New bipartisan legislation, H.R. 4543, that will provide flexibility for the Program of All-Inclusive Care for the Elderly (PACE) to test new models and bring their effective care plans to additional seniors and individuals with disabilities was unveiled today by U.S. Rep. Chris Smith (NJ-04), author of the bill.
“I’ve personally visited seniors who are enrolled in PACE and seen the good that comes from this important Medicare program,” said Smith, who last week helped St. Francis Medical Center in Trenton mark the fifth anniversary of its Living Independently for the Elderly (LIFE) program, the first PACE program in New Jersey. It opened in 2009 with Smith’s assistance. “There are today over 100 PACE programs serving seniors throughout the country. This bill is important to continue the success and make it better. We have one PACE program in the Hamilton area serving all of Mercer County and Northern Burlington County. There are plans underway to start a second at Fort Monmouth in the Patterson Clinic.”
PACE organizations provide the entire continuum of medical care and long-term services and supports required by frail older adults. First authorized in the Balanced Budget Act in 1997, PACE has grown to serve approximately 30,000 individuals through more than 100 programs in 31 states—including four in New Jersey, with a fifth planned at the former-Fort Monmouth.
The program delivers needed medical and supportive services including: adult day care; medical care and prescription drug services; physical or occupational therapy; respite care; and medical specialties, such as dentistry, optometry, and podiatry.
Currently, the PACE model is limited to those aged 55 and older who meet state-specified criteria for needing a nursing home level of care (LOC). However, many populations—including younger individuals, people with multiple chronic conditions and disabilities, seniors who need comprehensive care but do not yet meet the nursing home LOC standard—could benefit from the all-inclusive nature of the PACE model.
“PACE continues to provide patient centric care to many of the frailest members in our society and keep them in their homes and communities,” said Smith. “We know that all PACE participants are eligible for nursing home care, yet 90 percent continue to live at home. By removing the nursing home level of care requirement, PACE can work to reduce the likelihood that a senior’s health will deteriorate to that level, maintaining a better quality of life.”
Earlier this year, Reps. Smith and Blumenauer led a multi-member letter to the Chairmen and Ranking Members of the committees with jurisdiction over the Centers for Medicare & Medicaid Services (CMS)—urging them to include this program idea in any legislation that would repeal the Sustainable Growth Rate (SGR), the formula used to determine Medicare's physician reimbursements. To read Smith’s letter click here.
Unfortunately, the amendment was not included in the final law (the Protecting Access to Medicare Act/ now PL 113-93), so Reps. Smith and Blumenauer, in coordination with the National PACE Association, got to work on a standalone bill.
Smith’s bill,The PACE Pilot Act authorizes CMS to develop pilots using the PACE model to serve those under 55 years of age and those at-risk of needing a nursing home. It also encourages CMS to allow operational flexibilities that would support adaptation of the PACE model for new populations and promote PACE growth, efficiency and innovation.
“PACE has been a huge success,” said Blumenauer. “What we have realized is that there is a group of people out there who currently don’t qualify for PACE because of the age requirement, but would otherwise greatly benefit from the program due to serious medical conditions. This bill allows us to see how we can bring them into the fold efficiently and affordably.”
“The National PACE Association applauds Congressman Chris Smith and Congressman Earl Blumenauer for the introduction of the PACE Pilot Act,” said Shawn Bloom, president and CEO of the National PACE Association. “This legislation is a key step in providing the flexibility needed to help PACE grow. By providing a fully integrated, community-based model of care, PACE has proven effective at successfully enabling over 90 percent of nursing home eligible enrollees to live in the community. This legislation will allow PACE organizations the flexibility to implement proven innovations to grow faster, serve more communities and care for greater numbers of people with long term needs.”