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S. 1362, PACE Innovation Act of 2015 1 (July 9, 2015)

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                  CONGRESSIONAL BUDGET OFFICE
                              COST   ESTIMATE

                                                                      July 9, 2015


                                    S. 1362
                        PACE Innovation Act of 2015

      As ordered reported by the Senate Committee on Finance on June 24, 2015


S. 1362 would authorize the Secretary of Health and Human Services (HHS) to waive
requirements under section 1934 of the Social Security Act when designing and testing
models under the Center for Medicare and Medicaid Innovation (CMMI). Section 1934
authorizes the Program of All-Inclusive Care for the Elderly (PACE), and establishes
features of the program including payment rates and conditions of participation. Under
current law, CMMI lacks authority to waive those features included in section 1934, and
has limited flexibility to test changes to administering the PACE program. The legislation
would give the Secretary authority to change features of PACE for the purposes of testing
whether they improve the program.

Under current law, CMMI has broad authority to conduct other demonstration projects
under the Medicare and Medicaid programs (outside of PACE). CBO expects that some of
those projects will succeed in reducing federal spending without reducing quality of care,
and others will not, but CBO is unable to predict which projects will succeed.

It is uncertain whether the Secretary would decide to exercise the new authority provided
under the legislation to pursue projects through CMMI that differ from those she would
have tested using existing authority. However, if the Secretary decided to test a different
project under the legislation than she otherwise would have, then in CBO's judgment that
project would have roughly the same chances of success or failure. Thus, the decision to
use the new authority to test a PACE model instead of some other model would result in no
significant change in direct spending, CBO estimates. Because enacting the bill could
affect direct spending, pay-as-you-go procedures apply. Enacting the bill would not affect
revenues.

S. 1362 contains no intergovernmental or private-sector mandates as defined in the
Unfunded  Mandates Reform Act and would impose no costs on state, local, or tribal
governments.

The CBO  staff contact for this estimate is Paul Masi. The estimate was approved by
Holly Harvey, Deputy Assistant Director for Budget Analysis.

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