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Updates to PACE Quality Reporting and Monitoring Forthcoming

The Centers for Medicare and Medicaid Services (CMS) is scheduled to release updates to the Program of All-Inclusive Care for the Elderly (PACE) Quality Monitoring module on May 16th. The changes will be effective for the second quarter of Calendar Year (CY) 2023 and impact the Appeals reporting section of the module. The agency has added Appeal Source, Appeal Type, and Appeal Resolution values, with the complete list provided in the memo dated May 12th. The system will also implement a new automated series of validation checks when “Upload Data” files are uploaded to minimize the impact of potential duplicated records being entered. It will apply to all “Upload Data” reporting functionality. The memo is available here.

On May 15th, CMS issued a memo announcing the Healthcare Effectiveness Data and Information Set (HEDIS) measures required for submission on June 14, 2024 by most Medicare Advantage Organizations (MAOs). While most organizations are also required to participate in the Medicare Health Outcomes Survey (HOS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey, PACE organizations are only required to participate in the Health Outcomes Survey-Modified (HOS-M) administration.

The HOS-M is an abbreviated version of the HOS used to assess the physical and mental health functioning of beneficiaries enrolled in PACE. All PACE contracts in effect on or before Jan. 1, 2023 are required by CMS to administer the HOS-M survey in 2024 if they have a minimum enrollment of 30 members as of February 2024 as reflected in the March 2024 monthly enrollment file here. Eligible PACE organizations will receive further correspondence from the National Committee for Quality Assurance (NCQA) regarding HOS-M participation by March 1, 2024. HOS and HOS-M Survey Administration Organizations are required to contract with an approved HOS or HOS-M survey vendor and notify NCQA of their choice. Eligible PACE organizations will receive further correspondence from NCQA regarding HOS-M participation by March 1, 2024.

The memo that contains information on the quality survey requirements and timing for Medicare Advantage plans in addition to PACE is available here.

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