NPA Applauds CMS Guidance to Help Expand PACE Access in Rural Communities

Federal guidance supports innovative approaches to improving care for older adults in underserved areas

WASHINGTON, DC – July 30, 2026 – The National PACE Association (NPA) welcomes new guidance from the Centers for Medicare & Medicaid Services (CMS) that provides greater clarity for states and Programs of All-Inclusive Care for the Elderly (PACE®) seeking to expand access to comprehensive care for older adults living in rural communities.

The guidance, issued on July 22, addresses several longstanding operational questions surrounding rural PACE expansion, including the use of mobile clinics, participant travel, workforce development opportunities, and implementation of Rural Health Transformation (RHT) funding.

"Older adults living in rural communities often face significant barriers to accessing the coordinated health care and long-term services they need to remain safely at home," said Shawn Bloom, president and CEO of NPA. "This guidance provides important clarity that will help states and PACE organizations continue expanding access to this proven model of care while maintaining the high-quality, person-centered services that define PACE."

The new CMS guidance includes significant clarifications:

• A mobile clinic may serve as an approved alternative care setting (ACS) in rural service areas, allowing PACE organizations to extend clinical services closer to participants while continuing to operate through a central PACE center.
• While there is no federal standard establishing the maximum travel time to a PACE center, organizations must ensure participants have reasonable access to services while complying with state requirements.
• PACE organizations should consider becoming approved sites for the National Health Service Corps (NHSC) and Nurse Corps programs to create additional opportunities for recruiting physicians, nurses and other health care professionals.
• CMS outlined how states can leverage RHT funding to help establish and strengthen PACE programs while maintaining compliance with existing Medicaid payment requirements.

CMS also noted that while some services may be delivered through telehealth, comprehensive participant assessments must continue to occur in person. NPA will continue to engage with CMS on opportunities to expand telehealth use, particularly to improve access for rural and underserved participants.

The new guidance follows growing interest among states in expanding PACE through RHT initiatives. Nine states have incorporated PACE into their RHT plans: Connecticut, Kansas, Louisiana, Michigan, Montana, Oklahoma, Pennsylvania, Rhode Island and West Virginia.

The guidance comes at a time when more older Americans – more than 20 percent age 65 and over – are living in rural communities, according to the Administration for Community Living.

The PACE model provides comprehensive, coordinated care through an interdisciplinary team that includes physicians, nurses, therapists, social workers, dietitians, home care coordinators, transportation staff and other specialists. The team manages every aspect of a participant's health and well-being, delivering medical care, rehabilitation, prescription medications, meals, transportation and social engagement in a single, integrated model designed to help older adults live safely and independently at home.

As a result, 94 percent of PACE participants continue living in their communities rather than in nursing homes. In addition, they experience lower rates of hospitalization, emergency department visits and mortality compared with older adults enrolled in other integrated care models, according to recent research by the U.S. Department of Health and Human Services (HHS).

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The National PACE Association (NPA) works to advance the efforts of PACE programs, which coordinate and provide preventive, primary, acute and long-term care services so older adults can continue living in the community. The PACE model of care is centered on the belief that it is better for the well-being of seniors with chronic care needs and their families to be served in the community whenever possible. For more information, visit the NPA website and follow us on social media.