Understanding the PACE Model of Care

Home / Starting/Expanding PACE / Understanding the PACE Model of Care
IDT meeting

Developing an understanding of the program and service requirements of the Program of All-Inclusive Care for the Elderly (PACE®) Model of Care, its flexibility, and the stages of development across a team of management and clinical leaders will form a foundation for moving forward in the PACE development process.

PACE FAQs

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?
PACE serves over 68,000 participants in 32 states and the District of Columbia (see PACE in the 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 makes the PACE model unique?
  • PACE Participants Are Served by a Comprehensive Team of Professionals: Upon enrollment in PACE, participants and their caregivers meet with an interdisciplinary team (IDT) that includes doctors, nurses, therapists, social workers, dietitians, personal care aides, transportation drivers and others. Their needs are assessed, and an individualized care plan is developed to respond to all of the participant’s needs – 24 hours a day, seven days a week, 365 days a year.

 

  • PACE Participants Receive Regular, “High-Touch” Care: PACE participants receive comprehensive health and supportive services across a range of settings. At the PACE center they receive primary care, therapy, meals, recreation, socialization and personal care. In the home PACE offers skilled care, personal care supportive services, and supports such as ramps, grab bars, and other tools that facilitate participant safety. In the community PACE offers access to specialists and other providers.

 

  • PACE Is Both a Health Provider and a Health Plan: PACE combines the intensity and personal touch of a provider with the coordination and efficiency of a health plan. IDT members deliver much of the care directly, enabling them to personally monitor participants’ health and respond rapidly with any necessary changes. The PACE team also is responsible for managing and paying for services delivered by contracted providers such as hospitals, nursing homes and specialists. 
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.

For more information, see Medicare and Medicaid Payment to PACE organizations.

How is PACE authorized and regulated?
Congress authorized PACE as a permanent Medicare provider and Medicaid state option in the Balanced Budget Act of 1997 by establishing Sections 1894 (42 U.S.C. 1395eee) and 1934 (42 U.S.C. 1396u-4) of the Social Security Act. In the Deficit Reduction Act of 2005, Congress established a program to expand PACE to rural areas of the country. Regulatory authority for PACE can be found in 42 CFR Part 460. Operationally, the PACE program is unique and implemented through three-way program agreements among the Centers for Medicare & Medicaid Services (CMS), states and PACE organizations. CMS and the state are responsible for monitoring the operations, cost, quality and effectiveness of PACE programs. For more information about PACE regulatory requirements, see 42 CFR Part 460 and the CMS PACE Manual.(PDF)
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.

Developing an understanding of the program and service requirements of the Program of All-Inclusive Care for the Elderly (PACE®) Model of Care, its flexibility, and the stages of development across a team of management and clinical leaders will form a foundation for moving forward within the organization.