8804 PACE ORGANIZATION APPLICATION PROCESS

8804.1 To be eligible to become a PACE organization, an entity shall be, or be a distinct part of, one of the following:

1. (a) An entity of city, county, state, or tribal government;
2. (b) A private not-for-profit entity organized for charitable purposes under section 501(c)(3) of the Internal Revenue Code of 1986. The entity may be a corporation, a subsidiary of a larger corporation, or a department of a corporation; or
3. (c) A private for-profit entity.

8804.2 An entity that is interested in becoming a PACE organization shall submit a response to a Request for Proposals (RFP) issued by DHCF by no later than the established deadline published in the D.C. Register. The RFP response shall include the following:

1. (a) A description of the entity's experience delivering or contracting with PACE programs or other home- and community-based services and supports;
2. (b) A description of the proposed PACE program model, including an explanation of how the entity meets all the requirements to be a PACE organization;
3. (c) A description of the proposed service area and the entity's experience and familiarity with it;
4. (d) A description of the entity's financial capacity to operate a PACE program and fiscal readiness to implement its proposed program model;
5. (e) A PACE program development timeline; and
6. (f) Any additional information requested in the published RFP.

8804.3 Prior to the submission to CMS of an application to become a PACE organization, the interested entity shall:

1. (a) Respond to all DHCF requests for additional information necessary to assess whether the entity is qualified to be a PACE organization;
2. (b) Complete and submit a District Medicaid provider enrollment application

in accordance with Chapter 94 of Title 29 of the DCMR;

(c) Make its facilities available to onsite visit(s) by DHCF staff; and

(d) Obtain written assurances from DHCF that DHCF:

(1) Considers the entity to be qualified to be a PACE organization; and

(2) Is willing to enter into a PACE program agreement with the entity.

8804.4 An application submitted by an entity that seeks to become a PACE organization, or by a PACE organization that seeks to expand its service area and/or add a PACE center site, shall comply with the federal requirements set forth at 42 CFR § 460.12.

8804.5 Following CMS approval of an application to become a PACE organization, the entity shall enter into a three-way program agreement with CMS and DHCF for the operation of a PACE program. A PACE program agreement is effective for one (1) contract year, with the option to extend the agreement on a yearly basis for up to five (5) option years unless any of the three (3) parties chooses to terminate the agreement.

8804.6 The PACE program agreement shall comply with the federal requirements at 42 CFR §§ 460.30 – 460.34.

SOURCE: Final Rulemaking published at 69 DCR 006400 (June 3, 2022).