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CMS Suggested Template for Organizing a Root Cause Analysis - PDF 82K

CMS Policy on PACE Coverage Outside the U.S. - PDF 40K

CMS Policy on Notification of Proposed Adult Day Health Arrangements (known as alternative care settings) - PDF 70K

Notice for Solicitation of Proposals for For-Profit PACE Demonstrations - PDF 87KB

PACE Provider Application - Revised as of July 2004

This file is the electronic version of the application that States and PACE Provider Sites will utilize to complete and submit the Provider Application. This Provider Application has been updated to increase the clarity of requested information. (Zipped RTF 39K)

This file is in a zipped rich text format so States can download a writeable version for submission.

Appendices to the PACE Provider Application

These links are to documents that must be submitted to CMS as part of the PACE Provider Application, along with a readme file listing the various attachments.

There is a chart that must be completed detailing provider arrangements for the provision of required PACE services and another chart in which you are asked to describe your insurance coverage.

• Readme file, (paceread.pdf) PDF 13KB, and a zipped rich text format file, (paceread.zip).
• Provider arrangements file, (pacehsd.pdf)PDF 22KB, and a zipped rich text format file, (pacehsd.zip).
• Insurance coverage file, (paceinsu.pdf) PDF 13KB, and a zipped rich text format file, (paceinsu.zip).
• Payment Information Form PDF 70KB
• Medicare Contractor Form PDF 63KB

CMS Central and Regional Office Addresses for Application Submission

This link is to a list of mailing addresses for use by State Administering Agencies when submitting provider applications to CMS. Please submit applications to Central Office and the appropriate Regional Office simultaneously.

BIPA 903 Waiver Requests

This is a link to instructions and mailing addresses for State Administering Agencies when submitting waiver requests to CMS.

This is a link to instructions for PACE Organizations when submitting waiver requests to State Administering Agencies.

PACE Application Review Guide Tool - Modified 3/2004

This Review Guide (PDF 1.5 MB), has been developed by the Centers for Medicare and Medicaid Services (CMS) staff members as an informal tool to assist them in reviewing applications submitted by entities seeking to be permanent PACE providers. CMS has made an abbreviated version of the Review Guide available to potential PACE applicants to serve as a clarifying reference as entities prepare a PACE Application for CMS review.

Patient Rights Template for PACE organizations

This template (PDF 137K) is a model tool developed by CMS to guide potential PACE providers in developing their application for permanent provider status. Use of this model is suggested only and is not required for application for permanent provider status.

PACE Demonstration Transition Information

This link provides you with information that will be useful for PACE sites currently operating under Section 1115 Demonstration authority. Procedures and timeframes for transitioning to permanent provider status are discussed in a mid-October 1999 renewal letter to current demonstration sites. Accompanying terms and conditions to the renewal letter are also provided. For more information, contact Michael Henesch at mhenesch@cms.hhs.gov.

Go to Transition Information.

PACE State Readiness Review Tool - Modified 10/2003

This State Readiness Review tool (28KB) was developed by CMS to be used by State Administering Agencies to perform the readiness review of non-operational PACE organization applicants.

This file is in zipped Rich Text Format (RTF) so States can download a writeable version for use.

CMS PACE State Readiness Review Public Notifications

The following links are to the November 2, 2000 letter (PDF 215KB) from CMS to all PACE State Administering Agencies releasing the review tool and to the July 19, 2002 letter (PDF 90KB) from CMS informing all PACE State Administering Agencies of a policy change in the readiness review process.

PACE Provider Agreement - Revised as of September 2004

This link is to the revised Program Agreement that is executed between CMS, the State Administering Agency, and the PACE organization upon approval of a permanent PACE provider application. Included in the Program Agreement are required data elements to be reported by the PACE organization. (PDF 112K)

PACE Monitoring -- Health Plan Management System (HPMS)

In order to comply with the PACE regulations, all permanent PACE Provider Organizations must submit certain data to CMS as specified by CMS and the State Administering Agency in the program agreement. The documents below are a guide to assist PACE providers in establishing connectivity to the HPMS and in submitting data into the HPMS.

• HPMS Connectivity Guide (PDF 160 KB)
• HPMS User Instruction Manual (PDF 2.7 MB)

States may also establish connectivity to monitor PACE permanent providers. The document below instructs States on how to establish connectivity to the HPMS.

• HPMS Connectivity Instructions for States (PDF 75K)

PACE State Plan Amendment - Revised as of September 10, 2001

Revised suggested pre-print pages (RTF 59KB) for use by State Medicaid Agencies in amending Section 3.1(a)(1) and (2) to elect PACE. (These revised pages should be used in conjunction with the November 9, 2000 State Medicaid Directors'letter (PDF 216KB) releasing the original suggested pre-print.) CMS is available for technical assistance to States desiring to modify their State Plan at this time. Please contact Tonya Moore at (410) 786-0019 or tmoore1@cms.hhs.gov.

Abt Evaluation

This link is to the evaluation of the PACE Program conducted by Abt Associates Inc. The evaluation was described in a report released on October 27, 2000. (PDF 505K)

PACE Expansions

This link is to a policy document outlining requirements for expanding operations under the PACE program.

This link is to the PACE expansion application required for PACE organizations wishing to expand their service area or add a new PACE center. (This file is in Rich Text Format (RTF 109K) so States can download a writeable version for use.)