The program is modeled on On Lok Senior Health Services in San Francisco, Calif. The model allows providers to deliver all the care and supportive services participants need rather than be limited to those reimbursable under Medicare and Medicaid. PACE is as a permanent provider type within the Medicare program and a state option under Medicaid. Each PACE program requires a three-way agreement between the State, CMS and the provider in order for PACE to operate. Not all states offer PACE programs.

Understanding PACE – It Provides a Full Continuum of Care

The ability to coordinate the care of each participant enrolled in PACE is key to the model. PACE programs coordinate and provide all needed preventive, primary, acute and long-term care services so that its participants can continue living in the community. Care plans could include any or all of the following services/providers, in addition to other services and interventions that the PACE team decide is needed.

Pace Center Services

  • Physician/Nurse Practitioner
  • Nursing
  • Social Work
  • Physical Therapy
  • Occupational Therapy
  • Speech Therapy
  • Recreation Therapy
  • Nutrition Counseling
  • Personal Care
  • Chore Services
  • Transportation
  • Meals
  • Escort Services

In-Home Services

  • Home Health Care Personal Care
  • Homemaker/Chore Services
  • Meals

Specialist Services

  • Medical Specialists
  • Audiology
  • Dentistry
  • Optometry
  • Podiatry

Other Medical Services

  • Prescriptions
  • Lab Tests/Procedures
  • Radiology Services/ Procedures
  • Durable Medical Equipment
  • Outpatient Surgery
  • Emergency Room Care
  • Medical Transportation

Inpatient Services

  • Hospital
  • Nursing Home
  • Inpatient Specialists

The Center for Medicare Education gives this succinct example. A Medicare beneficiary shows up at the emergency room every month to be treated for skin infections caused by flea bites. The traditional, care delivery system would have trouble addressing the root cause of her condition and might just keep admitting the patient and treating her. For a PACE enrollee, the team, with input from social workers, home health aides and drivers who have been in her home, may decide to fumigate her home and provide a flea dip for her pet. This flexibility can produce more cost-effective solutions and a higher quality of life than prescribing costly medications or continually hospitalizing an individual.

Who is Eligible for Services
Participants must be at least 55 years old, live in the PACE service area, and be certified as eligible for nursing home care by the appropriate State agency. The PACE program becomes the source of services for Medicare and Medicaid eligible enrollees.

An interdisciplinary team assesses participants’ needs, develops care plans, and delivers all services for a seamless provision of total care. The PACE service package must include all Medicare and Medicaid covered services, and other services determined necessary by the interdisciplinary team for the care of the PACE participant. Providers receive monthly Medicare and Medicaid capitation payments for each eligible enrollee.

Becoming a PACE Provider

Organizations that develop PACE programs must consider the following.

  • Look at market size and particularly the age, frailty and income status of the area they will serve. Is it large enough to sustain a program?
  • Are there related programs available to serve the same market? There may be community-based providers and nursing facilities that provide service options for their market. Consider how you will position yourself.
  • What members of the PACE team are already part of the organization? How will the other team members be recruited?
  • Reviewing the list of services above, what services are already offered? What services should be developed in-house? And what services should be contracted for?
  • Does the organizations have community support and partners for this project?
  • Is the organization positioned to market the program and gain referrals?
  • Is the PACE model integrated into the organization’s long- and short-term goals?

Resources are available to help. Start with the CMS PACE Site and also check the resources at The National Pace Association. Considering where healthcare is moving the PACE model is one to check out.