On Tuesday, March 17, 2020, the Centers for Medicare & Medicaid Services (CMS) released guidance to all Programs of All-Inclusive Care for the Elderly (PACE) Organizations (POs) on policies and standard practices to follow in regards to the COVID-19 public health emergency.
PACE is a Medicaid and Medicare program that provides healthcare and social services for participating elderly citizens who live in the community rather than in a nursing home or other facility. In CMS’s guidance on Tuesday, it explains that consistent with the infection control regulations codified at 42 C.F.R. 460.74, POs must follow “policies and standard procedures as well as guidelines developed by the Centers for Disease Control and Prevention (CDC).” POs should also implement and “maintain a documented infection control plan” that includes procedures to identify infections both in PACE centers and in participants’ homes.
In addition, POs should “frequently monitor” their participants, healthcare workers, PACE visitors, and other personnel for any signs of respiratory infection. If POs find a number of such individuals have respiratory infections, or if they believe a participant or any worker has COVID-19, CMS’s guidance provides that POs should notify their “state or local health department for further guidance.” Personal protective equipment (PPE) also needs to be provided to all PO personnel and CMS recommends that these personnel follow CDC guidance for healthcare professionals who are assisting in managing the care of patients in their homes who are suspected to have COVID-19.
This guidance also states that POs need to continue “providing all required Medicare and Medicaid covered services.” CMS states that this includes “diagnostic laboratory tests that identify COVID-19,” home setting services for participants who are experiencing COVID-19 symptoms, and services that POs’ interdisciplinary teams believe are necessary for “a participant’s overall health status.” CMS states that during this public health crisis POs may ask participants not to attend the PACE center even if those participants “do not display symptoms of COVID-19.”
CMS’s press release and the guidance itself explains that the agency will use discretion if POs need to use or create strategies during the COVID-19 outbreak that “do not fully comply with the CMS PACE program requirements.” For example, the guidance states that POs may “need to use remote technology as appropriate, including for scheduled and unscheduled participant assessments, care planning, monitoring, communication, and other related activities that would typically occur in an in-person visit.” CMS describes that it will “notify POs through the Health Plan Management System” when it is ending the guidance’s described enforcement discretion. The guidance also explains that POs can “relax” the “refill-too-soon” edits so that participants have access to Part D drugs.
CMS further directs POs to monitor the CDC’s website and the CMS Emergency Preparedness & Response Operations website for the latest guidelines and updates. If POs have any questions regarding this guidance, they should be submitted here.
The Health Law Pulse will continue to provide relevant updates for healthcare providers during this public health crisis.