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You are here: Home / For Tribal Leaders / Program of All-Inclusive Care for the Elderly (PACE)

Program of All-Inclusive Care for the Elderly (PACE)

DISCLAIMER: CoC (Continuum of Care) is an alternative term for LTSS (Long Term Services and Support). Please note that not all instances of LTSS have been transitioned to the new designation.

Program of All-Inclusive Care for the Elderly (PACE) is a type of HCBS that provides medical services and supports everyday living needs for certain elderly individuals, most of whom are eligible for benefits under both Medicare and Medicaid. These services are provided by an interdisciplinary team of professionals. For example, a primary care physician, nurse, social worker, physical therapist, and dietitian are a few of the necessary members.

PACE is:

  • Permanently available to beneficiaries under Medicare
  • Provided to Medicaid beneficiaries if the state chooses to provide PACE as a Medicaid benefit

Eligibility

Recipients must be age 55 or older, live in an area served by a PACE program, and be certified as eligible for a nursing home level of care by a state Medicaid agency or other contracted agency.

Financing

Medicare and Medicaid reimburse PACE programs for services provided to elders who are eligible for both benefits. This national model of care is permanently available through Medicare. People who are eligible for Medicare but not Medicaid make monthly payments.

The program receives capitated reimbursements (meaning the reimbursement rate is based on the number of eligible people in the service area) each month from Medicare and Medicaid for each patient the program serves. There are several things to consider about capitated rates:

  • Capitated rates can benefit a program with a larger client base because unused funds can be kept for future use.
  • A challenge of capitated rates is that serving high-expense or catastrophic cases may mean that all of the funding gets used much earlier than intended.

Benefits and Challenges of the PACE Model

Benefits

  • Varied team of healthcare providers and trained assistants with different specialties
  • Multiple services available, such as:
    • Primary care, rehabilitation, adult daycare, home health, respite services, caregiver training, transportation, etc.

Challenges

  • Need to hire team members with a wide variety of skills and qualifications
  • Need a steady workforce
  • Need a large enough patient population to be financially possible
  • Must serve all beneficiaries in the service area who choose to enroll (including non-tribal members)

Resources

Available resources include information on locating a PACE program, learning more about PACE, finding out about getting medical transportation, and support for family caregivers.

Find out if your state has any PACE programs.

Physical Address:
8500 Menaul Blvd. NE, Suite B-470
Albuquerque, NM 87112


Phone:
505-292-2001

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NICOA acknowledges that many sources of information from federal government websites, states, tribes, non-governmental organizations, and private entities were gathered to create this website. Those sources were used as templates on which we based the design and knowledge that is shared here. We appreciate the efforts of all to provide sound educational guidance on long term services and supports. The resources we find will continue to grow and change as we refine the website. See current list of website sources here.

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