Tag Archive for: Advocacy

DUALS Act of 2024 Would Dramatically Expand Access to PACE [Press Release]

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This article was originally posted on NPA Online. Read the full article here.

WASHINGTON, DC – MARCH 15, 2024 – Sens. Bill Cassidy (R-LA), Tom Carper (D-DE), John Cornyn (R-TX), Mark Warner (D-VA), Tim Scott (R-SC), and Bob Menendez (D-NJ) have introduced the Delivering United Access to Lifesaving Services (DUALS) Act of 2024. The legislation would dramatically increase access to the Program of All-Inclusive Care for the Elderly (PACE).

The National PACE Association (NPA) strongly supports the bill and has worked diligently with its sponsors to ensure that the PACE model of care can be accessed more easily by the millions of Americans who would benefit from it.

“We applaud your visionary leadership seeking to increase care integration for individuals covered by both Medicare and Medicaid, which will improve both their health status and quality of life,” NPA president and CEO Shawn Bloom said in a letter to the sponsors. “NPA commends you for embracing the critical role PACE will have in achieving those aims for older adults and people living with disabilities.”

Designed to ease frustrations in seeking care through Medicare and Medicaid for individuals who have insurance coverage through both programs, known as “dual eligibles,” the bill has several provisions to make PACE more widely available. Enrollees in PACE, who would be appropriate for a nursing home level of care, instead live in their own homes and are cared for through a multidisciplinary team of health care providers.

PACE is viewed by several non-partisan think tanks and leading aging experts as a model that would help solve the elder care crisis currently facing the United States.

The bill would expand access to PACE in several key ways:

  • require all states to offer PACE to eligible individuals;
    permit PACE organizations to enroll participants any time rather than just on the first of the month;
  • extend eligibility for PACE to Medicare-eligible individuals under age 55;
  • remove quarterly restrictions for the submission of applications for new PACE organizations and service area expansions; and
  • ensure that Medicare-only PACE program enrollees have a choice of prescription drug plans under Medicare part D.

Senators introduce bill to lower prescription costs for seniors with chronic illnesses

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This article was originally posted on The Hill. Read the full article here.

Sens. Tom Carper (D-Del.) and Bill Cassidy (R-La.) on Wednesday introduced a bill that would allow people enrolled in the Program of All-Inclusive Care for the Elderly (PACE) to choose their prescription drug plan under Medicare Part D and save more in monthly medication costs.

PACE is a Medicare/Medicaid program that provides medical and social services through a team of health care professionals which enrollees have regular access to, with the aim of avoiding placement in a nursing home.

PACE enrollees are currently required to get their Medicare Part D-covered medications through the program. Joining another Medicare prescription drug plan means being unenrolled from PACE benefits.

Carper and Cassidy’s bill, the PACE Part D Choice Act, would allow PACE beneficiaries to enroll in stand-alone prescription drug plans not operated through the program. This would also make beneficiaries eligible for prescription drug plans subject to the $2,000 annual cap that was instituted by the Inflation Reduction Act earlier this year.

The legislation, if passed, would require that PACE inform beneficiaries of their options for prescription drug plans outside of the program and help facilitate enrollment.

“PACE participants in Delaware and across our nation are dealing with rising prescription drug costs every time they need a refill for their live-saving medications. It makes no sense that these older Americans cannot choose which Medicare Part D plan makes the most financial sense for them,” Carper said in a statement.

Cassidy, a physician, said the bill would ensure that PACE beneficiaries have the “same access to lower premiums and affordable prescription drugs that lead to better health outcomes as those in other Medicare programs.”

Under the current rules, PACE beneficiaries have an average monthly premium of $1,015.03, according to the lawmakers. The senators estimated their bill would save PACE participants an average of $972.03 a month on prescription drugs, resulting in an average monthly payment of $43.

The lawmakers are aiming to pass the bill during the current lame-duck session, with the legislation designed to go into effect beginning on Jan. 1, 2023.

The Carper-Cassidy bill isn’t the only legislation seeking to reduce prescription drug costs that is in play during the lame-duck session.

A bill introduced by Sens. Jeanne Shaheen (D-N.H.) and Susan Collins (R-Maine) earlier this year aimed at reducing insulin costs could potentially move forward before the next Congress is sworn in next year.

Congress is also under pressure by medical groups to waive the 4 percent cut in Medicare payments to physicians that is scheduled to go into effect starting next year under the Statutory Pay-As-You-Go (PAYGO) Act of 2010, which requires that new legislation not increase projected deficits.

The PAYGO cut was suspended by Congress with the start of the COVID-19 pandemic, but this pause is set to expire beginning next year without additional action.

Rep. Madaro receives masspace award at EBNHC for spreading PACE Awareness

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This article was originally posted on EastBoston.com. Read the full article here.

(East Boston, September 15, 2022) The East Boston Neighborhood Health Center (EBNHC) recently lauded state Representative Adrian Madaro for his leadership on Beacon Hill increasing awareness of the PACE program among individuals seeking long-term services.

The EBNHC’s Neighborhood PACE program is a branch of the national PACE program — a Program of All-inclusive Care for the Elderly. Neighborhood PACE is an at-home healthcare service for adults 55+ that enables participants to stay healthy, active, and independent through integrated healthcare and various wellness programs at home and in the community.

The PACE Awareness bill has been passed through two committees and will be re-filed again next session. This progress is a testament to Madero’s commitment to advancing PACE awareness so local elders can get the assistance they need without compromise.

To honor his support, Mass PACE awarded Madaro with the MassPACE Legislative Champions award. This award is in recognition of state legislators who are enthusiastic champions of PACE, and advocates for the populations the program serves.

The award ceremony took place at the Neighborhood Health Center on September 15, 2022.

Prescription relief leaves out PACE participants; lets change that

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This article was originally posted on Mcknights Home Care. Read the full article here.

Among the benefits of the Inflation Reduction Act is a cap on out-of-pocket spending on Part D prescriptions for Medicare beneficiaries. The legislation sets the cap at $2,000 annually. This is a positive step toward reducing the healthcare burden for seniors generally. However, it inadvertently leaves out similar protections for beneficiaries who wish to be served by Programs of All-Inclusive Care for the Elderly (PACE). This is at a time when many seniors as well as state governments are realizing PACE’s potential to change the paradigm of senior care.

This is more of a technical oversight than a policy intent. Unlike all other Part D plans, PACE does not charge co-pays or deductibles for prescriptions. Instead, Medicare beneficiaries’ payments for their drug coverage are in the form of the monthly premium they pay to the PACE program. Because the Inflation Reduction Act aims to limit the expense of Part D coverage by capping co-pays and deductibles, PACE participants, whose expense for coverage is entirely based on the premium they pay, won’t have the same cost protection benefits as other Medicare beneficiaries.

Fortunately, legislation has already been introduced in Congress that would assure Medicare beneficiaries in PACE have the same Part D cost protections. The National PACE Association urges passage of the PACE Part D Choice Act, which would allow Medicare-only PACE participants to choose a Part D plan offered by their PACE organization or a marketplace Part D plan. The marketplace Part D plan would be more affordable and include the $2,000 out of pocket cost protections being put forward by the Inflation Reduction Act of 2022.

We are confident that by passing the PACE Part D Plan Choice bill Congress can finish the job and achieve its goal of reducing the cost of prescription drugs for all individuals covered by Medicare.

PACE programs use an interdisciplinary team approach to keep older Americans with long-term care needs healthy and cared for around the clock, while living independently in their own homes. PACE enrollees typically receive care at home; utilize a PACE center for socializing, medication management and physician visits; transportation to the PACE center and other appointments; and any other care or service needed to maintain their highest level of functioning.

PACE is a proven model of care, one that costs states and individuals less than nursing home care and allows participants to remain independent and cared for while living in their own homes.

During the COVID-19 pandemic, PACE organizations were able to continue caring for the older adults in their program, keeping them safe and well at home. In fact, PACE participants, who require a level of care comparable to older adults in a nursing home, experienced a COVID-19 infection rate and a COVID-19 death rate that was one-third the rate of nursing homes.

The Inflation Reduction Act will benefit many millions of Medicare covered individuals; we urge passage of the PACE Part D Choice Act so that PACE participants are not overlooked.

PACE health care model an help improve services for Ma veterans

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This article was originally posted on Metrowest Daily News. Read the full article here.

No one has sacrificed more for our country than veterans. Yet for years, Veterans Administration Medical Centers have been plagued by challenges. COVID-19 and the Afghan war — our longest ever — have put new strains on the VA. Policymakers in Washington are working hard to keep pace with demand for veterans services by building new facilities.

To be sure, adding new infrastructure is a welcome and important part of the strategy to improve health care services to veterans. Another is employing innovative care models that have been proven to work in the private health care market and can be married to the existing VA system.

One of these care models is the Program of All-inclusive Care for the Elderly (PACE), which is offered throughout Massachusetts under several different names, including Fallon Health’s Summit ElderCare.

PACE programs use an interdisciplinary team approach to keep older Americans with complex, chronic conditions safe and healthy while living independently in their own homes. PACE enrollees typically receive care at home and in a PACE center. Such care can include primary care, therapies, meals, socialization, medication management, transportation and any other care or service needed to maintain the highest level of functioning.

Ninety-five percent of enrollees are able to live in the community, outside a nursing home, with the support of PACE. And studies show that PACE and programs like it result in improved outcomes.

A report by the U.S. Department of Health and Human Services found that PACE members “are significantly less likely to be hospitalized, to visit the ED (emergency department) or be institutionalized.”

In Massachusetts, a study of a similar care model, Senior Care Options (SCO), found a “beneficial impact on enrollees in both NF (nursing facility) residency and risk of death.”

During the pandemic, PACE programs demonstrated the strength of their person-centered model of care by keeping enrollees safe at home. The rates of COVID-19 infection and death among PACE enrollees were one-third of those incurred by nursing home residents.

Congress is working on legislation that would marry PACE programs and VA Medical Centers. It is called the “Elizabeth Dole Home and Community Based Services for Veterans and Caregivers Act,” named for the former senator whose late husband, Bob Dole, was also a U.S. senator and a wounded hero in World War II.

Specifically, it would establish partnerships between PACE and VA Medical Centers that are within the service area of a PACE program.

“Age, combined with their unique health needs, makes many elderly veterans especially vulnerable to going into nursing homes and institutional care,” said Congresswoman Julia Brownley, Chair of the House Veterans’ Affairs Subcommittee on Health, who introduced the Dole bill. “Our nation’s veterans deserve the right to age comfortably and with dignity in their homes. The research is clear: providing health services and assistance in home settings improves health outcomes and delays, if not prevents, nursing home placement for people with disabilities and the elderly. However, VA’s current programs need to be improved and expanded to ensure that all veterans have access to these types of services.”

Given the hardships they’ve endured for the rest of the country, veterans deserve access to the most innovative and successful health care strategies we have. We urge Congress to pass the Dole bill.