CMS Proposes Update to PACE Regulations

The Centers for Medicare and Medicaid Services (CMS) released last week the first major update in ten years of regulations governing Programs of All-Inclusive Care for the Elderly (PACE). According to CMS, the proposed regulations are intended to strengthen beneficiary protections, while providing PACE programs with more administrative and operational flexibilities. Andy Slavitt, CMS Acting Administrator, highlighted his agency's commitment to the program in a blog post: "While PACE serves a relatively small number of people today, our proposal is intended to encourage states to further expand these programs."

The proposed regulations would provide flexibility and streamline requirements in a number of areas, including:

• Allowing nurse practitioners and physician assistants, in lieu of physicians, to serve on the Interdisciplinary Team (IDT) that develops care plans for members;
• Permitting an IDT member to fulfill more than one role on the team;
• Modifying the frequency of reassessments and the professionals who must conduct them; and
• Providing an electronic application process for entities seeking approval to operate or expand PACE programs.

In addition, the proposed regulations would impose new operational requirements on PACE programs, with the goal of protecting members and strengthening program integrity, including:

• Expanding internal compliance program requirements, while reducing the number of on-site audits;
• Strengthening provisions governing sanctions, enforcement actions, and terminations; and
• Prohibiting employment of individuals with convictions for physical, sexual, or drug or alcohol abuse, if they would pose a potential risk to beneficiaries in the PACE program.

On a conference call with stakeholders, CMS officials solicited feedback on many aspects of the proposed regulations, including its estimates of the administrative expenses associated with implementing the proposed requirements, as set forth in the agency's Regulatory Impact Analysis.

An unpublished version of the regulations is available here. A fact sheet is available here. The regulations will be published in the Federal Register on Aug. 16, 2016. Comments are due on Oct. 17, 2016 and may be submitted here.

Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8383 ext. 124