H.R. 10547 — PACE Access Improvement Act

This section permits PACE program eligible individuals to enroll in a PACE program at any time during a month beginning January 1, 2027. Enrollment is effective on the date the PACE provider receives the signed agreement, with prorated capitation payments for partial-month enrollments under both Medicare and Medicaid.

This section revises processes for new PACE provider status, service area expansions, and additions of PACE center sites beginning January 1, 2027. Entities may submit applications for these purposes at any time and file multiple applications per quarter. Applications are deemed approved unless the Secretary denies the request or requests additional information within 45 days. Qualified PACE providers may add a center site within an existing service area by submitting a qualifying notice instead of an application. Assurances on interdisciplinary team staffing and contractor execution by operational date substitute for prior deadlines, and providers may contract for staffing levels matching projected full census.

This section requires states to provide medical assistance for PACE program services to eligible individuals enrolled in a PACE program, beginning on the compliance date of 180 days after enactment for states with at least one existing PACE program agreement and 3 years after enactment for all other states (from optional). It eliminates state authority to set numerical enrollment limits and adds a corresponding requirement to each state Medicaid plan.

This section permits specified PACE programs to begin marketing to prospective enrollees upon submission of a complete application for initial approval, service area expansion, or addition of a new center, using materials that have received conditional approval. It authorizes use of the marketing practices described in 42 C.F.R. 460.82(e)(5) as in effect on June 1, 2025, repeals that regulatory paragraph, and applies these changes to activities conducted on or after the date that is 180 days after enactment.

This section repeals the numerical limitation on PACE program agreements under Medicare and Medicaid. It requires the Secretary, in cooperation with state agencies, to establish procedures for entering into, extending, and terminating agreements with any entities meeting PACE provider requirements, and it applies the same terms and conditions to for-profit providers as to nonprofit providers.