PACE Access Improvement Act

(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.