Program of All-Inclusive Care for the Elderly (PACE)

A Program of All-Inclusive Care for the Elderly (PACE) fulfills a critical need in a community: enabling frail senior citizens to remain living at home.

As with all managed care delivery systems for elderly individuals, a PACE program requires a significant degree of experience, competency, and resources from those responsible for its success. And as PACE’s expansion into more states and markets presents new opportunities, the need for experienced counsel becomes essential.

As a member of the National PACE Association and a designated PACE Technical Assistance Center (TAC)—one of only several organizations in the country with firsthand experience developing and implementing the PACE program and the only law firm with the TAC distinction—Epstein Becker Green provides invaluable insight and advice on navigating PACE’s complexities. Our PACE team is led by attorneys with extensive experience as regulators at the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services (CMS), who have been providing technical assistance to PACE organizations for nearly a decade. By leveraging resources from our affiliate consultancy, EBG Advisors, we deliver comprehensive support and services tailored to the needs of our clients.

Who We Serve

Our PACE clients have included, among others, hospital systems, health plans, managed care organizations, provider groups, venture-backed entities, nursing homes, state departments of health, private equity firms, and existing PACE organizations seeking assistance with overseeing and improving their PACE capabilities.

Whether you are participating in a current PACE operation, considering launching a PACE program, or seeking to invest in a PACE initiative—in a for-profit or nonprofit organization—Epstein Becker Green can help.

Our Services

We offer a wide range of PACE client services, encompassing:

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• Exploration: feasibility and marketing analysis, pro forma, regulatory license and infrastructure requirements, legal structuring options, expansion planning, financial reserves planning, and banking/finance strategy
• Development: application, licensing, and comprehensive legal, strategic, and operational support on structuring, applications, government relations, financing, and licensing
• Operations: audit preparation, growth, operations, training/coaching, and outside general counsel services on all legal and regulatory issues facing PACE organizations, including federal and state compliance, government relations, corporate counseling, employment law, litigation, contracting, privacy/security, banking, and tax matters

Exploration and Development: Starting a PACE Program

If you are interested in launching a PACE program, we are ready to guide you through every step of the process, from in-depth organizational and market assessments and planning to developing business plans and other materials for stakeholders. Specifically, we assist with:

• the preparation of the PACE Provider Application;
• facility development, such as PACE center design, capacity assumptions, and equipment needs;
• the creation of program policies and procedures;
• the development of an efficient management structure, with key staff roles and job descriptions;
• service integration training, interdisciplinary team training, service allocation, and care planning;
• marketing and census building;
• the development and implementation of a quality improvement program;
• the establishment of financial reporting and monitoring systems;
• data collection systems and training; and
• on-site reviews of operations and recommended improvements.

Operations: Supporting Current PACE Programs

If you are looking to expand an existing PACE program, our team can provide comprehensive support, counseling, training, and resources. This includes strategies for PACE center and Alternative Care Center development, CMS Service Area Expansion applications, state regulatory requirements, partner joint-venture strategy, and legal document drafting/negotiation. We also serve as outside counsel and seconded general counsel for PACE operations needs, including:

• PACE center operations and compliance;
• legal representation in financing and reinsurance transactions;
• real estate needs, including commercial leases and transactions;
• human resources and employment law counseling, with particular experience navigating California, Massachusetts, New York State, and New Jersey employment laws impacting PACE operators;
• marketing and census building compliance obligations;
• network provider contract drafting and negotiation, including value-based payment arrangements; and
• vendor sourcing and contract drafting for key PACE vendors, including pharmacy benefit managers, third-party administrators, electronic medical record vendors, transportation vendors, and durable medical equipment suppliers, among many others.

For States

We help state officials meet their PACE oversight and operational responsibilities so that PACE is implemented successfully and in compliance with federal requirements. These responsibilities include:

• licensing requirements policy and operations;
• readiness reviews (includes physical plant assessments, operational and technical system readiness, fiscal soundness, and compliance policy review);
• PACE-specific capitated rate-setting;
• nursing facility level of care determinations;
• marketing oversight;
• external appeals;
• coordination with CMS on PACE oversight; and
• integration with other Medicare and Medicaid delivery systems.

Our PACE attorneys perform operational assessments of state agency capabilities, capacity, and experience—evaluating the staff and technical resources needed to implement and operate PACE. We also conduct a qualitative review of existing Medicaid operations and licensing activities within the state that may apply to PACE. We include questions on operating PACE programs within stakeholder interviews to gather independent perspectives. In addition, we prepare written reports that outline existing capacity gaps and provide recommendations for how a state can implement PACE effectively.

For-Profits: Investing in PACE

While PACE was historically restricted to nonprofits, federal legislative changes have given for-profit companies the opportunity to offer a PACE program in states electing to participate. However, PACE programs need capital.

Our PACE team serves both for-profit and nonprofit entities—ranging from small startups to large corporations with multiple subsidiaries, including PACE, Medicare Advantage, Medicaid, and other managed care plans—as well as investors in the PACE space.

For private equity firms and venture capitalists looking to invest in PACE, we advise on the regulatory risks of a potential investment through the diligence and negotiation process—but that’s just the beginning. We also assist in developing and implementing compliance programs and more, helping ensure that the PACE programs not only thrive but also seize additional opportunities and innovations for growth.

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