Below are answers to some common questions about PACE. If you have additional questions, please ask by submitting a question through our contact form.
Yes. People are happier and healthier living in their own home, in their own community. Each PACE program endeavors to help seniors live safely in their own homes for as long as possible.
PACE provides and coordinates all your medical care. Your personal care will include some or all of the services listed below. If you have a medical need not on this list, PACE will provide that too.
- Primary care physician, specialists, and nursing care.
- Prescription medications, delivery to your home.
- Outpatient labs, blood tests and X-rays.
- Dentistry, optometry, audiology, podiatry and psychiatry.
- Wheelchairs, walkers and other durable medical equipment.
- Physical, occupational, speech, and mental health therapy.
- Emergency care, hospitalization, transportation.
When you enroll in PACE, all your healthcare will come through an interdisciplinary team comprised of doctors, nurses, and network of specialists.
You will have a new primary care doctor at PACE. Your new doctor has extra training in the needs of older adults. Sometimes participants see their “old doctor” during a brief transition period. These visits will need to be pre-authorized by PACE.
Your current specialist physicians may already be part of PACE’s network. Contact your local PACE provider and ask the enrollment specialist if you physician is in the PACE network.
If you receive services that are not pre-authorized, or are outside of our network, you will be personally responsible for paying.
PACE provides socialization, nutrition, transportation, and other social services:
|Transportation:||To and from your neighborhood PACE center, PACE medical clinics, outside medical appointments. PACE also transport you to all outings arranged through PACE, such as picnics, baseball games, and museums.|
|Recreation:||Art, drama, music, events, exercise, field trips.|
|Home care:||Help with personal care and light housekeeping.|
|Nutrition:||Hot meals, nutritional counseling, and meal delivery.|
|Supportive:||Counseling, family support, help with benefits, and a chaplain.|
|Logistics:||PACE providers manage it all — the paperwork, the prescription refills, getting people to and from medical appointments, and communication among the entire care team. PACE also manages and maintain your paperwork with Medicare and Medi-Cal.|
At PACE, all your care providers talk with each other. Your doctor and your entire care team have regular meetings. They meet face-to-face, in one room, around a table. Your care team includes your:
- Clinic nurse
- Home care nurse
- Certified Nursing Assistant
- Social worker
- Physical therapist
- Occupational therapist
- Speech therapist
- Mental health therapist
- Van driver
- Center director
- Activities director
If you are ever hospitalized, enter rehabilitation or skilled nursing, PACE coordinates care and pays the bills.
When you are ready to come home, PACE help you get settled.
PACE is required by law to keep your health information private. This applies to the information you share with us when you apply to PACE, and after you are enrolled in PACE.
Yes! PACE providers speak about 25 different languages. PACE providers throughout California speak about 25 languages across all of our programs. PACE does not discriminate based on your language. At PACE, you have the right to receive medical care instructions in your own language. You also have the right to have an interpreter at medical appointments.
PACE means “Program of All-inclusive Care for the Elderly”.
Participants love the care they get in PACE. 98% of PACE participants in California would recommend this kind of care to a friend or family member (according to 2016 Vital Research Customer Satisfaction Survey).
Here are 3 questions to help you decide to apply to PACE:
- Are you living with multiple health problems that make it difficult for you to stay at home without help?
- Have the activities and routines of everyday life become difficult?
- Is it difficult to manage all of your medications?
If you answered yes to these questions, and are 55 years or older, and live in a PACE service area, then PACE could be just the help you need. A conversation with an enrollment specialist can answer any additional enrollment questions you may have.
PACE organizations provide the entire continuum of medical care and long-term services and supports that frail older adults need to continue living at home and in the community. These include primary and specialty medical care; in-home services; prescription drugs; specialty care such as audiology, dentistry, optometry, podiatry and speech therapy; respite care; transportation; adult day services, including nursing, meals, nutritional counseling, social work, personal care, and physical, occupational and recreational therapies; and hospital and nursing home care, when necessary. In short, PACE covers all Medicare Parts A, B and D benefits, all Medicaid-covered benefits, and any other services or supports that are medically necessary to maintain or improve the health status of PACE program participants.
PACE is a permanent Medicare benefit, reimbursed by the government.
Medicare and Medi-Cal reimburse your PACE provider for care. If you are enrolled in Medicare and Medi-Cal, you will pay nothing, or you will pay the your Medi-Cal “share of cost” to your PACE provider.
PACE providers also accept people enrolled only in Medicare, and people who want to pay privately. If you have long-term care insurance, your carrier may pay for part of the premium as well.
When you apply to a PACE, your enrollment specialist will help you navigate the application process for Medicare and Medi-Cal.
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. Learn more about Medicare and Medicaid Payments to PACE Organizations.
PACE emphasizes the following processes, which are recognized as highly effective in the provision of primary care for community-based older adults with complex care needs:
- development of a comprehensive participant assessment that includes a complete review of all medical, functional, psychosocial, lifestyle and values issues;
- creation and implementation of a care plan that addresses all health and long-term care needs;
- communication and care coordination among all those who provide care for the participant; and
- promotion of participant and caregiver engagement in health care decision-making.
Furthermore, because PACE organizations are fully responsible for the quality and cost of all care provided, they have a financial incentive to provide all necessary care. According to the “HHS Interim Report to Congress: The Quality and Cost of the Program of All-Inclusive Care for the Elderly,” Medicare costs for PACE and a comparable group were analyzed for a 60-month period and found to be similar, suggesting that Medicare capitation rates for PACE were set appropriately.
Similarly, the Medicaid statute requires that PACE rates be set below the upper payment level for a similar population. According to an analysis done by the National PACE Association, PACE rates are 14 percent less than the state costs of providing alternative services to a comparable population. For additional information on the quality and cost-effectiveness of PACE, ask to see NPA Analysis of PACE Upper Payment Limits and Capitation.
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 threeway 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, ask to see 42 CFR Part 460 and the CMS PACE Manual.
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.
Usually, it takes at least two weeks to apply to a PACE program. For some people, it takes longer. PACE sends each application to the State of California. The State will certify that the person needs a level of care that Skilled Nursing Home Level of Care. When the State approves an application, the new participant starts with PACE on the 1st day of the next month. For example, if the application is approved on May 19th, the person can start at PACE on June 1st.