Program of All-Inclusive Care for the Elderly. P.A.C.E

What is P.A.C.E The Programs of All-Inclusive Care for the Elderly (PACE) provides comprehensive medical and social services to certain frail, community-dwelling elderly individuals, most of whom are dually eligible for Medicare and Medicaid benefits This is a long-term care program for older adults who wish to live at home but qualify for nursing home care. They need assistance in order to maintain their health, complete day-to-day activities and remain safe for as long as possible. (CMS, 2016 para. 1,2).

Eligibility Age 55 or older Live in the service area of a PACE organization Eligible for nursing home care Be able to live safely in the community (CMS, 2016 para. 4).

Service and Benefit's (CMS.gov, 2016 para. 18) PACE service/benefits include, but are not limited to, all Medicaid and Medicare covered services: Adult Day Care Dentistry Emergency Services Home Care Hospital Care Laboratory/X-ray Services Meals Medical Specialty Services Nursing Home Care (CMS.gov, 2016 para. 18)

Service and Benefit's (CMS.gov, 2016 para. 18) PACE service/benefits include, but are not limited to, all Medicaid and Medicare covered services: Nutritional Counseling Occupational Therapy Physical Therapy Prescription Drugs Primary Care (including doctor & nursing services) Recreational therapy Social Services Social Work Counseling Transportation (CMS.gov, 2016 para. 18)

Service and Benefit's PACE also includes all other services determined necessary by the health professionals team to improve and maintain an individual’s health. PACE programs provide services primarily in an adult day health center and are supplemented by in-home and referral services in accordance with the enrollee’s needs. (CMS.gov, 2016 para. 18)

The difference between PACE and other LTC programs. PACE is a Medicare and Medicaid program that helps people meet their health care needs in the community instead of going to a nursing home or other care facility. Housing is not a covered benefit or service under PACE. However, most PACE programs find that accessible, affordable housing is invaluable. With PACE, the focus is on you — you have a team of health care professionals working with you and your family to make sure you get the coordinated care you need. When you enroll in PACE, you may be required to use a PACE-preferred doctor. (medicaid.gov, 2017 para. 1,2)

What you have to pay for the PACE program If you have Medicaid, you won't pay a monthly premium for the long-term care portion of the PACE benefit. If you don't qualify for Medicaid but you have Medicare, you'll be charged these: A monthly premium to cover the long-term care portion of the PACE benefit A premium for Medicare Part D drugs (medicaid.gov, 2017, para. 6)

What you can expect to pay within the PACE program There's no deductible or copayment for any drug, service, or care approved by your health care team. If you don't have Medicare or Medicaid, you can pay for PACE privately. (medicaid.gov, 2017, para. 7)

Why Was PACE Developed? The PACE Model of Care can be traced to the early 1970s, when the Chinatown-North Beach community of San Francisco saw the pressing needs for long-term care services by families whose elders had immigrated from Italy, China and the Philippines. William Gee, DDS, a public health dentist, headed the committee that hired Marie-Louise Ansak in 1971 to investigate solutions. Along with other community leaders, they formed a nonprofit corporation called On Lok Senior Health Services to create a community-based system of care. On Lok is Cantonese for "peaceful, happy abode." In 1990 the first replication sites received Medicare and Medicaid waivers as demonstration programs and the model became known as the "Program of All-inclusive Care for the Elderly" or PACE. ... Existing PACE demonstration programs became permanent PACE providers by 2003. (National PACE Association, 2016)

PACE History 1990: The first Programs of All-Inclusive Care for the Elderly (PACE) receive Medicare and Medicaid waivers to operate. 1994: With the support of On Lok, the National PACE Association (NPA) is formed. 11 PACE organizations are operational in nine states.

PACE History 1996: 21 PACE programs are operational in 15 states 1994: With the support of On Lok, the National PACE Association (NPA) is formed. 1997: The Balanced Budget Act of 1997 establishes the PACE model as a permanently recognized provider type under both the Medicare and Medicaid programs. 2017: 122 PACE programs are operational in 31 states.

Challenges Census building and developing the interdisciplinary team are the major challenges. Reaching enrollment efficiency takes time since it requires the concerted efforts of the interdisciplinary team, state certifying agency, community referral sources, families and participants. In order to enable older adults with complex chronic medical conditions to remain living in the community and as independently as possible, the interdisciplinary team must learn to think beyond standard medical practices and the traditional roles of their professions. Housing challenges within the elderly community. (National PACE Association, 2016 para. 10)

Downfalls of PACE Current legislation provides for the elderly population only. NPA and PACE providers are working to advance legislation that would extend the PACE services and financing model to other high need, high cost populations. With PACE a single agency has full responsibility and risk for providing and managing all care needed by its participants.

Other Resources Available Through PACE The National PACE Association has developed the Core Resource for PACE (CRSP) to assist providers with the financial planning, provider application and program development stages of creating a PACE program. PACE technical assistance centers (TACs), some affiliated with PACE programs, assist organizations in conducting organizational assessment, market assessment, development of a business plan and the development of a PACE program.

PACE Is Working PACE is not only working it is growing. PACE is expanding state to state and is helping people stay in there home.

Changes I Would Make Allow clients to go out-of-network Have housing assistance for those in need

Life Program

References (2016, Jan.). Retrieved from CMS.gov: https://www.cms.gov/Regulations-and- Guidance/Guidance/Manuals/Downloads/pace111c03.pdf (2016, Apr). Retrieved from National PACE Association: http://www.npaonline.org/pace-you#History (2017, oct). Retrieved from medicaid.gov: https://www.medicare.gov/your-medicare-costs/help-paying- costs/pace/pace.html Medicaid.gov. (2016, Jan.). Retrieved from Medicaid.gov: https://www.medicaid.gov/medicaid/ltss/pace/index.html