The Louisiana Department of Health (LDH), Office of Aging and Adult Services (OAAS) may have a requirement for a Program of All-Inclusive Care for the Elderly (PACE).

The following information is sourced from the Request for Information (RFI) document and is subject to change upon the release of a formal solicitation.

GOALS AND OBJECTIVES

Louisiana Department of Health (LDH) is interested in expanding home and community-based alternatives throughout the state. Expanding PACE to other regions would be one way to achieve this goal. Currently there are PACE organizations serving the Greater New Orleans area, the Greater Lafayette area, East Baton Rouge Parish, West Baton Rouge Parish, Avoyelles Parish and Rapides Parish.

In 2024, LDH contracted with Myers and Stauffer to perform a Market Analysis to show in what areas in Louisiana would most benefit from a PACE provider. LDH’s Office of Aging and Adult Services has identified the Shreveport area as an area where residents could benefit from PACE services, as well as an area where a PACE provider could build the required network. Therefore, the goal of this RFI is to hear from organizations and others regarding the specific areas (parishes or zip codes) near and in Shreveport that should be served, where a center would be best located, potential barriers to having PACE in that area, and any other information that would be helpful in determining the next steps the department must take to provide PACE services in the Shreveport area.

Louisiana expects PACE providers to have the capacity to enroll and effectively serve individuals who are transitioning from nursing facilities back to life in the community, including individuals with serious mental illness (SMI) who meet all PACE eligibility requirements. LDH OAAS believes the PACE model of care aligns with this population because of the active wrap-around care coordination provided by PACE. Responding organizations must describe how a PACE organization could integrate mental health services into their care plans. OAAS transitions as many as 300-400 individuals each year and Louisiana expects PACE organizations to have resources and systems to serve this population properly. In addition, Louisiana expects PACE organization to work closely with the LDH Transition Coordinators and others that assist with nursing home transitions.

Once LDH-OAAS has the necessary information, the end goal is to identify a PACE organization willing to enter a collaborative agreement with LDH and the Center for Medicare and Medicaid Services (CMS) to provide quality PACE services in the Shreveport area that include assisting people who wish to transition from a nursing facility into the community.

BACKGROUND

LDH’s Office of Aging and Adult Services (OAAS) operates several Medicaid home and community-based programs to serve older adults and others who acquire a disability in adulthood.

Like other states, Louisiana is working to balance the state long-term care systems to provide greater access to non-institutional, home and community-based alternatives with a goal of assisting people to remain a part of their communities. Research indicates that people prefer to age in place. OAAS believes that offering PACE services in the Shreveport area will provide that opportunity to people who are eligible for PACE services and are currently unable to access desired home and community-based services.

OAAS administers the Community Choices Waiver, the Adult Day Health Care Waiver, Long-term Personal Care Services, as well as PACE. These programs provide home and community based longterm care services (HCBS) for individuals who are elderly or have disabilities, assisting them to remain in their homes and in the community. The intent of these HCBS programs is to provide services and supports that are not otherwise available and that assist an individual to remain in or return to the community. OAAS also oversees nursing facility admissions, Adult Protective Services and other nonMedicaid grants and programs.

Since 2009, OAAS has actively transitioned over 3,600 individuals from nursing facilities to live and receive services in the community through the Centers for Medicare and Medicaid Services (CMS) Money Follows the Person (MFP) Demonstration Grant. Louisiana’s re-institutionalization rate is less than 6% within the first year of nursing facility transition. In 2018, LDH entered into an agreement with the US Department of Justice (DOJ) that requires LDH to transition nursing facility residents with Serious Mental Illness (SMI) back into the community. PACE could be an important option to people who would prefer to live in the community rather than a nursing home.

OAAS has an annual administrative budget of approximately $80 million and provides services to approximately 19,000 participants (older adults and individuals with adult-onset disabilities) through several large and complex Medicaid programs whose budgets total approximately $1.8 billion annually.

DELIVERABLES

PACE is an innovative model of community-based care that enables individuals who are 55 and older and certified as meeting nursing facility level of care to live a healthy life in the community for as long as possible. The Program of All-Inclusive Care for the Elderly (PACE) is a service delivery model that began in San Francisco, California in 1973. The model was established as a permanently recognized organization type under both the Medicare and Medicaid programs. Since 2005, Louisiana has included PACE as an optional benefit in the Medicaid program. PACE organizations in Louisiana are required to adhere to all relevant federal, state and local laws and regulations.

National surveys show that older adults prefer to remain in their own homes and communities as they age, and PACE accomplishes this at approximately half the cost of out of home placement, which benefits PACE participants and taxpayers. Just as importantly, PACE provides and coordinates all services covered under both Medicaid and Medicare, thus reducing the fragmentation of healthcare delivery for this highly vulnerable population. PACE has flexibility to provide nontraditional healthcare services that address the social determinants of health, such as access to social activities, healthy foods, or even pest control services if a participant needs them to be safe and healthy in their home. PACE accepts full financial risk for all services determined necessary to address the social, emotional, medical and physical needs of their participants.

Louisiana currently has three PACE providers and four PACE centers: Associated Catholic Charities operating PACE Greater New Orleans, Franciscan Missionaries of Our Lady of the Lake operating Franciscan PACE Baton Rouge and Franciscan PACE Lafayette and Trinity Health operating Trinity Health PACE Alexandria. Each PACE center provides services to specifically identified parishes or zip code areas with each serving their own exclusive area. At this time in Louisiana, PACE providers are not in competition with each other; therefore, the PACE Center serving the Shreveport area will be the only PACE provider in that area when the PACE Center opens.

PACE programs offer pre-paid, capitated, coordinated, comprehensive health care services in a specific geographic area designed to meet the following objectives:

• To enhance the quality of life and autonomy for frail, older adults;
• To maximize the dignity and respect for older adults;
• To enable frail, older adults to live in the community as long as medically and socially feasible; and
• To preserve and support the older adult’s family unit.

The PACE provider’s interdisciplinary team, consisting of the participant, participant family, and professional and paraprofessional staff, assesses participant needs, develops a plan of care, and monitors delivery of all services (including acute care services as well as nursing facility services, when necessary) within an integrated system for a seamless provision of wrap-around healthcare. Typically, PACE organizations provide social and medical services in an adult day health center supplemented by clinical, in-home and other services as needed.

The financing model combines payments from Medicare and Medicaid, allowing PACE to provide all needed services rather than be limited to those reimbursable either under the Medicare and Medicaid fee-for-service systems. PACE organizations assume full financial risk for beneficiary care without limits on amount, duration or scope of services. PACE providers can also accept private pay for those not eligible for Medicaid and/or Medicare. PACE is obligated to provide the same level of support, which includes all Medicaid and Medicare services available in Louisiana, to each participant regardless of the participant’s funding source.

The PACE organization is able to coordinate an array of services, including comprehensive medical, physical, emotional and social services, to integrate acute and long-term care to older adults with chronic care needs while allowing PACE participants to maintain independence in the community for as long as possible. The PACE service package must include not only all Medicare and Medicaid covered services, but also other services determined necessary by the PACE’s interdisciplinary team to improve and maintain the participant’s overall health status. Typical services include, but are not limited to the following:

• Adult day health care that offers nursing; physical, occupational and recreational therapies; meals; nutritional counseling; social work and personal care,
• Primary medical care provided by either a PACE physician, a community-based physician, a physician assistant or a nurse practitioner familiar with the history, needs and preferences of each beneficiary, all specialty medical care, and all mental health care;
• Interdisciplinary team members’ assessments and treatment plans;
• Home health care, personal care, homemaker and chore services;
• Restorative therapies, including physical therapy and occupational therapy
• Diagnostic services, including laboratory, x-rays, and other necessary tests and procedures;
• Transportation to and from the PACE Center and other medical appointments;
• All necessary prescription drugs and any authorized over-the-counter medications included in the plan of care;
• Social services;
• All ancillary/specialty health services, such as audiology, dentistry, optometry, podiatry, speech therapy, prosthetics, durable medical equipment, and medical supplies;
• Respite care;
• Emergency room services;
• Acute inpatient hospital stays;
• Nursing facility care, which can be short term stays or for convalescent care, as needed.

In addition to being the provider of all service and support needs, PACE is also the “Health Insurer” and is obligated to follow the federal regulations that apply to PACE acting as such.

The Federal PACE regulation establishes basic PACE eligibility requirements. Individuals must meet the following criteria:

• Be at least 55 years old;
• Reside in the service area of the PACE organization;
• Meet the state criteria for nursing facility level of care; and
• Be able to live safely in the community at the time of enrollment.

Participation is voluntary and enrollees may disenroll at any time. However, enrollment and disenrollment always occur on the first day of a month.

PACE has distinct characteristics that distinguish it from other Home and Community-based services in Louisiana as listed below:

• From the point of inception until the first participant is served, the development process can (and usually does) take 18 -36 months prior to serving participants and begin receiving the capitated payments for enrolled participants.
• Potential PACE organizations must have adequate financial capacity to fund program development and start-up costs, including identification of participant enrollment opportunities.
• PACE organizations do not file claims; they receive a capitated payment at the beginning of each month from Medicare and/or Medicaid or private pay funds, based on the participant’s eligibility.
• PACE organization must participate as a provider in both Medicaid and Medicare.
• PACE organizations must develop a provider network in order to provide/contract for all required covered services and other services necessary to meet participant needs.
• PACE organizations must develop and maintain the full 11 member interdisciplinary team required by the Federal regulation.
• PACE organizations must have the ability to manage the comprehensive care (including acute and long term) of a complex nursing facility eligible population 365 days a year, 7 days per week, 24 hours per day regardless of setting.
• PACE is at full financial risk for enrolled participants.
• The PACE provider or its parent company must have adequate reserves or reinsurance to cover the potential catastrophic health events encountered by their participants.
• PACE organizations must have the ability and willingness to accept and serve nursing home residents who are eligible for PACE and wish to move into the community.
• Each PACE organization in Louisiana is geographically specific and has a cap on the number of participants that can be enrolled for that program (210 maximum). PACE service areas in Louisiana do not overlap.

The following information is sourced from the Request for Information (RFI) document and is subject to change upon the release of a formal solicitation.

DETAILED REQUIREMENTS

Responders are asked to clearly and concisely describe why they are submitting a response to the RFI along with any information regarding how the responding organization envisions development of a PACE program in the Shreveport area. OAAS welcomes information on available resources that will be important to a successful PACE provider in the Shreveport area and that would fully support the participants served by PACE. In addition to available resources, information regarding resources that would need to be developed or enhanced by a PACE provider in the Shreveport area are encouraged.

OAAS is inviting RFI responders to provide the following information, as applicable:

• Organization’s mission and history of serving the aging adults with disabilities and/or chronic conditions.
• Organization’s history of serving individuals that have a serious mental illness.
• Key partners needed by a PACE provider, and an indication of how those partners and others providers needed for the PACE provider network could be developed.
• Financial package including financial statements for the previous 3 years and financial projections for the next 5 years.
• A marketing/outreach plan to provide relevant information to the population eligible for PACE.
• A financial plan showing infrastructure costs and other start-up costs needed.
• Areas of Shreveport and its surrounding area where the Center could be located to best serve the population and an indication of why that area was chosen.
• A discussion of needed resources to assist people in nursing homes that want to transition into a life in the community.
• Any experience your organization has operating a PACE facility, including information about the current PACE centers under the organizations umbrella.
• Identify the challenges envisioned in opening a PACE Center in Shreveport.
• Experience in the area of affordable housing and how that experience will help to support a successful PACE organization and its participants.

LOCATION

LDH is interested in inviting a PACE organization to submit an application to become a provider of PACE services in the Shreveport area. If a responder knows of an appropriate location, specifics about that location such as size, general location, needed renovations, etc. will be useful and applicable to an RFI response.

PERFORMANCE REQUIREMENTS

The PACE Organization invited to apply to become a PACE provider in the Shreveport area of Louisiana will be expected to comply with federal and state regulations below:

• Code of Federal Regulations at 42 CFR Part 460 (eCFR :: 42 CFR Part 460 — Programs of All-inclusive Care for the Elderly (PACE)
• Louisiana Regulations at LAC Title 50 XXIII (LAC Title 50 TOC)
• Applicable Louisiana licensing regulations found in LAC Title 48 (LAC Title 48 Book 1 and LAC Title 48 Book 2).

Other resources with more information regarding PACE and PACE services:

• CMS website at https://www.medicaid.gov/medicaid/long-term-servicessupports/pace/programs-of-all-inclusive-care-for-elderly-for-states
• National PACE Association at http://www.npaonline.org
• Myers and Stauffer at https://myersandstauffer.com/what-we-do/