HouseH.R. 10547119th Congress
PACE Access Improvement Act
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[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 10547 Introduced in House (IH)]
<DOC>
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.
_______________________________________________________________________
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
_______________________________________________________________________
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.
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