Programs of All-Inclusive Care for the Elderly 4 States

Information for state Medicaid agencies and state administering agencies in fulfilling state-level responsibilities for operating PACE programs:

BIPA 903 Waiver Requests

Section 903 of the Benefits Improvement and Protection Act (BIPA) of 2000 allows states to modify or waive certain regulatory provisions to meet the needs of PACE organizations (POs). The Centers for Medicare & Medicaid Services (CMS) has provided additional guidance on submitting waiver requests in the PACE program. The following provisions may not be waived:

  • Focus on frail elderly qualifying individuals who require the level of care provided in a nursing facility
  • Delivery of comprehensive, integrated acute and long-term care services
  • Interdisciplinary team approach to care management and service delivery
  • Capitated, integrated financing that allows the provider to pool payments received from public and private programs and individuals
  • Assumption by the provider of full financial risk

Apply to be a PACE Provider

Information for providers interested in becoming a PACE provider:

For PACE Providers

POs can expand their service area or add a new PACE center by submitting a PACE Expansion Application. There are three scenarios under which a PACE provider may expand operations. Each scenario contains a list of steps that must be followed for expansion approval.

Scenario 1: A PACE Organization requests to expand its geographic service area without building additional sites.

  • PO must obtain approval for expansion from State Medicaid Agency (SMA) and State Administering Agency (SAA).
  • PO and SAA collaborate on the provider application in its entirety. To the extent the expanded service area reflects the same processes as the already approved service area of the provider, the application can note this without resubmitting approved material.
  • CMS reviews and renders a decision on the application.
  • If approved, the Program Agreement's Appendix C is amended to reflect the new service area.

Scenario 2: A PACE Organization requests to open another physical site in the existing geographic service area.

  • PO must obtain approval for expansion from SMA and SAA.
  • PO and SAA collaborate on the provider application in its entirety. To the extent the new site adopts the same processes as the already approved sites of the provider, the application can note this without resubmitting approved material.
  • The SAA conducts a readiness review of the new site while the clock is stopped.
  • CMS reviews and renders a decision on the application.
  • If approved, the Program Agreement's Appendix C is amended to reflect the new site.

Scenario 3: A PACE Organization requests to expand its geographic service area and open another physical site in the expanded area.

  • PO must obtain approval for expansion from SMA and SAA.
  • PO and SAA collaborate on the provider application in its entirety. To the extent the new site adopts the same processes as the already approved sites of the provider, the application can note this without resubmitting approved material.
  • The SAA conducts a readiness review of the new site while the clock is stopped.
  • CMS reviews and renders a decision on the application.
  • If approved, the Program Agreement's Appendix C is amended to reflect the new geographic area and new site.