Frequently asked questions
How is PACE financed?
PACE organizations receive fixed monthly payments from Medicare, Medicaid and private payers (for program participants who are not dually-eligible). These funds are pooled, and care is provided following a comprehensive assessment of a participant’s needs. This bundled payment provides a strong incentive to avoid duplicative or unnecessary services and encourages the use of appropriate community-based alternatives to hospital and nursing home care.
Who sponsors PACE organizations?
PACE organizations often are part of larger health care systems or organizations, including hospital systems, medical groups, federally qualified health centers, area agencies on aging, hospice organizations, and collaborations among several different entities. Some PACE programs operate as stand-alone entities.
Are people who do not qualify for Medicaid eligible for PACE enrollment?
If a person meets the income and assets limits to qualify for Medicaid, the program pays for a portion of the monthly PACE premium. Medicare pays for the rest. If a person does not qualify for Medicaid, he or she is responsible for the portion of the monthly premium Medicaid would pay. PACE staff can help determine a person's Medicaid eligibility.
What is PACE?
The Program of All-Inclusive Care for the Elderly (PACE®) is a comprehensive, fully integrated, provider based health plan for the frailest and costliest members of our society – those who require a nursing home level of care. The PACE philosophy is centered on the belief that it is better for frail individuals and their families to be served in the community whenever possible. Although all PACE participants are eligible for nursing home care, 95 percent continue to live at home.
Who does PACE serve?
According to the National PACE Association, PACE serves approximately 49,000 participants in 31 states. PACE serves individuals who are age 55 or over and certified by their state as needing a nursing home level of care. The average participant is 76 years old and has multiple, complex medical conditions, cognitive and/or functional impairments, and significant health and long term care needs. Approximately 90 percent are dually eligible for Medicare and Medicaid. PACE participants must live in a PACE service area and be able to live safely in the community with PACE services at the time of enrollment.
What benefits does PACE offer?
PACE organizations provide the entire continuum of medical care and long-term services and supports required by frail older adults. These include primary and specialty medical care; in-home services; prescription drugs; specialty care such as audiology, dentistry, optometry, podiatry and speech therapy; respite care; transportation; adult day services, including nursing, meals, nutritional counseling, social work, personal care, and physical, occupational and recreational therapies;and hospital and nursing home care, when necessary.In short, PACE covers all Medicare Parts A, B and D benefits, all Medicaid-covered benefits, and any other services or supports that are medically necessary to maintain or improve the health status of PACE program participants.
How do people get to the Day Health Center?
Transportation is a key part of the PACE benefit and is provided between the home and the Day Health Center. In some circumstances, transportation can also be arranged to medical appointments outside the PACE Center.
Do PACE participants attend the Day Center every day?
Day Center attendance is based on individual needs and can range from once a week, or every month, to several days a week, as needed.
What are Activities of Daily Living?
Activities of Daily Living (ADLs) are those skills required to manage one’s basic physical needs including personal hygiene or grooming, dressing, toileting, transferring or ambulating, and eating.
How do people qualify for PACE?
Average PACE Participant
What is the average age of a PACE participant?
According to the National PACE Association, the average age of PACE participants is 76 years old. Seventy-five percent of participants are female.
What are the top diagnoses of PACE participants?
A recent study by the National PACE Association found that the top diagnoses among PACE participants are vascular disease, diabetes with chronic complications, congestive heart failure, and chronic obstructive pulmonary disease, and major depressive, bipolar and paranoid disorders. Nearly 47% of PACE enrollees have dementia.
Are prescription drugs covered?
All prescription and non-prescription drugs deemed necessary by the PACE interdisciplinary care team are paid for by the PACE program.
Can I keep my own doctor?
What happens if a PACE participant needs nursing home care?
The goal of PACE is to keep participants out of a nursing home as long as possible. If at some point it is in the best interest of the participant to receive care in a nursing home, PACE will pay for the care, and medical oversight by the interdisciplinary team will continue.
If I belong to a Medicare HMO, can I also enroll in PACE? for long-term care services?
You can only enroll in one Medicare health plan. PACE health plans are both Medicare providers and long-term care providers. By enrolling in a PACE health plan you will be automatically disenrolled from your current Medicare/HMO.
Can I just use a specific service such as home care, meals, transportation or the Day Health Center?
Focusing on a single aspect of care does not provide the participant with the best chance of remaining independent in the community. Upon enrolling in PACE, the Interdisciplinary Team develops an individualized plan of care to provide the participant with a comprehensive health and wellness plan, integrating a variety of services.
If I want to join PACE, what do I do next?
What happens if a person wants to leave PACE?
A PACE participant is free to disenroll from PACE and resume their benefits in the traditional Medicare and Medicaid programs at any time.
i National PACE Association. (2018). PACE Reduces Burden of Family Caregivers, Aug. 30.
ii All data from the National PACE Association March 2019
iii Division of Health Care Finance and Policy, Executive Office of Elder Affairs. (2005). PACE Evaluation Summary. Accessed on line on May 25, 2011.
iv Kane, R.L., Homyak, P., Bershadsky, B., et al. (2006). Variations on a theme called PACE.Journal of Gerontology Series A, 61 (7): 689-93.
v Leavitt, M., U.S. Department of Health and Human Services, Interim Report on lhe Quality and Cost of the Program of All-inclusive Care for the Elderly, 2009, Mathematica Policy
Research evaluation prepared for The Secretary of Health and Human Services for submission to Congress.
Page Edits Made: 03/05/2021