The Program of All-Inclusive Care for the Elderly (PACE) benefits include, but are not limited to, all Medicaid and Medicare covered services:
- Adult day care
- Dentistry
- Emergency services
- Home care
- Hospital care
- Laboratory/x-ray services
- Meals
- Medical specialty services
- Nursing home care
- Nutritional counseling
- Occupational therapy
- Physical therapy
- Prescription drugs
- Primary care (including doctor & nursing services)
- Recreational therapy
- Social services
- Social work counseling
- Transportation
PACE also includes all other services determined necessary by the interdisciplinary team of health professionals to improve and maintain an individual’s health. PACE programs provide services primarily in an adult day health center and are supplemented by in-home and referral services in accordance with the enrollee’s needs.
Since comprehensive care is provided to PACE participants, individuals who need end-of-life care will receive the appropriate medical, pharmaceutical, and psychosocial services. If the individual wants to elect the hospice benefit, they must voluntarily disenroll from the PACE program.
Interdisciplinary Provider Team
An interdisciplinary team, consisting of professional and paraprofessional staff, assesses an enrollee’s needs, develops care plans, and delivers all services (including acute care services and when necessary, nursing facility services).
Minimally, the team is composed of a:
- Primary care provider
- Registered nurse
- Master's-level social worker
- Physical therapist
- Occupational therapist
- Recreational therapist or activity coordinator
- Dietitian
- PACE center manager
- Home care coordinator
- Personal care attendant or his or her representative
- Driver or his or her representative
The interdisciplinary team meets to ensure that the comprehensive medical, physical, emotional, and social needs of each participant are met. Teams typically meet daily to discuss the status of participants.
Program Administration
A PACE organization is an entity that is primarily engaged in providing PACE health care services. A state must agree to an entity applying to become a PACE provider. To qualify as a PACE program, organizations must have:
- A governing board that includes community representation
- A physical site to provide adult day services
- A defined service area
- The ability to provide the complete service package regardless of frequency or duration of services
- Safeguards against conflict of interest
- Acceptable past performance
- Demonstrated fiscal soundness
Individual Application and Enrollment Process
Enrollment in the PACE program is voluntary. If an individual meets the eligibility requirements and elects PACE, then an enrollment agreement is signed. Enrollment continues as long as desired by the individual, regardless of change in health status, until voluntary or involuntary disenrollment.
Financing
PACE providers receive monthly Medicare and Medicaid capitation payments for each enrollee, according to their eligibility. Medicare enrollees who are not eligible for Medicaid pay monthly premiums equal to the Medicaid capitation amount, and an amount for Part D prescription coverage. Individuals who do not have Medicare or Medicaid can opt to enroll and pay privately. PACE participants pay no deductibles, coinsurance, or any other type of Medicare or Medicaid cost-sharing.