Nevada PACE RFP: from proposal to an open center
Nevada is launching PACE from a standing start. One operator and one center per service area, a 300-participant cap, fixed rates, and a proposal scored entirely on the technical narrative, including your center's ZIP code and how ready the facility is. This brief walks through the parts that decide a bid: the calendar, the territory, the economics, the scoring, the building, and the risks.
60 days to name a site you can't sign until mid-2027
The procurement runs on the State's calendar. The building runs on four others: HCQC, the local building department, NVHA readiness and CMS. NVHA's onsite readiness review comes before CMS submission, so the center has to be built, licensed and staffed before the federal clock starts. Toggle the scenario to see how the building type moves first revenue.
Four fixed urban areas, one building each
The State drew the urban service areas by ZIP code and won't take alternatives. You are searching for the one building that best serves a predefined territory, with every participant inside 60 minutes. Henderson and the southwest valley sit outside every area. Pick an area, or check a ZIP.
The service areas on a map
Fixed rates, a hard cap, and a long runway before the first check
There is no price competition. NVHA's actuary set CY2028 Medicaid rates at 94% of the amount Medicaid would otherwise pay, and by submitting you accept them before the final methodology is published. Medicare Parts A, B and D for dual eligibles come separately from CMS and are not modeled here. The calculator below sets current Las Vegas, Reno and rural rents against that revenue.
| Region | Full dual PMPM | Non-dual PMPM | Medicaid at 300, all full dual | Note |
|---|---|---|---|---|
| Clark County (SA1 to SA3) | $4,978.04 | $8,385.06 | ~$17.9M / yr | |
| Washoe County | $4,532.24* | $7,642.05* | ~$16.3M / yr | *Printed as "$4,5324.24" and "$7,642,05." Confirm in Q&A. |
| All rural counties | $5,226.94 | $8,804.32 | ~$18.8M / yr |
Rent and occupancy calculator
How the rent numbers work, and where they come from
Office rates are full service gross: the landlord pays operating expenses, taxes and insurance. Retail rates are triple net, so the calculator adds an estimated NNN charge ($0.35 to $0.50 per SF per month in Las Vegas and Reno, $0.25 to $0.40 rural) to make the two comparable. Published retail averages are small-shop numbers; a PACE-sized junior anchor or big box usually leases below them, which is why large-format is shown separately. Las Vegas retail sources disagree ($1.90 vs. $2.97 NNN) because one includes the resort corridor; we use the lower, non-Strip basis.
Not included: tenant improvement cost, which runs well above typical office or retail TI for a healthcare buildout, and Medicare revenue for dual eligibles, so occupancy's true share of total revenue is lower than shown.
Office vacancy in parts of the Las Vegas valley is near 30%, while retail vacancy sits around 4%. That gap tells you where to negotiate hard on rent, TI and free rent, and where a good box in the right ZIP will go to someone else if you wait. Then slide census down to 50: occupancy is a manageable line at 300, and the 12 to 24 months before you get there are where it hurts. Negotiate free rent through buildout and licensing first and face rent second.
Want these numbers run on a real building in your service area?
Schedule a callThe narrative is the whole game
Attachment A is 100% of the score: five questions at 20 points each, plus a 20-point rural bonus. Financial stability is pass or fail. The State can limit presentations to bidders above a natural break in scores, so mid-pack can end a bid. Select a question.
No cross-referencing
Each answer must stand alone. Repeat leadership, site and network facts in every question that needs them.
Every number needs a method
Definition, why it matters, methodology and sample size. Outcome claims without them read as marketing.
Answer per service area
Bidding two areas means two center ZIPs, two staffing plans, two transport models. Name subcontractors to match Attachment B.
Size the building for the busiest day
The 300 cap is enrolled participants. Peak daily attendance drives the day rooms, dining, restrooms and the van loop. The kitchen, clinic core, IDT space and transportation operation carry over, which is why square footage doesn't double with enrollment. This planner uses our program model; refine it with a test fit on the actual building.
Center and capital planner
| Start-up capital | Low | High |
|---|
Four Nevada conditions that change the design
- Heat. Las Vegas runs past 110°F. Shade the drop-off at minimum, enclose it if the site allows, and design redundant HVAC. The Business Continuity Agreement treats a facility single point of failure as a compliance issue.
- Backup power. Medication refrigeration, life safety and IT on a generator or quick-connect.
- Fleet. 8 to 12 van stalls, covered loading for two or three vans at once, EV-ready conduit. Ask NV Energy what service exists before you ask the architect anything.
- Washoe winters. Snow and ice removal for the drop-off and lot, written into the lease and the operating plan.
Approvals the building has to clear
- Zoning: adult day care or medical use by right, confirmed before the LOI.
- HCQC plan review before construction; Facility for the Care of Adults During the Day license after completion and survey.
- Life Safety Code and NFPA 99 under 42 CFR 460.72, plus the local fire marshal.
- Food permit from Southern Nevada Health District or Northern Nevada Public Health if you cook or plate on site.
- Certificate of need may reach rural projects over $2M in counties under 100,000 people (NRS 439A.100). Get a DPBH determination first.
Carry more contingency than feels comfortable. On one PACE center I worked on, the 10% contingency was gone after the first change order, and the project finished 15% over contract. Inspector and fire marshal items added 7% of direct cost on their own, most of them late in the job. Price on complete documents, keep roof and base-building systems on the landlord, and hold about 5% for inspector and fire marshal items.
Have a candidate building? I'll run the test fit and the capital budget on it.
Schedule a callControl without commitment
The RFP doesn't require an executed lease. It does score facility readiness, and an evaluator comparing a named site under signed LOI with a test fit against "we will identify a site after award" will score the first one higher. Stage the commitment on the State's calendar, and write the lease so you can leave at every point where the State or CMS can leave you.
Site control for the proposal
Signed non-binding LOI or paid option. Test fit and a small option fee. Enough to name the ZIP and show readiness.
Notice of intent
Negotiate the full lease and extend the option. Lease form agreed, unsigned or signed with an award contingency.
Award and BOE approval
Lease effective on BOE approval. Design starts. No rent yet.
Permits and buildout
Rent abatement or reduced rent through construction and HCQC licensing.
CMS approval and service start
Full rent starts when capitation starts.
- 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
- 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 doesn't 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 unamortized TI and leasing costs, and the fee steps down as the term runs. The successor-assignment clause belongs in the same conversation. If the State hands your contract to another operator, the building stays in service and the landlord keeps a licensed tenant.
Eight issues that should shape the bid decision
The economics are attractive and the risk allocation is lopsided. You fund the center, fleet, IT, bond and losses up front. The State keeps a 30-day walk-away right and can cancel the award if CMS doesn't approve.
Questions worth submitting
Q&A runs through the nevadaepro bid Q&A only, and answers post to every bidder. Write them neutrally. Contact with anyone at the State other than the procurement officer before award can disqualify you (NAC 333.155), and that includes your broker and architect.
What to finish, and by when
The real estate path to a credible facility answer on December 10. Check items off as you go; your progress stays in this browser.
A named site and a contingent LOI by December 10
I run PACE site searches, test fits and lease negotiations from the first zoning screen through opening, as your fractional VP of real estate. If you need a site you can name in the operational plan, start this month.
Have an LOI on a Nevada site in front of you? LOI Review covers rent commencement, contingencies and termination rights on your deal.