Medicare Compliance & Reimbursement

Quality of care mandated by ACA to be reinforced with optimal use of advanced technology.

A new, more flexible approach to care for your elderly patients is on the horizon, thanks to a recent round of changes to the PACE program.

Projections are that the population of citizens over 65 could double over the next 30 years, according to U.S. Census Bureau reports. The numbers are large, with an estimate of around 83.7 million seniors by 2050.

Quality, comprehensive healthcare has never been better in the U.S. with increased technologies, disease cures, and pharmaceutical discoveries. All these factors combine with the elevated population numbers to lengthen the longevity of Americans’ lives. The Centers for Medicare & Medicaid Services (CMS), in conjunction with the Affordable Care Act (ACA) have risen to the challenge of caring for aging Medicare patients with some enrichments in a new proposed rule to the Programs of All-Inclusive Care for the Elderly (PACE).

Background: Oftentimes, aging patients do not want to make the move to nursing homes or other care facilities as their health wanes. PACE provides assistance to these seniors, helping them live out the remainder of their days in their homes.

Latest statistics: “More than 34,000 older adults are currently enrolled in about 100 PACE organizations in 31 states, and enrollment in PACE has increased by over 60 percent since 2011,” a CMS fact sheet from August 11, 2016 states. With the evolution of health care over the past decade in addition to these rising PACE statistics, CMS decided to make the necessary changes to better serve the elderly with this new ruling, the first since 2006.

“Today, CMS proposed the first major update to the PACE program in a decade. This proposal will help the program reflect the latest advances in caring for frail elders and changes in the use of technology,” said Andy Slavitt, CMS acting administrator explained in an August 11 blog post. “The goal of this proposal is to strengthen beneficiary protections and provide PACE organizations with more administrative and operational flexibilities so they can do what they do best — caring for our nation’s most vulnerable individuals.”

Here’s What the New Rule Entails

The new proposal aims to expand the program and offer it to more beneficiaries, taking into account advancements made in the administration of health care in the past decade and the rise of non-physician practitioners. The changes are subtle but would provide a more comprehensive, team-based care for the participants with the new PACE add-ons.

Here are some of the PACE highlights:

• Promotes care coordination between different providers with a team flexibility.
• Open to “non-physician primary care practitioners to provide some services in the place of primary care physicians” and expand the program.
• Requires PACE groups to follow Medicare Part D legislation.
• Deters fraudulent behavior with new sanctions and punishments that may include termination from the program.
• Provides the verbal ammunition to ensure that sexual, physical, and drug/alcohol abusers are never part of any PACE teams.

“Over the last six years, since the onset of the Affordable Care Act, we have been taking significant steps to care for more people, care for them better, and make health care more affordable,” Slavitt said. “But for us to be successful, we need to work hand-in-hand with patients and their families, physicians, and clinicians, and other actors to support new approaches to care. Team-based models that put the individual in the center, like PACE, will be a vital part of the fabric of our system.”

What This Means to You

With the expansion and greater flexibility promised in the proposal, team members would be able to perform more roles in the coordination of care, an added benefit to both patient care and each provider’s bottom line. CMS hopes that reaching out to nonphysician practitioners as well will add value to the team and make the cooperation across health care spectrums more efficient.

CMS will accept comments on the proposal until Oct. 17. Read the Federal Register ruling at: https://www.federalregister.gov/articles/2016/08/16/2016-19153/medicare-and-medicaid-programs-programs-of-all-inclusive-care-for-the-elderly-pace.

Resources: For more information on Andy Slavitt’s blog post on PACE with a link to the PACE fact sheet, visit https://blog.cms.gov.

To take a look at the U.S. Census Bureau statistics on aging, visit https://www.census.gov/prod/2014pubs/p25-1140.pdf.