Updated on: March 23, 2020

CMS Rolls Out Guidance for PACE Organizations Serving Elderly Populations

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Original story posted on: March 18, 2020

Vulnerable seniors, especially those with underlying health conditions, have been of particular concern to those working to stem the coronavirus pandemic.

Federal authorities have rolled out guidance for entities that serve senior populations, which are of particular concern to the nationwide corps of healthcare professionals seeking to curb the ongoing COVID-19 pandemic.

The Centers for Medicare & Medicaid Services (CMS) issued guidance Tuesday to all Programs of All-Inclusive Care for the Elderly (PACE) organizations, which work with the federal Medicare and Medicaid programs to help people meet their healthcare needs in the community instead of going to a nursing home or other type of facility. 

PACE is the latest area of focus because, as CMS noted in a press release, “these organizations serve older adults who often have serious chronic medical conditions, and therefore are at higher risk of serious illness from the virus.” The guidance, part of the White House Coronavirus Task Force efforts, offers what authorities described as “clear, actionable information” on accepted policies and standard procedures with respect to infection control. CMS also said it would “use discretion … if PACE centers need to implement strategies to mitigate the spread of the virus that are not in full compliance with the program’s requirements.”

There are now more than 6,500 coronavirus cases reportedly documented in the U.S., including at least one in all 50 states, with more than 200,000 cases worldwide, resulting in 115 deaths domestically and 8,200 globally.

“Today we announced guidance to PACE organizations to keep the beneficiaries who use these services healthy and safe,” CMS Administrator Seema Verma said in a statement. “It is critically important to ensure that those most at risk of serious illness from COVID-19 are protected in every care setting, including the seniors who rely on PACE centers as healthcare providers in their daily lives.”

In particular, CMS reported, the new guidance directs all PACE entities to establish, implement, and maintain a documented infection control plan and frequently monitor for potential symptoms of respiratory infection. Such entities experiencing an increased number of respiratory illnesses among participants, caregivers, and/or healthcare and PACE personnel should immediately contact their state and local health officials for further guidance. The guidance also states that PACE personnel should be given and trained on the use of recommended personal protective equipment (PPE).

“CMS recognizes that there may be circumstances where a (PACE provider) needs to implement strategies that do not fully comply with programmatic requirements in order to protect beneficiaries from the spread of the virus. The agency will take those situations into consideration when conducting monitoring or oversight activities,” CMS’s press release read. “This will allow (providers) to use strategies including, for example, using telehealth, to provide patient assessments that would normally be conducted on an in-person basis, or limiting PACE center attendance in order to minimize the potential for exposure.”

The guidance also outlined that PACE providers can ensure access to Part D drugs by relaxing “refill-too-soon” edits and providing maximum extended-day supplies, providing home or mail delivery of Part D drugs, and waiving prior authorization requirements at any time that they otherwise would apply to Part D drugs used to treat or prevent COVID-19, if or when such drugs are identified.

Mark Spivey

Mark Spivey is a national correspondent for RACmonitor.com, ICD10monitor.com, and Auditor Monitor who has been writing and editing material about the federal oversight of American healthcare for more than a decade. He can be reached at mcspivey@hotmail.com.

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