I 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Program of All-inclu5 sive Care for the Elderly Expanded Act’’ or the ‘‘PACE 

6 Expanded Act’’. 

7 SEC. 2. ANYTIME ENROLLMENT IN PACE. 

8 (a) IN GENERAL.— 


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1 (1) ANY TIME ENROLLMENT AND EFFECTIVE

2 DATE.—Section 1894(c)(5) of the Social Security 

3 Act (42 U.S.C. 1395eee(c)(5)) is amended by adding 

4 at the end the following new subparagraph: 

5 ‘‘(C) ANY TIME ENROLLMENT AND EFFEC6 TIVE DATE OF ENROLLMENT.— 

7 ‘‘(i) ANY TIME ENROLLMENT.—A 

8 PACE program eligible individual may en9 roll in a PACE program at any time dur10 ing a month. 

11 ‘‘(ii) EFFECTIVE DATE.—Subject to 

12 clause (iii), the enrollment of a PACE pro13 gram eligible individual in a PACE pro14 gram shall be effective on the date the 

15 PACE provider operating the PACE pro16 gram receives an enrollment agreement 

17 signed by such PACE program eligible in18 dividual with respect to such PACE pro19 gram. 

20 ‘‘(iii) SPECIAL RULE IN THE CASE OF

21 DUAL ELIGIBLE BENEFICIARIES.—In the 

22 case of a PACE program eligible individual 

23 who is eligible for benefits under this title 

24 and title XIX, clause (i) shall only apply if 

25 the State in which such individual resides 


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1 has made an election under section 

2 1934(c)(5)(C) to permit PACE program 

3 eligible individuals to enroll in a PACE 

4 program at any time during a month in 

5 such State.’’. 

6 (2) PRORATED PAYMENTS.—Section 1894(d) of 

7 the Social Security Act (42 U.S.C. 1395eee(d)) is 

8 amended by adding at the end the following new 

9 paragraph: 

10 ‘‘(4) PRORATED PAYMENTS.—In the case of a 

11 PACE program eligible individual enrolled in a 

12 PACE program operated by a PACE provider with 

13 an enrollment effective date that is not the first day 

14 of a month, the capitation amount that would other15 wise be made under this subsection to the PACE 

16 provider for such individual for the first month in 

17 which such individual is so enrolled shall be prorated 

18 accordingly.’’. 

19 (b) CONFORMING AMENDMENTS.— 

20 (1) ANYTIME ENROLLMENT AND EFFECTIVE

21 DATE.—Section 1934(c)(5) of the Social Security 

22 Act (42 U.S.C. 1396u–4(c)(5)) is amended by add23 ing at the end the following new subparagraph: 


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1 ‘‘(C) STATE OPTION TO PERMIT ANY TIME

2 ENROLLMENT AND EFFECTIVE DATE OF EN3 ROLLMENT.— 

4 ‘‘(i) ANY TIME ENROLLMENT.—A 

5 State may elect to permit a PACE pro6 gram eligible individual to enroll in a 

7 PACE program at any time during a 

8 month. 

9 ‘‘(ii) EFFECTIVE DATE.—Pursuant to 

10 a State election made under clause (i), the 

11 enrollment of a PACE program eligible in12 dividual in a PACE program shall be effec13 tive on the date the PACE provider oper14 ating the PACE program receives an en15 rollment agreement signed by such PACE 

16 program eligible individual with respect to 

17 such PACE program.’’. 

18 (2) PRORATED PAYMENTS.—Section 1934(d) of 

19 the Social Security Act (42 U.S.C. 1396u–4(d)) is 

20 amended by adding at the end the following new 

21 paragraph: 

22 ‘‘(3) PRORATED PAYMENTS.—If a State elects 

23 under subsection (c)(5)(C) to permit enrollment at 

24 any time during a month, in the case of a PACE 

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1 gram operated by a PACE provider with an enroll2 ment effective date that is not the first day of a 

3 month, the State shall prorate the capitation amount 

4 that would otherwise be made under this subsection 

5 to the PACE provider for such individual for the 

6 first month in which such individual is so enrolled.’’. 

7 (c) EFFECTIVE DATE.—The amendments made by 

8 this section shall take effect on January 1, 2025. 

9 SEC. 3. PACE SITE APPROVAL AND EXPANSION. 

10 (a) IN GENERAL.—Sections 1894(e) and 1934(e) of 

11 the Social Security Act (42 U.S.C. 1395eee(e); 1396u– 

12 4(e)) are each amended by striking paragraph (8) and in13 serting the following: 

14 ‘‘(8) AUTHORITY TO SUBMIT APPLICATIONS AT

15 ANY TIME; TIMELY CONSIDERATION OF APPLICA16 TIONS.— 

17 ‘‘(A) AUTHORITY TO SUBMIT APPLICA18 TIONS AT ANY TIME.— 

19 ‘‘(i) NEW PACE PROVIDER STATUS.— 

20 An entity that seeks to become a PACE 

21 provider may submit an application for 

22 PACE provider status at any time. 

23 ‘‘(ii) SERVICE AREA EXPANSION AND

24 ADDITION OF PACE CENTER SITE.—To the 

25 extent the Secretary requires a PACE proVerDate Sep 11 2014 03:03 Dec 12, 2023 Jkt 049200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H6590.IH H6590

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1 vider to submit an application to expand 

2 its service area or to add a PACE center 

3 site (or both), a PACE provider may sub4 mit such an application at any time, sub5 ject to the requirements of section 

6 460.12(d) of title 42, Code of Federal Reg7 ulations (relating to the first trial period 

8 audit), or any successor regulation. 

9 ‘‘(iii) ASSURANCES.—An application 

10 for PACE provider status under clause (i) 

11 or to add a PACE center site under clause 

12 (ii) shall include the following assurances: 

13 ‘‘(I) An assurance that the re14 quired members of the interdiscipli15 nary team are employees or contrac16 tors of the proposed PACE center or 

17 will be employees or contractors of the 

18 proposed PACE center by the time 

19 the PACE center becomes operational. 

20 ‘‘(II) An assurance that— 

21 ‘‘(aa) the PACE provider’s 

22 contracts for all contractors and 

23 contracted personnel will be exe24 cuted by the time the proposed 


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1 PACE center becomes oper2 ational; and 

3 ‘‘(bb) executed contracts 

4 may include provisions for staff5 ing levels commensurate with en6 rollment to full projected census. 

7 ‘‘(B) DEEMED APPROVAL.—An application 

8 described in subparagraph (A) shall be deemed 

9 approved unless the Secretary, within 45 days 

10 after the date of the submission of the applica11 tion to the Secretary, either denies such request 

12 in writing or informs the applicant in writing 

13 with respect to any additional information that 

14 is needed in order to make a final determina15 tion with respect to the application. After the 

16 date the Secretary receives such additional in17 formation, the application shall be deemed ap18 proved unless the Secretary, within 45 days of 

19 such date, denies such request.’’. 

20 (b) EFFECTIVE DATE.—The amendments made by 

21 subsection (a) shall take effect on January 1, 2025. 

22 SEC. 4. PACE PILOT. 

23 Section 1115A(b)(2) of the Social Security Act (42 

24 U.S.C. 1315a(b)(2)) is amended— 


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1 (1) in subparagraph (B), by adding at the end 

2 the following new clause: 

3 ‘‘(xxviii) National testing of a model 

4 for expanded eligibility for the Program of 

5 All-Inclusive Care for the Elderly as de6 scribed in subparagraph (D).’’; and 

7 (2) by adding at the end the following new sub8 paragraph: 

9 ‘‘(D) NATIONAL TESTING OF MODEL FOR

10 EXPANDED ELIGIBILITY FOR THE PROGRAM OF

11 ALL-INCLUSIVE CARE FOR THE ELDERLY.—In 

12 the case where the Secretary selects the model 

13 described in clause (ii) of this subparagraph for 

14 testing pursuant to clause (xxviii) of subpara15 graph (B), the following shall apply: 

16 ‘‘(i) NATIONAL TESTING.— 

17 ‘‘(I) IN GENERAL.—Subject to 

18 subclause (II), the Secretary shall de19 sign a demonstration that allows each 

20 PACE provider with an executed 

21 PACE agreement to develop and sub22 mit to the Secretary an application to 

23 begin testing expanded PACE eligi24 bility for high-need and high-cost pop25 ulations that are not otherwise eligible 


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1 to participate in a PACE program 

2 within 1 year of the date on which the 

3 model is selected. 

4 ‘‘(II) NO EFFECT ON ONGOING

5 MODELS OR DEMONSTRATION

6 PROJECTS.—Nothing in this subpara7 graph shall affect the testing of any 

8 model under this subsection or any 

9 demonstration project under this Act 

10 that is implemented prior to the date 

11 of the enactment of this subpara12 graph. 

13 ‘‘(ii) MODEL DESCRIBED.—The model 

14 described in this clause seeks to increase 

15 access to quality, integrated, care for high16 need, high-cost individuals who are not 

17 otherwise eligible to participate in a PACE 

18 program in order to improve health and re19 duce cost. Under this model, participating 

20 PACE providers would— 

21 ‘‘(I) be paid fixed, monthly 

22 capitated rates from both Medicare 

23 and the applicable State Medicaid 

24 agency for all services provided to 

25 each enrollee fitting the criteria of the 


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1 PACE provider’s designated popu2 lation; 

3 ‘‘(II) partner with non-PACE 

4 providers, such as Area Agencies on 

5 Aging, Centers for Independent Liv6 ing, local hospitals, and non-hospital 

7 providers such as physicians, behav8 ioral health providers and other com9 munity-based organizations to effec10 tively reach the PACE provider’s se11 lected population; 

12 ‘‘(III) adapt the PACE program 

13 model of care to appropriately serve 

14 the PACE provider’s selected popu15 lation to integrate care and meet the 

16 unique needs of said population; and 

17 ‘‘(IV) if the PACE provider is lo18 cated in a State that has not yet 

19 served the selected population through 

20 a PACE program under section 1934, 

21 receive an up-front fixed payment to 

22 coordinate with the State to develop a 

23 capitated payment rate, with appro24 priate risk adjustment, for the PACE 

25 provider’s selected population. 


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1 ‘‘(iii) REQUIREMENTS FOR PARTICI2 PATING PACE ORGANIZATIONS.—In order 

3 to participate in the model, a PACE pro4 vider must— 

5 ‘‘(I) conduct a survey or needs 

6 assessment of their service area to de7 termine the most appropriate popu8 lation with which to expand their serv9 ices; 

10 ‘‘(II) receive prior approval from 

11 the applicable State Medicaid agency 

12 to submit an application to participate 

13 in the model; and 

14 ‘‘(III) following such survey or 

15 needs assessment and approval from 

16 the applicable State Medicaid agency, 

17 submit and receive approval of an ap18 plication of expansion from the Sec19 retary. 

20 ‘‘(iv) APPLICATION.—A PACE pro21 vider’s application to participate in this 

22 model shall include the following informa23 tion: 

24 ‘‘(I) Results of the survey or 

25 needs assessment of their service area 


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1 under clause (iii)(I) and an expla2 nation of the expanded population the 

3 PACE organization will serve. 

4 ‘‘(II) The types of services that 

5 the expanded population will require 

6 and the PACE provider’s plan to im7 plement these services. 

8 ‘‘(III) How the PACE provider 

9 will achieve engagement and enroll10 ment of the new population in the 

11 model, including how it will partner 

12 with non-PACE providers in the ap13 plicable service area. 

14 ‘‘(IV) How the expanded popu15 lation’s participation in the PACE 

16 program is intended to improve qual17 ity of care and health outcomes under 

18 the model. 

19 ‘‘(V) Certification that the appli20 cable State Medicaid agency has ap21 proved the PACE provider’s applica22 tion to participate in the model. 

23 ‘‘(VI) Plans to coordinate with 

24 the State Medicaid agency to develop 


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1 an initial capitated rate with appro2 priate risk adjustment. 

3 ‘‘(VII) Plans for the PACE pro4 vider and the State Medicaid agency 

5 to review and adjust the Medicaid 

6 capitated rate on a biennial basis, as 

7 needed. 

8 ‘‘(VIII) Any other information 

9 required by the Secretary. 

10 ‘‘(v) TECHNICAL ASSISTANCE.—The 

11 Secretary shall provide, or designate an en12 tity to provide, technical assistance to par13 ticipating PACE providers as they apply 

14 for and implement the model. 

15 ‘‘(vi) ACCOUNTING FOR UNCER16 TAINTY.—In order for implementing 

17 PACE providers to receive unanticipated 

18 additional resources needed to implement 

19 the model, the Secretary shall establish 

20 procedures for the implementing PACE 

21 providers to submit to the Secretary a re22 quest for additional resources. 

23 ‘‘(vii) MONITORING OUTCOMES.—The 

24 Secretary, in conjunction with PACE pro25 viders and in consultation with States that 


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1 have elected to expand PACE program eli2 gibility under section 1934(l), shall develop 

3 a plan to— 

4 ‘‘(I) annually monitor outcomes 

5 under the model, which may include 

6 financial, quality, access, and utiliza7 tion outcomes; 

8 ‘‘(II) annually monitor the health 

9 outcomes of the PACE provider’s ex10 panded population; and 

11 ‘‘(III) any other outcomes as de12 termined by the Secretary. 

13 ‘‘(viii) REPORT TO CONGRESS.—Not 

14 less frequently than every 3 years (for the 

15 duration of the implementation of the 

16 model under this subparagraph), the Sec17 retary shall submit to Congress a report on 

18 the implementation of the model under this 

19 subparagraph. The report shall include de20 mographic information on the populations 

21 served under the demonstration, best prac22 tices for future implementation efforts and 

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1 ministrative action as the Secretary deter2 mines appropriate. 

3 ‘‘(ix) FUNDING.—The Secretary shall 

4 allocate funds made available under sub5 section (f)(1) to design, implement, evalu6 ate, and report on the model described in 

7 clause (ii) in accordance with this subpara8 graph.’’. 

9 SEC. 5. COORDINATION WITH THE FEDERAL COORDINATED 

10 HEALTH CARE OFFICE. 

11 Section 1934 of the Social Security Act (42 U.S.C. 

12 1396u–4), as amended by sections 2 and 3, is further 

13 amended by adding at the end the following new sub14 section: 

15 ‘‘(m) COORDINATION WITH THE FEDERAL COORDI16 NATED HEALTH CARE OFFICE.— 

17 ‘‘(1) STATE COORDINATION WITH FCHCO.—The 

18 Director of the Federal Coordinated Health Care Of19 fice established under section 2602 of the Patient 

20 Protection and Affordable Care Act shall serve as a 

21 point of contact between State administering agen22 cies and the Federal Government for purposes of im23 plementing and operating a PACE program in a 

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1 fices and staff of the Centers for Medicare & Med2 icaid Services involved in carrying out this section. 

3 ‘‘(2) ANNUAL REPORT.—Not later than Janu4 ary 1, 2025, and annually thereafter, the Director of 

5 the Federal Coordinated Health Care Office shall 

6 submit to Congress a report on the demographics of 

7 the populations served by PACE programs operated 

8 under this section and section 1894.’’. 

9 SEC. 6. EVALUATION OF EFFECTIVENESS OF PACE PRO10 GRAM IN RURAL AND UNDERSERVED AREAS. 

11 (a) IN GENERAL.—The Assistant Secretary for Plan12 ning and Evaluation of the Department of Health and 

13 Human Services (referred to in this section as the ‘‘Assist14 ant Secretary’’) shall conduct an evaluation of the effec15 tiveness of the program for all-inclusive care for the elder16 ly under sections 1894 and 1934 of the Social Security 

17 Act (42 U.S.C. 1395eee, 1396u–4) in rural and under18 served areas, including with respect to the following fac19 tors: 

20 (1) Reductions in hospitalizations and re-hos21 pitalizations among program beneficiaries. 

22 (2) Reductions in emergency department use 

23 among program beneficiaries. 

24 (3) Reductions in long-term nursing facility use 

25 among program beneficiaries. 


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1 (4) Reductions in mortality among program 

2 beneficiaries. 

3 (5) Achieving lower rates of functional decline, 

4 and improvements in reported health status and 

5 quality of life among program beneficiaries. 

6 (6) Reductions in the total cost of care among 

7 program beneficiaries. 

8 (7) The effect of activities supported under the 

9 program on the local area serviced by the program, 

10 including on the health and well-being of unpaid and 

11 family caregivers of program beneficiaries. 

12 (8) Improvements in quality of life among pro13 gram beneficiaries. 

14 (b) REPORT.—Not later than 60 months after the 

15 date of enactment of this Act, the Assistant Secretary 

16 shall submit a report containing the results of the evalua17 tion required under subsection (a), an analysis of which 

18 elements of the program for all-inclusive care for the elder19 ly under sections 1894 and 1934 of the Social Security 

20 Act (42 U.S.C. 1395eee, 1396u–4) should be replicated 

21 and scaled by governmental or non-governmental entities, 

22 and such recommendations for legislation and administra23 tive action as the Assistant Secretary determines appro24 priate to the chairs and ranking members of the following 

25 committees: 


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1 (1) The Special Committee on Aging of the 

2 Senate. 

3 (2) The Committee on Finance of the Senate. 

4 (3) The Committee on Health, Education, 

5 Labor, and Pensions of the Senate. 

6 (4) The Committee on Ways and Means of the 

7 House of Representatives. 

8 (5) The Committee on Energy and Commerce 

9 of the House of Representatives. 

10 (c) PARTNERS.—In conducting the evaluation and 

11 completing the report required under this section, the As12 sistant Secretary shall provide an opportunity for partners 

13 and persons that have participated in the program for all14 inclusive care for the elderly under sections 1894 and 

15 1934 of the Social Security Act (42 U.S.C. 1395eee, 

16 1396u–4) on every level, especially individuals who receive 

17 care through the program and their unpaid or family care18 givers, to have an opportunity to contribute their expertise 

19 to evaluating the strategy and outcomes of the program. 

Æ 


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