TY - JOUR
AU - A. Fleet
AU - A. Simoun
AU - M. Tomy
AU - D. Shalev
AU - B. Spaeth-Rublee
AU - H. A. Pincus
A1 - 
AB - OBJECTIVES: Present analysis of the federal and state regulations that guide The Program of All-Inclusive Care for the Elderly (PACE) operations and core clinical features for direction on behavioral health (BH). DESIGN: Review and synthesize the federal (Centers for Medicare and Medicaid Services [CMS]) and all publicly available state manuals according to the BH-Serious Illness Care (SIC) model domains. SETTING AND PARTICIPANTS: The 155 PACE organizations operating in 32 states and the District of Columbia. METHODS: A multipronged search was conducted to identify official state and federal manuals guiding the implementation and functions of PACE organizations. The CMS PACE website was used to identify the federal PACE manual. State-level manuals for 32 states with PACE programs were identified through several sources, including official PACE websites, contacts through official websites, the National PACE Association (NPA), and public and academic search engines. The manuals were searched according to the BH-SIC model domains that pertain to integrating BH care with complex care individuals. RESULTS: According to the CMS Manual, the interdisciplinary team is responsible for holistic care of PACE enrollees, but a BH specialist is not a required member. The CMS Manual includes information on BH clinical functions, BH workforce, and structures for outcome measurement, quality, and accountability. Eight of 32 PACE-participating states offer publicly available state PACE manuals; of which 3 offer information on BH clinical functions. CONCLUSIONS AND IMPLICATIONS: Regarding BH, federal and state manual regulations establish limited guidance for comprehensive care service delivery at PACE organizations. The absence of clear directives weakens BH care delivery due to a limiting the ability to develop quality measures and accountability structures. This hinders incentivization and accountability to truly all-inclusive care. Clearer guidelines and regulatory parameters regarding BH care at federal and state levels may enable more PACE organizations to meet rising BH demands of aging communities.
AD - Department of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, USA.; Department of Psychiatry, University of California Keck School of Medicine, Los Angeles, CA, USA.; Weill Cornell Medicine Division of Geriatrics and Palliative Medicine, New York, NY, USA.; Department of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, USA; Department of Pyschiatry, Columbia University Irving Medical Center, New York, NY, USA. Electronic address: hap2104@columbia.cumc.edu.
AN - 38158192
BT - J Am Med Dir Assoc
C5 - Healthcare Policy; Healthcare Disparities
CP - 5
DA - May
DO - 10.1016/j.jamda.2023.10.033
DP - NLM
ET - 20231226
IS - 5
JF - J Am Med Dir Assoc
LA - eng
N2 - OBJECTIVES: Present analysis of the federal and state regulations that guide The Program of All-Inclusive Care for the Elderly (PACE) operations and core clinical features for direction on behavioral health (BH). DESIGN: Review and synthesize the federal (Centers for Medicare and Medicaid Services [CMS]) and all publicly available state manuals according to the BH-Serious Illness Care (SIC) model domains. SETTING AND PARTICIPANTS: The 155 PACE organizations operating in 32 states and the District of Columbia. METHODS: A multipronged search was conducted to identify official state and federal manuals guiding the implementation and functions of PACE organizations. The CMS PACE website was used to identify the federal PACE manual. State-level manuals for 32 states with PACE programs were identified through several sources, including official PACE websites, contacts through official websites, the National PACE Association (NPA), and public and academic search engines. The manuals were searched according to the BH-SIC model domains that pertain to integrating BH care with complex care individuals. RESULTS: According to the CMS Manual, the interdisciplinary team is responsible for holistic care of PACE enrollees, but a BH specialist is not a required member. The CMS Manual includes information on BH clinical functions, BH workforce, and structures for outcome measurement, quality, and accountability. Eight of 32 PACE-participating states offer publicly available state PACE manuals; of which 3 offer information on BH clinical functions. CONCLUSIONS AND IMPLICATIONS: Regarding BH, federal and state manual regulations establish limited guidance for comprehensive care service delivery at PACE organizations. The absence of clear directives weakens BH care delivery due to a limiting the ability to develop quality measures and accountability structures. This hinders incentivization and accountability to truly all-inclusive care. Clearer guidelines and regulatory parameters regarding BH care at federal and state levels may enable more PACE organizations to meet rising BH demands of aging communities.
PY - 2024
SN - 1525-8610
SP - 774
EP - 778+
ST - Providing Behavioral Health Care in PACE - A Review of Federal and State Manual Regulations
T1 - Providing Behavioral Health Care in PACE - A Review of Federal and State Manual Regulations
T2 - J Am Med Dir Assoc
TI - Providing Behavioral Health Care in PACE - A Review of Federal and State Manual Regulations
U1 - Healthcare Policy; Healthcare Disparities
U3 - 10.1016/j.jamda.2023.10.033
VL - 25
VO - 1525-8610
Y1 - 2024
ER -