The Program of All-Inclusive Care for the Elderly (PACE) connects seniors with the resources they need to remain in their homes. Participants work with their own teams of health professionals to access comprehensive services to meet their needs.
This customized assistance enables seniors to reap the numerous benefits of staying active in their communities and helps them avoid the costs of expensive and isolating long-term nursing facilities.
PACE healthcare services are delivered in participants’ homes, at facilities in their communities or at their local PACE centers. Participants can receive fully integrated general and specialist care from networks of PACE providers. PACE’s extensive networks also include social work, counseling, caregiver education and other non-medical supports. Enrollment in the PACE program for elderly Medicaid or Medicare recipients is entirely voluntary, and participants can apply for or exit the program at any time.
PACE elder care programs assign an interdisciplinary team of professionals to work with each enrollee. These teams coordinate participant care to maximize the efficiency and effectiveness of patient care. PACE healthcare teams must include at least one of each of the following:
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PACE programs may mandate that participants select an in-program primary physician to coordinate with their assigned care teams.
The PACE program for seniors is delivered at the local level by non-profit organizations or public agencies. All program providers must meet a series of federally-established guidelines for appropriate governance, fiscal responsibility and client treatment. All PACE services providers are required to offer, at minimum:
PACE elder care programs cover both home and hospital care, as well as emergency services including laboratory work and x-rays. Prescription drugs are also covered. PACE programs may choose to include additional products and services, such over-the-counter medications, that medical teams deem necessary for participant health, at their discretion.
By law, PACE programs must provide hospice care for participants, when appropriate. Participants who prefer to receive hospice care services from non-PACE providers are required to un-enroll from the program to receive Medicaid or Medicare assistance for that care.
Like most Medicaid-related programs, PACE programs are intentionally structured to coordinate and integrate participant needs so that all necessary services can be covered. In most cases, this allows participants and programs more flexibility and access than they would receive under standard Medicare reimbursement plans or Medicaid fee-for-service options.
PACE eligibility is based primarily on age, location and health. Prospective participants must be 55 years of age or older and live in a PACE program service area. Generally, applicants must also be enrolled in Medicaid, Medicare or both. However, in some cases participants may be able to pay the costs of PACE elder care enrollment independently and be accepted into a program without joining Medicaid or Medicare.
Eligibility for PACE is also influenced by applicants’ health. Seniors must meet state certification requirements deeming them in need of nursing-home level care but also be capable of remaining safely in their communities with appropriate assistance.
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PACE healthcare programs are federally-regulated. As a result, they are prohibited from discriminating against any applicants on the grounds of race, color, national origin, religion, gender identity, or any other federally-protected characteristics.
Seniors seeking assistance can find out if there are Programs of All-inclusive Care for the Elderly serving their communities by contacting their local Medicaid or Medicare offices. Actual enrollment processes will vary from provider to provider, as PACE provider organizations are authorized to tailor their intake processes to their unique communities and administrative structures.
Generally, however, PACE programs for seniors accept initial inquiries in person, by phone or online. Organization representatives then arrange to meet with applicants in person. These meetings may occur at the PACE facility or in applicants’ homes, depending on their health and transportation needs. Prospective applicants can expect to receive a full introduction to program offerings and should be prepared to provide information about themselves and their needs at this time.
Applicants who wish to continue pursuing enrollment after their initial meeting can schedule PACE elder care assessments with program staff. During these assessments, Nurses or other trained practitioners will evaluate applicants’ health and support needs against state and federal criteria to verify that they are eligible to receive services.
Applicants found to be eligible for PACE services will be invited to sign an enrollment agreement. Typically, enrollees’ membership in PACE goes into effect the first day of the month following the one in which the agreement is signed. For example, an applicant who signs their agreement in February will begin services on the first of March. PACE providers may offer services immediately, at this discretion.
PACE program for the elderly providers have the right to disenroll participants who experience a serious health event between the date they sign their agreement and the date services are scheduled to begin if the event results in the participant no longer being able to safely live in the community, even with program support.
Program of All-inclusive Care for the Elderly enrollment replaces participants’ existing Medicaid coverage. As a result, Medicaid patients who enroll in PACE programs for seniors:
PACE program for seniors enrollees who are not eligible for Medicaid but receive Medicare:
Seniors who do not qualify for Medicaid or Medicare may be permitted to enroll in Programs of All-inclusive Care for the Elderly. Eligibility and enrollment in these cases is handled on an individual basis between providers and enrollees. Participants will be required to pay monthly premiums for care. Actual costs and the details of enrollment agreements will vary from provider to provider based on enrollee needs, state laws and individual providers’ policies.
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