I 

117TH CONGRESS 

2D SESSION H. R. 6770 

To improve access to the Program of All-Inclusive Care for the Elderly, 

and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 18, 2022 

Mrs. DINGELL (for herself and Mr. BLUMENAUER) 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 Plus Act’’ or the ‘‘PACE Plus 

6 Act’’. 

7 SEC. 2. PACE EXPANSION GRANT PROGRAM. 

8 (a) DEFINITIONS.—In this section: 


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1 (1) AREA AGENCY ON AGING.—The term ‘‘area 

2 agency on aging’’ has the meaning given that term 

3 in section 102 of the Older Americans Act of 1965 

4 (42 U.S.C. 3002). 

5 (2) CMS.—The term ‘‘CMS’’ means the Cen6 ters for Medicare & Medicaid Services. 

7 (3) FOR-PROFIT PACE PROVIDER.—The term 

8 ‘‘for-profit PACE provider’’ means a PACE provider 

9 that is operated by an entity that is not a public en10 tity or a private, nonprofit entity organized for char11 itable purposes under section 501(c)(3) of the Inter12 nal Revenue Code of 1986. 

13 (4) PACE PILOT SITE.—The term ‘‘PACE pilot 

14 site’’ means a PACE provider that— 

15 (A) has been approved to provide services 

16 in a geographic service area that is, in whole or 

17 in part, a rural area or an underserved urban 

18 area; and 

19 (B) has received a grant under subsection 

20 (b). 

21 (5) PACE PROGRAM.—The term ‘‘PACE pro22 gram’’ has the meaning given that term in sections 

23 1894(a)(2) and 1934(a)(2) of the Social Security 

24 Act (42 U.S.C. 1395eee(a)(2); 1396u–4(a)(2)). 


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1 (6) PACE PROVIDER.—The term ‘‘PACE pro2 vider’’ has the meaning given that term in section 

3 1894(a)(3) or 1934(a)(3) of the Social Security Act 

4 (42 U.S.C. 1395eee(a)(3); 1396u–4(a)(3)). 

5 (7) RURAL AREA.—The term ‘‘rural area’’ has 

6 the meaning given that term in section 

7 1886(d)(2)(D) of the Social Security Act (42 U.S.C. 

8 1395ww(d)(2)(D)). 

9 (8) SECRETARY.—The term ‘‘Secretary’’ means 

10 the Secretary of Health and Human Services. 

11 (9) UNDERSERVED URBAN AREA.—The term 

12 ‘‘underserved urban area’’ means an urban health 

13 professional shortage area (as such term is defined 

14 in section 332 of the Public Health Service Act (42 

15 U.S.C. 254e)). 

16 (b) SITE DEVELOPMENT ASSISTANCE PROGRAM.— 

17 (1) SITE DEVELOPMENT ASSISTANCE.— 

18 (A) IN GENERAL.—The Secretary shall es19 tablish a process and criteria to award grants 

20 to qualified PACE providers that have been ap21 proved to serve a rural area or an underserved 

22 urban area. 

23 (B) REQUIREMENTS FOR PARTICIPATING

24 PACE PROVIDERS.—To be eligible for a grant 

25 under subparagraph (A), a PACE provider shall 


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1 demonstrate to the Secretary that the provider 

2 has a plan to partner with— 

3 (i) each area agency on aging serving 

4 the area that the provider is approved to 

5 serve; or 

6 (ii) if there is no area agency on aging 

7 serving such area, the applicable State 

8 Unit on Aging. 

9 (C) AMOUNT PER AWARD.—A grant 

10 awarded under subparagraph (A) to any indi11 vidual PACE pilot site shall not exceed 

12 $1,000,000. 

13 (D) NUMBER OF AWARDS.—Not more than 

14 30 PACE pilot sites shall be awarded a grant 

15 under subparagraph (A). 

16 (E) USE OF FUNDS.—Funds made avail17 able under a grant awarded under subpara18 graph (A) may be used for the following ex19 penses only to the extent such expenses are in20 curred in relation to establishing or delivering 

21 PACE program services in a rural area or un22 derserved urban area: 

23 (i) Feasibility analysis and planning. 

24 (ii) Interdisciplinary team develop25 ment. 


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1 (iii) Development of a provider net2 work, including contract development. 

3 (iv) Development or adaptation of 

4 claims processing systems. 

5 (v) Preparation of special education 

6 and outreach efforts required for the 

7 PACE program. 

8 (vi) Development of any special qual9 ity of care or patient satisfaction data col10 lection efforts. 

11 (vii) Purchase or lease of a building. 

12 (viii) Modifications to a building. 

13 (ix) To cover the cost of reinsurance 

14 during the grant period. 

15 (x) Establishment of a working capital 

16 fund to sustain fixed administrative, facil17 ity, or other fixed costs until the provider 

18 reaches sufficient enrollment size. 

19 (xi) Startup and development costs in20 curred prior to the approval of the PACE 

21 pilot site’s PACE provider application, new 

22 center application, or service area expan23 sion application by CMS. 

24 (xii) Any other efforts determined by 

25 the PACE pilot site to be critical to its 


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1 successful startup, as approved by the Sec2 retary. 

3 (F) SITE DEVELOPMENT GRANT ELIGI4 BILITY.— 

5 (i) GRANT ELIGIBILITY.—A PACE 

6 provider shall only be eligible to receive a 

7 grant under this subsection if the provider 

8 is not a for-profit PACE provider. 

9 (ii) LIMITATION ON ELIGIBILITY TO

10 PROVIDERS IN 3-WAY PACE PROGRAM

11 AGREEMENTS.—A PACE provider shall 

12 not be eligible for a grant under this sub13 section unless the provider has entered into 

14 an agreement, consistent with sections 

15 1894 and 1934 of the Social Security Act 

16 (42 U.S.C. 1395eee, 1396u–4), and regula17 tions promulgated to carry out such sec18 tions, among the PACE provider, the Sec19 retary, and a State administering agency 

20 for the operation of a PACE program by 

21 the provider under such sections. 

22 (2) TECHNICAL ASSISTANCE PROGRAM.—The 

23 Secretary shall establish a technical assistance pro24 gram to provide— 


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1 (A) outreach and education to State agen2 cies and provider organizations interested in es3 tablishing and expanding PACE programs in 

4 rural areas or underserved urban areas; and 

5 (B) technical assistance necessary to sup6 port PACE pilot sites. 

7 (3) APPROPRIATION.—There is appropriated to 

8 the Secretary $30,000,000 to carry out this sub9 section, to remain available until expended. 

10 (c) EVALUATION OF PACE PROVIDERS SERVING

11 RURAL OR UNDERSERVED URBAN SERVICE AREAS.—Not 

12 later than 60 months after the date of enactment of this 

13 Act, the Secretary shall submit a report to Congress, in14 cluding the Special Committee on Aging of the Senate and 

15 the Committee on Finance of the Senate, containing an 

16 evaluation of the experience of PACE pilot sites in rural 

17 areas and underserved urban areas. 

18 (d) STATE EXPANSION GRANTS.— 

19 (1) IN GENERAL.—The Secretary shall establish 

20 a process and criteria to award State expansion 

21 grants to qualified State agencies in States that do 

22 not currently have PACE providers. 

23 (2) AMOUNT PER AWARD.—A State expansion 

24 grant awarded under subparagraph (A) to any State 

25 agency shall not exceed $100,000. 


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1 (3) USE OF FUNDS.—Funds made available 

2 under a State expansion grant awarded under para3 graph (1) may be used for the following expenses 

4 only to the extent such expenses are incurred in re5 lation to establishing a PACE program in the State: 

6 (A) Expenditures related to the develop7 ment of a capitated payment rate model, includ8 ing appropriate risk adjustment, for making 

9 payments to PACE providers under a PACE 

10 program agreement. 

11 (B) Expenditures on any other efforts de12 termined by the State Medicaid agency to be 

13 critical to the successful implementation of a 

14 PACE program in the State, as approved by 

15 the Secretary. 

16 (4) APPROPRIATION.—There are appropriated 

17 to the Secretary $2,000,000 to carry out this sub18 section, to remain available until expended. 

19 (e) AMOUNTS IN ADDITION TO PAYMENTS UNDER

20 SOCIAL SECURITY ACT.—Any amounts paid under the au21 thority of this section to a PACE provider shall be in addi22 tion to payments made to the provider under section 1894 

23 or 1934 of the Social Security Act (42 U.S.C. 1395eee; 

24 1396u–4). 


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1 SEC. 3. TWO-WAY PACE PROGRAM AGREEMENTS. 

2 (a) MEDICARE.—Section 1894(a)(4) of the Social Se3 curity Act (42 U.S.C. 1395eee(a)(4)) is amended by add4 ing at the end the following new sentence: ‘‘Beginning 

5 January 1, 2022, with respect to a PACE provider oper6 ating in a State that has not entered into an agreement 

7 described in the previous sentence as of such date, such 

8 term shall include an agreement, consistent with this sec9 tion and regulations promulgated to carry out this section, 

10 between such a PACE provider and the Secretary for the 

11 operation of a PACE program in such State by the pro12 vider under this section alone.’’. 

13 (b) MEDICAID.—Section 1934 of the Social Security 

14 Act (42 U.S.C. 1396u–4) is amended— 

15 (1) in subsection (a)(4), by adding at the end 

16 the following new sentence: ‘‘Beginning January 1, 

17 2022, with respect to a PACE provider operating in 

18 a State that has not entered into an agreement de19 scribed in the previous sentence as of such date, 

20 such term shall include an agreement, consistent 

21 with section 1894 and regulations promulgated to 

22 carry out such section, between such a PACE pro23 vider and the Secretary for the operation of a PACE 

24 program in such State by the provider under such 

25 section 1894 alone.’’; and 


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1 (2) by adding at the end the following new sub2 section: 

3 ‘‘(k) APPLICATION TO PACE PROVIDERS IN 2-WAY

4 PACE PROGRAM AGREEMENT STATES.— 

5 ‘‘(1) IN GENERAL.—In the case of a State de6 scribed in the second sentence of subsection (a)(4), 

7 the Secretary shall administer the preceding provi8 sions of this section with respect to PACE programs 

9 offered by PACE providers under PACE program 

10 agreements described in such sentence to PACE pro11 gram eligible individuals who are eligible for benefits 

12 under part A, or enrolled under part B, of title 

13 XVIII. 

14 ‘‘(2) ASSESSMENT OF NEED OF NURSING HOME

15 LEVEL OF CARE.— 

16 ‘‘(A) IN GENERAL.—For purposes of the 

17 administration of this section pursuant to this 

18 subsection, the determination under subsection 

19 (a)(5)(B) of whether an individual requires the 

20 level of care required under the State plan for 

21 coverage of nursing facility services shall be 

22 made by an independent entity based on a level 

23 of care assessment tool used by the State to de24 termine whether an individual requires such 

25 level of care. 


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1 ‘‘(B) INDEPENDENT ENTITY DEFINED.— 

2 In this subsection, the term ‘independent entity’ 

3 means an entity with demonstrated professional 

4 knowledge to identify institutional level of care 

5 needs that— 

6 ‘‘(i) is not the PACE provider oper7 ating the PACE program involved; 

8 ‘‘(ii) is not owned or controlled by, or 

9 an employee of, such PACE provider; 

10 ‘‘(iii) does not receive any differential 

11 payment (such as a bonus) for identifying 

12 individuals who are PACE program eligible 

13 individuals under the PACE program 

14 agreement involved; and 

15 ‘‘(iv) is free of any other conflict of 

16 interest (as defined by the Secretary) be17 tween the entity and the PACE provider 

18 operating the PACE program involved.’’. 

19 SEC. 4. ANY TIME ENROLLMENT IN PACE. 

20 (a) IN GENERAL.— 

21 (1) ANY TIME ENROLLMENT AND EFFECTIVE

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

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

24 at the end the following new subparagraph: 


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1 ‘‘(C) ANY TIME ENROLLMENT AND EFFEC2 TIVE DATE OF ENROLLMENT.— 

3 ‘‘(i) ANY TIME ENROLLMENT.—A 

4 PACE program eligible individual may en5 roll in a PACE program at any time dur6 ing a month. 

7 ‘‘(ii) EFFECTIVE DATE.—Subject to 

8 clause (iii), the enrollment of a PACE pro9 gram eligible individual in a PACE pro10 gram shall be effective on the date the 

11 PACE provider operating the PACE pro12 gram receives an enrollment agreement 

13 signed by such PACE program eligible in14 dividual with respect to such PACE pro15 gram. 

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

17 DUAL ELIGIBLE BENEFICIARIES.—In the 

18 case of a PACE program eligible individual 

19 who is eligible for benefits under this title 

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

21 the State in which such individual resides 

22 has made an election under section 

23 1934(c)(5)(C) to permit PACE program 

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1 gram at any time during a month in such 

2 State.’’. 

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

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

5 amended by adding at the end the following new 

6 paragraph: 

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

8 PACE program eligible individual enrolled in a 

9 PACE program operated by a PACE provider with 

10 an enrollment effective date that is not the first day 

11 of a month, the capitation amount that would other12 wise be made under this subsection to the PACE 

13 provider for such individual for the first month in 

14 which such individual is so enrolled shall be prorated 

15 accordingly.’’. 

16 (b) CONFORMING AMENDMENTS.— 

17 (1) ANY TIME ENROLLMENT AND EFFECTIVE

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

19 Act (42 U.S.C. 1396u–4(c)(5)) is amended by add20 ing at the end the following new subparagraph: 

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

22 ENROLLMENT AND EFFECTIVE DATE OF EN23 ROLLMENT.— 

24 ‘‘(i) ANY TIME ENROLLMENT.—A 

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1 gram eligible individual to enroll in a 

2 PACE program at any time during a 

3 month. 

4 ‘‘(ii) EFFECTIVE DATE.—Pursuant to 

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

6 enrollment of a PACE program eligible in7 dividual in a PACE program shall be effec8 tive on the date the PACE provider oper9 ating the PACE program receives an en10 rollment agreement signed by such PACE 

11 program eligible individual with respect to 

12 such PACE program.’’. 

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

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

15 amended by adding at the end the following new 

16 paragraph: 

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

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

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

20 program eligible individual enrolled in a PACE pro21 gram operated by a PACE provider with an enroll22 ment effective date that is not the first day of a 

23 month, the State shall prorate the capitation amount 

24 that would otherwise be made under this subsection 


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1 to the PACE provider for such individual for the 

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

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

4 this section shall take effect on January 1, 2022. 

5 SEC. 5. IMPROVING ACCESS TO AND AFFORDABILITY OF 

6 PACE PROGRAMS FOR MEDICARE BENE7 FICIARIES WHO ARE NOT DUAL ELIGIBLE 

8 BENEFICIARIES THROUGH FLEXIBILITY IN 

9 RATE SETTING FOR SERVICES NOT COVERED 

10 BY MEDICARE. 

11 (a) IN GENERAL.—Section 1894 of the Social Secu12 rity Act (42 U.S.C. 1395eee) is amended by adding at the 

13 end the following new subsection: 

14 ‘‘(j) FLEXIBILITY IN ESTABLISHING PREMIUMS FOR

15 MEDICARE PACE PARTICIPANTS WHO ARE NOT ALSO

16 ENTITLED TO BENEFITS UNDER A STATE MEDICAID

17 PROGRAM.— 

18 ‘‘(1) CODIFICATION OF AUTHORITY TO CHARGE

19 A MONTHLY CAPITATION AMOUNT FOR NON-MEDI20 CARE SERVICES.—Subject to the succeeding provi21 sions of this subsection, a PACE program operated 

22 by a PACE provider under a PACE program agree23 ment in any State may charge a Medicare-only 

24 PACE program eligible individual (as defined in 

25 paragraph (4)(A)) who is enrolled in such PACE 


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1 program a monthly capitation payment amount for 

2 the provision of non-Medicare services (as defined in 

3 paragraph (4)(B)) under the PACE program. 

4 ‘‘(2) DETERMINATION OF MONTHLY CAPITA5 TION PAYMENT AMOUNT.— 

6 ‘‘(A) IN GENERAL.—Notwithstanding sec7 tion 460.186 of title 42, Code of Federal Regu8 lations (or any successor regulation), the 

9 monthly capitation payment amount that may 

10 be charged under paragraph (1) shall be deter11 mined by the PACE provider operating the 

12 PACE program. Such monthly capitation pay13 ment amount shall be based on assessments 

14 conducted on the Medicare-only PACE program 

15 eligible individual who is enrolled in such PACE 

16 program by the PACE program interdiscipli17 nary team and shall take into account the 

18 health status of such individual. In determining 

19 the monthly capitation amount for a Medicare20 only PACE program eligible individual under 

21 this paragraph, a PACE provider may take into 

22 account the services determined necessary for 

23 the individual by the PACE program inter24 disciplinary team based upon their assessment 

25 of the individual. A determination described in 


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1 the preceding sentence shall not be construed as 

2 limiting the responsibility of the PACE provider 

3 to meet any unforeseen needs or provide for any 

4 required services for such individual. 

5 ‘‘(B) AUTHORITY TO ADJUST MONTHLY

6 CAPITATION AMOUNT.— 

7 ‘‘(i) IN GENERAL.—Subject to clause 

8 (ii) and paragraph (3), the monthly capita9 tion payment amount that may be charged 

10 under paragraph (1) to a Medicare-only 

11 PACE program eligible individual enrolled 

12 in a PACE program for non-Medicare 

13 services may increase or decrease based on 

14 assessments conducted on such individual. 

15 Any change in the monthly capitation pay16 ment amount charged to such an indi17 vidual shall take effect beginning with the 

18 first day of the first month that begins 

19 after the month during which the plan of 

20 care is developed for such individual based 

21 on such an assessment. 

22 ‘‘(ii) LIMITATION ON FREQUENCY OF

23 INCREASE.—The monthly capitation pay24 ment amount that may be charged under 

25 paragraph (1) to such an individual may 


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1 not increase more frequently than once per 

2 calendar quarter. 

3 ‘‘(3) BENEFICIARY PROTECTIONS.— 

4 ‘‘(A) DISCLOSURE OF PREMIUM RATE

5 STRUCTURE.—A PACE provider shall disclose 

6 to Medicare-only PACE program eligible indi7 viduals the capitation payment amounts that 

8 may be charged under this section to such indi9 viduals for non-Medicare services under the 

10 PACE program operated by such PACE pro11 vider under this section— 

12 ‘‘(i) prior to enrollment of such indi13 vidual in such PACE program, and 

14 ‘‘(ii) periodically, and upon request of 

15 such individual, after enrollment. 

16 ‘‘(B) ASSESSMENT INSTRUMENT.— 

17 ‘‘(i) IN GENERAL.—The Secretary 

18 shall develop an assessment instrument for 

19 use by PACE programs with respect to 

20 Medicare-only PACE program eligible indi21 viduals under this subsection. 

22 ‘‘(ii) REQUIREMENT FOR DISCLOSURE

23 OF ASSESSMENT INSTRUMENT.—The 

24 monthly capitation payment amount 

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1 care-only PACE program eligible individual 

2 for non-Medicare services shall be based on 

3 an assessment of such individual conducted 

4 by the PACE provider (using the assess5 ment instrument developed by the Sec6 retary under clause (i)), accounting for 

7 health status and corresponding needs. 

8 ‘‘(iii) REQUIREMENT FOR DISCLOSURE

9 OF ASSESSMENT INSTRUMENT.—The as10 sessment instrument used by the inter11 disciplinary team of the PACE program to 

12 evaluate the health and social status of 

13 PACE participants shall be disclosed to 

14 the individual prior to the assessment. 

15 ‘‘(C) PROCESS TO SEEK REVIEW OF AS16 SESSMENTS.—The Secretary shall establish a 

17 process for a Medicare-only PACE program eli18 gible individual to seek review of any assess19 ment conducted on the individual under this 

20 subsection. 

21 ‘‘(4) RULE OF CONSTRUCTION.—Nothing in 

22 this subsection shall be construed to preclude the 

23 testing under section 1115A of a model to permit a 

24 PACE provider operating a PACE program to es25 tablish and charge monthly capitation payment 


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1 amounts for the provision of non-Medicare services 

2 under the PACE program to Medicare-only PACE 

3 program eligible individuals under a rate structure 

4 established by such PACE provider for such pur5 pose, including the use of an assessment instrument 

6 developed by the PACE program to assign such indi7 viduals to an appropriate rate category under such 

8 rate structure. 

9 ‘‘(5) DEFINITIONS.—In this subsection— 

10 ‘‘(A) the term ‘Medicare-only PACE pro11 gram eligible individual’ means an individual 

12 who is described in subsection (a)(1) and who 

13 is not entitled to medical assistance under title 

14 XIX, and includes the designated representative 

15 of the individual as appropriate; and 

16 ‘‘(B) the term ‘non-Medicare services’ 

17 means items and services covered under title 

18 XIX that are not covered under this title and 

19 items and services described in subsection 

20 (b)(1)(A)(ii).’’. 

21 (b) EFFECTIVE DATE.—The amendment made by 

22 subsection (a) shall take effect on the date of the enact23 ment of this Act, and apply with respect to capitation 

24 amounts that may be charged for months beginning on 

25 or after January 1, 2022. 


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1 (c) RULE OF CONSTRUCTION.—Nothing in this sec2 tion, or the amendments made by this section, shall be 

3 construed to modify or otherwise impact the following 

4 Medicare capitation rates that may be charged by PACE 

5 plans for PACE participants who are Medicare bene6 ficiaries who are not both entitled to (or enrolled for) bene7 fits under part A of title XVIII of the Social Security Act 

8 (42 U.S.C. 1395 et seq.) and enrolled for benefits under 

9 part B of such title: 

10 (1) PART A ONLY MEDICARE BENEFICIARY.—In 

11 the case of a Medicare beneficiary who is a PACE 

12 participant who is entitled to (or enrolled for) bene13 fits under part A of such title XVIII but who is not 

14 enrolled for benefits under part B of such title, the 

15 Medicare Part B capitation rate under paragraph 

16 (b) of section 460.186 of title 42, Code of Federal 

17 Regulations (or any successor regulations). 

18 (2) PART B ONLY MEDICARE BENEFICIARY.—In 

19 the case of a Medicare beneficiary who is a PACE 

20 participant who is enrolled for benefits under part B 

21 of such title XVIII but who is not entitled to (or en22 rolled for) benefits under part A of such title, the 

23 Medicare Part A capitation rate under paragraph (c) 

24 of such section 460.186 (or any successor regula25 tions). 


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1 SEC. 6. PACE SITE APPROVAL AND EXPANSION. 

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

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

4 4(e)) are each amended by striking paragraph (8) and in5 serting the following: 

6 ‘‘(8) AUTHORITY TO SUBMIT APPLICATIONS AT

7 ANY TIME; TIMELY CONSIDERATION OF APPLICA8 TIONS.— 

9 ‘‘(A) AUTHORITY TO SUBMIT APPLICA10 TIONS AT ANY TIME.— 

11 ‘‘(i) NEW PACE PROVIDER STATUS.— 

12 An entity that seeks to become a PACE 

13 provider may submit an application for 

14 PACE provider status at any time. 

15 ‘‘(ii) SERVICE AREA EXPANSION AND

16 ADDITION OF PACE CENTER SITE.—To the 

17 extent the Secretary requires a PACE pro18 vider to submit an application to expand 

19 its service area or to add a PACE center 

20 site, a PACE provider may submit such an 

21 application at any time, subject to the re22 quirements of section 460.12(d) of title 42, 

23 Code of Federal Regulations (relating to 

24 the first trial period audit), or any suc25 cessor regulation. 


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1 ‘‘(iii) ASSURANCES.—An application 

2 for PACE provider status under clause (i) 

3 or to add a PACE center site under clause 

4 (ii) shall include the following assurances: 

5 ‘‘(I) An assurance that the re6 quired members of the interdiscipli7 nary team are employees or contrac8 tors of the proposed PACE center or 

9 will be employees or contractors of the 

10 proposed PACE center by the time 

11 the PACE center becomes operational. 

12 ‘‘(II) An assurance that— 

13 ‘‘(aa) the PACE provider’s 

14 contracts for all contractors and 

15 contracted personnel will be exe16 cuted by the time the proposed 

17 PACE center becomes oper18 ational; and 

19 ‘‘(bb) executed contracts 

20 may include provisions for staff21 ing levels to commensurate with 

22 enrollment to full projected cen23 sus. 

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

25 described in subparagraph (A) shall be deemed 


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1 approved unless the Secretary, within 45 days 

2 after the date of the submission of the applica3 tion to the Secretary, either denies such request 

4 in writing or informs the applicant in writing 

5 with respect to any additional information that 

6 is needed in order to make a final determina7 tion with respect to the application. After the 

8 date the Secretary receives such additional in9 formation, the application shall be deemed ap10 proved unless the Secretary, within 45 days of 

11 such date, denies such request.’’. 

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

13 subsection (a) shall take effect on January 1, 2022. 

14 SEC. 7. PACE PILOT. 

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

16 U.S.C. 1315a(b)(2)) is amended— 

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

18 the following new clause: 

19 ‘‘(xxviii) National testing of a model 

20 for expanded eligibility for the Program of 

21 All-Inclusive Care for the Elderly as de22 scribed in subparagraph (D).’’; and 

23 (2) by adding at the end the following new sub24 paragraph: 


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1 ‘‘(D) NATIONAL TESTING OF MODEL FOR

2 EXPANDED ELIGIBILITY FOR THE PROGRAM OF

3 ALL-INCLUSIVE CARE FOR THE ELDERLY.—In 

4 the case where the Secretary selects the model 

5 described in clause (ii) of this subparagraph for 

6 testing pursuant to clause (xxviii) of subpara7 graph (B), the following shall apply: 

8 ‘‘(i) NATIONAL TESTING.— 

9 ‘‘(I) IN GENERAL.—Subject to 

10 subclause (II), the Secretary shall de11 sign a demonstration that allows each 

12 PACE provider with an executed 

13 PACE agreement to develop and sub14 mit to the Secretary an application to 

15 begin testing expanded PACE eligi16 bility for high-need and high-cost pop17 ulations that are not otherwise eligible 

18 to participate in a PACE program 

19 within 1 year of the date on which the 

20 model is selected. 

21 ‘‘(II) NO EFFECT ON ONGOING

22 MODELS OR DEMONSTRATION

23 PROJECTS.—Nothing in this subpara24 graph shall affect the testing of any 

25 model under this subsection or any 


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1 demonstration project under this Act 

2 that is implemented prior to the date 

3 of the enactment of this subpara4 graph. 

5 ‘‘(ii) MODEL DESCRIBED.—The model 

6 described in this clause seeks to increase 

7 access to quality, integrated, care for high8 need, high-cost individuals who are not 

9 otherwise eligible to participate in a PACE 

10 program in order to improve health and re11 duce cost. Under this model, participating 

12 PACE providers would— 

13 ‘‘(I) be paid fixed, monthly 

14 capitated rates from both Medicare 

15 and the applicable State Medicaid 

16 agency for all services provided to 

17 each enrollee fitting the criteria of the 

18 PACE provider’s designated popu19 lation; 

20 ‘‘(II) partner with non-PACE 

21 providers, such as Area Agencies on 

22 Aging, Centers for Independent Liv23 ing, local hospitals, and non-hospital 

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1 munity-based organizations to effec2 tively reach the PACE provider’s se3 lected population; 

4 ‘‘(III) adapt the PACE program 

5 model of care to appropriately serve 

6 the PACE provider’s selected popu7 lation to integrate care and meet the 

8 unique needs of said population; and 

9 ‘‘(IV) if the PACE provider is lo10 cated in a State that has not yet 

11 served the selected population through 

12 a PACE program under section 1934, 

13 receive an up-front fixed payment to 

14 coordinate with the State to develop a 

15 capitated payment rate, with appro16 priate risk adjustment, for the PACE 

17 provider’s selected population. 

18 ‘‘(iii) REQUIREMENTS FOR PARTICI19 PATING PACE ORGANIZATIONS.—In order 

20 to participate in the model, a PACE pro21 vider must— 

22 ‘‘(I) conduct a survey or needs 

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1 lation with which to expand their serv2 ices; 

3 ‘‘(II) receive prior approval from 

4 the applicable State Medicaid agency 

5 to submit an application to participate 

6 in the model; and 

7 ‘‘(III) following such survey or 

8 needs assessment and approval from 

9 the applicable State Medicaid agency, 

10 submit and receive approval of an ap11 plication of expansion from the Sec12 retary. 

13 ‘‘(iv) APPLICATION.—A PACE pro14 vider’s application to participate in this 

15 model shall include the following informa16 tion: 

17 ‘‘(I) Results of the survey or 

18 needs assessment of their service area 

19 under clause (iii)(I) and an expla20 nation of the expanded population the 

21 PACE organization will serve. 

22 ‘‘(II) The types of services that 

23 the expanded population will require 

24 and the PACE provider’s plan to im25 plement these services. 


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1 ‘‘(III) How the PACE provider 

2 will achieve engagement and enroll3 ment of the new population in the 

4 model, including how it will partner 

5 with non-PACE providers in the ap6 plicable service area. 

7 ‘‘(IV) How the expanded popu8 lation’s participation in the PACE 

9 program is intended to improve qual10 ity of care and health outcomes under 

11 the model. 

12 ‘‘(V) Certification that the appli13 cable State Medicaid agency has ap14 proved the PACE provider’s applica15 tion to participate in the model. 

16 ‘‘(VI) Plans to coordinate with 

17 the State Medicaid agency to develop 

18 an initial capitated rate with appro19 priate risk adjustment. 

20 ‘‘(VII) Plans for the PACE pro21 vider and the State Medicaid agency 

22 to review and adjust the Medicaid 

23 capitated rate on a biennial basis, as 

24 needed. 


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1 ‘‘(VIII) Any other information 

2 required by the Secretary. 

3 ‘‘(v) TECHNICAL ASSISTANCE.—The 

4 Secretary shall provide, or designate an en5 tity to provide, technical assistance to par6 ticipating PACE providers as they apply 

7 for and implement the model. 

8 ‘‘(vi) ACCOUNTING FOR UNCER9 TAINTY.—In order for implementing 

10 PACE providers to receive unanticipated 

11 additional resources needed to implement 

12 the model, the Secretary shall establish 

13 procedures for the implementing PACE 

14 providers to submit to the Secretary a re15 quest for additional resources. 

16 ‘‘(vii) MONITORING OUTCOMES.—The 

17 Secretary, in conjunction with PACE pro18 viders and in consultation with States that 

19 have elected to expand PACE program eli20 gibility under section 1934(l), shall develop 

21 a plan to— 

22 ‘‘(I) annually monitor outcomes 

23 under the model, which may include 

24 financial, quality, access, and utiliza25 tion outcomes; 


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1 ‘‘(II) annually monitor the health 

2 outcomes of the PACE provider’s ex3 panded population; and 

4 ‘‘(III) any other outcomes as de5 termined by the Secretary. 

6 ‘‘(viii) REPORTING REQUIREMENTS.— 

7 ‘‘(I) REPORT TO CONGRESS.— 

8 Not less frequently than every 3 years 

9 (for the duration of the implementa10 tion of the model under this subpara11 graph), the Secretary shall submit to 

12 Congress a report on the implementa13 tion of the model under this subpara14 graph. The report shall include demo15 graphic information on the popu16 lations served under the demonstra17 tion, best practices for future imple18 mentation efforts and any other infor19 mation the Secretary determines ap20 propriate together with recommenda21 tions for such legislation and adminis22 trative action as the Secretary deter23 mines appropriate. 

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

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1 section (f)(1) to design, implement, evalu2 ate, and report on the model described in 

3 clause (ii) in accordance with this subpara4 graph.’’. 

5 SEC. 8. STATE OPTION TO EXPAND ELIGIBILITY FOR PACE 

6 PROGRAM. 

7 (a) IN GENERAL.—Section 1934 of the Social Secu8 rity Act (42 U.S.C. 1396u–4), as amended by section 3(b), 

9 is amended— 

10 (1) in subsection (a)(5)(B), by inserting ‘‘, sub11 section (k), and subsection (l)’’ after ‘‘subsection 

12 (c)(4)’’; and 

13 (2) by adding at the end the following new sub14 section: 

15 ‘‘(l) STATE OPTION TO EXPAND ELIGIBILITY.— 

16 ‘‘(1) IN GENERAL.—A State described in para17 graph (3) may, at the option of the State, deem in18 dividuals described in paragraph (2) to be PACE 

19 program eligible individuals for the purposes of this 

20 section without regard to the requirement under 

21 subsection (a)(5)(B) that a PACE program eligible 

22 individual require the level of care required under 

23 the State medicaid plan for coverage of nursing fa24 cility services. 


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1 ‘‘(2) EXPANSION OF ELIGIBILITY.—An indi2 vidual is described in this paragraph if— 

3 ‘‘(A) the individual meets the requirements 

4 of subparagraphs (A), (C), and (D) of sub5 section (a)(5); 

6 ‘‘(B) the individual is unable to perform at 

7 least 2 (or such higher number as the State 

8 may establish) activities of daily living, as de9 termined by the State; and 

10 ‘‘(C) the individual’s income does not ex11 ceed 150 percent of the poverty line (as defined 

12 in section 2110(c)(5)) or, if greater, the income 

13 level applicable for an individual who has been 

14 determined to require an institutional level of 

15 care to be eligible for nursing facility services 

16 under the State plan and with respect to whom 

17 there has been a determination that, but for the 

18 provision of such services, the individual would 

19 require the level of care provided in a hospital, 

20 a nursing facility, an intermediate care facility 

21 for the mentally retarded, or an institution for 

22 mental diseases, the cost of which could be re23 imbursed under the State plan. 


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1 ‘‘(3) STATES ELIGIBLE FOR OPTION.—A State 

2 shall only be eligible to exercise the option under 

3 this subsection if— 

4 ‘‘(A) the State administering agency has 

5 entered into an agreement for the operation of 

6 a PACE program under this section (and sec7 tion 1894, if applicable) among such agency, 

8 the Secretary, and a PACE provider; and 

9 ‘‘(B) the State provides coverage under the 

10 State plan under this title (or a waiver of such 

11 plan) for long-term services and supports. 

12 ‘‘(4) ENHANCED FMAP.—Notwithstanding sec13 tion 1905(b), in the case of a State that exercises 

14 the option under this subsection, the Federal med15 ical assistance percentage applicable with respect to 

16 expenditures by such State on monthly payments 

17 made to PACE providers under a PACE program 

18 agreement under this section for individuals who are 

19 deemed to be PACE program eligible individuals in 

20 accordance with paragraph (2) shall be equal to 90 

21 percent.’’. 

22 (b) CONFORMING AMENDMENT.—Section 1894(a)(5) 

23 of the Social Security Act (42 U.S.C. 1395eee(a)(5)) is 

24 amended by inserting ‘‘and section 1934(l)’’ after ‘‘sub25 section (c)(4)’’. 


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1 SEC. 9. COORDINATION WITH THE FEDERAL COORDINATED 

2 HEALTH CARE OFFICE. 

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

4 1396u–4), as amended by sections 3 and 8, is amended 

5 by adding at the end the following new subsection: 

6 ‘‘(m) COORDINATION WITH THE FEDERAL COORDI7 NATED HEALTH CARE OFFICE.— 

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

9 Director of the Federal Coordinated Health Care Of10 fice established under section 2602 of the Patient 

11 Protection and Affordable Care Act shall serve as a 

12 point of contact between State administering agen13 cies and the Federal Government for purposes of im14 plementing and operating a PACE program in a 

15 State, and shall coordinate with other relevant of16 fices and staff of the Centers for Medicare & Med17 icaid Services involved in carrying out this section. 

18 ‘‘(2) ANNUAL REPORT.—Not later than Janu19 ary 1, 2023, and annually thereafter, the Director of 

20 the Federal Coordinated Health Care Office shall 

21 submit to Congress a report on the demographics of 

22 the populations served by PACE programs operated 

23 under this section and section 1894.’’. 

Æ 


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