Report Outlines Recommendations for PACE Growth
Federal policies should encourage increasing capacity and participation in the Program of All-Inclusive Care for the Elderly (PACE), says a new report from the Bipartisan Policy Center (BPC). BPC is a Washington, D.C.-based think tank that "seeks to foster bipartisanship by combining the best ideas from both parties." Through interviews with key stakeholders and a private roundtable discussion, BPC identified several challenges to the growth of PACE that they urge policymakers and the Centers for Medicare and Medicaid Services (CMS) to address through legislative, regulatory, and policy reforms.
The report indicates that while PACE currently serves a relatively small number of Medicare and Medicaid beneficiaries, the program has demonstrated its value as a fully integrated, flexible model with potential to improve health outcomes and reduce costs. Policymakers should work together to advance bipartisan policy solutions that will address barriers to the appropriate spread and scale of PACE.
To support that goal, members of Congress should consider policy reforms that will substantially increase access to and enrollment in PACE and improve care for individuals with chronic illness, including many dually eligible beneficiaries. The reforms would also address expected demand for long-term services and supports (LTSS) among the rapidly aging U.S. population. The report includes the following broad legislative and administrative federal policy recommendations:
- Expand the capacity and geographic reach of PACE;
- Increase PACE enrollment;
- Raise consumer awareness of PACE; and
- Ensure and demonstrate the continued value of PACE.
More specifically, the report recommends a number of strategies to streamline the administrative process of PACE development such as accepting applications on a monthly rather than quarterly basis, allowing multiple expansion applications per application cycle, and permitting attestation regarding employment of staff during readiness review. To bolster participation, BPC would allow participants the choice of a qualifying, standalone Part D plan and calls for the Center for Medicare and Medicaid Innovation (CMMI) to test a model for expanded PACE eligibility targeting high-need/high-cost full benefit populations. To increase consumer awareness of PACE, the report suggests improving the Medicare.gov website to make it easier to access information about PACE and allow PACE organizations to market their program earlier when expanding their geographic area or adding a PACE site. Other recommendations would increase some requirements to include the public posting of quality improvement plans and report disaggregated health outcome data by participant characteristics.
Funding-related suggestions include a one-time $38 million investment with $12 million in ongoing, annual funding. Of this, $15 million would support grants for developing non-profit PACE programs in areas with low PACE access and competitive grants to states to establish loan programs aimed at increasing Electronic Health Record purchase, upgrade, and use.
The release of the report was accompanied by a panel discussion and question and answer session that included various knowledgeable stakeholders.
The report notes that there are currently 148 PACE programs operating 273 centers across 32 states, serving about 62,000 people. Ninety percent of PACE participants are dually eligible beneficiaries, while 9 percent are enrolled only in Medicaid and 1 percent are enrolled only in Medicare or pay privately. In New York State, nine programs currently serve 7,500 participants, with additional programs expected soon.
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