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 statesâ 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 stateâs 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