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-
gram operated by a PACE provider with an enroll-
ment effective date that is not the first day of a 
month, the State shall prorate the capitation amount 
that would otherwise be made under this subsection 
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pamtmann on DSKBC07HB2PROD with BILLS
to the PACE provider for such individual for the 
first month in which such individual is so enrolled.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on January 1, 2022. 
SEC. 5. IMPROVING ACCESS TO AND AFFORDABILITY OF 
PACE 
PROGRAMS 
FOR 
MEDICARE 
BENE-
FICIARIES WHO ARE NOT DUAL ELIGIBLE 
BENEFICIARIES THROUGH FLEXIBILITY IN 
RATE SETTING FOR SERVICES NOT COVERED 
BY MEDICARE. 
(a) IN GENERAL.—Section 1894 of the Social Secu-
rity Act (42 U.S.C. 1395eee) is amended by adding at the 
end the following new subsection: 
‘‘(j) FLEXIBILITY IN ESTABLISHING PREMIUMS FOR 
MEDICARE PACE PARTICIPANTS WHO ARE NOT ALSO 
ENTITLED
TO BENEFITS UNDER
A STATE MEDICAID 
PROGRAM.— 
‘‘(1) CODIFICATION OF AUTHORITY TO CHARGE 
A MONTHLY CAPITATION AMOUNT FOR NON-MEDI-
CARE SERVICES.—Subject to the succeeding provi-
sions of this subsection, a PACE program operated 
by a PACE provider under a PACE program agree-
ment in any State may charge a Medicare-only 
PACE program eligible individual (as defined in 
paragraph (4)(A)) who is enrolled in such PACE 
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program a monthly capitation payment amount for 
the provision of non-Medicare services (as defined in 
paragraph (4)(B)) under the PACE program. 
‘‘(2) DETERMINATION
OF
MONTHLY
CAPITA-
TION PAYMENT AMOUNT.— 
‘‘(A) IN GENERAL.—Notwithstanding sec-
tion 460.186 of title 42, Code of Federal Regu-
lations (or any successor regulation), the 
monthly capitation payment amount that may 
be charged under paragraph (1) shall be deter-
mined by the PACE provider operating the 
PACE program. Such monthly capitation pay-
ment amount shall be based on assessments 
conducted on the Medicare-only PACE program 
eligible individual who is enrolled in such PACE 
program by the PACE program interdiscipli-
nary team and shall take into account the 
health status of such individual. In determining 
the monthly capitation amount for a Medicare- 
only PACE program eligible individual under 
this paragraph, a PACE provider may take into 
account the services determined necessary for 
the individual by the PACE program inter-
disciplinary team based upon their assessment 
of the individual. A determination described in 
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