Overview and Eligibility

Programs of All-Inclusive Care for the Elderly (PACE) is a Medicare program that works to provide elder care services while allowing patients to stay in their community instead of transitioning to a nursing home or hospice care center. PACE’s elder care solutions provide participants with social services and comprehensive medical care. Individuals are eligible for PACE if they fit the following criteria:

  • Age 55 or older
  • Eligible for nursing home care
  • Able to live safely in their community
  • Live within a PACE organization’s service area

Payment

Programs of All-Inclusive Care for the Elderly is a joint Medicare/Medicaid program that also offers Medicare Part D prescription drug coverage. Medicare eligible participants pay the Medicaid capitation amount and Medicare Part D premium. No additional copayments or deductibles are required. Medicaid eligible participants pay nothing; the state pays the full amount for the participant to enroll in the PACE organization. Since the program’s financing is capped, the services provided are not restricted to those reimbursed under Medicare and Medicaid fee-for-service plans.

Services

Individuals who are enrolled in Programs of All-Inclusive Care for the Elderly receive all of their care through the organization unless the local PACE contracts with another provider for specialty medical services to meet the participants’ needs. The services provided through the PACE organization are determined by an interdisciplinary team that develops a comprehensive care plan for each participant based on their individual needs. The benefits package available for all PACE participants includes the following:

  • Primary Care*
  • Hospital Care
  • Medical Specialty Services
  • Prescription Drugs
  • Nursing Home Services
  • Nursing Services
  • Personal Care Services
  • Emergency Services
  • Home Care
  • Physical Therapy
  • Occupational Therapy
  • Adult Day Health Care
  • Recreational Therapy
  • Meals*
  • Dental Care
  • Nutritional Counseling
  • Social Services
  • Laboratory/X-Ray Services
  • Social Work Counseling
  • End of Life Care/Hospice and Palliative Care
  • Transportation*

*required at all PACE centers

PACE Care in Emergency and Urgent Situations

Emergency situations are when medical services are required immediately to prevent permanent damage to the patient. Treatment for these situations does not need to occur within a PACE service area and the PACE organization does not need to approve of the services prior to treatment.

In urgent situations treatment cannot be postponed until the patient is within the PACE service area, however the patient’s life is not in immediate jeopardy. Post-stabilization care is urgent care required after an emergency situation after the patient has been stabilized. The PACE organization must preapprove the services provided for urgent situations or post-stabilization care.

Summary

Overall, Programs of All-Inclusive Care for the Elderly aim to enhance the quality of life for the elderly and provide them with the dignity and comfort of remaining in their community while still receiving the medical and social care they require. To find a PACE organization near you, visit the National PACE Association website.