‘‘(D) NATIONAL TESTING OF MODEL FOR 
EXPANDED ELIGIBILITY FOR THE PROGRAM OF 
ALL-INCLUSIVE CARE FOR THE ELDERLY.—In 
the case where the Secretary selects the model 
described in clause (ii) of this subparagraph for 
testing pursuant to clause (xxviii) of subpara-
graph (B), the following shall apply: 
‘‘(i) NATIONAL TESTING.— 
‘‘(I) IN
GENERAL.—Subject to 
subclause (II), the Secretary shall de-
sign a demonstration that allows each 
PACE provider with an executed 
PACE agreement to develop and sub-
mit to the Secretary an application to 
begin testing expanded PACE eligi-
bility for high-need and high-cost pop-
ulations that are not otherwise eligible 
to participate in a PACE program 
within 1 year of the date on which the 
model is selected. 
‘‘(II) NO
EFFECT
ON
ONGOING 
MODELS
OR
DEMONSTRATION 
PROJECTS.—Nothing in this subpara-
graph shall affect the testing of any 
model under this subsection or any 
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demonstration project under this Act 
that is implemented prior to the date 
of the enactment of this subpara-
graph. 
‘‘(ii) MODEL DESCRIBED.—The model 
described in this clause seeks to increase 
access to quality, integrated, care for high- 
need, high-cost individuals who are not 
otherwise eligible to participate in a PACE 
program in order to improve health and re-
duce cost. Under this model, participating 
PACE providers would— 
‘‘(I) be paid fixed, monthly 
capitated rates from both Medicare 
and the applicable State Medicaid 
agency for all services provided to 
each enrollee fitting the criteria of the 
PACE provider’s designated popu-
lation; 
‘‘(II) partner with non-PACE 
providers, such as Area Agencies on 
Aging, Centers for Independent Liv-
ing, local hospitals, and non-hospital 
providers such as physicians, behav-
ioral health providers and other com-
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munity-based organizations to effec-
tively reach the PACE provider’s se-
lected population; 
‘‘(III) adapt the PACE program 
model of care to appropriately serve 
the PACE provider’s selected popu-
lation to integrate care and meet the 
unique needs of said population; and 
‘‘(IV) if the PACE provider is lo-
cated in a State that has not yet 
served the selected population through 
a PACE program under section 1934, 
receive an up-front fixed payment to 
coordinate with the State to develop a 
capitated payment rate, with appro-
priate risk adjustment, for the PACE 
provider’s selected population. 
‘‘(iii) REQUIREMENTS
FOR
PARTICI-
PATING
PACE
ORGANIZATIONS.—In order 
to participate in the model, a PACE pro-
vider must— 
‘‘(I) conduct a survey or needs 
assessment of their service area to de-
termine the most appropriate popu-
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lation with which to expand their serv-
ices; 
‘‘(II) receive prior approval from 
the applicable State Medicaid agency 
to submit an application to participate 
in the model; and 
‘‘(III) following such survey or 
needs assessment and approval from 
the applicable State Medicaid agency, 
submit and receive approval of an ap-
plication of expansion from the Sec-
retary. 
‘‘(iv) APPLICATION.—A PACE pro-
vider’s application to participate in this 
model shall include the following informa-
tion: 
‘‘(I) Results of the survey or 
needs assessment of their service area 
under clause (iii)(I) and an expla-
nation of the expanded population the 
PACE organization will serve. 
‘‘(II) The types of services that 
the expanded population will require 
and the PACE provider’s plan to im-
plement these services. 
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‘‘(III) How the PACE provider 
will achieve engagement and enroll-
ment of the new population in the 
model, including how it will partner 
with non-PACE providers in the ap-
plicable service area. 
‘‘(IV) How the expanded popu-
lation’s participation in the PACE 
program is intended to improve qual-
ity of care and health outcomes under 
the model. 
‘‘(V) Certification that the appli-
cable State Medicaid agency has ap-
proved the PACE provider’s applica-
tion to participate in the model. 
‘‘(VI) Plans to coordinate with 
the State Medicaid agency to develop 
an initial capitated rate with appro-
priate risk adjustment. 
‘‘(VII) Plans for the PACE pro-
vider and the State Medicaid agency 
to review and adjust the Medicaid 
capitated rate on a biennial basis, as 
needed. 
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