CMS Proposes Reforms To PACE Program

CMS is proposing numerous changes to the regulations governing the Programs of All-Inclusive Care for the Elderly (PACE) program, which is a Medicare/Medicaid managed care service delivery model designed to enable nursing home-eligible elderly individuals to remain in the community. Notably, the rule would require each PACE organization (PO) to develop compliance oversight requirements and adopt measures to prevent, detect, and correct waste, fraud, and abuse and address non-compliance with CMS's program requirements. In addition, CMS is proposing to streamline processes for oversight and monitoring of POs, including reducing the number of onsite visits by targeting POs for audit based on risk assessment. The proposed rule also addresses dozens of other requirements, including: application and waiver procedures; sanctions, enforcement actions, and termination; various administrative requirements; flexibility in the composition of PACE interdisciplinary teams;