The PACE Association of Michigan is a 501(c)(6) association dedicated to the expansion of comprehensive health care services to the frail elderly through the Program of All-inclusive Care for Elderly (PACE).
The Association was officially incorporated in March of 2015. Today there are 14 independent PACE organizations in 21 Michigan locations providing comprehensive services for seniors in partnership with a team of health care professionals.
All PACE organizations share the same goal: improve the health and maintain the independence of older adults while honoring their desire to live in their community.
Nationally, there are over 115 PACE organizations operating in over 31 states.
What is PACE?
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, 90 percent continue to live at home.
Who does PACE serve?
Who does PACE serve?
PACE serves more than 40,000 participants in 31 states (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 77 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 benefits does PACE offer?
What benefits does PACE offer?
PACE organizations provide the entire continuum of medical
care and long-term services and supports required by frail
older adults. 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.
What makes the PACE model unique?
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. For more information, ask to see Core Differences
Between PACE and Medicare Advantage and Core Differences
Between PACE and SNPs.
How is PACE financed?
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, ask to see Medicare and
Medicaid Payment to PACE Organizations.
How does PACE ensure quality care and cost-effectiveness?
How does PACE ensure quality care and cost-effectiveness?
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.
How is PACE authorized and regulated?
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 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.
Who sponsors PACE organizations?
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.