PACE Access Improvement Act

[Congressional Bills 119th Congress] [From the U.S. Government Publishing Office] [H.R. 10547 Introduced in House (IH)]

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119th CONGRESS 2d Session H. R. 10547

To amend titles XVIII and XIX of the Social Security Act to improve access to the Program of All-Inclusive Care for the Elderly (PACE), to reduce regulatory burdens on PACE providers, and for other purposes.

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IN THE HOUSE OF REPRESENTATIVES

September 24, 2026

Mrs. Dingell (for herself and Mr. Moolenaar) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

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A BILL

To amend titles XVIII and XIX of the Social Security Act to improve access to the Program of All-Inclusive Care for the Elderly (PACE), to reduce regulatory burdens on PACE providers, and for other purposes.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``PACE Access Improvement Act''.

SEC. 2. ANYTIME ENROLLMENT IN PACE.

(a) In General.-- (1) Any time enrollment and effective date.--Section 1894(c)(5) of the Social Security Act (42 U.S.C. 1395eee(c)(5)) is amended by adding at the end the following new subparagraph: ``(C) Any time enrollment and effective date of enrollment.-- ``(i) Any time enrollment.--With respect to enrollments made on or after January 1, 2027, a PACE program eligible individual may enroll in a PACE program at any time during a month. ``(ii) Effective date.--With respect to enrollments made on or after January 1, 2027, the enrollment of a PACE program eligible individual in a PACE program shall be effective on the date the PACE provider operating the PACE program receives an enrollment agreement signed by such PACE program eligible individual with respect to such PACE program.''. (2) Prorated payments.--Section 1894(d) of the Social Security Act (42 U.S.C. 1395eee(d)) is amended by adding at the end the following new paragraph: ``(4) Prorated payments.--With respect to enrollments made on or after January 1, 2027, in the case of a PACE program eligible individual enrolled in a PACE program operated by a PACE provider with an enrollment effective date that is not the first day of a month, the capitation amount that would otherwise be made under this subsection to the PACE provider for such individual for the first month in which such individual is so enrolled shall be prorated accordingly.''. (b) Requirements Under Medicaid.-- (1) Any time enrollment and effective date.--Section 1934(c)(5) of the Social Security Act (42 U.S.C. 1396u-4(c)(5)) is amended by adding at the end the following new subparagraph: ``(C) Any time enrollment and effective date of enrollment.-- ``(i) Any time enrollment.--With respect to enrollments made on or after January 1, 2027, a PACE program eligible individual may enroll in a PACE program in a State at any time during a month. ``(ii) Effective date.--With respect to enrollments made on or after January 1, 2027, the enrollment of a PACE program eligible individual in a PACE program shall be effective on the date the PACE provider operating the PACE program receives an enrollment agreement signed by such PACE program eligible individual with respect to such PACE program.''. (2) Prorated payments.--Section 1934(d) of the Social Security Act (42 U.S.C. 1396u-4(d)) is amended by adding at the end the following new paragraph: ``(3) Prorated payments.--With respect to enrollments made on or after January 1, 2027, in the case of a PACE program eligible individual enrolled in a PACE program operated by a PACE provider with an enrollment effective date that is not the first day of a month, the State shall prorate the capitation amount that would otherwise be made under this subsection to the PACE provider for such individual for the first month in which such individual is so enrolled.''.

SEC. 3. PACE SITE APPROVAL AND EXPANSION.

Sections 1894(e) and 1934(e) of the Social Security Act (42 U.S.C. 1395eee(e), 1396u-4(e)) are each amended by striking paragraph (8) and inserting the following: ``(8) Revised processes for new provider status, service area expansions, and additions of pace center sites.-- ``(A) In general.--Beginning January 1, 2027, the following shall apply: ``(i) Seeking new pace provider status.--An entity may submit an application for the purpose described in section 460.10(a)(1) of title 42, Code of Federal Regulations, or any successor regulation, at any time and may submit multiple applications for such purpose in the same quarter. ``(ii) Seeking service area expansion or addition of pace center site (but not both).-- ``(I) In general.--An entity may submit an application for a purpose described in section 460.10(a)(2) of title 42, Code of Federal Regulations, or any successor regulation, at any time, subject to the requirements of section 460.12(d) of such title (relating to the first trial period audit), or any successor regulation, and may submit multiple applications for such purpose in the same quarter. ``(II) Application not required for qualified pace providers seeking addition of a pace center site in existing service area.--A qualified PACE provider (as defined in subparagraph (E)(ii)) operating a PACE program in a service area that seeks to add a PACE center site under such PACE program to such service area (and does not also seek to expand its service area) shall not be required to submit an application to the Secretary in order to so add such PACE center site if the qualified PACE provider submits to the Secretary (at such time as the Secretary may specify in regulation) a qualifying notice (as defined in subparagraph (E)(i)) with respect to the proposed additional PACE center site. Such a qualifying notice shall not be considered an application for purposes of subpart B of part 460 of title 42, Code of Federal Regulations, or any successor to such regulations. ``(iii) Seeking both service area expansion and addition of pace center site.--An entity may submit an application for the purposes described in section 460.10(a)(3) of title 42, Code of Federal Regulations, or any successor regulation, at any time, subject to the requirements of section 460.12(d) of such title (relating to the first trial period audit), or any successor regulation, and may submit multiple applications for such purposes in the same quarter. ``(B) Deemed approval for applications.--An application described in subparagraph (A)(i), (A)(ii)(I), or (A)(iii) shall be deemed approved unless the Secretary, within 45 days after the date of the submission of the application to the Secretary, either denies such request in writing or informs the applicant in writing with respect to any additional information that is needed in order to make a final determination with respect to the application. After the date the Secretary receives such additional information, the application shall be deemed approved unless the Secretary, within 45 days of such date, denies such request. ``(C) Certain assurances substituting for certain application requirements for required interdisciplinary team and contractors.-- ``(i) In general.--In the case of an application described in subparagraph (A)(i), (A)(ii)(I), or (A)(iii) that includes each of the assurances described in clause (ii), with respect to a PACE provider and proposed PACE center site, such assurances shall be treated as satisfying any application or other requirement applying a deadline by which the members of the interdisciplinary team described in section 460.102(b) of title 42, Code of Federal Regulations, or any successor regulation, are required to be employees or contractors of the proposed PACE center site and any deadline by which the PACE provider's contracts for contracted health care providers, personnel, staff, or other contractors to provide contracted services must be executed (and, if such assurances are so included, any such deadlines shall not apply with respect to such application). ``(ii) Assurances described.--For purposes of clause (i), the assurances described in this clause, with respect to a PACE provider and proposed PACE center site are each of the following: ``(I) An assurance that the required members of the interdisciplinary team are employees or contractors of the proposed PACE center site or will be employees or contractors of the proposed PACE center site by the time the PACE center becomes operational. ``(II) An assurance that the PACE provider's contracts for all contractors and contracted personnel will be executed by the time the proposed PACE center site becomes operational. ``(D) Permission to contract for projected staffing needs.--In executing contracts with contracted health care providers, personnel, staff, or other contractors to provide contracted services or to establish an interdisciplinary team, for a purpose described in clause (i), (ii)(I), (ii)(II), or (iii) of subparagraph (A), a PACE provider may include provisions for staffing levels to be commensurate with enrollment to full projected census. ``(E) Definitions for qualified pace provider and qualifying notice.--For purposes of subparagraph (A)(ii)(II): ``(i) Qualifying notice.--The term `qualifying notice' means, with respect to a qualified PACE provider operating a PACE program in a service area, a notice containing each of the following assurances with respect to the addition of a PACE center site to such service area by such qualified PACE provider: ``(I) An assurance that the additional PACE center site will be located within such service area of such PACE program. ``(II) An assurance from the State administering agency of the State in which the PACE program is located that the State is willing to amend the PACE program agreement to include the additional PACE center site in such service area. ``(III) Each of the assurances described in subparagraph (C)(ii). ``(ii) Qualified pace provider.--The term `qualified PACE provider' means, with respect to a PACE program operated by such qualified PACE provider, a PACE provider that, at the time of submission of a qualifying notice to the Secretary-- ``(I) has successfully completed the first trial period audit with respect to such PACE program; and ``(II) is not the subject of a sanction, an enforcement action or a termination proceeding under subpart D of part 460 of title 42, Code of Federal Regulations, or any successor regulation, with respect to such PACE program.''.

SEC. 4. REQUIRING STATES TO OFFER PACE PROGRAM SERVICES TO ELIGIBLE INDIVIDUALS.

(a) In General.--Section 1934(a) of the Social Security Act (42 U.S.C. 1396u-4(a)) is amended-- (1) in paragraph (1)-- (A) by striking ``A State may elect to provide'' and inserting ``Before the compliance date described in paragraph (11) with respect to a State, the State may elect to provide, and on and after such compliance date with respect to the State, the State shall provide''; and (B) by striking ``A State may establish a numerical limit on the number of individuals who may be enrolled in a PACE program under a PACE program agreement.''; and (2) by adding at the end the following new paragraph: ``(11) Compliance date described.--For purposes of this section, subject to section 4(c) of the PACE Access Improvement Act, the compliance date with respect to a State is-- ``(A) in the case of a State that, as of the date of the enactment of this paragraph, has in effect a PACE program agreement with at least 1 PACE provider to operate a PACE program in the State, the date that is 180 days after such date of enactment; and ``(B) in the case of a State that is not described in subparagraph (A), the date that is 3 years after such date of enactment.''. (b) State Plan Requirement.--Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)) is amended-- (1) in paragraph (89), by striking ``; and'' and inserting a semicolon; (2) in paragraph (90)(C), by striking the period at the end and inserting ``; and''; and (3) by inserting after paragraph (90) the following new paragraph; ``(91) provide, in accordance with section 1934, that the State, beginning on the compliance date described in section 1934(a)(11) with respect to such State, shall provide medical assistance with respect to PACE program services to PACE program eligible individuals who are eligible for medical assistance under the State plan or under a waiver of such plan and who are enrolled in a PACE program under a PACE program agreement.''. (c) Effective Date.-- (1) In general.--Except as provided in paragraph (2) and unless otherwise specified, the amendments made by this section shall take effect on the date of the enactment of this Act and shall apply beginning with respect to medical assistance provided on the date that is 180 days after such date of enactment. (2) Delay permitted if state legislation required.--In the case of a State plan approved under title XIX of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirements imposed by the amendments made by this section, the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of the failure of the plan to meet such additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that ends after the date of the enactment of this section. For purposes of the preceding sentence, in the case of a State that has a 2-year legislative session, each year of the session is deemed to be a separate regular session of the State legislature.

SEC. 5. REPEAL OF OVERLY BURDENSOME REGULATIONS ON OUTREACH.

(a) Repeal of Unnecessarily Burdensome Regulatory Restrictions.-- (1) In general.--Sections 1894(f)(3) and 1934(f)(3) of the Social Security Act (42 U.S.C. 1395eee(f)(3), 1396u-4(f)(3)) are each amended by adding at the end the following new subparagraph: ``(C) Revision of certain marketing requirements.-- ``(i) Permissible commencement of marketing.-- ``(I) In general.--A specified PACE program (as defined in subclause (II)) that submits a complete application to the Secretary (as determined under section 460.20 of title 42, Code of Federal Regulations, or any successor regulation) for any of the purposes described in subclause (III) may conduct marketing activities with respect to prospective PACE program eligible individuals, such as making available marketing materials that have been conditionally approved by the Secretary, on or after the date the specified PACE program submits such complete application. ``(II) Specified pace program defined.--In this subparagraph, the term `specified PACE program' means a PACE program, and includes an entity that submits an application to CMS for approval as a PACE program. ``(III) Application purposes described.--For purposes of subclause (I), an application described in such subclause may be submitted for any of the following purposes: ``(aa) For an entity seeking approval from the Secretary as a PACE program. ``(bb) For a PACE program seeking to expand its service area. ``(cc) For a PACE program seeking to add a new PACE center. ``(dd) For a PACE program seeking to expand its service area and to add a new PACE center. ``(ii) Marketing activities.--A specified PACE program may use marketing practices described in section 460.82(e)(5) of title 42, Code of Federal Regulations, as in effect on June 1, 2025.''. (2) Conforming repeal.--Section 460.82(e)(5) of title 42, Code of Federal Regulations, is repealed and shall have no force or effect in law. (b) Effective Date.--The amendments made by subsection (a) shall apply with respect to marketing activities under section 1894 or 1934 of the Social Security Act (42 U.S.C. 1395eee; 1396u-4) conducted on or after the date that is 180 days after the date of the enactment of this Act.

SEC. 6. REPEAL OF OUTDATED AND BURDENSOME NUMERICAL LIMITATION.

(a) Medicare.--Section 1894 of the Social Security Act (42 U.S.C. 1395eee) is amended-- (1) in subsection (e), by striking paragraph (1) and inserting the following: ``(1) Requirement.--The Secretary, in close cooperation with the State administering agency, shall establish procedures for entering into, extending, and terminating PACE program agreements for the operation of PACE programs by entities that meet the requirements for a PACE provider under this section, section 1934, and regulations.''; and (2) in subsection (h), by striking paragraph (2) and inserting the following: ``(2) Similar terms and conditions.--Except as provided under paragraph (1), the terms and conditions for operation of a PACE program by a provider under this subsection shall be the same as those for PACE providers that are nonprofit, private organizations.''. (b) Medicaid.--Section 1934 of the Social Security Act (42 U.S.C. 1396u-4) is amended-- (1) in subsection (e), by striking paragraph (1) and inserting the following: ``(1) Requirement.--The Secretary, in close cooperation with the State administering agency, shall establish procedures for entering into, extending, and terminating PACE program agreements for the operation of PACE programs by entities that meet the requirements for a PACE provider under this section, section 1894, and regulations.''; and (2) in subsection (h), by striking paragraph (2) and inserting the following: ``(2) Similar terms and conditions.--Except as provided under paragraph (1), the terms and conditions for operation of a PACE program by a provider under this subsection shall be the same as those for PACE providers that are nonprofit, private organizations.''. (c) Effective Date.--The amendments made by this section shall take effect on the date of the enactment of this Act. <all>