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PACE provides comprehensive medical and social services to certain frail, elderly people (participants) still living in the community. Most of the participants who are in PACE are dually eligible for both Medicare and Medicaid.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n
PACE offers a wide range of health care services, as well as social services. Most PACE programs offer primary care; hospital care; medical specialty services; prescription drugs (including Part D 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 and x-ray services; social work counseling; and end of life care. In addition, transportation, hospital, nursing home, home health, and other specialized services are usually provided under contract. In most cases, beneficiaries are given the opportunity to live at home (CMS, 2011b).<\/p>\n
In order to qualify for PACE, beneficiaries must be 55 or older, live in a PACE service area, be eligible for nursing home care, and be able to live safely in a community setting at the time of enrollment. PACE is funded through Medicare and Medicaid through capitation payments (CBO, 2013; CMS, 2011b). A capitated payment can be defined as, \u201ca single payment, made on a per-enrollee basis, that covers all care within a specified set of benefits\u2026.The recipient of a capitated payment keeps the difference between its cost and the amount of the payment if costs are below the payment, but it is responsible for paying any costs that exceed the capitated payment\u201d (CBO, 2013, p. 39). This means that Medicare and Medicaid will pay a flat capitated payment per enrollee to the PACE organization, which goes into a pool that the provider uses to deliver care to all the enrollees in the program. In return, the PACE organization assumes all financial risk, but does not have to return any funding that is not needed. Since PACE organizations provide services to dually eligible participants, they receive two capitated payments per month per enrollee \u2013 one from Medicare and one from Medicaid (CMS, 2011b).<\/p>\n
The Centers for Medicare and Medicaid Services clarify that, even though PACE has similarities to Medicare Advantage, it is not an MA plan and it does have many differences to MA plans. One example is the payment structure as already explained. In addition, it is only available in limited areas, and not available in all states; since PACE works in conjunction with Medicaid, a state-run program, the state has to also be involved with the PACE program. Furthermore, it is not available to all Medicare beneficiaries since it is intended for a defined population of frail elderly individuals (PACE, 2011). If you would like to see if you are eligible for PACE, or to see if there is a PACE provider in your area, go to www.pace4you.org<\/a> or call your state Medicaid office (DHHS, 2014).<\/p>\n","protected":false},"excerpt":{"rendered":"Similar to Extra Help, there is also the \u201cMedicare Savings Program\u201d. The main difference is that Extra Help is specifically<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"open","template":"","meta":{"footnotes":""},"class_list":["post-300","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/medicarereport.org\/index.php?rest_route=\/wp\/v2\/pages\/300","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicarereport.org\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/medicarereport.org\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/medicarereport.org\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicarereport.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=300"}],"version-history":[{"count":2,"href":"https:\/\/medicarereport.org\/index.php?rest_route=\/wp\/v2\/pages\/300\/revisions"}],"predecessor-version":[{"id":26379,"href":"https:\/\/medicarereport.org\/index.php?rest_route=\/wp\/v2\/pages\/300\/revisions\/26379"}],"wp:attachment":[{"href":"https:\/\/medicarereport.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=300"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}