Tennessee Senate advances bill aiming to extend PACE services statewide

The Tennessee Senate Health and Welfare Committee unanimously approved a bill on Wednesday that would expand long-term care services for qualified elderly TennCare recipients throughout the state.

Senate Bill 459—sponsored by Sen. Bo Watson (R-Hixson)—would require the Division of TennCare to establish a statewide program for all-inclusive care for the elderly (PACE). The bill would authorize TennCare’s director to obtain any Centers for Medicare and Medicaid Services (CMS) waiver needed to establish the program.

“PACE is a coordinated health and social services program that enables participants to remain in their homes and communities rather than moving into nursing homes,” Watson said. “The services are provided to seniors who require the level of care given in a nursing facility and meet eligible criteria established by CMS.”

There is currently one PACE center in Tennessee. Eligible seniors must live in Hamilton County to receive its services. The bill expands PACE services to other counties, beginning with Meigs County, Rhea County, and Bradley County.

“The attempt of the legislation is to grow the program slowly so we can afford it,” Watson said.

Individuals who qualify for long-term TennCare services are not required to pay any fees for PACE services.

PACE services include (but are not limited to):

• Access to an adult day center
• Primary care
• Specialty care
• Physical, occupational, and speech therapies
• Prescription medications
• In-home personal care like bathing and grooming
• Referrals to out-patient providers
• In-patient care
• Transportation

Watson said PACE services are predominantly for people who live at home. PACE provides transportation to the adult center, where a majority of the program’s services are provided.

Sen. Joey Hensley (R-Hohenwald) noted that a similar Tennessee program, CHOICES, provides services in both residences and nursing home facilities to seniors and adults with physical disabilities. He asked Watson for clarification on the difference between CHOICES and PACE.

“The key difference is, under a PACE program, the services are provided at a centralized location,” Watson said. “In the CHOICES arrangement, individuals have to seek those individual services to come to them.” 

Watson said he has always supported CHOICES, but wants patients to have options. CHOICES is a viable option for many people, but PACE’s coordinated care options may be easier to navigate for some, he said. 

The committee adopted an amendment to SB 459 that would require an annual report by TennCare to the speakers of the House and Senate, and to the chairs of the Finance, Ways, and Means Committees in both chambers. The amendment sets enrollment limits for each year of the program’s operation until fiscal year (FY) 2030.

“This bill, as amended, caps the participant enrollee numbers each year to encourage smart growth of the program,” Watson said. “The expected ramp-up will start with 1,000 enrollees in FY 2026 and up to 3,000 enrollees by FY 2030.”

Watson said he wants to determine the initial costs for rolling out SB 459 because PACE services tend to be expensive for states to offer. That prompted him to set limits on enrollee numbers in the bill. 

“We should acknowledge and recognize that [cost], but for certain individuals, (PACE) works better in their lifestyle than other individuals,” he said. “And when possible, we should provide options to patients. And (SB 459) provides options.”

The bill’s fiscal note projects a net impact of almost $1.8 million on state expenditures and $3.3 million on federal expenditures annually beginning in FY 2025, and during subsequent years of the program.

SB 459 was referred to the Senate Finance, Ways, and Means Committee and awaits further discussion.