states, codify a number of current practices, and specify that the existing process governing initial applications will be applied for existing POs seeking approval to expand. The text of the rule is available here, and a CMS fact sheet is here.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841