Nevada's PACE RFP Is Out. Your Building Gets Scored December 10
If you're bidding on Nevada PACE, you have about 60 days to put a named site in your proposal, and you can't safely commit to that building until the Board of Examiners approves contracts around June 2027. Hold the site under a signed LOI or paid option. Write into it the same exits the State wrote into your contract: award, permits, HCQC licensing, CMS approval, and the State's 30-day termination right. Size the center at 15,000 to 20,000 square feet, plan on roughly $4.5M to $8.5M of real estate and fleet capital per urban center, and expect first capitation around early 2029.
Nevada posted its PACE RFP on the night of October 8, three days before the National PACE Association conference opens in Denver. I read the full package (the RFP, Scope of Work, Attachments A and B, the standard contract, and the Business Continuity Agreement) for what it asks of the building. Proposals are due December 10, and the operational plan scores your proposed center: the ZIP code, why you picked it, and how ready the facility is.
The calendar works against you from there. The State expects to award around the end of April and take contracts to the Board of Examiners around June 8, so the building you name in December is one you shouldn't sign for until summer. That same building is the longest item between you and revenue, because NVHA's onsite readiness review happens before CMS submission. Plan to do six months of site work in eight weeks while committing to as little as possible. Below: what the RFP requires of the building, where to look in each service area, how to hold a site through award, and what to finish before December 10.
What does the Nevada PACE RFP require of the center?
The real estate requirements are scattered across the RFP, the Scope of Work, Attachment A, the contract, and 42 CFR Part 460. Here they are in one place.
| Requirement | Source | What it means for the building |
|---|---|---|
| One center per service area | SOW | One building serves the whole ZIP set. No satellite plan unless NVHA allows alternative care settings (ask in Q&A). |
| 300 participant cap | SOW | Size for 300. Negotiate expansion rights in case NVHA raises the cap. |
| 60-minute travel time | SOW | Every participant in the service area within 60 minutes. Central site, arterial and freeway access. |
| Center ZIP, site rationale, facility readiness | Attachment A, Operational Plan | A named site or a tight shortlist at submission. |
| Start-up milestones for facility preparation | Attachment A, Operational Plan | A dated design, permit, and build schedule. |
| Funding for buildout, fleet, IT | Attachment A, Financial Capacity | A budget with a funding source behind it. |
| Facility for the Care of Adults During the Day license | SOW, NAC 449 | HCQC plan review before construction. License after completion and survey. |
| Life Safety Code and NFPA 99 | 42 CFR 460.72 | Designed in from the start. Verified at readiness. |
| No single points of failure | SOW, Business Continuity Agreement | Backup power, HVAC redundancy, an alternate site plan. |
| NVHA onsite readiness review | RFP | Building finished, furnished, and staffed before the review. |
| Real and personal property taxes | Contract, section 17 | Yours. Check possessory interest tax on tax-exempt or public property. |
The RFP does not require an executed lease at submission. It does score facility readiness. An evaluator comparing a named site with a signed LOI and a test fit against "we will identify a site after award" will score the first one higher, and you should plan your next eight weeks around that.
Where should the center go in each service area?
The State fixed the service areas by ZIP code, so you are searching for the one building that best serves a predefined territory. Start with where dual-eligible adults 55 and older live, then filter for drive time and building fit.
| Service area | Character | Where I would search |
|---|---|---|
| Clark SA1 (8 ZIPs) | Compact, dense, older housing stock, high Medicaid share in East Las Vegas | Central east valley near US-95 and I-515, along Charleston, Eastern, and Boulder Highway. Shortest drive times of the four. |
| Clark SA2 (10 ZIPs) | The Strip corridor plus west-side residential, including Spring Valley | West-central, near Spring Mountain, Desert Inn, Decatur, and Rainbow, with fast access to I-15 and the 215. |
| Clark SA3 (15 ZIPs) | North Las Vegas to Centennial Hills and north Summerlin, plus a required rural center | A central north-valley site near US-95, the northern 215, and Craig Road, so North Las Vegas and the northwest both fall inside 60 minutes. |
| Washoe SA1 (18 ZIPs) | Reno and Sparks core plus the north valleys, Spanish Springs, Verdi, and south Reno | Central Reno or west Sparks near the I-80 and I-580 interchange. Winter roads to the north valleys and Verdi set your travel-time risk. |
Henderson and the southwest valley sit outside every service area. A building there does not count, however close it looks on a map.
Run the 60-minute test at peak, from each candidate site to the farthest ZIP in the set, on a weekday morning when the vans will be running. In SA3 and Washoe, test the edge ZIPs first, because they are the ones that fail. Then look past the requirement. A 55-minute ride each way meets the contract and still produces a bad day for a frail participant, and attendance drops with it. In my PACE searches I have taken a worse building near the center of the population over a better one at the edge, because the van budget and the participant's day both pay for distance every day the center operates.
What about the rural center?
SA3 bidders also propose a rural center, and the rural bonus is worth 20 points with three letters of support from local hospitals, clinics, tribal entities, or senior organizations. Ask for those letters early. The same people know which buildings in town are empty.
For a Clark SA3 operator, Nye County (Pahrump, about 60 miles from Las Vegas) is the natural pairing because leadership, fleet maintenance, and specialists can be shared. Carson City is the strongest rural market by size and provider base and pairs with Washoe. Before you commit to any rural county, request a determination from DPBH on whether a certificate of need applies: Nevada's CON statute (NRS 439A.100) can reach health facility projects over $2 million in counties under 100,000 people, and nobody has yet confirmed whether a PACE center counts. Expect thin building stock, and keep a build-to-suit on a pad in the plan from day one.
How big a building does a 300-participant center need?
Plan on 15,000 to 20,000 gross square feet, single story. A 300-participant center puts about 80 participants in the building on a given day at most, and that daily number drives the size of the day rooms, dining, restrooms, and van loop. For comparison, I am building 600-participant centers at about 25,000 square feet. Square footage does not double with enrollment, because the kitchen, the clinic core, IDT space, and the transportation operation carry over between a 300 and a 600 census. I walk through how the participant day drives the room list in programming a PACE center from the care model out.
Here is how I would rough out the program before a test fit. These are my planning numbers, not RFP requirements.
| Space | Approx. SF | Notes |
|---|---|---|
| Day center activity rooms | 3,200 | About 40 SF per participant at an 80-person peak, divisible into cohorts |
| Dining | 1,200 | Flexes with the day center |
| Kitchen | 800 to 1,200 | Warming kitchen if meals are contracted; full commercial if you cook on site |
| Primary care clinic | 2,000 | About 6 exam rooms, nurse station, lab draw, medication room |
| PT/OT gym and ADL training | 1,400 | Includes ADL kitchen and bath |
| Bathing, showers, laundry | 600 | Core PACE service |
| Participant restrooms | 600 | Distributed near the day rooms |
| Quiet, dementia, behavioral health rooms | 400 | |
| Flex specialty (dental, podiatry, audiology, vision) | 300 | If delivered on site |
| IDT, admin, conference, staff support | 2,200 | Full IDT on site; staff count follows enrollment, not daily attendance |
| Transportation dispatch and drivers | 250 | Next to the drop-off |
| Storage, DME, IT, janitorial, MEP | 1,000 | |
| Gross, with ~15% circulation | ~16,300 | Net program ~14,200 |
That lands near the bottom of the range. Lean toward 20,000 if you want room for a cap increase without moving, and negotiate a right of first offer on adjacent space either way. Do not size for 600 on a 300 contract: you would carry the extra rent and buildout through the entire ramp with no capitation to cover it.
Four Nevada conditions change the design:
- Heat. Las Vegas summers run past 110°F. Shade the drop-off at minimum and enclose it if the site allows, design redundant HVAC, and write a cooling plan for outages. The Business Continuity Agreement treats a facility single point of failure as a compliance issue.
- Backup power. Cover medication refrigeration, life safety, and IT with a generator or a quick-connect so the center can stay open in an outage.
- Fleet. Plan 8 to 12 van stalls, a covered loading zone for two or three vans at once, and EV-ready conduit even if you start with gas vehicles. Ask NV Energy what service exists at the address before you ask the architect anything.
- Washoe winters. Put snow and ice removal for the drop-off and lot into the lease and the operating plan.
How do you hold a site you can't commit to until June 2027?
Proposals are due December 10. The State expects to issue a notice of intent around December 22, award around the end of April 2027, and take the contract to the Board of Examiners around June 8, 2027. Until the BOE approves, you do not have a contract to build a center for. Stage your commitment to the building on the same calendar.
| Stage | Timing | Instrument | What you commit |
|---|---|---|---|
| Site control for the proposal | Now to 12/10/2026 | Signed non-binding LOI or paid option | Test fit, LOI terms, a small option fee |
| Notice of intent | ~12/22/2026 | Negotiate the full lease, extend the option | Lease form agreed, unsigned or signed with an award contingency |
| Award and BOE approval | ~4/30 to 6/08/2027 | Lease effective on BOE approval | Design starts; no rent yet |
| Permits and buildout | Mid-2027 to 2028 | Rent abatement or reduced rent | Construction and HCQC licensing |
| CMS approval and service start | 2028 to early 2029 | Full rent starts | Capitation starts |
The State's contract gives the State several ways out. It can terminate on 30 days' notice for convenience or non-appropriation with no stranded-cost recovery, and the contract falls apart if CMS does not approve. Write the lease so you can leave at every point where the State or CMS can leave you, and agree the price of each exit with the landlord before you sign. A standard ten-year healthcare lease without those exits leaves the whole buildout on your balance sheet if the program ends.
A standard healthcare lease
- Signed when the site is chosen
- Rent starts on delivery or a fixed date
- Permit contingency at most
- No termination right tied to the State contract
- Assignment needs landlord consent
A lease matched to the Nevada contract
- LOI or option through award; lease effective on BOE approval
- Rent starts at the later of an outside date or CMS approval and service start
- Award, permit, HCQC licensing, and CMS contingencies with outside dates
- Termination right if the State terminates or does not renew, with a declining fee equal to unamortized landlord TI and leasing costs
- Assignment to a State-designated successor PACE operator without landlord consent beyond credit review
Landlords accept a State-termination right when the fee schedule is clear: they recover their unamortized TI and leasing costs, and the fee steps down as the term runs. Make the successor-assignment clause part of the same conversation. If the State requires you to hand the contract to another operator on wind-down, the building stays in service for participants and the landlord keeps a licensed tenant. That argument matters to an owner, and I made the broader version of it in why PACE tenants deliver the stability landlords want.
Then push the economics that protect your ramp:
- Term: about ten years from rent start, with two five-year options, so you are not committed far past the 2032 contract term and its extensions to 2036.
- Landlord work: roof, structure, base HVAC, electrical service, fire sprinkler, and the ADA path of travel delivered in good working order.
- Use clause: broad enough to cover the PACE center and the activities that come with running it (clinic, adult day, kitchen, pharmacy if you dispense, transportation).
- Guaranty: capped, burning off as enrollment hits targets.
- Expansion: a right of first offer on adjacent space in case NVHA lifts the 300 cap.
- Taxes: spell out who pays possessory interest tax if the property is tax-exempt or publicly owned, since the State contract makes property taxes yours.
Do the rent math before you trade anything for a lower face rate. At 17,500 square feet, every $5 per square foot of annual rent costs about $87,500 a year. Against Clark County Medicaid revenue of roughly $17.9 million at a full 300 census (before Medicare), occupancy is a manageable line once you reach census. The 12 to 24 months before census are where rent hurts, so negotiate abatement through buildout and licensing first and face rent second.
When does a Nevada PACE center open?
On a realistic path, first capitation lands around March 2029, roughly 21 months after a June 2027 contract start. That still falls inside the State's SFY 2028 to 2029 target. The sequence runs: BOE approval, design, HCQC plan review, building permit, construction, HCQC licensing survey, NVHA onsite readiness review, CMS review, service start. The center has to be built, licensed, furnished, and staffed before the CMS clock starts. Your performance security ($1.5 million) comes due around September 2027, well before any revenue.
Your general contractor's schedule covers one of the timelines that decide that date. NV Energy, HCQC, NVHA, and CMS each run their own calendar, and none of them reports to your GC. I wrote about reading a construction schedule against those outside calendars in the schedule says January 31; that is not your opening date. For Nevada, watch four places where the schedule slips:
- The lease waits on award. Use the months between the notice of intent and BOE approval to finish the lease and start design at your own risk, so you file for permits soon after the contract starts.
- Utility service. An NV Energy service upgrade can take longer than the construction itself. Check capacity in due diligence and order early.
- HCQC plan review. It happens before construction. Submit as soon as the design supports it.
- Readiness sequencing. Ask in Q&A whether CMS submission can run in parallel with the end of construction. If NVHA says yes, the path shortens by several months.
Second-generation space that needs a light renovation can cut construction to four or five months and pull service start into late 2028. Weigh that against location: a faster building in the wrong part of the service area costs you in van miles for the life of the contract.
What should the start-up capital line show?
Attachment A asks you to show how you will fund the buildout, fleet, and IT. For one urban center of about 17,500 square feet, I would put these planning ranges in front of a bidder's finance team, net of whatever TI allowance you negotiate. Confirm them with local GC pricing on a test fit before they go in the proposal.
| Item | Basis | Range |
|---|---|---|
| Construction (tenant improvement) | 17,500 SF at $175 to $275/SF | $3.1M to $4.8M |
| Design, engineering, permits, HCQC review | ~8 to 10% of construction | $0.25M to $0.5M |
| FF&E, medical equipment, IT, low voltage | $25 to $40/SF | $0.45M to $0.7M |
| Transportation fleet | 6 to 10 accessible vans | $0.55M to $1.3M |
| Contingency | 10 to 15% of construction | $0.3M to $0.7M |
| Pre-opening rent and carry | Depends on abatement | $0 to $0.4M |
| Subtotal | ~$4.6M to $8.4M | |
| Performance security (separate) | Bond or approved security | $1.5M |
Operating losses to break-even come on top of that, and they belong in the same financial capacity answer. You will hire staff ahead of census, and the State is running a cold start with no pre-approval marketing.
Carry more contingency than feels comfortable. On one PACE center I worked on, the 12 percent contingency was gone after the first change order, and the project finished 18 percent over contract. Inspector and fire marshal items added about 5 percent on their own, most of them late in the job. Nevada pricing and permitting may be easier than California's, and I would still do the same things there: price on complete documents rather than locking a GMP on preliminary design, keep the roof and base-building systems on the landlord in the lease, check structural capacity before any rooftop or vertical work, carry 10 to 15 percent contingency, and hold about 5 percent for inspector and fire marshal items on a healthcare occupancy.
What should you do before December 10?
- Before Q&A closes on October 22. Choose your target service areas and, for SA3, the rural county. Submit the real estate questions: whether the center must sit inside the ZIP list or may be contiguous to it, whether NVHA allows alternative care settings, what counts as facility readiness, the licensing and readiness sequence, and how the rural center is awarded. Pull Medicaid caseload data and map demand by ZIP.
- By mid-November. Run peak drive-time analysis from candidate locations. Tour and shortlist two or three sites per service area. Check zoning (adult day care or medical use by right, not by use permit) and electrical capacity on the shortlist. Get an architect's test fit on the lead site. For the rural center, start the letter-of-support conversations and request a CON determination from DPBH.
- Before submission on December 10. Sign an LOI or option on at least one site per service area, with award, permit, licensing, and State-termination contingencies written in. Build the dated design, permit, and construction schedule for the operational plan, the start-up capital budget for the financial capacity answer, and the facility sections of your business continuity and disaster recovery plans (backup power, alternate site, HVAC redundancy).
The LOI is where the contingencies first get agreed, so draft it with the lease you will need in 2027 in mind. The clause-by-clause version of that is in the founder's guide to the LOI.
Use the eight weeks to put the State's own risks into your site work. Find a building you can name in December, hold it with a document you can walk away from if the award goes to someone else, and price every exit before the landlord knows how badly you need the site. The bidders who do that submit a stronger facility answer and start design the week the BOE votes. The ones who wait for award start the site search in June 2027 and open in 2029 at the earliest.
Prepared from the RFP 41NHA-S4038 package released October 8, 2026, and my PACE project experience. Planning guidance, not legal or financial advice. Confirm cost ranges with local pricing.
Key takeaways
- Nevada's PACE RFP scores the proposed center's ZIP code, site rationale, and facility readiness in the operational plan due December 10, 2026. Name a site and hold it under a signed LOI or paid option before you submit.
- Each service area gets one center with a 300-participant cap, and every participant must be within 60 minutes. Run drive times at peak to the farthest ZIP, especially in Clark SA3 and Washoe.
- Size a 300-participant center at 15,000 to 20,000 gross square feet, single story, for no more than about 80 participants a day, with a shaded or enclosed van drop-off, backup power, and redundant HVAC.
- Match the lease to the State contract: award, permit, HCQC licensing, and CMS contingencies, a State-termination right with a declining unamortized-TI fee, successor assignment, and rent that starts at CMS approval and service start.
- Expect first capitation around March 2029 and $4.6M to $8.4M of real estate and fleet capital per urban center, plus $1.5M of performance security and operating losses to break-even.
Frequently asked questions
Do I need a signed lease to submit a proposal for the Nevada PACE RFP?
No. RFP 41NHA-S4038 does not require an executed lease at submission. It does ask for the proposed center ZIP code, the rationale for the site, and facility readiness in the operational plan, and those are scored. Retained CRE's recommendation is a signed non-binding LOI or a paid option on a named site, with award, permit, licensing, and State-termination contingencies, plus a test fit and a dated build schedule.
How large should a PACE center for 300 participants be?
Plan on roughly 15,000 to 20,000 gross square feet on a single floor. A 300-participant PACE center has about 80 participants in the building on a given day at most, and that daily number sizes the day rooms, dining, restrooms, and van loop. Retained CRE builds 600-participant centers at about 25,000 square feet, because the kitchen, clinic, IDT space, and transportation operation do not double with enrollment. Refine the number with a test fit on the actual building.
When will a Nevada PACE center be able to open under this RFP?
On a realistic path, first capitation arrives around March 2029. Award is expected around April 2027 and Board of Examiners approval around June 2027. Design, HCQC plan review, permitting, construction, HCQC licensing, the NVHA onsite readiness review, and CMS review stack up to roughly 18 to 24 months after that. Second-generation space needing a light renovation could move service start into late 2028.
What lease terms should a PACE operator bidding in Nevada negotiate?
Match the lease to the State contract. Include contingencies for award, permits, HCQC licensing, and CMS approval with outside dates; a termination right if the State terminates or does not renew, with a fee equal to the landlord's unamortized TI and leasing costs that declines over time; assignment to a State-designated successor PACE operator; and rent that starts at the later of an outside date or CMS approval and service start. Retained CRE also pushes for landlord delivery of roof, structure, base HVAC, and electrical service.
Bidding on the Nevada PACE RFP?
I run PACE site searches, test fits, and lease negotiations from the first zoning screen through opening. If you need a named site and a contingent LOI by December 10, let's talk this month.
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