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115TH CONGRESS REPT. 115–934 " ! HOUSE OF REPRESENTATIVES 2d Session Part 1 

COMPREHENSIVE CARE FOR SENIORS ACT OF 2018 

SEPTEMBER 10, 2018.—Committed to the Committee of the Whole House on the 

State of the Union and ordered to be printed 

Mr. BRADY of Texas, from the Committee on Ways and Means, 

submitted the following 

R E P O R T 

[To accompany H.R. 6561] 

[Including cost estimate of the Congressional Budget Office] 

The Committee on Ways and Means, to whom was referred the 

bill (H.R. 6561) to direct the Secretary of Health and Human Services to finalize certain proposed provisions relating to the Programs 

of All-Inclusive Care for the Elderly (PACE) under the Medicare 

and Medicaid programs, having considered the same, report favorably thereon with amendments and recommend that the bill as 

amended do pass. 

CONTENTS 

Page 

I. SUMMARY AND BACKGROUND ............................................................... 2 

A. Purpose and Summary ..................................................................... 2 

B. Background and Need for Legislation ............................................. 2 

C. Legislative History ............................................................................ 3 

II. EXPLANATION OF THE BILL ................................................................... 3 

A. Comprehensive Care for Seniors Act of 2018 ................................. 3 

III. VOTES OF THE COMMITTEE .................................................................... 4 

IV. BUDGET EFFECTS OF THE BILL ............................................................ 4 

A. Committee Estimate of Budgetary Effects ...................................... 4 

B. Statement Regarding New Budget Authority and Tax Expenditures Budget Authority .................................................................. 4 

C. Cost Estimate Prepared by the Congressional Budget Office ....... 4 

V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF 

THE HOUSE .............................................................................................. 5 

A. Committee Oversight Findings and Recommendations ................. 5 

B. Statement of General Performance Goals and Objectives ............. 5 

C. Information Relating to Unfunded Mandates ................................ 5 

D. Congressional Earmarks, Limited Tax Benefits, and Limited 

Tariff Benefits ................................................................................. 5 

E. Duplication of Federal Programs ..................................................... 5 

F. Disclosure of Directed Rule Makings .............................................. 6 


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VI. CORRESPONDENCE ................................................................................... 7 

VII. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED 10 

A. Changes in Existing Law Proposed by the Bill, as Reported ........ 10 

The amendments are as follows: 

Strike all after the enacting clause and insert the following: 

SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘Comprehensive Care for Seniors Act of 2018’’. 

SEC. 2. DIRECTING THE SECRETARY OF HEALTH AND HUMAN SERVICES TO ISSUE A FINAL 

REGULATION BASED ON THE PROPOSED REGULATION RELATING TO THE PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) UNDER THE MEDICARE AND MEDICAID PROGRAMS. 

Not later than December 31, 2018, the Secretary of Health and Human Services 

shall issue a final regulation based on the provisions of the proposed regulation titled ‘‘Medicare and Medicaid Programs; Programs of All-Inclusive Care for the Elderly (PACE)’’ (81 Fed. Reg. 54666). 

Amend the title so as to read: 

A bill to direct the Secretary of Health and Human Services to 

issue a final regulation based on the proposed regulation relating 

to the Programs of All-Inclusive Care for the Elderly (PACE) under 

the Medicare and Medicaid programs. 

I. SUMMARY AND BACKGROUND 

A. PURPOSE AND SUMMARY

The bill, H.R. 6561, the Comprehensive Care for Seniors Act of 

2018,’’ as ordered reported by the Committee on Ways and Means 

on September 5, 2018, directs the Secretary of the Department of 

Health and Human Services (the Secretary’’) to finalize the Program of All-Inclusive Care for the Elderly (PACE) regulations, 

originally proposed in August 2016, no later than December 31, 

2018. The bill provides the Secretary with the flexibility to make 

updates and changes to the proposed regulation. 

B. BACKGROUND AND NEED FOR LEGISLATION

PACE is a capitated benefit for frail elders that features a comprehensive service delivery system and integrated Medicare and 

Medicaid financing. PACE was tested through demonstration 

projects that began in the mid-1980s and were permanently authorized in the Balanced Budget Act of 1997. PACE enables states 

to provide services to Medicaid beneficiaries who are also enrolled 

in Medicare as a state plan option. Operationally, the PACE program is unique as a three-way partnership between the Federal 

government, the State, and the PACE organization. More than 

34,000 older adults are currently enrolled in about 100 PACE organizations in 31 states. Enrollment in PACE has increased by over 

60 percent since 2011. 

CMS published a regulation on August 16, 2016, proposing 

changes to the PACE model to increase flexibility of the Interdisciplinary Team (IDT) to better coordinate care for the beneficiary, as well as other updates and clarifications to improve operation. This regulation represents the first major proposed update to 

the PACE program since 2006. Specifically, the pending regulation 

includes changes to application and waiver procedures, sanctions, 

enforcement actions and termination, administrative requirements, 

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ance improvement, participant enrollment and disenrollment, payment, federal and state monitoring, data collection, record maintenance, and reporting. The most needed changes include: (1) allowing PACE organizations to include community physicians as part 

of their hallmark IDT; (2) using nurse practitioners and physician 

assistants as primary care providers; (3) providing services in settings other than the PACE Center; and (4) configuring the IDT to 

meet the needs of individual participants. To date, CMS has not 

published a regulation finalizing the PACE changes proposed in 

2016. 

C. LEGISLATIVE HISTORY

Background 

H.R. 6561 was introduced on July 26, 2018, and was referred to 

the Committee on Ways and Means and additionally the Committee on Energy and Commerce. 

Committee hearings 

On June 7, 2017, the Subcommittee on Health held a hearing on 

Promoting Integrated and Coordinated Care for Medicare Beneficiaries to review the current status of the PACE program and 

Special Needs Plans. 

Committee action 

The Committee on Ways and Means marked up H.R. 6561, the 

Comprehensive Care for Seniors Act of 2018,’’ on September 5, 

2018, and ordered the bill, as amended, favorably reported (with a 

quorum being present). 

II. EXPLANATION OF THE BILL 

A. COMPREHENSIVE CARE FOR SENIORS ACT OF 2018 

PRESENT LAW

The Secretary has the authority to issue initial interim and final 

PACE program regulations. However, it is not required by law to 

finalize pending regulations within a certain timeframe. 

REASONS FOR CHANGE

The 2016 proposed regulation provides much needed flexibilities 

and updates to the PACE program. 

EXPLANATION OF PROVISIONS

Section 1: Short Title: The Comprehensive Care for Seniors Act 

of 2018.’’ 

Section 2: Directing the Secretary of Health and Human Services 

to finalize certain proposed provisions relating to the Programs of 

All-Inclusive Care for the Elderly (PACE) under the Medicare and 

Medicaid programs. 

This section stipulates that the Secretary has until December 31, 

2018, to finalize the provisions proposed in the rule titled Medicare 

and Medicaid Programs; Programs of All-Inclusive Care for the Elderly (PACE)’’ (81 Fed. Reg. 54666). This section also provides the 


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Secretary with the authority to make updates and changes to the 

proposed regulation. 

EFFECTIVE DATE

The Secretary must finalize PACE regulations no later than December 31, 2018. 

III. VOTES OF THE COMMITTEE 

In compliance with clause 3(b) of rule XIII of the Rules of the 

House of Representatives, the following statement is made concerning the vote of the Committee on Ways and Means in its consideration of H.R. 6561, the Comprehensive Care for Seniors Act of 

2018,’’ on September 5, 2018. 

The Chairman’s amendment in the nature of a substitute was 

adopted by a voice vote (with a quorum being present). 

The bill, H.R. 6561, was ordered favorably reported as amended 

by voice vote (with a quorum being present). 

IV. BUDGET EFFECTS OF THE BILL 

A. COMMITTEE ESTIMATE OF BUDGETARY EFFECTS

In compliance with clause 3(d) of rule XIII of the Rules of the 

House of Representatives, the following statement is made concerning the effects on the budget of the bill, H.R. 6690, as reported. 

The Committee agrees with the estimate prepared by the Congressional Budget Office (CBO), which is included below. 

B. STATEMENT REGARDING NEW BUDGET AUTHORITY AND TAX

EXPENDITURES BUDGET AUTHORITY

In compliance with clause 3(c)(2) of rule XIII of the Rules of the 

House of Representatives, the Committee states that the bill involves no new or increased budget authority. The Committee states 

further that the bill involves no new or increased tax expenditures. 

C. COST ESTIMATE PREPARED BY THE CONGRESSIONAL BUDGET

OFFICE

In compliance with clause 3(c)(3) of rule XIII of the Rules of the 

House of Representatives, requiring a cost estimate prepared by 

the CBO, the following statement by CBO is provided. 

U.S. CONGRESS, 

CONGRESSIONAL BUDGET OFFICE, 

Washington, DC, September 10, 2018. Hon. KEVIN BRADY, 

Chairman, Committee on Ways and Means, 

House of Representatives, Washington, DC. 

DEAR MR. CHAIRMAN: The Congressional Budget Office has prepared the enclosed cost estimate for H.R. 6561, the Comprehensive 

Care for Seniors Act of 2018. 

If you wish further details on this estimate, we will be pleased 

to provide them. The CBO staff contact is Lori Housman. 

Sincerely, KEITH HALL, 

Director. Enclosure. 


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H.R. 6561—Comprehensive Care for Seniors Act of 2018 

H.R. 6561 would direct the Secretary of Health and Human Services to issue a final regulation based on the provisions of the proposed regulation for the Programs of All-Inclusive Care for the Elderly program by December 31, 2018. 

CBO estimates that enacting this bill would have no significant 

effect on the federal budget. Enacting H.R. 6561 would not affect 

direct spending or revenues; therefore, pay-as-you-go procedures do 

not apply. CBO estimates that enacting H.R. 6561 would not increase net direct spending or on-budget deficits in any of the four 

consecutive 10-year periods beginning in 2029. 

H.R. 6561 contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act. 

The CBO staff contact for this estimate is Lori Housman (for federal costs) and Andrew Laughlin (for intergovernmental or privatesector mandates). The estimate was reviewed by Theresa Gullo, Assistant Director for Budget Analysis. 

V. OTHER MATTERS TO BE DISCUSSED UNDER THE 

RULES OF THE HOUSE 

A. COMMITTEE OVERSIGHT FINDINGS AND RECOMMENDATIONS

With respect to clause 3(c)(1) of rule XIII of the Rules of the 

House of Representatives, the Committee made findings and recommendations that are reflected in this report. 

B. STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

With respect to clause 3(c)(4) of rule XIII of the Rules of the 

House of Representatives, the Committee advises that the bill contains no measure that authorizes funding, so no statement of general performance goals and objectives for which any measure authorizes funding is required. 

C. INFORMATION RELATING TO UNFUNDED MANDATES

This information is provided in accordance with section 423 of 

the Unfunded Mandates Reform Act of 1995 (Pub. L. No. 104–4). 

The Committee has determined that the bill does not contain 

Federal mandates on the private sector. The Committee has determined that the bill does not impose a Federal intergovernmental 

mandate on State, local, or tribal governments. 

D. CONGRESSIONAL EARMARKS, LIMITED TAX BENEFITS, AND

LIMITED TARIFF BENEFITS

With respect to clause 9 of rule XXI of the Rules of the House 

of Representatives, the Committee has carefully reviewed the provisions of the bill, and states that the provisions of the bill do not 

contain any congressional earmarks, limited tax benefits, or limited 

tariff benefits within the meaning of the rule. 

E. DUPLICATION OF FEDERAL PROGRAMS

In compliance with Sec. 3(g)(2) of H. Res. 5 (114th Congress), the 

Committee states that no provision of the bill establishes or reauthorizes: (1) a program of the Federal Government known to be duVerDate Sep 11 2014 04:10 Sep 13, 2018 Jkt 079006 PO 00000 Frm 00005 Fmt 6659 Sfmt 6602 E:\HR\OC\HR934P1.XXX HR934P1

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plicative of another Federal program; (2) a program included in any 

report from the Government Accountability Office to Congress pursuant to section 21 of Public Law 111–139; or (3) a program related 

to a program identified in the most recent Catalog of Federal Domestic Assistance, published pursuant to the Federal Program Information Act (Pub. L. No. 95–220, as amended by Pub. L. No. 98– 

169). 

F. DISCLOSURE OF DIRECTED RULE MAKINGS

In compliance with Sec. 3(i) of H. Res. 5 (114th Congress), the 

following statement is made concerning directed rule makings: The 

Committee estimates that the bill requires no directed rule makings within the meaning of such section. 


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VII. CHANGES IN EXISTING LAW MADE BY THE BILL, AS 

REPORTED 

A. CHANGES IN EXISTING LAW PROPOSED BY THE BILL, AS REPORTED

In compliance with clause 3(e)(1)(B) of rule XIII of the Rules of 

the House of Representatives, the bill, as reported, makes no 

changes to existing law. 

Æ 


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