PACE Access Improvement Act
- Sponsor
- Rep. Dingell, Debbie [D-MI-6]
- Committees
- Ways and Means Committee (primary)
- Last action
- Sep 24, 2026
Bottom line
This bill seeks to modernize and expand the PACE program by reducing administrative hurdles for providers and increasing enrollment flexibility for eligible seniors, while also mandating state participation.
What it actually does
This bill aims to expand access to the Program of All-Inclusive Care for the Elderly (PACE) by allowing eligible individuals to enroll at any time during a month, streamlining the approval process for PACE providers to establish new sites or expand service areas, and mandating that all states offer PACE program services under Medicaid. It also repeals certain marketing restrictions and numerical limitations on PACE providers.
Proponents argue
Proponents argue that the bill will make it significantly easier for eligible seniors to access comprehensive, coordinated care through PACE, which is crucial for helping them remain in their homes and communities. They contend that reducing regulatory burdens will allow more providers to offer PACE services and expand into underserved areas, ultimately improving health outcomes and quality of life for the elderly.
Opponents contend
Potential opponents might raise concerns about the financial implications of mandating state participation in PACE, particularly for states with limited resources or existing long-term care programs. They might also question whether the streamlined approval processes could compromise oversight or quality of care, or lead to increased federal and state expenditures without sufficient cost controls.
The bill is relatively short and its core provisions are clear, making it accessible for an informed reader to understand its main objectives and proposed changes within a reasonable timeframe.
Section 2(a) and 2(b) of H.R. 10547, amending 42 U.S.C. 1395eee(c)(5), 1395eee(d), 1396u-4(c)(5), and 1396u-4(d).
Anytime Enrollment and Prorated Payments for PACE
This provision allows eligible individuals to enroll in a PACE program at any time during a month, with enrollment becoming effective on the date their signed agreement is received by the provider, starting January 1, 2027. It also mandates that Medicare and Medicaid capitation payments to PACE providers be prorated for the first month if enrollment does not begin on the first day of the month.
Supporters argue
Supporters argue this removes an unnecessary barrier to care, allowing individuals to enroll when they need care most, rather than being forced to wait for the next calendar month. This flexibility is crucial for timely access to integrated services, especially for those with urgent care needs.
Critics contend
No specific opposition is typically raised against this provision, as it primarily addresses administrative flexibility and is generally seen as beneficial for patient access. Some might raise minor concerns about the administrative burden for providers in adjusting billing systems for prorated payments.
Tradeoffs
This provision balances administrative simplicity (monthly enrollment cycles) with patient-centered flexibility (anytime enrollment), requiring a minor adjustment to payment mechanisms to achieve greater access.
Section 3 of H.R. 10547, amending 42 U.S.C. 1395eee(e) and 1396u-4(e).
Streamlined Processes for New PACE Providers, Service Area Expansions, and New Sites
This section revises the approval process for entities seeking new PACE provider status, expanding service areas, or adding PACE center sites. It allows applications at any time, permits multiple applications per quarter, and introduces a 'deemed approval' mechanism if the Secretary (CMS) does not respond within 45 days. It also allows 'qualified PACE providers' to add new sites within existing service areas with a 'qualifying notice' instead of a full application, provided certain assurances are met.
Section 4(a) and 4(b) of H.R. 10547, amending 42 U.S.C. 1396u-4(a) and 1396a(a).
Mandatory State Participation in PACE
This provision mandates that states offer PACE program services to eligible individuals under their Medicaid programs. States with existing PACE programs must comply within 180 days of the bill's enactment, while states without existing programs have 3 years. It also removes the ability for states to set numerical limits on PACE enrollment.
Section 5(a) and 5(b) of H.R. 10547, amending 42 U.S.C. 1395eee(f)(3) and 1396u-4(f)(3), and repealing 42 CFR 460.82(e)(5).
Revised Marketing Requirements for PACE Programs
This section allows PACE programs to begin marketing activities, including using conditionally approved materials, as soon as they submit a complete application for new provider status, service area expansion, or new center addition. It also explicitly permits certain marketing practices described in a specific regulation (42 CFR 460.82(e)(5) as of June 1, 2025) and repeals that regulation, effectively loosening restrictions.
Section 6(a) and 6(b) of H.R. 10547, amending 42 U.S.C. 1395eee(e), 1395eee(h), 1396u-4(e), and 1396u-4(h).
Removal of Numerical Limits and Equal Treatment for For-Profit PACE Providers
This section removes previous language that allowed the Secretary to establish numerical limits on PACE program agreements. It also ensures that the terms and conditions for operation are the same for all PACE providers, regardless of whether they are nonprofit or for-profit, effectively removing any distinction or potential limitation based on organizational structure.
Allows 'qualified PACE providers' to add new PACE center sites within their existing service area by submitting a 'qualifying notice' to the Secretary (CMS) instead of a full application. A 'qualified PACE provider' is defined as one that has successfully completed its first trial period audit and is not under sanction. The 'qualifying notice' must include assurances from the state and regarding staffing.
Section 3(A)(ii)(II) and 3(E) of H.R. 10547, amending 42 U.S.C. 1395eee(e) and 1396u-4(e).
Why it matters:This is standard legislative practice for defining specific exceptions and conditions within a broader rule, providing a nuanced pathway for certain entities. It is not necessarily evasive but requires careful reading to fully grasp its implications.
Case for: Proponents argue this significantly reduces administrative burden for established, compliant PACE providers, allowing them to expand services more quickly and efficiently to meet demand in their existing service areas. This accelerates access to care without compromising quality, given the 'qualified' status.
Case against: Critics might argue that even for qualified providers, a full application process ensures thorough review of new sites, particularly regarding infrastructure, staffing adequacy, and local community needs, which a mere 'notice' might bypass. This could potentially lead to less rigorous oversight of new facilities.
Estimated impact: Likely to accelerate the expansion of PACE center sites for existing, successful providers, leading to more rapid growth in areas already served by PACE programs.