Sending Office: Honorable Earl Blumenauer
Sent By:
Kristen.Donheffner@mail.house.gov

Urge CMS to Release PACE Final Rule and Proceed on Pilots

Dear Colleague:

The Program of All-Inclusive Care for the Elderly (PACE) is a proven care model delivering high-quality, comprehensive, integrated and coordinated community-based care to both Medicare and Medicaid beneficiaries 55 years of age or older, who meet the criteria
for a nursing home level of care, but wish to live at home. Multiple studies show that people receiving care from PACE organizations live longer, experience better health, have fewer hospitalizations and spend more time living at home than those receiving
care through other programs.

PACE is a comprehensive, capitated, fully integrated, provider-based health plan. At present, there are 122 PACE organizations operating in 31 states, serving over 42,000 elders and those living with disabilities every day. The PACE care model was first
developed in 1971 by an organization called On Lok in San Francisco; since then, PACE operates based on the fundamental principle that it is preferable in terms of quality of life, quality of care, and costs to public and private payers for PACE-eligible individuals
to be served in the community whenever possible. Despite their frailty and medical complexity, PACE participants enjoy a high quality of care and quality of life. Ninety-five percent live at home in their communities.

PACE provides participants with the entire spectrum of medical and long term care services and supports, and addresses all other biopsychosocial needs. The PACE organization assesses each individual upon enrollment and develops a personalized care plan,
implemented primarily by PACE staff across all settings of care twenty-four hours a day, seven days a week, 365 days a year. Most PACE participants, 90 percent, are dually eligible for Medicare and Medicaid. The average participant is 77 years of age, and
lives with multiple chronic, complex medical conditions, which often significantly limit activities of daily living. Approximately half live with dementia. Thus, PACE organizations enroll an exclusively high-risk, high-cost population, with 85 percent being
at least 65 years of age, with 15 percent between the ages of 55 and 64.

When individuals with chronic and medically complex conditions do not have access to care, their quality of life is diminished, which over time leads to increased expenditures. PACE deliberately was constructed to address the chronic care needs of individuals
by providing timely and clinically appropriate treatments and social supports.

However, PACE programs operate under outdated regulations dating to 2006. It is critically important that CMS issue the PACE final rule, which will bring much needed regulatory flexibility, allowing PACE organizations to innovate and grow to best serve their
participants, their families, and their communities.

Further, the PACE model of care could serve others. Congress directed CMS to explore the broader applicability of PACE to other medically complex populations through the PACE Innovation Act of 2015. However, to date CMS has not requested any applications
for pilots.

Please join us in sending the following letter to CMS Administrator Seema Verma requesting that  CMS promulgates the PACE final rule and moves the PACE pilots forward. Thank you in advance for your consideration.

To sign on or obtain additional information, please contact Marisa Kovacs with Rep. Chris Smith at
marisa.kovacs@mail.house.gov, Kristen Donheffner with Rep. Earl Blumenauer at
kristen.donheffner@mail.house.gov, Baruch Humble with Rep. Jenkins at
baruch.humble@mail.house.gov, or Alex Eveland with Rep. Kind at
alex.eveland@mail.house.gov.

Sincerely,

Rep. Christopher H. Smith                                                                                  Rep. Earl Blumenauer

Rep. Lynn Jenkins                                                                                               Rep. Ron Kind

 

###

May xx, 2018

Dear Administrator Verma:

We write in strong support of Programs of All-Inclusive Care for the Elderly (PACE) and to inquire about the status of the proposed rule issued by the Centers for Medicare and Medicaid Services (CMS) on August 2016 (CMS-4168-P), that would revise and update
current PACE requirements.

As you know, PACE is a proven care model delivering high-quality, comprehensive, integrated and coordinated community-based care to both Medicare and Medicaid beneficiaries 55 years of age or older, who meet the criteria for a nursing home level of care,
but wish to live at home. At present, there are 123 PACE organizations operating with 250 centers in 31 states, serving over 45,000 elders and those living with disabilities every day. Multiple studies show that people receiving care from PACE organizations
live longer, experience better health, have fewer hospitalizations and spend more time living at home than those receiving care through other programs. Additionally, PACE has already incorporated many of the reforms promoted by Medicare, including coordinated
care and integrated financing, and has proven to be a good value to taxpayers, while increasing the quality of life for many of our nation’s elders, persons living with disabilities, and their families.

However, the existing regulatory framework for PACE is over a decade old and in need of reform to allow for maximum program efficiencies. The necessary changes include: (1) allowing PACE organizations to include community physicians as part of their hallmark
interdisciplinary teams (IDT); (2) using nurse practitioners and physician assistants as primary care providers, which would be cost saving and improve quality of care; (3) providing services in settings other than the PACE Center, and; (4) configuring the
IDT to meet the needs of individual participants. The proposed rule would provide PACE with badly needed operational flexibility. We strongly urge CMS to prioritize promulgating a final rule soon so that PACE programs may be afforded the operational flexibility
needed to expand and serve more frail seniors and those living with disabilities.

Thank you in advance for your timely response to our concerns.

Sincerely,

Related Legislative Issues

Selected legislative information: HealthCare

icon eDC logo e-Dear Colleague version 2.0