Bill Overview
Title: PACE Expanded Act
Description: This bill modifies requirements regarding Programs of All-Inclusive Care for the Elderly (PACE). PACE is a program under Medicare and Medicaid that provides in-home and community services for certain individuals as an alternative to nursing home care. The bill allows Medicare beneficiaries to enroll in a PACE program at any time and provides states with the option to allow Medicaid beneficiaries to do the same. Entities may also apply to become PACE providers at any time, upon specified assurances relating to staffing and other requirements. The bill also (1) allows the Center for Medicare and Medicaid Innovation to test a model for expanded PACE eligibility that targets high-need and high-cost populations, and (2) requires an evaluation of the effectiveness of PACE in rural and underserved areas.
Sponsors: Sen. Casey, Robert P., Jr. [D-PA]
Target Audience
Population: Elderly individuals requiring in-home or community care
Estimated Size: 20000000
- PACE serves elderly individuals, typically 55 and older, who are eligible for nursing home care but prefer to receive services at home or in their community.
- The expansion under Medicare and Medicaid suggests that all elderly persons who are beneficiaries of these programs are potential candidates for PACE services.
- Globally, an aging population with similar needs could be large, but is less directly impacted as PACE is specifically a US program.
Reasoning
- We need to interview a diverse group of elderly individuals who are affected by institutional care decisions, urban-rural dynamics, and socioeconomic status as all of these factors influence potential selection and benefit from the PACE program.
- Since PACE serves a narrow but important segment of the elderly demographic who qualify for nursing home-level care, the interviews should include a mix of beneficiaries who face different access challenges to healthcare, as well as a mixture of geographic settings from rural, suburban, and urban localities.
- The budget limits imply that not all eligible individuals will benefit immediately, but understanding perceived impact is crucial, hence include voices from those currently sidelined by existing provisions.
- PACE, while cost-effective in preventing the need for costly nursing homes, will have varied impacts depending on prior access to alternative care solutions.
- The policy should impact significant improvements in wellbeing for those currently unable to access such comprehensive care programs, thus potentially raising scores for those transitioning from institutional settings.
Simulated Interviews
retired school teacher (rural Idaho)
Age: 78 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 5.0 years
Commonness: 12/20
Statement of Opinion:
- I find it hard to travel for regular Medicaid appointments due to limited mobility and transportation options.
- The idea of receiving necessary care at home or close by sounds like a blessing.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 7 | 4 |
| Year 3 | 8 | 3 |
| Year 5 | 8 | 3 |
| Year 10 | 6 | 3 |
| Year 20 | 5 | 3 |
retired engineer (urban New York)
Age: 84 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 15/20
Statement of Opinion:
- If I can avoid nursing homes and stay with my family while getting the care I need, it matters a lot to my happiness.
- The potential for more PACE providers in urban areas could mean shorter wait times for important services.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 4 |
| Year 10 | 7 | 4 |
| Year 20 | 6 | 3 |
retired nurse (suburban Ohio)
Age: 72 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 17/20
Statement of Opinion:
- Having more options for at-home care makes it feasible to continue taking care of my husband myself.
- PACE might ease the pressure of managing his appointments and specialist visits.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 9 | 5 |
| Year 20 | 7 | 4 |
retired farmer (rural Wyoming)
Age: 69 | Gender: male
Wellbeing Before Policy: 3
Duration of Impact: 3.0 years
Commonness: 20/20
Statement of Opinion:
- There aren’t enough healthcare options nearby, and I'm often struggling to get out for attention.
- If PACE can bring healthcare services closer to me, it would mean fewer hospital trips.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 3 |
| Year 2 | 6 | 3 |
| Year 3 | 6 | 3 |
| Year 5 | 5 | 2 |
| Year 10 | 4 | 2 |
| Year 20 | 4 | 2 |
retired librarian (urban California)
Age: 90 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 0.0 years
Commonness: 10/20
Statement of Opinion:
- A program like PACE isn't something I'll apply for because I have support, but options are always good.
- My concern is more about the services maintaining quality when they're stretched to more people.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 6 | 6 |
| Year 5 | 6 | 6 |
| Year 10 | 6 | 6 |
| Year 20 | 5 | 5 |
retired factory worker (suburban Texas)
Age: 75 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 5.0 years
Commonness: 18/20
Statement of Opinion:
- Through PACE, having access to therapeutic services without depending on rides from friends would improve my life.
- It’s tough navigating multiple health appointments across town.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 7 | 4 |
| Year 3 | 8 | 5 |
| Year 5 | 8 | 4 |
| Year 10 | 7 | 4 |
| Year 20 | 6 | 3 |
retired homemaker (rural Kentucky)
Age: 82 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 14/20
Statement of Opinion:
- Having services close by would not only provide care but also social interaction, which is often lacking for us older folks.
- I hope the expansion doesn’t mean overworked health workers, though.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 4 |
retired store manager (urban Florida)
Age: 77 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 3.0 years
Commonness: 13/20
Statement of Opinion:
- Though I’m managing well now, having a PACE provider could prevent potential future hospital stays.
- It’s more about peace of mind than immediate change.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 6 |
| Year 10 | 7 | 6 |
| Year 20 | 6 | 5 |
retired seamstress (suburban Illinois)
Age: 81 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 7.0 years
Commonness: 11/20
Statement of Opinion:
- The biggest challenge is the logistics and coordination of all these care appointments.
- Having an encompassing service like PACE can reduce stress for my son as well.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 6 | 4 |
| Year 20 | 5 | 4 |
retired artist (rural New Mexico)
Age: 68 | Gender: other
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 8/20
Statement of Opinion:
- The PACE expansion could provide better care options in the future, though I currently manage steadily with support from my partner.
- More local services would reduce travel burdens hugely over time.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 4 |
Cost Estimates
Year 1: $1000000000 (Low: $850000000, High: $1150000000)
Year 2: $1050000000 (Low: $900000000, High: $1200000000)
Year 3: $1100000000 (Low: $950000000, High: $1250000000)
Year 5: $1200000000 (Low: $1050000000, High: $1350000000)
Year 10: $1400000000 (Low: $1250000000, High: $1550000000)
Year 100: $2000000000 (Low: $1800000000, High: $2200000000)
Key Considerations
- Expansion of PACE accessibility will require significant initial investment but may lead to cost-effectiveness in geriatric care delivery over time.
- Administrative burden and complexity might increase with more entities becoming PACE providers.
- Continuous enrollment requires robust monitoring and infrastructure to assure service quality and compliance.