|
||||||||
| |||||||||
|
CMS Modifies Rules to Provide Flexibility for Program of Care for Frail Elderly September 27, 2002 - The Centers for Medicare and Medicaid Services (CMS) today made it easier for organizations to start or expand programs that allow frail elderly who meet nursing home level of care to live in their communities and receive comprehensive care. An interim final rule, to be published Oct. 1 in the Federal Register, will permit flexibility from regulatory requirements in the Program of All-inclusive Care for the Elderly (PACE). The rule establishes a process for new and existing PACE organizations to request a waiver of regulatory requirements and modifies employment requirements established in the previous interim final rule published in November 1999. "By offering waivers for PACE programs, we're offering the kind of flexibility we need to continue the growth of these programs, which help frail seniors to stay in their communities instead of living in nursing homes," Health and Human Services Secretary Tommy G. Thompson said. "PACE programs provide the kind of compassionate, coordinated care that helps seniors to remain in their homes and maintain their health and independence." "The PACE program is a great example of how we can work together with our state and provider partners for a program that provides significant, comprehensive benefits to those frail elderly who need it most," CMS Administrator Tom Scully said. "PACE organizations give these beneficiaries the opportunity to live at home close to their loved ones, while receiving the care they need. The regulation will provide more flexibility to build on the successful working relationship among CMS, the states and providers." A PACE organization requesting a waiver must provide a detailed description of how the proposed waiver differs from the regulatory requirement, how its approach meets the intent of the regulatory provision, and why the organization needs the waiver for start-up or expansion. The waiver is submitted to the state PACE administering agency, which will forward it to CMS, along with any concerns or conditions to be met before CMS grants waiver approval. CMS has 90 days to approve or deny the request. The Balanced Budget Act of 1997 established PACE as a permanent provider in the Medicare and Medicaid programs and included provisions that enabled PACE demonstration sites to convert to permanent status. The Benefits Improvement and Protection Act of 2000 (BIPA) reinforced CMS' authority to waive regulatory requirements for PACE if, in CMS' judgment, the intent of the regulation was met by the proposed alternative operating arrangement. PACE is available only in states that have chosen to offer the program under the Medicaid state plan. Currently, there are PACE programs in 16 states: California, Colorado, Kansas, Maryland, Massachusetts, Michigan, Missouri, New York, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Washington and Wisconsin. To be eligible for PACE, a person must be 55 or older, live in the service area of a PACE organization, be able to live safely in the community and be certified as eligible for nursing home care by the state. Enrollment is voluntary, and once enrolled, PACE becomes the sole source of all Medicare and Medicaid covered services, as well as any other items or medical, social or rehabilitation services the PACE interdisciplinary team determines an enrollee needs. If a participant requires placement in a nursing home, PACE is responsible and accountable for the care and services provided and regularly evaluates the participant's condition. A team, including a physician, registered nurse, therapists and other health professionals, assesses the participant's needs, develops a comprehensive plan of care and provides for total care. Generally, services are provided in an adult day health center, but also may be given in the participant's home, a hospital or a long-term care facility. Transportation is provided to the PACE center, as well as medical specialists, and laboratory and other diagnostic services. A PACE organization receives a fixed monthly payment from Medicare and Medicaid for each participating beneficiary, depending on their Medicare and Medicaid eligibility. The payments remain the same during the contract year, regardless of the services a participant may need. The new rule has a 60-day comment period. The regulatory requirements will be effective 30 days after publication in the Federal Register. Further information about PACE is available on the CMS Web site at http://www.medicare.gov/nursing/alternatives/pace.asp.
|
