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H.R. 3243 could expand federal LTC role

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A Republican lawmaker has rounded up nine Democrats and 10 Republicans to support H.R. 3243, a bill that could expand use of a federal program that bundles coverage for acute medical care together with coverage for long-term care (LTC) services.

Rep. Chris Smith, R-N.J., and other supporters want to open Programs of All-Inclusive Care for the Elderly (PACE) up to a wider range of people.

Managers of a PACE program get a flat monthly fee from Medicare and a flat monthly fee from Medicaid to provide both acute medical care and LTC services for people ages 55 and older who already have enough problems with the activities of daily living (ADLs) to need the kind of services that are often provided in a nursing home.

Today, 115 PACE programs are managing care for 35,000 people in 32 states, according to the National PACE Association

H.R. 3243 would let a state ask the secretary of the U.S. Department of Health and Human Services (HHS) to ease some of the usual PACE eligibility requirements.

In a PACE eligibility waiver state, a PACE program could serve people ages 55 and older who do not yet need nursing home care, or younger people who either need nursing home care or have conditions that could lead to a need for nursing home care.

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The House Energy & Commerce health subcommittee looked at the PACE expansion bill today at a hearing. The committee considered the bill along with H.R. 209, a bill that would help Medicaid enrollees participate in clinical trials, and H.R. 670, a bill that would change the rules governing special needs trusts.

Tim Clontz, a witness from the National PACE Association, testified that PACE improves the quality of care enrollees get without increasing the cost of their care.

Opening the PACE program to people under 55 could be especially helpful to younger patients that are dealing with conditions such as early-onset Alzheimer’s disease, Clontz said.

A PACE program can help keep people in the community by improving care coordination, providing high-quality attendant care services, and using telehealth services and other technology to increase people’s ability to function on their own, Clontz said.

See also: Bruce Chernof to lead new LTC Commission

PACE program managers would like to see Congress ease the PACE startup rules as well as the eligibility requirements, Clontz said. Today, he said, the process for applying to set up a PACE program takes more than 18 months and costs more than $4 million per program.


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