HRSA Rural Program of All-Inclusive for the Elderly Planning and Development

HRSA Rural Program of All-Inclusive for the Elderly Planning and Development is sponsored by Health Resources & Services Administration (HRSA). Provides funding to develop or expand PACE programs in rural areas to serve aging populations.

Notice of Funding Opportunity Application due April 17, 2025 Federal Office of Rural Health Policy # Rural Program of All-Inclusive # Care for the Elderly (PACE) # Planning and Development ## Opportunity number: HRSA-25-101 Contents Step 1: Review the Opportunity 5 Step 2: Get Ready to Apply 16 Find the application package 17 Application writing help 17 Step 3: Prepare Your Application 19 Application contents and format 20 Step 4: Learn About Review and Award 36 Step 5: Submit Your Application 45 Application submission and deadlines 46 Step 6: Learn What Happens After Award 50 Post-award requirements and administration 51 If you believe you are a good candidate for this funding opportunity, secure your SAM.

gov and Grants. gov registrations now. If you are already registered, make sure your registrations are active and up-to-date.

SAM. gov registration (this can take several weeks) You must have an active account with SAM. gov. This includes having a Unique Entity See Step 2: Get Ready to Apply Grants.

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gov See Step 2: Get Ready to Apply Apply by the application due date Applications are due by 11:59 p. m. Eastern Time on April 17, 2025.

To help you find what you need, this NOFO uses internal links. In Adobe Reader, you can go back to where you were by pressing Alt + Left Arrow (Windows) or Command + Left Arrow (Mac) on your keyboard. Before you begin 4Jump to a step 1.

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Award Contacts Award information 14 Basic information Health Resources and Services Administration (HRSA) Federal Office of Rural Health Policy Increasing access to Program of All-Inclusive Care for the Elderly Program of All-Inclusive Care Federal assistance listing: Statutory authority: Social Security Act, §711(b) (42 Expected award date is by: See other submissions for other time frames that may The Rural Program of All-Inclusive Care for the Elderly (PACE) Planning and Development supports organizations in the development or expansion of sustainable PACE programs to improve delivery of comprehensive medical and social services tailored to the needs of elderly individuals in rural areas.

Expected total available funding in FY 2025: $2,000,000. 00 Expected number and type of awards: 4 grants Funding range per award: $500,000 We plan to fund awards in four 12-month budget periods for a total 4-year period of performance from September 30, 2025 to September 29, 2029. The program and awards depend on the appropriation of funds and are subject to change based on the availability and amount of appropriations.

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Award Contacts Step 1: Review the Opportunity 6Eligibility You can apply if you are a domestic* public or private, non-profit, or for-profit entity.

## Types of eligible organizations These types of domestic* organizations may apply: • Public institutions of higher education • Private institutions of higher education • Non-profits with or without a 501(c)(3) IRS status • For-profit organizations, including small businesses • State, county, city, township, and special district governments, including the District of Columbia, domestic territories, and freely associated states • Independent school districts • Native American tribal governments • Native American tribal organizations • State and county health departments • Hospitals, including rural emergency hospitals • Community-based organizations • Federally qualified health centers * “Domestic” means the 50 states, the District of Columbia, the Commonwealth of Puerto Rico, the Northern Mariana Islands, American Samoa, Guam, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, and Individuals are not eligible applicants under this NOFO.

## Completeness and responsiveness criteria We will review your application to make sure it meets these basic requirements to move forward in the competition. We will not consider an application that: • Is from an organization that does not meet all eligibility criteria . • Requests funding above the award ceiling shown in the funding range .

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Submit 6. Award Contacts > Step 1: Review the Opportunity 7 Generally, you may not submit multiple applications under the same unique entity identifier (UEI) number or employer identification number (EIN).

However, we recognize a trend toward consolidation within the rural health care industry and the possibility that multiple organizations may share the same UEI or EIN with their parent You may only submit multiple applications under the same UEI or EIN if each application proposes a distinct project. You must also submit Attachment 10: EIN/UEI exception request (if applicable) with your application.

We will only review your last validated application for each distinct project before the deadline. NOTE: Single organizations (e.g., a parent organization/headquarters) may not apply more than once for this funding opportunity on behalf of its satellite offices.

If you provide insufficient information in Attachment 10 , or submit multiple applications that are nearly identical, we will only accept the last on-time submission associated with the EIN/UEI number. Tribal exception: HRSA is aware that tribes and tribal organizations may not meet the EIN or UEI requirement of this NOFO.

As a result, tribes and tribal organizations that only have one EIN or UEI or cannot demonstrate that the network is composed of at least three unique entities may request a tribal exception. Applicants must request a tribal EIN exception in attachment 11: Tribal EIN/UEI exception request. This program has no cost-sharing requirement.

If you choose to share in the costs of the project, we will not consider it during merit review . We will hold you accountable for any funds you add, including through reporting . > 1.

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Learn 5. Submit 6. Award Contacts > Step 1: Review the Opportunity 8 The purpose of this Rural Program of All-Inclusive Care for the Elderly (PACE) Planning and Development program is to improve health care in rural areas, including expanding access to medical care and long-term services, for rural aging populations by expanding PACE programs into rural areas.

The program goals are to: • Provide start-up funding for organizations to develop a new PACE site serving the • Provide funding for organizations to expand existing PACE programs into rural areas through service area expansion. • Implement sustainable PACE programs that will effectively serve critical health care needs for rural aging populations.

This funding will support organizations to develop an initial PACE program or expand an existing PACE organization into rural areas. Successful Rural PACE Planning and Development award recipients will be required to work with their State Administering Agency (SAA) and Centers for Medicare & Medicaid Services (CMS) on completing and submitting their PACE application.

By the end of the 4-year period of performance, award recipients are expected have a plan in place for long term financial sustainability of the new or expanded PACE organization. Note: This funding does not guarantee that an organization will receive approval of their PACE application and does not provide long term funding for the delivery of clinical services to PACE clients.

The Program for All-Inclusive Care for the Elderly (PACE) is a Medicare and Medicaid program that helps people meet their health care needs in the community instead of going to a nursing home or other care facility. Since its inception in the 1970s, the PACE model has expanded to 33 states with 180 PACE organizations [1] . PACE programs provide, and are financially responsible for, all health care services of their enrollees.

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Award Contacts > Step 1: Review the Opportunity 9 The PACE model provides care management to enrollees, and the PACE center serves as a central hub for adult day care services where enrollees can receive primary care, therapy, meals, recreation, and socialization.

The PACE model can address issues related to transportation and affordability for eligible participants, and the PACE program pays for all services and provides transportation. Studies have found that PACE participants have a lower mortality rate and lower use of acute care hospitals. 97% of family members of a PACE participant would recommend PACE services to other families, and 58% reported lower caregiver burden [2] .

Since most PACE enrollees are dually eligible for Medicare and Medicaid, it is critical for PACE organizations to have a steady patient volume to sustain its PACE program. According to the National Advisory Committee on Rural Health and Human Services 2023 policy brief , the start-up and application process to become a certified PACE provider with CMS may present some challenges in rural areas [3] .

With a focus on supporting rural community capacity and infrastructure to support seniors locally, Rural PACE Planning and Development is designed to support improving access to and delivery of comprehensive and sustainable medical and social services for adults 55 and older living in rural areas by allowing organizations to plan, develop and apply for an initial or expanded PACE Program through CMS.

Through two funding pathway options , recipients are funded to improve health care in rural areas by implementing projects to develop an initial PACE program or expand existing certified CMS PACE programs into rural areas through PACE service area All applications must meet the requirements stated in the Eligibility criteria section of this NOFO.

Your application is also expected to meet the program guidance outlined in this section by detailing how your project will address the program guidance outlined in your application’s project narrative description. Failure to respond to this guidance can impact your application’s score. > 1.

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Learn 5. Submit 6. Award Contacts > Step 1: Review the Opportunity 10 This program aims to improve and expand access to long term elder care services in rural areas by expanding PACE services into rural areas.

• Applicants are expected to prioritize improving delivery and access to PACE program services in rural areas and for beneficiaries enrolled in PACE and living in rural areas, as evidenced consistently throughout the project narrative and supported through inclusion of information in Attachment 3: Map of service area and Attachment 6: PACE Beneficiary Enrollment Plan ◦ For the purposes of this NOFO, rural service areas are defined as a county or census tract is located in a HRSA-designated rural area .

Please refer to Appendix A: Determining a rural service area. • Applicants must have demonstrated experience serving, or the capacity to serve, rural underserved populations as evidenced in the corresponding rural service area section of the Project Narrative . Partner Collaboration Plan Applicants must provide a clear business plan that identifies any organization, provider, or service partners that will be involved in the project.

This is evidenced by providing all required documentation requested in Attachment 2: Agreements with other entities and supported by your project description provided in your corresponding project Non-duplication of services We recognize that more than one PACE organization may provide complementary services in a rural area.

If you are aware of other PACE organizations in the service area you are proposing to serve, you must detail in Attachment 7: Non-duplication of services how you will avoid duplicating efforts of the other PACE organizations in any > 1. Review 2. Get Ready 3.

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Award Contacts > Step 1: Review the Opportunity 11 This program includes two funding pathways.

You are required to select one of these two funding pathways for your proposed project: Funding Pathway 1: Initial PACE Program This funding pathway supports new CMS applicants seeking to become a PACE organization in a rural area for the first time : • To qualify for this funding pathway, you must not have previously registered with CMS as a certified PACE provider.

• Under this funding pathway, Rural PACE Planning and Development grant funding can be used to apply for PACE certification from CMS and implement approved PACE programs in a designated rural geographic area and to provide sustainable PACE services to rural recipients by the end of the 4-year funding period.

Funding Pathway 2: Service Area Expansion This funding pathway supports the expansion of existing PACE organizations who are seeking to expand the service area to a HRSA-designated rural area .

This includes an expansion of the currently approved geographic service area and/or the addition of a • To qualify for this funding pathway, you must be currently registered with CMS as a certified PACE provider and pursuing expanding to a HRSA-designated rural area.

• Under this funding pathway, Rural PACE Planning and Development grant funding can be used to support PACE service area expansion applications to CMS and to provide sustainable expanded PACE services to rural recipients resulting from approve service expansion by the end of the 4-year funding period.

Funding pathway selection requirement To select a Funding Pathway, you must clearly state your application’s Funding Pathway selection in the Project abstract and provide the required documentation requested under Attachment 9: Funding Pathway Participation Statement .

Funding pathway requirements Funding Pathway 1: Initial PACE Program To accomplish the goal of this funding pathway, you are expected to use Rural PACE Planning and Development funds to implement activities that: • Lead to the successful submission of an initial PACE organization application with CMS to become a PACE organization in a HRSA-designated rural area for the first > 1. Review 2. Get Ready 3.

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Award Contacts > Step 1: Review the Opportunity 12 Funding Pathway 2: Service Area Expansion To accomplish the goal of this funding pathway, you are expected to use Rural PACE Planning and Development funds to implement activities that: • Lead to the successful submission of a PACE service area expansion application with CMS to expand the service area to a HRSA-designated rural area .

As part of this funding pathway, there are 3 possible expansion avenues for current PACE organizations to expand service to HRSA-designated rural area s through PACE service area expansion: [3] 1. A current PACE organization requesting to expand into a HRSA-designated rural area without adding an additional PACE center. 2.

A current PACE organization requesting to add a new PACE center in their existing HRSA-designated rural area. 3. A current PACE organization requesting to expand into a HRSA-designated rural area and add a new PACE center in the expanded area.

# Program requirements and expectations All applicants proposing projects that align under either funding pathway are required to meet all additional program guidance listed in this section: • Successful award recipients of Rural PACE Planning and Development funding are required to work directly with their State Administering Agency (SAA) and Centers for Medicare & Medicaid Services (CMS) to complete the appropriate PACE application submission, review and approval process respective to the awarded • Successful award recipients are responsible for following their SAA and CMS’ application and approval processes (including meeting CMS’ and any State agency • Funding under this program does not guarantee award recipients will receive CMS approval of any PACE applications submitted through funded grant activities.

• If a PACE application submitted by a successful award recipient of this grant funding is not approved by their SAA or by CMS, HRSA reserves the right to > 1. Review 2. Get Ready 3.

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Award Contacts > Step 1: Review the Opportunity 13 ## Program data collection Award recipients of this grant funding will be required to report measures annually to HRSA through an electronic performance measurement data collection system.

A final set of measures will be provided by FORHP to award recipient following receipt Award recipient will be expected to collect, track, and report on data for recipients of funded PACE program over time, including at least one year during the period of performance following CMS certification as a PACE organization under the initial PACE program funding pathway or service area expansion funding pathway .

# Funding policies and limitations • We will only make awards if this program receives funding. If Congress appropriates funds for this purpose, we will move forward with the review and • Support beyond the first budget year will depend on: ◦ Appropriation of funds. ◦ Your satisfactory progress in meeting the project’s objectives.

◦ A decision that continued funding is in the government’s best interest. • If we receive more funding for this program, we may: ◦ Fund more applicants from the rank order list. ◦ Extend the period of performance.

◦ Award supplemental funding. 1. Review 2.

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Submit 6. Award Contacts Step 1: Review the Opportunity 14 General limitations • For guidance on some types of costs we do not allow or restrict, see Project Budget Information in Section 3. 1.

4 of the Application Guide . You can also see 45 CFR part 75, or any superseding regulation, General Provisions for Selected Items • You cannot earn profit from the federal award. See 45 CFR 75.

400(g) . • Congress’s current appropriations act includes a salary limitation, which applies to this program. As of January 2025, the salary rate limitation is $225,700.

This limitation may be updated. Indirect costs are costs you charge across more than one project that cannot be easily separated by project. For example, this could include utilities for a building that supports multiple projects).

To charge indirect costs you can select one of two methods: Method 1 – Approved rate. You currently have an indirect cost rate approved by your cognizant federal agency at the time of award. Method 2 – De minimis rate.

Per 2 CFR 200. 414(f) , if you have never received a negotiated indirect cost rate, you may elect to charge a de minimis rate. If you choose this method, costs included in the indirect cost pool must not be charged as direct This rate is 15% of modified total direct costs (MTDC).

See 2 CFR 200. 1 for the definition of MTDC. You can use this rate indefinitely.

Program income is money earned as a result of your award-supported project activities. You must use any program income you generate from awarded funds for approved project-related activities. Find more about program income at 45 CFR 75.

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Submit 6. Award Contacts > Step 1: Review the Opportunity 15 1. Review 2.

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Submit 6. Award Contacts Find the application package 17 Application writing help 17 Get registered You must have an active account with SAM. gov to apply.

This includes having a Unique Entity Identifier (UEI). SAM. gov registration can take several weeks.

Begin that process To register, go to SAM. gov Entity Registration and select Get Started. From the same page, you can also select the Entity Registration Checklist to find out what you’ll need When you register or update your SAM.

gov registration, you must agree to the financial assistance general certifications and representations . You must agree to those for grants specifically, as opposed to contracts, because the two sets of agreements are different. You will have to maintain your registration throughout the life of any award.

You must also have an active account with Grants. gov . You can see step-by-step instructions at the Grants.

gov Quick Start Guide for Applicants . The application package has all the forms you need to apply. You can find it online.

Go to Grants Search at Grants. gov and search for opportunity number HRSA-25-101. # Application writing help Visit HHS Tips for Preparing Grant Proposals .

Visit HRSA’s How to Prepare Your Application page for more guidance. See Apply for a Grant for other help and resources. 1.

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Learn 5. Submit 6. Award Contacts Step 2: Get Ready to Apply 17 Join the webinar For more information about this opportunity, join the webinar on February 11, 2025 at More information on HRSA 25-101’s webinar will be posted at a later date to the related documents tab here: https://grants.

gov/search-results-detail/358301 We will record the webinar. Visit the HRSA’s open opportunities website to learn more about the resources available for this funding opportunity. Have questions?

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Submit 6. Award Contacts > Step 2: Get Ready to Apply 18 1. Review 2.

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Submit 6. Award Contacts # Prepare Your Application Application contents and format 20 Application contents and Applications include 5 main components. This section includes guidance on each.

Application page limit: 50 pages. Submit your information in English and express whole number budget figures using Make sure you include each of these: Components Submission format Project abstract Use the Project Abstract Summary form. Project narrative Use the Project Narrative Attachment form.

Budget narrative Use the Budget Narrative Attachment form. Attachments Insert each in the Attachments form. Other required forms Upload using each required form.

You must format your narratives and attachments using our required formats for fonts, size, color, format, and margins. See the formatting guidelines in Section 3. 2 of the 1.

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Learn 5. Submit 6. Award Contacts Step 3: Prepare Your Application 20 Project abstract Complete the information in the Project Abstract Summary form.

All applicants are required to include the following in the Project Abstract field: • A short description of your proposed project. • Your application’s funding pathway selection for your project. You many only select one of the two available funding pathways: 1.)

Initial PACE Program Funding Pathway or 2.) Service Area Expansion Funding Pathway . • Briefly describe the target population you will serve.

• Identify and describe the proposed project goals and objectives as it related to the needs you plan to address. • Proposed rural service area(s), including rural census tracts. For more information, see Section 3.

1. 2 of the Application Guide . In this section, you will describe all aspects of your project.

Project activities must comply with the non-discrimination requirements and align with Rural PACE Planning and Development program guidance . All applicants under both Funding Pathways must complete responses to all respective sections of the project narrative. Failure to respond to these instructions will impact your application’s score.

Use the section headers and the order listed. See merit review criterion 1: Need • Describe the purpose of your project, including the funding pathway selection and overview rural geographic area that the new or expanded PACE program will serve. Include a summary of your proposed project that discusses how your proposed project will best support the needs of your project’s identified service area and target population.

• Outline the goals and expected outcomes of the proposed project, include specifics relevant to the selected funding pathway your proposed project will implement, including which of the three specific expansion avenues your project will address, if applying under the Service Area Expansion funding pathway. • Describe unmet health care needs that the PACE program will address. > 1.

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Award Contacts > Step 3: Prepare Your Application 21 Applicants selecting to participate in the Service Area Expansion funding pathway must include the following items in list format: • Name of PACE organization • PACE Center address(es) • PACE organization’s eligibility qualifications • Current service area(s) • Current PACE beneficiary enrollment • Anticipated service area expansion Applicants selecting to participate in Initial PACE funding pathway must describe the details of your proposed PACE program and application status.

See merit review criterion 1: Need • Describe the target population and their unmet health needs related to long term services and supports, including the level of care that may be required, and how the PACE program will address these needs for the community in the proposed • Outline the community or organization’s needs you plan to address, including the delivery of comprehensive, integrated acute and long-term care services.

• Use and cite demographic data whenever possible to support the health care needs of your project’s identified target population, including any available data or details on demographic, social, or other key health care needs of the population the project will serve, as well as any available data or details on barriers to accessing care, such as transportation, among others.

• Describe the HRSA-designated rural geographic area you plan to expand or implement new PACE services and explain why you chose this target area. • Cite the number of dually eligible Medicare and Medicaid beneficiaries (ages 55 and older) in the proposed service area(s). > 1.

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Learn 5. Submit 6. Award Contacts > Step 3: Prepare Your Application 22 See merit review criterion 2: Response • Describe your readiness to initiate a new PACE program or expand existing PACE organization into a designated rural service area .

• Tell us how you will address the needs you described and meet the program guidance , including the funding pathway requirements for the funding pathway selection identified in your application.

• Describe how you will establish an interdisciplinary team approach to care management and service delivery to keep the elderly population in the • Include strategies for ongoing staff training, teamwork, and information sharing as well as strategies for outreach and collaboration to involve patients, families, and • Describe how you’ll implement PACE into your initial or expanded site, as it relates to the funding pathway your project aligns to.

• Detail how your organization has demonstrated capacity to fund an Initial PACE Program or a Service Area Expansion. If you are selecting to participate in the Initial PACE program funding pathway , you must include a description that details: • How you will approach PACE program application feasibility analysis and • Your approach and plans for interdisciplinary team development. • Your education and outreach plans.

Please note, organizations are not permitted to promote any PACE sites/services being developed through this grant until they have been approved by CMS. • How you will sustain costs until PACE organization reaches sufficient enrollment • Any other efforts your organization determines as critical to its successful start-up.

If you are selecting to participate in the Service Area Expansion Funding Pathway , you must include a description that details: • Identification of the services that will be directly provided by the PACE Organization and those to be provided under contract and details your capacity to support individuals transitioning from acute care and individuals transitioning from institutional long-term care.

• How you will sustain costs until the provider reaches sufficient enrollment size. > 1. Review 2.

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Submit 6. Award Contacts > Step 3: Prepare Your Application 23 See merit review criteria 2: Response and 4: Impact This section will help reviewers understand how you will achieve each of the objectives during the 4-year grant period of performance.

The details listed in this section asks you to describe specific elements of your work plan and must clearly align to the work plan provided in table format in Attachment 4: • Describe how your work plan will meet the goal of commencing your selected funding pathway for either an Initial PACE Program or an existing PACE organization service area expansion , including: ◦ How your work plan will support advancement of the overall purpose, goals, objectives, and activities of the proposed project ◦ How the timeline for proposed activities during the project’s funding cycle is appropriate for project implementation.

◦ Who will be responsible for overseeing implementation for work plan ◦ Any support or collaboration from identified project partners and key stakeholders to plan, design, and implement work plan activities. ◦ Performance, outcome measures, and/or benchmarks to help monitor progress for work plan activities. ◦ Expected results, outcomes and/or impact on the target population.

◦ Timeline of your plan to work with respective State agencies and submission of the appropriate PACE application to CMS, including all respective application requirements. > 1. Review 2.

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Submit 6. Award Contacts > Step 3: Prepare Your Application 24 See merit review criterion 2: Respo nse This section will help reviewers understand how you will address anticipated challenges and barriers throughout the project period. Discuss any anticipated challenges and barriers you will likely encounter in your project.

This includes description of anticipated challenges and barriers that detail: • what the specific challenges and barriers are and how you plan to address them with respect to establishing and implementing your proposed project’s PACE program in your target rural service area.

• Please include how you will address solutions and approaches to identified challenges and barriers including how you handle: ◦ outreach to the target population, ◦ securing specialty providers and other needed staff, including training ◦ beneficiary enrollment, including low initial enrollment.

◦ delivery and coordination of care ◦ transportation for beneficiaries ◦ electronic medical record system management for beneficiaries ◦ financial viability and sustainability ◦ maintenance and adherence to PACE program CMS policies and regulations ◦ Any State level barriers, such as, no State Plan Option for PACE or duplication of services.

This may also include any anticipated challenges or barriers related to working directly with related state agencies or CMS on the PACE application review and approval process. ◦ Any challenges or barriers likely to be encountered with implementing a PACE program in a rural geographic area.

◦ Any expected internal challenges (such as managing expectations among key partners and interdisciplinary team members, data sharing, and reporting) and external challenges (like regulatory changes) that may directly or indirectly affect the development of the rural PACE program, including how the organization will become an approved PACE site. ◦ Process for handling participant grievances and appeals.

◦ Any other relevant challenges or barriers identified with approaches for > 1. Review 2. Get Ready 3.

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