PACE final rule enforces patient protections through sanctions, monetary penalties

The Centers for Medicare and Medicaid Services today issued a final rule in the Programs of All-Inclusive Care for the Elderly, or PACE, that holds organizations accountable for patient protections through sanctions and civil money penalties.

The rule includes these changes in enforcement actions to protect individuals from harm, CMS said.

CMS is adding language to ensure that individuals with a conviction for a criminal offence relating to physical, sexual or drug or alcohol abuse or use, will not be employed by a PACE organization in any capacity where their contact with patients would pose a potential risk.

PACE provides in-home medical and social services to certain frail, elderly individuals who qualify for nursing home care.

Under the rule CMS is also allowing greater flexibility for non-physician primary care providers to provide some services in place of PCPs. This means that PACE interdisciplinary teams can be do more aspects of their patients' care.

The rule also clarifies that PACE organizations offering qualified prescription drug coverage must comply with Medicare Part D prescription drug program requirements unless the requirement has been waived; and it increases transparency and simplifies regulations to help clarify enrollment policies and requirements for quality improvement.

IMPACT          

The policies finalized in this rule reflect the latest standards in caring for PACE participants – many of whom are dually-eligible for both Medicare and Medicaid – and will strengthen patient protections, improve care coordination, and provide administrative flexibilities for PACE organizations, CMS said. The final rule removes redundancies and eliminates outdated information, which will reduce administrative burden.

TREND

More than 45,000 older adults are currently enrolled in more than 100 PACE organizations in 31 states, and enrollment in PACE has increased by over 120 percent since 2011.

This final rule is the first major update to the program since 2006.

ON THE RECORD

"The changes we are making to the PACE program will help to protect our seniors from abuse and neglect," CMS Administrator Seema Verma said. "This rule strengthens the PACE program by offering a more flexible and adaptable approach to the coordinated care that patients receive from PACE organizations, which will allow care teams to provide seamless, better-tailored care to individual patients."

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com