NASHP State PACE Action Network Request for Applications – Due April 15
The National Academy for State Health Policy (NASHP) is seeking applications to participate in its State Program of All-Inclusive Care for the Elderly (PACE) Action Network. The network will engage up to five teams of state leaders to expand access to their existing PACE programs. Lessons learned and best practices from this effort will be shared with other states. NASHP is convening the network in partnership with the National PACE Association and with generous support from The John A. Hartford Foundation, the Gary and Mary West Foundation, and the Harry and Jeanette Weinberg Foundation.
What’s in it for states? Each state team will receive technical support during an eight-month period. The network will provide team members with opportunities for peer-to-peer discussion, targeted support for their state policy strategies, and access to national experts. The support period will conclude with a next-steps virtual or in-person meeting to launch network participants into their future work. (If face-to-face meetings are safe, it will be held in-person in Washington, DC.)
Team composition: State applications may include a team of up to four members. The team must include at least one Medicaid official and one PACE representative, such as a representative of a PACE program or state PACE association. (The PACE representative requirement may be waived in extenuating circumstances. Please contact Luke Pluta-Ehlers to request a waiver of the requirement.) The team may include additional state or PACE staff and others who can directly support team goals (e.g., aging agency administrators, managed care enrollment counselors, etc.)
To apply: NASHP will select up to five state teams. Applications should be emailed to Luke Pluta-Ehlers at lpehlers@oldsite.nashp.org by 5 p.m. (ET) Thursday, April 15, 2021.
More information: Interested state officials are encouraged to participate in an informational webinar about the PACE Action Network RFA from 2 to 3 p.m. (ET) Tuesday, March 30, 2021. Register here.
Overview of PACE Action Network RFA Opportunity
PACE programs are designed to benefit very frail elders by enabling them to stay in their communities as long as safely possible. The services are very comprehensive, including and extending beyond traditional Medicare and Medicaid services. PACE programs directly provide the majority of covered services, including primary care and transportation. PACE participants experience fewer hospitalizations, unmet needs, and emergency room visits than older adults in other programs.
Research also shows that care coordination and supports provided by PACE interdisciplinary teams reduce caregiver burden and stress — enabling families and caregivers to maintain frail elders more effectively at home or in a community-based setting. About 58 percent of caregivers experience a reduced burden after their family member enrolled in PACE, and 97.5 percent of family caregivers would recommend PACE to someone in a similar situation.
To date, 31 states have implemented 138 PACE programs that serve more than 55,000 elders. However, even in those states, some elders and families who would benefit from PACE are not able to participate due to a lack of access to a PACE site or lack of knowledge about the PACE program. The network is intended to help states with existing PACE programs increase Medicaid enrollees’ access to PACE programs so more individuals who would benefit from PACE can participate in the program.
PACE can also bring benefits to state Medicaid programs. PACE integrates and coordinates all medical and long-term care services and supports for enrollees across both community and institutional settings. The program is especially valuable for the high-need, high-cost segment of the home- and community-based services (HCBS) recipient population. Because PACE is a capitated program it, like managed care programs, limits Medicaid’s financial risk. With its focus on a challenging segment of the Medicaid population, PACE can help state Medicaid programs ensure that these enrollees have ready access to a range of coordinated, high-quality services and supports that can be critical to maintaining individuals in the community. The access to a consistent set of providers may be especially helpful to the 46 percent of PACE members who have dementia. Some states have found that PACE can complement other HCBS and managed long-term care services and support (MLTSS) programs.
Establishing and administering a PACE program can require significant Medicaid resources. States can, however, structure their PACE programs to minimize the resources needed. California, for example, has aligned PACE program policies with those of its other MLTSS programs in order to minimize the resources needed to administer the PACE program. States can also scale the program so it serves sufficient numbers of Medicaid enrollees to offset the required resources. While most PACE programs are small, six states have at least one PACE organization that serves more than 1,000 patients. Also, of the 138 PACE programs nationwide, 27 are serving an estimated 15 percent or more of the dual-eligible older adults in their service areas.
There are at least three ways to expand access to PACE that interested states could consider.
- Implement Medicaid policies that increase access to existing PACE sites. For example, states can modify managed care program enrollment material and policies to better explain PACE’s benefits, work with managed care organizations to better manage transitions between PACE and other managed care contractors, or speed the assessment and enrollment process.
- Enable existing PACE programs to serve more people in their current service areas. For example, states can achieve this by working with the program to establish a new site within an existing service area or by lifting a cap on enrollment.
- Enable existing PACE programs to serve people in more areas of the state. For example, by working with a PACE provider to establish a site in a new service area or expand an existing service area.
NASHP is launching this network to assist states in helping those who would benefit from PACE access the program. NASHP will serve as a resource and convener to help policymakers connect with peers and experts, identify and share strategies and solutions, and provide insights for other state leaders who are seeking to increase access to PACE. Participating states will achieve the following during this eight-month State PACE Action Network:
- Gain information and insights into policies and practices that:
- Efficiently identify those who would benefit from the program and speed their enrollment,
- Increase the number of people who existing PACE programs may serve, and
- Minimize the resources required to administer PACE
- Develop a work plan for implementing the state’s chosen approach.
- Achieve key milestones to increase access to PACE services.
About NASHP
NASHP is a non-partisan, nonprofit organization with over three decades of experience in helping state policymakers lead. NASHP provides expertise, convenes states, shares innovations and best practices, and supports state policymakers in making concrete and sustainable health system reform. For more information, visit NASHP’s website at www.oldsite.nashp.org
Application Guidelines
Team composition: State applicants may identify a core team of up to four members to participate in the network, including at least one state Medicaid official and one PACE representative. Additional members may include other state staff, key state contractor staff (e.g., managed care enrollment broker staff), or representatives from community-based organizations, family caregiver associations, providers, or other key stakeholder groups. Strong candidates will demonstrate existing working relationships among key partners.
Applicants should identify a team lead who can provide overall leadership and serve as the primary point of contact for the project. The team lead must be a Medicaid official. Applicants must describe why that official is the right choice to ensure the state achieves its goals — and commit to providing that individual with sufficient time to fulfill their project responsibilities.
State approach: Applicants will describe their selected approach to increasing access to PACE and explain why they selected that approach.
State goals and initial planning: Applicants should describe specific and measurable goals, and a realistic timeline and activities to achieve these goals.
Technical assistance needs: Applicants should describe what specific expertise, technical support, and other resources would be helpful in making progress.
Submission: To apply to participate in the State PACE Action Network, please complete the brief application.
The application must be submitted electronically to Luke Pluta-Ehlers at lpehlers@oldsite.nashp.org by 5 p.m. (ET) Thursday, April 15, 2021. NASHP will notify each state of the state of its application status no later than April 26, 2021.
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
