PACE applicants could enroll people any day of the month

Eligible people could enroll in PACE any day of the month, and providers and states would prorate first-month payments for midmonth enrollment. The rules cover Medicare and Medicaid payments to providers for enrolled individuals. The individual must be eligible for a PACE program. These rules would apply to enrollments made on or after January 1, 2027.

Entities could submit PACE applications at any time, and certain applications would count as approved if the Secretary does not meet the review deadlines. The procedures cover entities seeking PACE provider status, service area changes, or new PACE center sites. Applications to expand a service area, add a center, or do both are subject to requirements tied to the first trial period audit. A qualified provider adding a center in its existing service area could send a notice instead of applying if the state is willing to amend the program agreement, the provider passed its first audit, and it is not subject to a specified sanction, enforcement action, or termination proceeding. For certain applications, assurances that required team members and contracts will be in place when the center opens would replace deadlines for having them in place earlier. The procedures would begin January 1, 2027. If the Secretary requests more information, a new 45-day review period would begin when the Secretary receives it.

States would have to provide Medicaid coverage for PACE services to eligible people enrolled in a PACE program. The requirement would apply to every state and to its Medicaid-eligible residents enrolled in PACE. Coverage would apply to people eligible for Medicaid through a state plan or waiver and enrolled under a PACE program agreement. If the Secretary determines that a state needs legislation other than an appropriation to comply, the state would have until after its first regular legislative session ending after enactment. The compliance date would be 180 days after enactment for states with an existing PACE agreement, and three years after enactment for other states. A state that needs legislation could have until after its next qualifying regular legislative session.

PACE programs with a complete application could market to prospective participants while the application is under review. This would cover PACE programs and entities applying to become PACE programs. The application must seek program approval, a service area expansion, a new center, or both an expansion and a new center. Marketing could include materials conditionally approved by the Secretary. The rule would apply to marketing conducted on or after 180 days after enactment.

The Secretary and state agencies would establish procedures for PACE provider agreements, and providers would generally have the same operating terms as nonprofit private providers. The provisions cover PACE providers and entities that meet the requirements to become providers. The procedures would cover entering into, extending, and ending agreements with entities that meet the provider requirements. These provisions would take effect on enactment.