The National PACE Association (NPA) works proactively with staff at the Centers for Medicare & Medicaid Services (CMS) and members of Congress who work on policy issues affecting PACE® organizations. Because PACE organizations are innovative programs that work with both the Medicare and Medicaid programs, the PACE Model of Care has its own regulations that govern PACE organization operations.

CMS Issues Proposed Rule with Significant PACE Policy and Technical Changes

On Dec. 27, 2022, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule containing extensive policy and technical changes impacting PACE. Once finalized, and unless otherwise specified in the rule, the proposed provisions take effect in Contract Year (CY) 2024, beginning Jan. 1, 2024.

The National PACE Association (NPA) prepared a summary of the proposed PACE provisions in the rule and seeks your feedback by Wednesday, Jan. 25, on how the rule could impact PACE organizations and participants.

NPA held a webinar on Jan. 18, 2023, that provided an overview of the proposed rule.

Key provisions of the proposed rule include those related to the contract year definition to address the timing of initial audits during the trial period (to ensure PACE organizations have sufficient enrollment and operational experience prior to their first audit); modifications to the grievance process; detailed specifications regarding the plan of care; and new timeframes required of the interdisciplinary team (IDT) relative to the provision of services, as well as to review, assess, and act on recommendations of other providers, including medical specialists.

The PACE-specific provisions of the proposed rule are delineated on pages 184-222 (proposed PACE policy and technical changes); in Table 21 on page 256 (summary of the cost and transfer of the proposals, including PACE); on pages 235-238 and 241 (PACE information collection requirements); and pages 292-298 (proposed changes to PACE regulatory text).

Additionally, as mentioned previously, due to the breadth of the rule, NPA staff also reviewed the broader, non-PACE-specific provisions included in the rule, such as those pertaining to Part D, health equity and behavioral health to determine their impact on PACE.

This summary provides a high-level overview of those broader provisions in the rule that, while not directly applicable to PACE, may have implications to PACE organizations, in part because they are Part D plan sponsors.

Those provisions include the following:

• Strengthening Translation and Accessible Format Requirements for Medicare Advantage, Part D, and D-SNP Enrollee Marketing and Communication Materials
• Health Equity in Medicare Advantage
• Behavioral Health in Medicare Advantage
• Medicare Parts A, B, C and D Overpayment Provisions of the Affordable Care Act
• Changes to an Approved Part D Formulary – Immediate Substitutions
• Expanding Eligibility for Low-Income Subsidies (LIS) Under Part D of the Medicare Program

If you have questions regarding this information, please contact Charles Fontenot, senior director of Health Plan Management and Reimbursement Policy at NPA.

NPA seeks member input to assist in the development of our comments on the proposed rule. Please provide your feedback by Wednesday, Jan. 25, to Katie Pahner. Your feedback will assist our development of draft comments that will be shared with NPA members by Tuesday, Feb. 7, along with a template to submit comments on behalf of your individual organization prior to the CMS deadline for comments on Feb. 13, 2023. (Unless there are significant changes to the NPA draft comment letter, we will circulate a copy of the final iteration following CMS submission.)   

NPA Submits Comments to CMS on PACE Regulatory Burden

NPA submitted comments late last month in response to a CMS notice delineating updated administrative burden and cost estimates anticipated of PACE organizations and, in some cases, of states to comply with PACE federal regulatory requirements, including those recently outlined in the 2021 PACE final rule (NPA summary). Depending on the PACE regulatory requirement, the CMS estimates may be new (if a new regulatory requirement) or revised (to reflect current labor wage data).

The 2021 PACE final rule required PACE organizations by Jan. 1, 2022, to update several policies and procedures, including those related to service determination requests (SDRs), drug management programs, medical record documentation, training for employed and contracted staff on revised requirements, and participant bill of rights and enrollment agreements.

NPA’s comments reflected valuable feedback from our members on CMS’ estimated administrative and cost burden to PACE organizations on SDR requirements, service delivery, participant rights and more.   

For more information, contact Katie Pahner.

NPA Highlights the Role of Family Caregivers in Comments to ACL

NPA submitted comments late last month in support of and in response to the Administration for Community Living’s (ACL) 2022 National Strategy to Support Family Caregivers. NPA’s comments highlighted the valuable and unique role that caregivers play in the PACE model of care and called on HHS, specifically CMS, to leverage existing programs like PACE that provide vital support to caregivers and yet do not require additional legal authorities.

Further, NPA expressed support for the administration’s goals regarding increased Medicaid funding to access home- and community-based services (HCBS), including PACE; engage with family caregivers; and expand data, research, and evidence-based practices to support family caregivers. Regarding federal HCBS funding specifically, NPA strongly recommended that Congress and CMS ensure that all HCBS programs – including PACE – have equal access to any future federal funding beyond the American Rescue Plan (ARP) dollars previously authorized by Congress.

For more information, contact Katie Pahner.

NPA Calls on CMS to Advance Health Equity Via Expanded PACE and Extend COVID-19 PHE Flexibilities

On Nov. 3, 2022, NPA submitted comments in response to the CMS "Make Your Voice Heard: Promoting Efficiency and Equity Within CMS Programs" RFI. The goal of the RFI was to “solicit public input on accessing health care and related challenges, understanding provider experiences, advancing health equity, and assessing the impact of waivers and flexibilities provided in response to the COVID-19 Public Health Emergency [PHE].”

NPA conveyed opportunities to leverage the PACE model of care to effectively serve Medicare, Medicaid and dually eligible individuals, the latter of whom disproportionately face challenges accessing health care. Additionally, NPA reiterated key administrative and legislative barriers to meaningfully accessing home- and community-based services through PACE, including for Medicare-only individuals, as well as PACE application requirements that inhibit the proliferation of the model. Finally, NPA called on CMS to extend, beyond the impending expiration of the COVID-19 PHE, the enforcement discretion extended to PACE organizations over the pandemic that have been essential to their ability to protect the health and safety of PACE participants and staff.

For more information, contact Katie Pahner.

Share Your Comments with CMS on the Proposed Rule to Streamline Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment and Renewal Process

On Sept. 7 the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule titled “Streamlining the Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Process,” which aims to simplify the Medicaid enrollment process as well as the redetermination process.

NPA has drafted a comment letter in response to the proposed rule, which will be submitted by the CMS deadline of Nov. 7. In addition, NPA encourages PACE organizations to use the template comment letter, which can be modified and personalized, to submit comments to ensure that the proposed changes improve the enrollment process for Medicaid beneficiaries, including PACE participants.

For more information, contact Liz Parry.

HHS Proposed Rule on Nondiscrimination in Health Programs and Activities

On Aug. 4, 2022, the U.S. Department of Health and Human Services (HHS) issued a proposed rule on Section 1557 of the Affordable Care Act titled “Nondiscrimination in Health Programs and Activities.” Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age and disability in certain health programs and activities. The Section 1557 Notice of Proposed Rulemaking (NPRM) includes a number of provisions that are particularly relevant for older adults and people with disabilities.

NPA has developed a summary of the proposed rule for review by the membership.

NPA has developed draft comments for member consideration in the development of their own comments.

Comments are due by Oct. 3, 2022.

For more information, contact Charles Fontenot.

Medicare Request for Information

On Aug. 1, 2022, CMS released a Request for Information (RFI) seeking input from the public regarding various aspects of the Medicare Advantage program. Responses to this RFI may be used to inform potential future rule-making or other policy development.

NPA has taken this opportunity to offer its draft comments to the statements and questions contained in the RFI related to service delivery to PACE Medicare-eligible beneficiaries for member consideration in the development of their own comments.

To be assured consideration, comments must be received by CMS by Aug. 31, 2022.

For more information, contact Charles Fontenot

CY 2023 Policy and Technical Changes to the MA and Part D Programs Final Rule with Implications for PACE

The Contract Year (CY) 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (CMS-4192-F) was published on May 9, 2022, in the Federal Register. Provisions of the CY 2023 final rule that NPA believes are applicable to PACE are described in an NPA memo. These are effective June 28, 2022, and have an applicability date of Jan. 1, 2023.

CY 2022 Final Rule with Revisions to PACE Requirements

The Contract Year (CY) 2022 Final Rule with Revisions to PACE Requirements was published Jan. 19, 2021, in the Federal Register.

For more information, contact Liz Parry.

2019 PACE Final Rule

CMS released the 2019 PACE Final Rule, which was published in the Federal Register on June 3, 2019, with an effective date of Aug. 2, 2019. You can view the NPA analysis of the final rule.

Proposed Rule for PACE

CMS released the proposed rule for PACE (CMS-4168-P) in 2016. It was on public display at FederalRegister.gov and was published in the Federal Register on Aug. 16, 2016. CMS also issued a Fact Sheet and Blog Post on the proposed rule.

NPA prepared the following resources:

• Section-by-Section Summary of the Proposed Rule
• NPA Comment on Proposed PACE Rule (10/12/16)
• Template Response Letter for NPA Members

PACE Regulations and Other Resources

• Consolidated PACE Regulation (42 CFR Part 460)
• PACE Final Rule (F.R. Vol. 71, No. 236, 12/8/06)
• PACE Interim Final Rule (F.R. Vol. 67, No. 190, 10/1/02)
• PACE Interim Final Rule (F.R. Vol. 64, No. 226, 11/24/99)
• CMS PACE Manual

NPA Comments and Summaries

Members can log in to view NPA Comments and Summaries.