CMS Finalizes Significant Updates to PACE Regulatory Requirements
On April 4 the Centers for Medicare & Medicaid Services (CMS) issued a final rule, scheduled to be published in the Federal Register on April 23, codifying Contract Year (CY) 2025 policy and technical changes to Medicare Advantage (MA), the Medicare Prescription Drug Benefit Program (Part D), and Programs of All-Inclusive Care for the Elderly (PACE). A CMS press release and fact sheet on the CY 2025 Final Rule are available. Unless otherwise specified, while the final regulations take effect June 3, the applicability date for PACE organization compliance purposes is Jan. 1, 2025.
NPA has prepared for members a detailed analysis of the final PACE provisions. This memorandum presents the first of two NPA summaries of the CY 2025 Final Rule. In Part 1 we focus on PACE provisions directly impacting PACE organizations. In Part 2 we present provisions applied to MA that may impact PACE organizations through broader market or future precedent implications, as well as Part D provisions directly applicable to PACE organizations as Part D sponsors.
Importantly, the CY 2025 Final Rule addresses the outstanding 10 PACE provisions included in the CY 2024 Proposed Rule (NPA resources) issued in December 2022, such as enhanced personnel medical clearance requirements; new maximum service delivery and care coordination timeframes; changes to participant rights relative to consent and the provision of palliative, comfort, and end-of-life (EOL) care; and changes to the CMS evaluation of PACE applications [both initial and service area (SAE) applications] based on the past performance of an organization, among other provisions. For some of the PACE provisions, CMS finalizes the policies as proposed, while for others CMS modifies its proposals to reflect stakeholder feedback received during the formal comment process.
Finally, beyond PACE, the CY 2025 Final Rule codifies significant revisions to MA policies and benefits – including provisions to curb predatory MA marketing, policies that aim to integrate enrollment in Dual Eligible Special Needs Plans (D-SNPs), and limitations on D-SNP look-alikes – that may have broader market and/or future policy implications (precedent) for PACE. As noted above, NPA is carefully reviewing these provisions and will provide a separate summary of the MA and Part D final provisions in a subsequent “Part 2” communication.
In the meantime, NPA strongly advises each PACE organization to review carefully the CY 2025 Final Rule and NPA educational resources on the rule to assess the impact of these provisions on your organization, modify internal Policies and Practices (P&Ps) and make other adjustments, including to operations and the provision of care, as necessary, bearing in mind the Jan. 1, 2025, compliance timeframe.
Please stay tuned for information and advance registration to attend an upcoming NPA member webinar on the CY 2025 Final Rule, as well as additional NPA member educational resources on the rule as noted above. Should you have any questions about the final PACE provisions, please contact Katie Pahner, vice president of Regulatory Affairs.