New
PACE programs begin with a desire to provide high quality care,
in the community, to older people with chronic care needs. Translating
this desire into a start-up plan requires a thorough understanding
of the PACE model of care, the community a prospective PACE program
will serve, and your own organization. With this information, a
prospective rural PACE sponsor can develop a sound business plan
and apply for the regulatory authorizations needed to proceed.
For most organizations, the assessment and planning
process will address both new and familiar considerations. As a
result, in some areas the organization may be able to refer to its
experience while in others innovation will be required. This is
particularly true for organizations seeking to develop rural PACE
programs. Rural PACE programs adapting the model to serve their
communities today will generate insights that will guide future
rural programs.
Objective and Overview
Past experience tells us that PACE programs pass
through four general phases in completing their assessment and planning
process:
- Understanding the PACE Model
- Assessing Community Needs
- Organizational Commitment and Capacity
- Planning and Development/PACE Provider Application
This guide is designed to help organizations that
wish to serve a rural area navigate through each of these distinct
phases, identify what they need to accomplish in each phase, and
access technical assistance resources available to them. Each phase
is presented in terms of objectives, activities, milestones and
resources particular to that stage of decision-making. The last
part of this guide describes how the interested organization translates
its plan into an operating a PACE program.
At each phase, the National PACE Association (NPA)
and a number of Technical Assistance Centers (TACs) are available
to assist you with expertise, support and counsel throughout the
development phases. If you have any questions, please call NPA at
(703) 535-1517. For further information regarding TACs, please visit
our web site at www.NPAOnline.org.
FIRST STAGE: Understanding the
PACE Model
Prospective providers of PACE in rural areas will
need to understand the model as it is currently designed and implemented
in order to develop adaptations that will allow it to succeed in
rural areas. Developing this understanding across a team of management
and clinical leaders will form a foundation for moving forward within
the organization.
OBJECTIVES
- Gain an understanding of the PACE model's
program and service requirements.
- Understand scope and extent of current PACE
experience.
- Determine opportunities for flexibility in
the PACE model.
- Understand the stages of development for initiating
a new PACE program.
- Assess availability and cost of resources
to assist in decision-making and start-up.
ACTIVITIES
- Acquire and review information about the PACE
model and current status of PACE providers.
- Assemble internal work group/team.
- Establish a timeline and work plan for completing
an assessment process.
TECHNICAL ASSISTANCE OPPORTUNITIES
Prospective PACE providers can benefit enormously from the expertise
of existing PACE programs. One of the best ways to understand the
PACE model is to visit an operating PACE program. Technical Assistance
Centers may arrange these site visits as well as initial on-site
presentations and assessment.
FIRST STAGE MILESTONE
Based on its understanding of the PACE model and internal interest,
the organization is asked by its governing body to assess demand
for PACE services and the community's need for services.
RESOURCES FOR DEVELOPMENT
Public Resources
- PACE Program Fact Sheet
- NPA Calendar of Events
- PACE FAQs
- National PACE Association (NPA) Fact Sheet
- PACE in the News
- Developing PACE Education Series Library
- PACE Profile
- An Overview of Self-Assessment Considerations
- Setting the PACE for Rural Elder Care: A Framework
for Action
- Rural PACE Issue Briefs
SECOND STAGE: Assessing Community
Needs
The development of a PACE program requires an
understanding of the potential demand for services, viewed in the
context of existing community relationships and services. This understanding
determines if there is adequate demand to support a new PACE program
and lays the foundation for establishing referral networks that
will help the program build census, contract for services to meet
PACE participant needs, and foster public support. Assessing community
relationships and existing services is an opportunity to gather
information about the resources present in the proposed service
area that may be used to implement a PACE program. In addition,
the assessment is an opportunity to educate other stakeholders and/or
referral sources in the service area about the PACE model so they
can be potential partners.
OBJECTIVES
- Quantify the potential demand for services.
- Describe access and referral patterns affecting
potential enrollment.
- Describe existing services for similar populations.
- Identify potential partnerships.
- Build community support.
- Assess state support.
ACTIVITIES
- Analyze demographic and state data to estimate
the potential population your program could serve.
- Contact community health, housing and aging
service providers to discuss PACE.
- Discuss state support for a rural PACE program
with state Medicaid and Aging agencies and local legislators.
- Begin to document critical factors affecting
development of PACE in your area (e.g., demographics, community
resources and relationships, and state support).
TECHNICAL ASSISTANCE OPPORTUNITIES
Prospective PACE providers can work with NPA or a TAC to analyze
demographic data available from the U.S. Census Bureau and state
agencies. Assistance also is available for conducting a community
needs assessment. NPA and the TACs can assist with materials and
presentations for outreach to community organizations and state
agencies.
SECOND STAGE MILESTONE
Based on its understanding of the potential demand for PACE services
and community support, the organization receives commitment from
its governing body to develop a full organizational analysis related
to initiating a rural PACE program.
RESOURCES FOR DEVELOPMENT
Public Resources, as listed in First Stage
Rural PACE Assessment Instrument - Section 1 (all), Section 2 (Critical
Factors 1-3)
THIRD STAGE: Organizational Commitment and Capacity
Having identified the opportunities and challenges
for a PACE program based on demographics, community needs and state
interest, a prospective PACE program then will need to assess its
internal strengths and weaknesses. Consideration of the external
and internal factors that will determine a PACE program's success
is applied to the development of a business plan. The business plan
is the basis for the organization to make a formal decision on whether
to move forward with development of a new PACE program.
OBJECTIVES
- Assess federal and state regulatory requirements
and implications for PACE.
- Describe the organization's critical factors
for moving forward and assess the need for outside support.
- Outline the key questions/factors to be addressed
by the decision-making plan.
- Complete a business plan that will present
a recommendation to the organization's governing body.
ACTIVITIES
- Gather information and complete assessment
process.
- Establish a timeline and work plan for developing
a business plan.
- Explore and identify options for potential
relationships/partnerships with community organizations.
- Develop a business plan and present it to
the organization's governing body.
THIRD STAGE MILESTONE
Based on the business plan, the organization commits resources to
a timeline and work plan for start-up.
TECHNICAL ASSISTANCE OPPORTUNITIES
TACs can assist with organizational assessments and the development
of a business plan for presentation to an organization's stakeholders
and governing body.
RESOURCES FOR DEVELOPMENT
Public Resources, see First Stage
NPA Membership Resources
- Demographic Report
- Developing PACE Education Series
- Exploring PACE List Serve
- Guide to PACE Site Selection and Center Development
- State Assessment
- PACE Financial Proforma Baseline Scenario
FOURTH STAGE: Planning and Development/PACE
Provider Application
A decision to move forward with a new PACE program
will require the completion of a Provider Application, access to
start-up funds and development of the infrastructure needed to provide
services. The prospective PACE sponsoring organization will need
to work with state and federal agencies, internal and external funding
sources, community organizations and health care providers to assemble
an operational PACE program.
OBJECTIVES
- Secure financing and risk insurance.
- Assemble management team and start-up staff.
- Establish administrative and information systems.
- Obtain approval of PACE provider application
including any necessary waivers, to establish PACE provider status
with state and federal agencies.
- Establish marketing strategies.
- Establish an operational PACE center along
with any related alternative care delivery sites.
ACTIVITIES
- Develop program policies and procedures.
- Prepare PACE provider application and any
necessary waiver requests.
- Identify target audiences for development
of referral network.
- Develop marketing plan and materials.
- Design, construct and equip PACE day center.
- Hire and train staff.
- Select, install and train staff on information
system.
- Establish financial accounting system and
procedures.
FOURTH STAGE MILESTONES
- PACE provider application and any necessary
waivers are approved; provider agreement is signed.
- PACE center and any alternative delivery sites
are operational.
- Organization is ready to offer services and
begins enrolling participants.
TECHNICAL ASSISTANCE OPPORTUNITIES
Once an organization has decided to proceed with PACE, TACs are
available to assist with the initial planning and development of
the PACE program, including the development of the PACE center,
hiring and training center staff, start-up and preparation of the
PACE provider application. TACs also provide ongoing consultation
once an organization is fully operational and has begun providing
services to participants. TACs provide support through telephone
consultation, on-site visits, intensive trainings and resource materials.
RESOURCES FOR DEVELOPMENT
NPA Membership Resources
- Core Resource Set for PACE (CRSP) -
a compendium of PACE program operational resources to assist providers
in PACE development and expansion
- PACE Operating Resources - resources for
administering and operating a PACE program
- A Guide to Preparing the PACE Provider
Application - resources for preparing the PACE provider application
and for the Center for Medicare and Medicaid Services (CMS)/state
on-site review
- PACE Financial Proforma - a financial model
for forecasting budgets and financial performance, including
a Financial Baseline Scenario and Proforma User's Guide
- Baseline Scenario and Proforma User's Guide
- Networking list serves
- Federal and state advocacy
- Updates on federal and state policies
- NPA communications
- Discounted NPA conference registration fees
- CMS-sponsored meetings
- Keeping the PACE newsletter
- Monthly Educational Teleconference Series
Looking Ahead: Enrollment and
Ongoing Operations
After federal approval of the PACE provider application,
the new PACE program, the state and the federal government sign
a program agreement to establish the program's PACE provider status.
At this point in the program's development, activities shift from
planning to operations. NPA and the Technical Assistance Centers
(TACs) continue to provide resources to support the success of new
PACE programs as they move into this operational mode.
Early in the program's operations, the organization
will need to focus on building its census. During this time it also
is important to ensure that planned systems and procedures for establishing
the interdisciplinary care team, integrating services and allocating
resources are working effectively. Provider status also requires
the establishment of quality improvement mechanisms and readiness
for on-site reviews by state and federal agencies.
As the program matures, the PACE program continues
to build upon and improve existing operations, increase census and
consider plans for future expansion.
The Centers for Medicare and Medicaid Services
(CMS) and the state will continue ongoing monitoring of the program.
The PACE program will be responsible for meeting evolving state
and federal regulatory requirements.
Resources available to start-up and operational
PACE programs include:
- Updated and expanded resources for PACE start-up
and operations in the Core Resource Set for PACE (CRSP)
- Performance benchmarking for service outcomes,
utilization and costs
- Networking list serves
- Federal and state advocacy
- Updates on federal and state policies
- NPA communications
- Discounted NPA conference registration fees
- CMS-sponsored meetings
- Keeping the PACE newsletter
- Developing PACE Education Series
- Monthly Educational Teleconference Series
The National PACE Association (NPA) exists to
advance the efforts of Programs of All-inclusive Care for the Elderly
(PACE). PACE programs coordinate and provide all needed preventive,
primary, acute and long term care services so that older individuals
can continue living in the community.
How NPA Supports PACE Programs
Public Policy and Advocacy
NPA works closely with members of Congress, senior administration
officials and their staff, and state policy makers to educate and
promote a reimbursement and regulatory environment that enables
PACE programs to continue to provide high quality, individualized
and innovative care.
Educational Opportunities
NPA hosts two conferences per year and a monthly teleconference
series, so members can learn from one another and from leading experts
in the long term care field.
Start-up and Operational Resources
NPA facilitates networking list serves for staff from various disciplines
within PACE programs, and produces other communications vehicles
to assist developing and operational programs.
NPA members have access to the Core Resource Set
for PACE (CRSP), a compendium of resources for PACE program development,
expansion and operations.
NPA members have access to financial planning
tools, including the PACE Financial Proforma, a financial spreadsheet
model for forecasting budgets and financial performance.
NPA hosts a quarterly teleconference series focused
on issues faced by organizations contemplating and pursuing PACE
development.
NPA provides guidance and support for a range
of policy and operational issues and challenges.
Quality Assurance
NPA collects data from participating PACE programs to help them
compare the provision of services and participant characteristics
across PACE programs. This benchmarking data is helpful in allowing
PACE program staff to continuously improve their delivery of services.
Research
NPA is committed to supporting the study of innovative and integrated
models of care with the goal of improving the lives of seniors and
their families, regardless of the health care setting.
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