Program of All-Inclusive Care for the Elderly (PACE): For States Actively Implementing or Expanding PACE

We support states in expanding enrollment, optimizing service areas, and enhancing operations while maintaining quality care. Our targeted strategies help ensure successful program growth.

Market Analysis

We evaluate the viability of PACE in your state by using census data to develop a detailed market inventory of eligible participants by ZIP code. This inventory is enhanced with heat maps and data visualizations, providing decision-makers with clear insights into potentially viable PACE markets.

Service Area Analysis

Building on data from the Market Analysis, we identify which areas of your state are most suitable for PACE services. Our analysis includes drive times, population densities, existing waiver populations, and review of the current healthcare infrastructure to establish optimal service areas and maximize the impact of the PACE program.

Stakeholder Engagement

We design and implement comprehensive stakeholder engagement strategies, collaborating with providers and provider organizations, advocacy groups, community-based organizations, State agency leadership, and contracted vendors to measure and ensure broad-based support and effective program implementation.

Agency Capacity

We assess and enhance the administrative capacity of agencies to manage PACE programs effectively, ensuring they have the necessary staff, resources, and infrastructure to support program success. We integrate insights from the market analysis, service area analysis, and stakeholder engagement to provide agency leadership with the comprehensive information needed to make informed decisions about implementing PACE in your state.

AWOP Calculation, Rate Projection, Rate Setting, and Rate Adequacy

Federal law mandates that PACE rates must be less than what would otherwise have been paid (AWOP) under the State plan if participants were not enrolled in PACE. These rates should reflect the frailty of participants, be set at a fixed amount, and can be renegotiated annually. Our team collaborates with actuaries to gather relevant data and calculate your state’s unique AWOP. We provide detailed projections of potential PACE rates if the program is elected as a service in your state plan, and conduct thorough analyses to ensure these rates are sufficient to attract PACE providers.

State Plan Amendment

You can rely on our assistance to complete the Medicaid PACE SPA preprint, ensuring all necessary details and compliance requirements are met for CMS approval and successful program implementation.

State Policy and Manual Creation

We assist with the creation of comprehensive state policies, procedures, and operational manuals to guide the successful implementation and operation of the PACE program.

  • Procurement Design: We help design the procurement process, including drafting the RFP and contract requirements.
  • Stakeholder/Bidder Conference Assistance: We assist in planning and conducting conferences to engage stakeholders and bidders.
  • Bid Review: We prepare public announcements, timelines, and executive briefing documents. We also create scoring tools and coordinate the evaluation process, providing support to states during the scoring and review stages.

This approach ensures that every aspect of the PACE program implementation is meticulously planned and executed, leading to successful outcomes for the state and its participants.

PACE Organization Operationalization Reviews

We provide support to clients in the state readiness review process, ensuring that PACE organizations meet all regulatory requirements. Our services cover:

  • Administrative, Financial, and Operational Reviews: Comprehensive examination of applications from various perspectives, offering constructive feedback.
  • On-Site Readiness Review: Includes a critical clinical evaluation to ensure compliance with CMS guidelines.

PO Application Reviews

Each PACE program applicant submits an electronic application to CMS, which includes state assurances. Myers and Stauffer will thoroughly review these application documents for compliance with federal and state regulations.

PO Policy and Procedure Review

We review an extensive list of PACE policies and procedures to ensure compliance with federal and state regulations in several key areas:

  • Physical environment
  • Infection control
  • Transportation services
  • Dietary services
  • Participant rights
  • Personnel qualifications, training, and competency
  • Overall safety
  • PO Onsite State Readiness Reviews

Monthly PO Meeting Attendance

Our subject matter experts—clinicians, former PACE directors, and consultants—join your monthly check-ins with each PACE organization. These meetings provide ongoing technical assistance, oversight, and monitoring.

Periodic Quality Data Set Design

Our subject matter experts—clinicians, former PACE directors, and consultants—join your monthly check-ins with each PACE organization. These meetings provide ongoing technical assistance, oversight, and monitoring.

Quality Monitoring

Portal: We can set up a secure web portal for easy information exchange between state administering agencies and PACE organizations, enhancing documentation requests and storage.

Portal + Dashboard: Enhance your quality monitoring portal with a dashboard that includes data visualizations designed for state agency staff to quickly assess PACE organization quality data.

Periodic On-Site Assessment

We offer both announced and unannounced on-site visits, including:

  • Observations
  • In-person interviews
  • Remote document reviews These assessments help determine the performance of key duties such as service provision, service determination requests, grievances, and appeals.

Periodic Medical Records Review

We conduct periodic reviews of medical records to ensure compliance and quality of care.

System Workarounds During Implementation/MMIS Redesign

During the implementation and MMIS redesign phases, we assist with programming requests and change orders to ensure they meet the needs of PACE implementation. We also help with monthly capitation rate payment calculations to avoid delays in service delivery.

Technical Assistance

We provide technical assistance throughout the entire process to support the successful implementation and operation of the PACE program.

For More Information:

Jared B. Duzan, CFE
Principal
PH: 317.815.2925
jduzan@mslc.com

Vicki Bartlett, RN, CCM, COC
Director
PH: 404.524.9052
vbartlett@mslc.com

Lydia Powell, CPA
Senior Manager
PH 509.695.6870
lpowell@mslc.com

“Myers and Stauffer has met every challenge and, in doing so has developed a valuable consulting relationship with our staff. They are the contractor we turn to first when a question arises.”

— State Principal Financial Specialist

“We have been extremely pleased with the services that Myers and Stauffer provides and recommend them without hesitation to assist you with your audit needs.”

— State Medicaid Client

“Myers and Stauffer has established itself as more than an audit contractor. They are who we turn to first when a question arises.”

— State Principal Financial Specialist

“I looked at them as being a role model and ideal vendor. They always met deadlines. They always were flexible. They always were helpful. They always produced things that were accurate, certainly timely. Everything was really tops.”

— Association Director (Formerly with a State Medicaid Agency)

“They deliver a top quality product. I don’t have to second guess or worry. It is timely, professional, complete. They anticipate my needs. I just can’t say enough.”

— State Medicaid Client

“They have never, ever disappointed me. They’ve always been outstanding.”

— State Principal Financial Specialist

“You guys do a lot to ‘make it happen’ … I don’t forget that.”

— State Medicaid Client

Myers and Stauffer “staff conduct themselves in a highly professional manner when working with both state agency personnel and providers of health care services.”

— State Principal Financial Specialist

“Myers and Stauffer makes my job easier. They do complex work so that we can focus more attention on planning and future projects. They help me sleep at night.”

— State Principal Financial Specialist

“We have received the benefit of education, knowledge, and context from Myers and Stauffer’s effective communication.”

— Director (A State Office of Inspector General)