CMS Updates PACE SPA Preprint and Capitation Rate Setting Guide
Summary
The Centers for Medicare & Medicaid Services (CMS) has updated both the Program of All-inclusive Care for the Elderly (PACE) State Plan Amendment (SPA) Preprint (CMS-10398 #83) and the PACE Medicaid Capitation Rate Setting Guide (CMS-10398 #84) for state use. Both documents are available on the PACE for States page of Medicaid.gov. The PACE SPA Preprint does not include substantive changes, and the updated version should be used for any new PACE SPA submissions.
The PACE Medicaid Capitation Rate Setting Guide replaces the version released in 2015 and provides detailed explanations for development of the amount that would otherwise have been paid (AWOP), development of Medicaid PACE rates, and documentation for inclusion in rate package submissions to CMS. The PACE Medicaid Capitation Rate Setting Guide applies to all PACE rate packages submitted to CMS after January 1, 2025. Given that the release of the Guide to states is occurring after the effective date of the Guide, CMS indicates that it will not require amendments to any rate packages that have already been submitted to CMS prior to release of the notice on the new Guide.
The PACE Medicaid Capitation Rate Setting Guide replaces the version released in 2015 and provides detailed explanations for development of the amount that would otherwise have been paid (AWOP), development of Medicaid PACE rates, and documentation for inclusion in rate package submissions to CMS. The PACE Medicaid Capitation Rate Setting Guide applies to all PACE rate packages submitted to CMS after January 1, 2025. Given that the release of the Guide to states is occurring after the effective date of the Guide, CMS indicates that it will not require amendments to any rate packages that have already been submitted to CMS prior to release of the notice on the new Guide.