MLTSS & PACE
At Incline, we bring decades of experience supporting Medicaid agencies and managed care organizations in the complex world of long-term services and supports. Our actuaries have worked extensively on Managed Long-Term Services and Supports (MLTSS) and the Program of All-Inclusive Care for the Elderly (PACE), ensuring rate structures are accurate, compliant, and aligned with program goals.
Managed Long-Term Services and Supports (MLTSS)
Incline has certified actuarially sound MLTSS rates across multiple states, developed methodologies to comply with CMS requirements, and supported states through the federal review process. Our actuaries have led presentations and Q&A sessions with MCOs and CMS, helping secure approval and build confidence in the rate-setting approach. We are experienced in addressing the unique challenges of long-term care populations, including:
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Risk adjustment tailored to high-need beneficiaries
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Site-of-service mix assumptions between nursing facilities and home- and community-based services (HCBS)
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Integration of pay-for-performance programs into long-term care rate structures
Program of All-Inclusive Care for the Elderly (PACE)
For PACE, Incline brings deep expertise in developing and certifying rates, as well as determining the “amount that would otherwise have been paid” (AWOP) in compliance with CMS standards. We balance regulatory requirements with program sustainability—ensuring rates that support both financial soundness and high-quality care delivery.
Decades of Combined Experience
Our team has guided states through regulatory changes, implemented cost neutrality analyses for long-term care populations, and evaluated the impact of new incentive programs on MCOs, providers, and beneficiaries. By combining actuarial rigor with hands-on program knowledge, we deliver solutions that reflect real-world program dynamics.
Why It Matters
Long-term care populations are among the most vulnerable in Medicaid. With proven expertise in both MLTSS and PACE, Incline ensures rate structures not only meet compliance requirements but also advance agency goals for quality, efficiency, and sustainable care delivery.