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115th Congress } { Rept. 115-934
HOUSE OF REPRESENTATIVES
2d Session } { Part 1
======================================================================
COMPREHENSIVE CARE FOR SENIORS ACT OF 2018
_______
September 10, 2018.--Committed to the Committee of the Whole House on
the State of the Union and ordered to be printed
_______
Mr. Brady of Texas, from the Committee on Ways and Means, submitted the
following
R E P O R T
[To accompany H.R. 6561]
[Including cost estimate of the Congressional Budget Office]
The Committee on Ways and Means, to whom was referred the
bill (H.R. 6561) to direct the Secretary of Health and Human
Services to finalize certain proposed provisions relating to
the Programs of All-Inclusive Care for the Elderly (PACE) under
the Medicare and Medicaid programs, having considered the same,
report favorably thereon with amendments and recommend that the
bill as amended do pass.
CONTENTS
Page
I. SUMMARY AND BACKGROUND..........................................2
A. Purpose and Summary................................ 2
B. Background and Need for Legislation................ 2
C. Legislative History................................ 3
II. EXPLANATION OF THE BILL.........................................3
A. Comprehensive Care for Seniors Act of 2018......... 3
III. VOTES OF THE COMMITTEE..........................................4
IV. BUDGET EFFECTS OF THE BILL......................................4
A. Committee Estimate of Budgetary Effects............ 4
B. Statement Regarding New Budget Authority and Tax
Expenditures Budget Authority...................... 4
C. Cost Estimate Prepared by the Congressional Budget
Office............................................. 4
V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF THE HOUSE......5
A. Committee Oversight Findings and Recommendations... 5
B. Statement of General Performance Goals and
Objectives......................................... 5
C. Information Relating to Unfunded Mandates.......... 5
D. Congressional Earmarks, Limited Tax Benefits, and
Limited Tariff Benefits............................ 5
E. Duplication of Federal Programs.................... 5
F. Disclosure of Directed Rule Makings................ 6
VI. CORRESPONDENCE..................................................7
VII. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED..........10
A. Changes in Existing Law Proposed by the Bill, as
Reported........................................... 10
The amendments are as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Comprehensive Care for Seniors Act of
2018''.
SEC. 2. DIRECTING THE SECRETARY OF HEALTH AND HUMAN SERVICES TO ISSUE A
FINAL REGULATION BASED ON THE PROPOSED REGULATION
RELATING TO THE PROGRAMS OF ALL-INCLUSIVE CARE FOR
THE ELDERLY (PACE) UNDER THE MEDICARE AND MEDICAID
PROGRAMS.
Not later than December 31, 2018, the Secretary of Health and Human
Services shall issue a final regulation based on the provisions of the
proposed regulation titled ``Medicare and Medicaid Programs; Programs
of All-Inclusive Care for the Elderly (PACE)'' (81 Fed. Reg. 54666).
Amend the title so as to read:
A bill to direct the Secretary of Health and Human Services
to issue a final regulation based on the proposed regulation
relating to the Programs of All-Inclusive Care for the Elderly
(PACE) under the Medicare and Medicaid programs.
I. SUMMARY AND BACKGROUND
A. Purpose and Summary
The bill, H.R. 6561, the Comprehensive Care for Seniors Act
of 2018,'' as ordered reported by the Committee on Ways and
Means on September 5, 2018, directs the Secretary of the
Department of Health and Human Services (the Secretary'') to
finalize the Program of All-Inclusive Care for the Elderly
(PACE) regulations, originally proposed in August 2016, no
later than December 31, 2018. The bill provides the Secretary
with the flexibility to make updates and changes to the
proposed regulation.
B. Background and Need for Legislation
PACE is a capitated benefit for frail elders that features
a comprehensive service delivery system and integrated Medicare
and Medicaid financing. PACE was tested through demonstration
projects that began in the mid-1980s and were permanently
authorized in the Balanced Budget Act of 1997. PACE enables
states to provide services to Medicaid beneficiaries who are
also enrolled in Medicare as a state plan option.
Operationally, the PACE program is unique as a three-way
partnership between the Federal government, the State, and the
PACE organization. More than 34,000 older adults are currently
enrolled in about 100 PACE organizations in 31 states.
Enrollment in PACE has increased by over 60 percent since 2011.
CMS published a regulation on August 16, 2016, proposing
changes to the PACE model to increase flexibility of the
Interdisciplinary Team (IDT) to better coordinate care for the
beneficiary, as well as other updates and clarifications to
improve operation. This regulation represents the first major
proposed update to the PACE program since 2006. Specifically,
the pending regulation includes changes to application and
waiver procedures, sanctions, enforcement actions and
termination, administrative requirements, PACE services,
participant rights, quality assessment and performance
improvement, participant enrollment and disenrollment, payment,
federal and state monitoring, data collection, record
maintenance, and reporting. The most needed changes include:
(1) allowing PACE organizations to include community physicians
as part of their hallmark IDT; (2) using nurse practitioners
and physician assistants as primary care providers; (3)
providing services in settings other than the PACE Center; and
(4) configuring the IDT to meet the needs of individual
participants. To date, CMS has not published a regulation
finalizing the PACE changes proposed in 2016.
C. Legislative History
Background
H.R. 6561 was introduced on July 26, 2018, and was referred
to the Committee on Ways and Means and additionally the
Committee on Energy and Commerce.
Committee hearings
On June 7, 2017, the Subcommittee on Health held a hearing
on Promoting Integrated and Coordinated Care for Medicare
Beneficiaries to review the current status of the PACE program
and Special Needs Plans.
Committee action
The Committee on Ways and Means marked up H.R. 6561, the
Comprehensive Care for Seniors Act of 2018,'' on September 5,
2018, and ordered the bill, as amended, favorably reported
(with a quorum being present).
II. EXPLANATION OF THE BILL
A. Comprehensive Care for Seniors Act of 2018
PRESENT LAW
The Secretary has the authority to issue initial interim
and final PACE program regulations. However, it is not required
by law to finalize pending regulations within a certain
timeframe.
REASONS FOR CHANGE
The 2016 proposed regulation provides much needed
flexibilities and updates to the PACE program.
EXPLANATION OF PROVISIONS
Section 1: Short Title: The Comprehensive Care for Seniors
Act of 2018.''
Section 2: Directing the Secretary of Health and Human
Services to finalize certain proposed provisions relating to
the Programs of All-Inclusive Care for the Elderly (PACE) under
the Medicare and Medicaid programs.
This section stipulates that the Secretary has until
December 31, 2018, to finalize the provisions proposed in the
rule titled Medicare and Medicaid Programs; Programs of All-
Inclusive Care for the Elderly (PACE)'' (81 Fed. Reg. 54666).
This section also provides the Secretary with the authority to
make updates and changes to the proposed regulation.
EFFECTIVE DATE
The Secretary must finalize PACE regulations no later than
December 31, 2018.
III. VOTES OF THE COMMITTEE
In compliance with clause 3(b) of rule XIII of the Rules of
the House of Representatives, the following statement is made
concerning the vote of the Committee on Ways and Means in its
consideration of H.R. 6561, the Comprehensive Care for Seniors
Act of 2018,'' on September 5, 2018.
The Chairman's amendment in the nature of a substitute was
adopted by a voice vote (with a quorum being present).
The bill, H.R. 6561, was ordered favorably reported as
amended by voice vote (with a quorum being present).
IV. BUDGET EFFECTS OF THE BILL
A. Committee Estimate of Budgetary Effects
In compliance with clause 3(d) of rule XIII of the Rules of
the House of Representatives, the following statement is made
concerning the effects on the budget of the bill, H.R. 6690, as
reported. The Committee agrees with the estimate prepared by
the Congressional Budget Office (CBO), which is included below.
B. Statement Regarding New Budget Authority and Tax Expenditures Budget
Authority
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee states that the
bill involves no new or increased budget authority. The
Committee states further that the bill involves no new or
increased tax expenditures.
C. Cost Estimate Prepared by the Congressional Budget Office
In compliance with clause 3(c)(3) of rule XIII of the Rules
of the House of Representatives, requiring a cost estimate
prepared by the CBO, the following statement by CBO is
provided.
U.S. Congress,
Congressional Budget Office,
Washington, DC, September 10, 2018.
Hon. Kevin Brady,
Chairman, Committee on Ways and Means,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 6561, the
Comprehensive Care for Seniors Act of 2018.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Lori Housman.
Sincerely,
Keith Hall,
Director.
Enclosure.
H.R. 6561--Comprehensive Care for Seniors Act of 2018
H.R. 6561 would direct the Secretary of Health and Human
Services to issue a final regulation based on the provisions of
the proposed regulation for the Programs of All-Inclusive Care
for the Elderly program by December 31, 2018.
CBO estimates that enacting this bill would have no
significant effect on the federal budget. Enacting H.R. 6561
would not affect direct spending or revenues; therefore, pay-
as-you-go procedures do not apply. CBO estimates that enacting
H.R. 6561 would not increase net direct spending or on-budget
deficits in any of the four consecutive 10-year periods
beginning in 2029.
H.R. 6561 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act.
The CBO staff contact for this estimate is Lori Housman
(for federal costs) and Andrew Laughlin (for intergovernmental
or private-sector mandates). The estimate was reviewed by
Theresa Gullo, Assistant Director for Budget Analysis.
V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF THE HOUSE
A. Committee Oversight Findings and Recommendations
With respect to clause 3(c)(1) of rule XIII of the Rules of
the House of Representatives, the Committee made findings and
recommendations that are reflected in this report.
B. Statement of General Performance Goals and Objectives
With respect to clause 3(c)(4) of rule XIII of the Rules of
the House of Representatives, the Committee advises that the
bill contains no measure that authorizes funding, so no
statement of general performance goals and objectives for which
any measure authorizes funding is required.
C. Information Relating to Unfunded Mandates
This information is provided in accordance with section 423
of the Unfunded Mandates Reform Act of 1995 (Pub. L. No. 104-
4).
The Committee has determined that the bill does not contain
Federal mandates on the private sector. The Committee has
determined that the bill does not impose a Federal
intergovernmental mandate on State, local, or tribal
governments.
D. Congressional Earmarks, Limited Tax Benefits, and Limited Tariff
Benefits
With respect to clause 9 of rule XXI of the Rules of the
House of Representatives, the Committee has carefully reviewed
the provisions of the bill, and states that the provisions of
the bill do not contain any congressional earmarks, limited tax
benefits, or limited tariff benefits within the meaning of the
rule.
E. Duplication of Federal Programs
In compliance with Sec. 3(g)(2) of H. Res. 5 (114th
Congress), the Committee states that no provision of the bill
establishes or reauthorizes: (1) a program of the Federal
Government known to be duplicative of another Federal program;
(2) a program included in any report from the Government
Accountability Office to Congress pursuant to section 21 of
Public Law 111-139; or (3) a program related to a program
identified in the most recent Catalog of Federal Domestic
Assistance, published pursuant to the Federal Program
Information Act (Pub. L. No. 95-220, as amended by Pub. L. No.
98-169).
F. Disclosure of Directed Rule Makings
In compliance with Sec. 3(i) of H. Res. 5 (114th Congress),
the following statement is made concerning directed rule
makings: The Committee estimates that the bill requires no
directed rule makings within the meaning of such section.
VII. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED
A. Changes in Existing Law Proposed by the Bill, as Reported
In compliance with clause 3(e)(1)(B) of rule XIII of the
Rules of the House of Representatives, the bill, as reported,
makes no changes to existing law.
[all]
