[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6590 Introduced in House (IH)]
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118th CONGRESS
1st Session
H. R. 6590
To improve access to the Program of All-Inclusive Care for the Elderly,
and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
December 5, 2023
Mrs. Dingell (for herself and Mr. Moolenaar) introduced the following
bill; which was referred to the Committee on Energy and Commerce, and
in addition to the Committee on Ways and Means, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To improve access to the Program of All-Inclusive Care for the Elderly,
and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Program of All-inclusive Care for
the Elderly Expanded Act'' or the ``PACE Expanded Act''.
SEC. 2. ANYTIME ENROLLMENT IN PACE.
(a) In General.--
(1) Any time enrollment and effective date.--Section
1894(c)(5) of the Social Security Act (42 U.S.C. 1395eee(c)(5))
is amended by adding at the end the following new subparagraph:
``(C) Any time enrollment and effective date of
enrollment.--
``(i) Any time enrollment.--A PACE program
eligible individual may enroll in a PACE
program at any time during a month.
``(ii) Effective date.--Subject to clause
(iii), the enrollment of a PACE program
eligible individual in a PACE program shall be
effective on the date the PACE provider
operating the PACE program receives an
enrollment agreement signed by such PACE
program eligible individual with respect to
such PACE program.
``(iii) Special rule in the case of dual
eligible beneficiaries.--In the case of a PACE
program eligible individual who is eligible for
benefits under this title and title XIX, clause
(i) shall only apply if the State in which such
individual resides has made an election under
section 1934(c)(5)(C) to permit PACE program
eligible individuals to enroll in a PACE
program at any time during a month in such
State.''.
(2) Prorated payments.--Section 1894(d) of the Social
Security Act (42 U.S.C. 1395eee(d)) is amended by adding at the
end the following new paragraph:
``(4) Prorated payments.--In the case of a PACE program
eligible individual enrolled in a PACE program operated by a
PACE provider with an enrollment effective date that is not the
first day of a month, the capitation amount that would
otherwise be made under this subsection to the PACE provider
for such individual for the first month in which such
individual is so enrolled shall be prorated accordingly.''.
(b) Conforming Amendments.--
(1) Anytime enrollment and effective date.--Section
1934(c)(5) of the Social Security Act (42 U.S.C. 1396u-4(c)(5))
is amended by adding at the end the following new subparagraph:
``(C) State option to permit any time enrollment
and effective date of enrollment.--
``(i) Any time enrollment.--A State may
elect to permit a PACE program eligible
individual to enroll in a PACE program at any
time during a month.
``(ii) Effective date.--Pursuant to a State
election made under clause (i), the enrollment
of a PACE program eligible individual in a PACE
program shall be effective on the date the PACE
provider operating the PACE program receives an
enrollment agreement signed by such PACE
program eligible individual with respect to
such PACE program.''.
(2) Prorated payments.--Section 1934(d) of the Social
Security Act (42 U.S.C. 1396u-4(d)) is amended by adding at the
end the following new paragraph:
``(3) Prorated payments.--If a State elects under
subsection (c)(5)(C) to permit enrollment at any time during a
month, in the case of a PACE program eligible individual
enrolled in a PACE program operated by a PACE provider with an
enrollment effective date that is not the first day of a month,
the State shall prorate the capitation amount that would
otherwise be made under this subsection to the PACE provider
for such individual for the first month in which such
individual is so enrolled.''.
(c) Effective Date.--The amendments made by this section shall take
effect on January 1, 2025.
SEC. 3. PACE SITE APPROVAL AND EXPANSION.
(a) In General.--Sections 1894(e) and 1934(e) of the Social
Security Act (42 U.S.C. 1395eee(e); 1396u-4(e)) are each amended by
striking paragraph (8) and inserting the following:
``(8) Authority to submit applications at any time; timely
consideration of applications.--
``(A) Authority to submit applications at any
time.--
``(i) New pace provider status.--An entity
that seeks to become a PACE provider may submit
an application for PACE provider status at any
time.
``(ii) Service area expansion and addition
of pace center site.--To the extent the
Secretary requires a PACE provider to submit an
application to expand its service area or to
add a PACE center site (or both), a PACE
provider may submit such an application at any
time, subject to the requirements of section
460.12(d) of title 42, Code of Federal
Regulations (relating to the first trial period
audit), or any successor regulation.
``(iii) Assurances.--An application for
PACE provider status under clause (i) or to add
a PACE center site under clause (ii) shall
include the following assurances:
``(I) An assurance that the
required members of the
interdisciplinary team are employees or
contractors of the proposed PACE center
or will be employees or contractors of
the proposed PACE center by the time
the PACE center becomes operational.
``(II) An assurance that--
``(aa) the PACE provider's
contracts for all contractors
and contracted personnel will
be executed by the time the
proposed PACE center becomes
operational; and
``(bb) executed contracts
may include provisions for
staffing levels commensurate
with enrollment to full
projected census.
``(B) Deemed approval.--An application described in
subparagraph (A) shall be deemed approved unless the
Secretary, within 45 days after the date of the
submission of the application to the Secretary, either
denies such request in writing or informs the applicant
in writing with respect to any additional information
that is needed in order to make a final determination
with respect to the application. After the date the
Secretary receives such additional information, the
application shall be deemed approved unless the
Secretary, within 45 days of such date, denies such
request.''.
(b) Effective Date.--The amendments made by subsection (a) shall
take effect on January 1, 2025.
SEC. 4. PACE PILOT.
Section 1115A(b)(2) of the Social Security Act (42 U.S.C.
1315a(b)(2)) is amended--
(1) in subparagraph (B), by adding at the end the following
new clause:
``(xxviii) National testing of a model for
expanded eligibility for the Program of All-
Inclusive Care for the Elderly as described in
subparagraph (D).''; and
(2) by adding at the end the following new subparagraph:
``(D) National testing of model for expanded
eligibility for the program of all-inclusive care for
the elderly.--In the case where the Secretary selects
the model described in clause (ii) of this subparagraph
for testing pursuant to clause (xxviii) of subparagraph
(B), the following shall apply:
``(i) National testing.--
``(I) In general.--Subject to
subclause (II), the Secretary shall
design a demonstration that allows each
PACE provider with an executed PACE
agreement to develop and submit to the
Secretary an application to begin
testing expanded PACE eligibility for
high-need and high-cost populations
that are not otherwise eligible to
participate in a PACE program within 1
year of the date on which the model is
selected.
``(II) No effect on ongoing models
or demonstration projects.--Nothing in
this subparagraph shall affect the
testing of any model under this
subsection or any demonstration project
under this Act that is implemented
prior to the date of the enactment of
this subparagraph.
``(ii) Model described.--The model
described in this clause seeks to increase
access to quality, integrated, care for high-
need, high-cost individuals who are not
otherwise eligible to participate in a PACE
program in order to improve health and reduce
cost. Under this model, participating PACE
providers would--
``(I) be paid fixed, monthly
capitated rates from both Medicare and
the applicable State Medicaid agency
for all services provided to each
enrollee fitting the criteria of the
PACE provider's designated population;
``(II) partner with non-PACE
providers, such as Area Agencies on
Aging, Centers for Independent Living,
local hospitals, and non-hospital
providers such as physicians,
behavioral health providers and other
community-based organizations to
effectively reach the PACE provider's
selected population;
``(III) adapt the PACE program
model of care to appropriately serve
the PACE provider's selected population
to integrate care and meet the unique
needs of said population; and
``(IV) if the PACE provider is
located in a State that has not yet
served the selected population through
a PACE program under section 1934,
receive an up-front fixed payment to
coordinate with the State to develop a
capitated payment rate, with
appropriate risk adjustment, for the
PACE provider's selected population.
``(iii) Requirements for participating pace
organizations.--In order to participate in the
model, a PACE provider must--
``(I) conduct a survey or needs
assessment of their service area to
determine the most appropriate
population with which to expand their
services;
``(II) receive prior approval from
the applicable State Medicaid agency to
submit an application to participate in
the model; and
``(III) following such survey or
needs assessment and approval from the
applicable State Medicaid agency,
submit and receive approval of an
application of expansion from the
Secretary.
``(iv) Application.--A PACE provider's
application to participate in this model shall
include the following information:
``(I) Results of the survey or
needs assessment of their service area
under clause (iii)(I) and an
explanation of the expanded population
the PACE organization will serve.
``(II) The types of services that
the expanded population will require
and the PACE provider's plan to
implement these services.
``(III) How the PACE provider will
achieve engagement and enrollment of
the new population in the model,
including how it will partner with non-
PACE providers in the applicable
service area.
``(IV) How the expanded
population's participation in the PACE
program is intended to improve quality
of care and health outcomes under the
model.
``(V) Certification that the
applicable State Medicaid agency has
approved the PACE provider's
application to participate in the
model.
``(VI) Plans to coordinate with the
State Medicaid agency to develop an
initial capitated rate with appropriate
risk adjustment.
``(VII) Plans for the PACE provider
and the State Medicaid agency to review
and adjust the Medicaid capitated rate
on a biennial basis, as needed.
``(VIII) Any other information
required by the Secretary.
``(v) Technical assistance.--The Secretary
shall provide, or designate an entity to
provide, technical assistance to participating
PACE providers as they apply for and implement
the model.
``(vi) Accounting for uncertainty.--In
order for implementing PACE providers to
receive unanticipated additional resources
needed to implement the model, the Secretary
shall establish procedures for the implementing
PACE providers to submit to the Secretary a
request for additional resources.
``(vii) Monitoring outcomes.--The
Secretary, in conjunction with PACE providers
and in consultation with States that have
elected to expand PACE program eligibility
under section 1934(l), shall develop a plan
to--
``(I) annually monitor outcomes
under the model, which may include
financial, quality, access, and
utilization outcomes;
``(II) annually monitor the health
outcomes of the PACE provider's
expanded population; and
``(III) any other outcomes as
determined by the Secretary.
``(viii) Report to congress.--Not less
frequently than every 3 years (for the duration
of the implementation of the model under this
subparagraph), the Secretary shall submit to
Congress a report on the implementation of the
model under this subparagraph. The report shall
include demographic information on the
populations served under the demonstration,
best practices for future implementation
efforts and any other information the Secretary
determines appropriate together with
recommendations for such legislation and
administrative action as the Secretary
determines appropriate.
``(ix) Funding.--The Secretary shall
allocate funds made available under subsection
(f)(1) to design, implement, evaluate, and
report on the model described in clause (ii) in
accordance with this subparagraph.''.
SEC. 5. COORDINATION WITH THE FEDERAL COORDINATED HEALTH CARE OFFICE.
Section 1934 of the Social Security Act (42 U.S.C. 1396u-4), as
amended by sections 2 and 3, is further amended by adding at the end
the following new subsection:
``(m) Coordination With the Federal Coordinated Health Care
Office.--
``(1) State coordination with fchco.--The Director of the
Federal Coordinated Health Care Office established under
section 2602 of the Patient Protection and Affordable Care Act
shall serve as a point of contact between State administering
agencies and the Federal Government for purposes of
implementing and operating a PACE program in a State, and shall
coordinate with other relevant offices and staff of the Centers
for Medicare & Medicaid Services involved in carrying out this
section.
``(2) Annual report.--Not later than January 1, 2025, and
annually thereafter, the Director of the Federal Coordinated
Health Care Office shall submit to Congress a report on the
demographics of the populations served by PACE programs
operated under this section and section 1894.''.
SEC. 6. EVALUATION OF EFFECTIVENESS OF PACE PROGRAM IN RURAL AND
UNDERSERVED AREAS.
(a) In General.--The Assistant Secretary for Planning and
Evaluation of the Department of Health and Human Services (referred to
in this section as the ``Assistant Secretary'') shall conduct an
evaluation of the effectiveness of the program for all-inclusive care
for the elderly under sections 1894 and 1934 of the Social Security Act
(42 U.S.C. 1395eee, 1396u-4) in rural and underserved areas, including
with respect to the following factors:
(1) Reductions in hospitalizations and re-hospitalizations
among program beneficiaries.
(2) Reductions in emergency department use among program
beneficiaries.
(3) Reductions in long-term nursing facility use among
program beneficiaries.
(4) Reductions in mortality among program beneficiaries.
(5) Achieving lower rates of functional decline, and
improvements in reported health status and quality of life
among program beneficiaries.
(6) Reductions in the total cost of care among program
beneficiaries.
(7) The effect of activities supported under the program on
the local area serviced by the program, including on the health
and well-being of unpaid and family caregivers of program
beneficiaries.
(8) Improvements in quality of life among program
beneficiaries.
(b) Report.--Not later than 60 months after the date of enactment
of this Act, the Assistant Secretary shall submit a report containing
the results of the evaluation required under subsection (a), an
analysis of which elements of the program for all-inclusive care for
the elderly under sections 1894 and 1934 of the Social Security Act (42
U.S.C. 1395eee, 1396u-4) should be replicated and scaled by
governmental or non-governmental entities, and such recommendations for
legislation and administrative action as the Assistant Secretary
determines appropriate to the chairs and ranking members of the
following committees:
(1) The Special Committee on Aging of the Senate.
(2) The Committee on Finance of the Senate.
(3) The Committee on Health, Education, Labor, and Pensions
of the Senate.
(4) The Committee on Ways and Means of the House of
Representatives.
(5) The Committee on Energy and Commerce of the House of
Representatives.
(c) Partners.--In conducting the evaluation and completing the
report required under this section, the Assistant Secretary shall
provide an opportunity for partners and persons that have participated
in the program for all-inclusive care for the elderly under sections
1894 and 1934 of the Social Security Act (42 U.S.C. 1395eee, 1396u-4)
on every level, especially individuals who receive care through the
program and their unpaid or family caregivers, to have an opportunity
to contribute their expertise to evaluating the strategy and outcomes
of the program.
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