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LTSS Roadmap - PACE programs

Guidance for the LTSS Roadmap planning model, which can guide communities through the planning process if they need to establish long-term services and supports or improve its current program. This module provides information on PACE programs.

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: August 03, 2016

Program of All-Inclusive Care for the Elderly (PACE) uses an interdisciplinary team of professional health providers to provide an array of health and human services that address the medical and everyday living needs of elders in need of LTSS.

Purpose

To provide timely health care needs through a comprehensive health care service delivery system designed to keep elders at home and in the community and out of nursing home facilities. The PACE program is:

Permanently available to beneficiaries under Medicare program
Provided to Medicaid beneficiaries as a state option

Eligibility

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

Financing

Medicare and Medicaid reimbursement
Reimbursement rate: Capitated (contracted rate for each patient assigned) all-inclusive rate.
- Capitated rate can be advantageous for providers with a large population served.
- Captitated rate can be a challenge when serving high-needs populations or catastrophic cases.
- More about capitated rates and comparing reimbursement rates.

Benefits and Challenges of the PACE Model

Benefits

Interdisciplinary team of health professionals and paraprofessionals
Multiple services (e.g., primary care, rehabilitation services, adult day services, home health, respite services, caregiver training, and transportation)

Challenges

Need access to diverse professional and paraprofessional providers
Need a stable workforce
Need large patient population to be financially viable
Must serve all beneficiaries (including nontribal members) in service area who choose to enroll

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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.