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PA Bulletin, Doc. No. 22-1880



Expanding the Living Independence for the Elderly Program to Multiple Counties

[52 Pa.B. 7474]
[Saturday, December 3, 2022]

 The Department of Human Services (Department) is planning to expand the Living Independence for the Elderly (LIFE) Program to serve additional counties, specifically Carbon County and Monroe County as one area. The Department's goal is to have LIFE services available across this Commonwealth.


 The Department's LIFE Program is the State Administering Agency (Agency) for the Federal Program of All-Inclusive Care for the Elderly (PACE), fulfilling State-level responsibilities for operating the program. The LIFE Program is unique, as a three-way partnership between the Federal government, this Commonwealth and the LIFE Provider Organizations. The Centers for Medicare & Medicaid Services (CMS) depends on the Agency as the single point of contact on State-related requirements regardless of whether the functions are housed directly within the Agency. (42 CFR Part 460 (relating to Programs of All-Inclusive Care for the Elderly (PACE)) and CMS Publication # 100-11, Programs of All-Inclusive Care for the Elderly (PACE) Manual).

 This solicitation is open to the PACE/LIFE provider organizations currently operating in this Commonwealth and to other organizations wishing to become a new Commonwealth LIFE provider organization. If an organization not currently operating a LIFE Program in this Commonwealth is selected to serve an area, it must follow the protocols to become a new PACE provider organization, as specified in 42 CFR 460.12 (relating to application requirements). A new PACE contract number must be issued. It must form a corporation in this Commonwealth and be registered with the Department of State. It must operate according to Commonwealth laws and regulations and agree that all disputes will be adjudicated in this Commonwealth or under Federal jurisdiction. The program must have an independent board dedicated to the Commonwealth LIFE operations. A majority of the board must be full-time Commonwealth residents. It must fulfill all obligations to do business in this Commonwealth and to conduct any other PACE and LIFE activities.

 The Department will not authorize marketing of a new area, or enrollment of participants from that area, until: the PACE program agreement between the PACE organization, CMS and the Department has been signed; the selected organization has executed a Commonwealth Medicaid (Medical Assistance) Provider Agreement; and the Commonwealth budget includes an allocation that is sufficient to support this expansion. Prior to executing the PACE program agreement, the Department requires the organization to execute the LIFE State side agreement which contains specific obligations between the Department and the organization. Compliance with the LIFE State side agreement is compulsory, enforceable equally with the PACE program agreement and is required for an organization to start and continue to operate a LIFE program.

 The Department is soliciting information from organizations interested in opening a LIFE center in and serving Carbon County and Monroe County as one area.

 The Department requires the response to contain a commitment to serve the entire counties and for the organization to emphasize enrollment growth. Rural areas, traditionally, have posed a challenge to PACE enrollment; however, the performance of the Commonwealth LIFE Providers has shown these difficulties can be overcome and the Department expects providers in new areas to achieve the same success.

 Proposing incremental service is not allowed, service for both Counties will be available upon opening of the LIFE center.

 The response must not express interest in another area.

 The response must not impose conditions on the Department.

 The response must provide details on the planning, personnel and resources committed to achieving a sustainable program within 36 months of opening the LIFE center in the new service area. Sustainability is defined as being fiscally sound under 42 CFR 460.80(a)(1)—(3) (relating to fiscal soundness) and having enrollment, net census and growth keep up with projections in the response.

 The successful responder must agree to submit a completed PACE provider application or Service Area Expansion application to the Department within 3 months of being notified of its selection. The Department must review the PACE provider application and concur with the submission before it is sent to CMS. The responder agrees that the details provided in its response will be included in the PACE provider application and the PACE program agreement, where applicable, the LIFE State side agreement and in pertinent operations and policies.

 The Department will not provide any grant dollars or other payment for the development of a LIFE Program. Responders will be accountable for all costs incurred in the response and in subsequent approval and development processes.

 The selection will be based on the enrollment and service strategy determined to be best for the citizens of this Commonwealth, on the scope of resources committed to the project and on the comprehensiveness of the response.

Schedule of Areas to Be Opened

 Upon commencing the project to serve Carbon County and Monroe County, a public notice for Adams County will be published in the Pennsylvania Bulletin. Following a 6-month schedule, the Department plans to publish notices in the Pennsylvania Bulletin for the remaining areas:

 1. Pike County and Wayne County (as one area).

 2. Huntingdon County.

 3. Bradford, Potter, Sullivan, Susquehanna or Tioga Counties (BPSST). The responder may propose combining two or three contiguous Counties from the BPSST group into a project area.

Response Requirements

 The response must include the following, in the order listed and in separate PDF format documents. The responder must label all documents clearly. A partnership (multiple organizations working together on a response) must submit a single, consolidated response.

1. Cover Letter

 An officer of the responder authorized to contractually bind the organization should submit a signed cover letter which commits to sending a complete PACE application to the Department within 3 months of selection and to starting LIFE services from a new center within 24 months of the PACE application being sent to CMS.

 This letter must specify the area for which the responder wishes consideration. It should include general information about the responder and responder's organization and include its address, a point of contact and the direct telephone number and e-mail address for the point of contact.

2. Project Narrative

 The narrative should describe the area, a brief account of the market, steps taken to inform the response (such as list of possible sites, lease or purchase negotiations underway, preliminary agreements and cost estimates from building contractors, discussions with possible net-work providers and systems and community supporters) and provide a synopsis taking the project from inception through the point of sustainability.

 Partnering in responses is allowable; however, each partner must provide a letter of commitment authorized by its board of directors, which is signed by an officer of the organization authorized to contractually bind the organization. Each partner must submit all information required in section 3. Organization Description and section 8. Financial Viability and Commitment, as follows. Partnering in a response does not limit an organization's ability to respond independently. Partnership responses must be submitted as a single response, commit to serve the entire service area described in this notice and have clear definitions of the partners' responsibilities. If successful, a separate PACE application will be required from each partner and separate PACE provider agreements and LIFE State side agreements will be executed for each partner.

3. Organization Description

 The responder should identify all members of its corporate governing board by name, their responsibilities, their relationships to any parent organization and include the telephone number and e-mail for each member and their business office addresses. It should also identify the members and contact information of any company or organization (or individuals) able to exercise any control or influence over this LIFE Program. This information should include the highest-level parent organization, or individuals, and all subsidiary organizations, or individuals, able to exercise control or influence over this LIFE Program. (42 CFR 422.2 (relating to definitions) and 42 CFR 423.4 (relating to definitions)).

 The response should identify the proposed management team for the project with contact information for each management team member. The response should describe the experience of each member, especially the marketing and business growth expertise of those responsible for enrollment growth. It should describe the composition of the board intended for this LIFE project.

 Each responder, its parent corporations and other PACE programs associated with the responder should not be in significant noncompliance with Department, Commonwealth or CMS laws and regulations. Responders should provide copies of any reports, penalties or restrictions issued for a period of 5 years prior to the date of this notice by CMS, the Department or other governmental agency against any PACE organization or other organization associated with the responder. The responder gives the Department permission to contact CMS, any other State's PACE administrator and other governmental agencies about the responder's performance. The Department must be satisfied that any deficiencies have been or are being corrected and that the deficiency is unlikely to recur.

4. Feasibility Study

 The responder shall provide a PACE feasibility study (including an operational, market and financial assessment) of the project to the Department, estimating the number of PACE-eligible citizens in the project service area and the expected growth of enrollment by month for at least the first 2 years of operation and to the sustainability point. The study must be conducted by a PACE Technical Assistance Center. The responder should provide a complete, unredacted copy of the study or the response will be rejected.

 The feasibility study must address the following and provide evidence to support any claims:

 • The demand for the PACE services in the proposed service area. The analysis must cite the sources and years of the data used, the calculations and rationale to estimate the PACE-eligible population and must provide comparison to successful PACE programs in similar regions, Nationally or in this Commonwealth. The analysis cannot assume that the program will achieve substantial market penetration in the early years without providing the strategies and resources committed to achieve that goal.

 • The responder's experience in programs having principles consistent with the PACE model and the responder's depth of leadership and experience required to address the challenges in developing a sustainable PACE program.

 • The responder's experience with primary, acute or long-term care services and demonstrated capability in serving a Medicare and Medicaid-eligible population.

 • The financial capacity to fund program development, assume financial risk and fund risk reserve to and through the sustainability point. This should include a 2-year start-up budget showing the following:

 a) Monthly enrollment growth projections.

 b) Costs of operations, including marketing and advertising.

 c) Sources of funding for start-up and periodic infusions.

 d) The financial commitments from any parent company or organization to maintain program operations for at least 5 years from startup.

 • A project design that incorporates a new LIFE center in the area, describes the service plan and has staffing ratios at or above PACE best practices. The project design must also describe the transportation resources to be committed for the participants and its 24-hour service capability.

 • The responder's accessibility to nursing facilities, home and community-based services, hospitals and other needs of this population.

 • The program shall have the capacity to provide for at least 2 days of center attendance, weekly, for each member who desires it.

5. Service Area

 Responders shall describe the service area (by a list of zip codes and stating service will be provided to the ''Full County(s)'') and describe its geography and demographics. A map showing county boundaries, zip codes, municipalities and travel times to the LIFE center and to critical health care and other contracted facilities should be included.

6. Marketing Plan

 Responders should describe the outreach methods, the advertising methods and schedules, and follow-up schedules. Responders should also detail contracts, relationships and commitments that are already in place with aging organizations, medical and service providers, community leaders and the like. Responders should describe the success the responder has had in growing PACE in other areas and outline innovative referral or marketing methods to be used.

 The responder should provide background on the professional staff who have successfully started and sustained a PACE-like program. The responder should illustrate any distinctiveness in this project design or outcomes expected, how it might reduce nursing facility beds or improve the quality of collaborations with hospitals, personal service and medical providers and access to housing sources.

 Responders should describe the resources allocated to marketing for this project, including the budget for advertising. It shall also commit to hiring or allocating an experienced marketing and sales professional, with at least 1/2 full-time-equivalent (FTE) level of effort (preferably full-time) dedicated to this project. That professional must be on staff before the PACE program agreement is executed and continue at that level of effort for at least 2 years from start-up or until the sustainability point. Current Commonwealth LIFE Providers and other PACE Organizations should not decrease the marketing efforts now allocated to existing areas to divert effort to this project.

 The Department will compare the responder's enrollment levels to other LIFE or PACE programs of similar maturity. If the responder has current enrollment levels significantly below comparable programs, the Department may also require that at least one FTE marketing professional, additional to the 1/2 FTE marketing professional for this project, be on staff or hired before the project can continue. That FTE must be dedicated only to current LIFE enrollment and growth. The Department expects the current program to reach, or be on track to reach, a comparable enrollment level within 2 years, along with having the new area grow toward sustainability. The Department may require a responder to engage a PACE enrollment and management consultant to reach these goals.

7. Implementation Plan

 The responder must describe how it will construct a PACE center (LIFE center) in the service area to open within 24 months of the PACE application being sent to CMS. It must conform to all applicable construction codes, obtain all operating permits and inspection reports and the Responder must provide certification by a qualified professional of the center's compliance with the Life Safety Code (NFPA 101, 2012 version and NFPA 99). Life Safety Code compliance is required by PACE regulations.

 Responders should commit to provide services to participants within 24 months of submitting the PACE application to CMS, a schedule will be provided. The Department may establish certain milestones for the project. Details of the implementation plan shall include the construction needed for the new LIFE center and whether a lease or land purchase has been made and if a design firm or contractor has been consulted. Responders should describe the staffing plan and whether a set of professionals and others has been surveyed for interest in serving the program. The implementation plan shall also explain how it will provide care that meets the needs of each participant across all care settings 24 hours a day, every day of the year.

 Regular progress meetings will be scheduled, no less than quarterly, with the Department. The Department will terminate a project that does not meet the requirements of this notice or is not executed in a timely manner, or both, (for example, the schedule and milestones are not being met or insufficient marketing staffing and effort is not being maintained).

8. Financial Viability and Commitment

 Responders should provide realistic and justified financial projections, including resources for consulting, acquisition of space, acquisition of equipment, vans, working capital and solvency reserves and enrollment census projections for at least 2 years from opening and until the sustainability point. If applicable, the responder should provide evidence that the organization has been successful with similar operations. The responder should provide a letter of commitment from the board of directors, signed by an officer of the organization authorized to contractually bind the organization, to support the project for at least 5 years. In addition, the responder should provide documentation of a risk reserve that will satisfy the obligations for its entire Commonwealth operations, including this project. The responder should provide the last 2 years of audited financial statements. If external financing is to be used, the responder should provide a letter of intent from the lender.

Evaluation of Responses

 The Department will select the response that best fits the needs of the Department. The Department reserves the right of final approval. If no response is satisfactory, the Department reserves the right to modify and reissue this solicitation. The Department also reserves the right to investigate any claims made or information provided. If selected, the Department may request the responder to complete additional steps.

 Responses not describing service to the entire area will be rejected. The LIFE participants in this new area must receive equal quality, quantity and variety of services.

 Upon notification that its response has been selected, the successful responder should confirm its commitment to the project, as described in the response, in writing, within 3 business days. It should schedule the first project meeting with the Department and immediately begin to execute its implementation plan. The other responders will also be notified.

Fiscal Impact

 The fiscal impact of this change is estimated at $0.000 million ($0.000 million in State funds) for FY 2022-2023.

Submittal of Information

 Responses must have a separate PDF file for each section. Responses must be provided on a new USB drive or sent by means of encrypted e-mail to Malcolm Furman at ZIP files are acceptable. Electronic and USB drive responses must be in text-searchable PDF format, except for maps and audited financial information. The USB drive must be addressed to the Department of Human Services, Office of Long-Term Living, Division of Integrated Care Programs, Attention: Jonathan Bowman, P.O. Box 8025, Harrisburg, PA 17105-8025. The Department must receive the response within 90 days of the date of this publication or the response will be rejected. Questions regarding this notice should be submitted to the Department at Questions will be answered (at the discretion of the Department) to all responders at the same time.

 Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania Hamilton Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).

Acting Secretary

Fiscal Note: 14-NOT-1551. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 22-1880. Filed for public inspection December 2, 2022, 9:00 a.m.]

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