Programs of All-Inclusive Care for the Elderly Benefits
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
- Emergency services
- Home care
- Hospital care
- Laboratory/x-ray services
- 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
PACE also includes all other services determined necessary by the health professionals team 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:
- Home care liaison
- Occupational therapist
- PACE center supervisor
- Personal care attendants
- Physical therapist
- Primary care physician
- Recreational therapist or activity coordinator
- Social worker
The interdisciplinary team meets to ensure that the comprehensive medical and social needs of each participant are met. Teams typically meet daily to discuss the status of participants.
A PACE organization is a non-profit private or public entity that is primarily engaged in providing PACE health care services. To qualify for PACE, 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
- 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.
PACE providers receive monthly Medicare and Medicaid capitation payments for each enrollee. Medicare enrollees who are not eligible for Medicaid pay monthly premiums equal to the Medicaid capitation amount, but no deductibles, coinsurance, or any other type of Medicare or Medicaid cost-sharing.