{"id":355778,"date":"2022-10-11T13:27:45","date_gmt":"2022-10-11T18:27:45","guid":{"rendered":"https:\/\/content.findlaw-admin.com\/ability-law\/elder\/what-is-elder-law\/program-of-all-inclusive-care-for-the-elderly.html"},"modified":"2024-01-15T16:18:00","modified_gmt":"2024-01-15T21:18:00","slug":"program-of-all-inclusive-care-for-the-elderly","status":"publish","type":"page","link":"https:\/\/www.findlaw.com\/elder\/what-is-elder-law\/program-of-all-inclusive-care-for-the-elderly.html","title":{"rendered":"Program of All-Inclusive Care for the Elderly (PACE): History and FAQ"},"content":{"rendered":"\n
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Program of All-Inclusive Care for the Elderly (PACE): History and FAQ<\/h1>\n
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\n By Olivia Wathne, J.D.<\/a> | Legally reviewed by Melissa Bender, Esq.<\/a>\n | Last reviewed\n
\n \n <\/i>\n Legally Reviewed\n <\/summary>\n\n
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This article has been written and reviewed for legal accuracy, clarity, and style by FindLaw\u2019s team of legal writers and attorneys<\/a> and in accordance with our editorial standards<\/a>.<\/em><\/p>\n\n <\/div>\n <\/details>\n\n

\n \n <\/i>\n Fact-Checked\n <\/summary>\n\n
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The last updated date refers to the last time this article was reviewed by FindLaw or one of our contributing authors<\/a>. We make every effort to keep our articles updated. For information regarding a specific legal issue affecting you, please contact an attorney in your area<\/a>.<\/em><\/p>\n\n <\/div>\n <\/details>\n<\/section>\n

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The PACE model was developed to address the needs of long-term care clients, providers, and payers.<\/p>\n\n <\/div>\n\n

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The Program of All-Inclusive Care for the Elderly (PACE) is a benefit program for older adults. The PACE model<\/a> was developed to address the needs of long-term care clients, providers, and payers. Specifically, the program is designed to help low-income older adults, 55 years of age and above, stay at home for as long as possible before having to enter a nursing home. It has capitated benefits, meaning there is a fixed amount of money per patient and per unit of time.<\/p>\r\n

This budget was authorized by the Balanced Budget Act of 1997 (BBA). The program features a comprehensive service delivery system and integrates with Medicare<\/a> and Medicaid<\/a> financing.<\/p>\r\n

History of PACE<\/h2>\r\n

The PACE program was modeled on the system of acute and long-term care services developed by On Lok Senior Health Services in San Francisco, California.<\/p>\r\n

The model was tested through Health Care Finance Administration (HCFA) demonstration projects that began in the mid-1980s.<\/p>\r\n

Who benefits from PACE?<\/h2>\r\n

Typically, PACE benefits older adults facing medical issues and their informal caregivers. It also helps home health care providers and other medical staff make sure individuals have the care they need.<\/p>\r\n

Most PACE participants are 70+ years old and have numerous medical conditions and special needs. Many of these are chronic conditions.<\/p>\r\n

For most participants, the comprehensive service package lets them continue living at home while receiving services. This is ideal for many participants rather than being institutionalized in a nursing home or assisted living facility.<\/p>\r\n

It is intended to help maintain their quality of life, continue their activities of daily living, and support their care needs in their own community. In about 5% of cases<\/a>, they may be in assisted living or nursing home care facilities, which PACE pays for.<\/p>\r\n

Does PACE cooperate with Medicare and Medicaid?<\/h2>\r\n

Capitated financing allows providers to deliver all the services participants need. Otherwise, they would be limited to services reimbursable under the Medicare and Medicaid fee-for-service systems. You can learn more specifics about the services Medicare and Medicaid cover through FindLaw’s article on Medicare and Medicaid<\/a>.<\/p>\r\n

The BBA established the PACE model of care as a permanent entity within the Medicare program. It enables states to provide PACE services to Medicaid beneficiaries as a state option.<\/p>\r\n

The state plan must include PACE as an optional Medicaid benefit. This must happen before the state and the Secretary of the Department of Health and Human Services (DHHS) can enter into program agreements with PACE providers.<\/p>\r\n

Once approved, the PACE program becomes the sole source of services for Medicare and Medicaid eligible enrollees.<\/p>\r\n

Is there always access to PACE?<\/h2>\r\n

Some states have chosen to expand access to PACE services. <\/a>However, as of January 2022, there were 20 states that did not operate a PACE program at all. In fact, no states operate the PACE program statewide. A major barrier to access is geography, in addition to a long enrollment process.<\/p>\r\n

What medical professionals and staff work with PACE?<\/h2>\r\n

The program requires an interdisciplinary team consisting of professional and paraprofessional staff. They will need to:<\/p>\r\n