Sen. Toomey Urges Administration To Help Medicare and Medicaid Beneficiaries Continue To Live At Home

WASHINGTON, D.C. - U.S. Senator Pat Toomey (R-Pa.) wants to ensure that Medicare and Medicaid beneficiaries who wish to continue to live at home with a little bit of support are able to do so. Sen. Toomey and Sen. Tom Carper (D-Del.) led a bipartisan group of 13 Senators urging the Administration to increase regulatory flexibility for Programs of All-inclusive Care for the Elderly (PACE), which is also known as Living Independently for Elders (LIFE) in Pennsylvania.

PACE programs give nursing home eligible beneficiaries the ability to receive a high level of coordinated care while still living in their home. With more flexibility, PACE would be able to improve, innovate, and reduce technical and administrative barriers so that more beneficiaries can participate in the program thus keeping them out of long-term care institutions.

"In Pennsylvania, the PACE program has been extremely successful," said Sen. Toomey. "The commonwealth has 17 PACE programs - the most in the country-- and 4,300 enrollees. Sen. Carper and I want to allow these programs to build on their innovative model and give PACE beneficiaries access to improved health care delivery of other social services."

"Sen. Toomey is fighting to strengthen and expand the PACE/LIFE program and allow individuals to avoid nursing home placement and continue to receive the critical health and long term care services in their homes and communities," said Frank Byrne, President and CEO of the Pennsylvania LIFE Provider Alliance. "We applaud him for his steadfast leadership and unwavering commitment to caring for our most vulnerable and frailest populations."

"We support Sen. Toomey's leadership to expand PACE's growth and innovation by amending specific regulatory requirements" said Robert McQuillan Associate Vice President - LIFE Geisinger. "PACE has always been about providing patient centered care and services through an innovative system. Caring for frail seniors in the community is the core mission of LIFE Geisinger. When we have the opportunity to update and streamline regulations - to be inclusive of other community providers in our service areas - and meet the needs of a larger senior population in their homes, we see that as a win for seniors."

The text of the letter is below:

September 17, 2014

Marilyn Tavenner
Administrator
Center for Medicare and Medicaid Services
Department of Health and Human Services
Room-445G, Hubert H. Humphrey Building
200 Independence Avenue
Washington, D.C. 20201

Dear Administrator Tavenner,

For more than 40 years, the Program of All Inclusive Care for the Elderly (PACE) has offered a comprehensive, fully integrated, provider-based option for the frailest and costliest members of our society - those who require a nursing home level of care. The PACE philosophy is centered on the belief that it is better for frail individuals and their families to be served in the community whenever possible. Although all PACE participants are eligible for nursing home care, 90 percent continue to live in the community.

PACE is in a unique position to help the Centers for Medicare and Medicaid Services (CMS) achieve its goals of better care, better health and increased cost-effectiveness for a larger and more diverse number of dually eligible individuals. However, current regulatory and statutory barriers have inhibited PACE growth and innovation.

It is our understanding that CMS is currently revising 42 CFR Chapter IV, Subchapter E -Programs of All Inclusive Care for the Elderly. As the Agency considers regulatory changes, we encourage you to offer PACE the operational flexibility it needs to more effectively and efficiently serve our seniors who need long term services and supports. These flexibilities should:
1. Allow PACE organizations, as an alternative to operating a PACE Center, the option to offer services in other community settings, such as adult day health centers or senior centers, that support PACE participants interaction with one another and with the PACE interdisciplinary team members.
2. Allow PACE organizations to integrate community physicians as members of the PACE interdisciplinary team.
3. Provide operational flexibility to configure the PACE interdisciplinary team based on the needs of the individual participant, including greater flexibility in the use of nurse practitioners and physician assistants as primary care providers.
4. Conduct concurrent, CMS and state agency, reviews of new PACE provider applications or service area expansion applications.
Operational flexibility is needed to ensure that PACE programs can continue to offer a high quality, cost effective option to seniors. We encourage CMS to release a revised PACE regulation and foster a regulatory environment that increases access to the proven, high-quality, cost-effective PACE model.

Thank you for your consideration of this request.

Sincerely,

Senator Thomas R. Carper (Del.)
Senator Patrick J. Toomey (Pa.)
Senator Michael F. Bennet (Colo.)
Senator Richard Burr (N.C.)
Senator Charles E. Schumer (N.Y.)
Senator Marco Rubio (Fla.)
Senator Debbie Stabenow (Mich.)
Senator Lamar Alexander (Tenn.)
Senator Mark R. Warner (Va.)
Senator Michael B. Enzi (Wyo.)
Senator Bill Nelson (Fla.)
Senator Pat Roberts (Kan.)
Senator Cory A. Booker (N.J.)

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