PACE organizations must demonstrate
their ability to provide quality community-based care for the frail
elderly who meet their State's nursing home eligibility standards
using capitated payments from Medicare and the state. The model of
care includes as core services the provision of adult day health
care and multidisciplinary team case management, through which
access to and allocation of all health services is controlled.
Physician, therapeutic, ancillary, and social support services are
provided in the participant's residence or on-site at the adult day
health center. PACE programs must provide all Medicare and Medicaid
covered services including hospital, nursing home, home health, and
other specialized services. Financing of this model is accomplished
through prospective capitation of both Medicare and Medicaid
payments.
PL:
Pub.L. 106 - 554 903 Name of Law: Medicare, Medicaid and SCHIP
Benefits Improvement Act of 2000
US Code: 42
USC 1395eee Name of Law: PAYMENTS TO, AND COVERAGE OF BENEFITS
UNDER PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)
PL:
Pub.L. 108 - 173 902 Name of Law: Medicare Prescription Drug
Improvement and Modernization Act of 2003 (MMA)
US Code: 42
USC 1396U-4 Name of Law: PROGRAM OF ALL-INCLUSIVE CARE FOR THE
ELDERLY (PACE)
PL:
Pub.L. 105 - 33 4801 Name of Law: the Balanced Budget Act of
1997
Total annual burden, in
aggregate, for this collection, is now estimated to be 71,455
hours. This represents an upward adjustment of +15,274 hours from
the currently-approved estimate of 56,181 hours annually. This
revised total estimate, in large part, reflects an increase in
active POs. The currently-approved burden specific to the PO
(48,006 hours of the 56,181 total hours) accounts for 74 active
PACE programs. We have revised the burden estimates upward to
include all currently-active PACE programs (about 120) plus an
average of 10 new PACE programs resulting from initial applications
submitted annually over the next 3 year approval cycle, for a total
of 130 PACE plans. In addition, we have extracted the application
burden from this collection (previously estimated to be 3,775
hours). However, the new, automated application process relies to a
significant extent on attestations and more limited documentation
uploads and only captures the burden associated with the required
uploads. We therefore are recognizing the burden associated with
the development of required documentation that is not uploaded as
part of the application in this collection, which also contributes
to the increased estimated annual burden. The burden associated
with requirements related to 460.72(c)(5), regarding emergency
preparedness and 460.202(a) and (b), regarding participant health
outcomes data, is now captured as part of separate information
collections, resulting in a decrease of -7,437 annual burden hours.
The total annual burden attributed to the states’ role in this
collection is now 10,115 hours, which represents an increase of
1,940 hours compared to the currently-approved collection (8,175
total annual hours). This estimate no longer includes applicable
state burden (500 hours) related to the application process
(460.12(a)(2)). However, while the estimated hour per response for
the state’s tasks associated with 460.152(a)(3), 460.160(b) and
460.164(e) remains the same, the total estimated annual burden has
increased because the estimate is based on a greater number of
states (35 instead of 25).
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.
Summary of Changes_ CMS-R-244_3282017.docx
Requirements for PACE Entities