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 subse-
quently 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 Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Program of All-inclu-
sive Care for the Elderly Expanded Act’’ or the ‘‘PACE 
Expanded Act’’. 
SEC. 2. ANYTIME ENROLLMENT IN PACE. 
(a) IN GENERAL.— 
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(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 EFFEC-
TIVE DATE OF ENROLLMENT.— 
‘‘(i) ANY
TIME
ENROLLMENT.—A 
PACE program eligible individual may en-
roll in a PACE program at any time dur-
ing a month. 
‘‘(ii) EFFECTIVE
DATE.—Subject to 
clause (iii), the enrollment of a PACE pro-
gram eligible individual in a PACE pro-
gram shall be effective on the date the 
PACE provider operating the PACE pro-
gram receives an enrollment agreement 
signed by such PACE program eligible in-
dividual with respect to such PACE pro-
gram. 
‘‘(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 
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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 other-
wise 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 add-
ing at the end the following new subparagraph: 
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‘‘(C) STATE OPTION TO PERMIT ANY TIME 
ENROLLMENT
AND
EFFECTIVE
DATE
OF
EN-
ROLLMENT.— 
‘‘(i) ANY
TIME
ENROLLMENT.—A 
State may elect to permit a PACE pro-
gram 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 in-
dividual in a PACE program shall be effec-
tive on the date the PACE provider oper-
ating the PACE program receives an en-
rollment 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 pro-
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vider to submit an application to expand 
its service area or to add a PACE center 
site (or both), a PACE provider may sub-
mit such an application at any time, sub-
ject 
to 
the 
requirements 
of 
section 
460.12(d) of title 42, Code of Federal Reg-
ulations (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 re-
quired members of the interdiscipli-
nary team are employees or contrac-
tors 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 exe-
cuted by the time the proposed 
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PACE 
center 
becomes 
oper-
ational; and 
‘‘(bb) 
executed 
contracts 
may include provisions for staff-
ing levels commensurate with en-
rollment 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 applica-
tion 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 determina-
tion with respect to the application. After the 
date the Secretary receives such additional in-
formation, the application shall be deemed ap-
proved 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— 
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(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 de-
scribed in subparagraph (D).’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(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 subpara-
graph (B), the following shall apply: 
‘‘(i) NATIONAL TESTING.— 
‘‘(I) IN
GENERAL.—Subject to 
subclause (II), the Secretary shall de-
sign a demonstration that allows each 
PACE provider with an executed 
PACE agreement to develop and sub-
mit to the Secretary an application to 
begin testing expanded PACE eligi-
bility for high-need and high-cost pop-
ulations that are not otherwise eligible 
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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 subpara-
graph 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 subpara-
graph. 
‘‘(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 re-
duce 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 
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PACE provider’s designated popu-
lation; 
‘‘(II) partner with non-PACE 
providers, such as Area Agencies on 
Aging, Centers for Independent Liv-
ing, local hospitals, and non-hospital 
providers such as physicians, behav-
ioral health providers and other com-
munity-based organizations to effec-
tively reach the PACE provider’s se-
lected population; 
‘‘(III) adapt the PACE program 
model of care to appropriately serve 
the PACE provider’s selected popu-
lation to integrate care and meet the 
unique needs of said population; and 
‘‘(IV) if the PACE provider is lo-
cated 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 appro-
priate risk adjustment, for the PACE 
provider’s selected population. 
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‘‘(iii) REQUIREMENTS
FOR
PARTICI-
PATING
PACE
ORGANIZATIONS.—In order 
to participate in the model, a PACE pro-
vider must— 
‘‘(I) conduct a survey or needs 
assessment of their service area to de-
termine the most appropriate popu-
lation with which to expand their serv-
ices; 
‘‘(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 ap-
plication of expansion from the Sec-
retary. 
‘‘(iv) APPLICATION.—A PACE pro-
vider’s application to participate in this 
model shall include the following informa-
tion: 
‘‘(I) Results of the survey or 
needs assessment of their service area 
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under clause (iii)(I) and an expla-
nation 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 im-
plement these services. 
‘‘(III) How the PACE provider 
will achieve engagement and enroll-
ment of the new population in the 
model, including how it will partner 
with non-PACE providers in the ap-
plicable service area. 
‘‘(IV) How the expanded popu-
lation’s participation in the PACE 
program is intended to improve qual-
ity of care and health outcomes under 
the model. 
‘‘(V) Certification that the appli-
cable State Medicaid agency has ap-
proved the PACE provider’s applica-
tion to participate in the model. 
‘‘(VI) Plans to coordinate with 
the State Medicaid agency to develop 
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