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The PACE program is a unique capitated managed care benefit for the frail elderly provided by a not-for-profit or public entity that features a comprehensive medical and social service delivery system using a multidisciplinary team approach in an adult day health center, supplemented by in-home and referral services in accordance with participants' needs.

A PACE organization is a not-for-profit private or public entity that is primarily engaged in providing PACE services. The following characteristics also apply to a PACE organization. It must:

• have a governing board that includes community representation
• be able to provide the complete service package regardless of frequency or duration of services
• have a physicial site to provide adult day services
• have a defined service area
• have safeguards against conflict of interest
• have demonstrated fiscal soundess
• have a formal Participant Bill of Rights

To qualify as a PACE participant, you must be age 55 or older; meet a Nursing Facility level of care; and live in the PACE service area.

Enrollment in the PACE program is voluntary. If a participant meets the eligibility requirements and elects PACE, an Enrollment Agreement is signed. This contains things such as participant demographic data, description of benefits, effective date, explanation of policy regarding premiums, emergency care, etc. Enrollment continues as long as desired by the PACE participant, regardless of change in health status, until death or voluntary or involuntary disenrollment.

PACE services include, but are not limited to, all Medicare and Medicaid services. At a minimum, there are an additional 16 services that a PACE organization must provide: e.g., social work, drugs, NF care. Minimum services that must be provided in the PACE center include primary care services, social services restorative therapies, personal care and supportive services, nutritional counseling, recreational therapy, and meals.

The service delivery settings include an adult day health center, home, and inpatient facilities.

At a minimum, the multidisciplinary team is composed of a primary care physician, nurse, social worker, physical therapist, occupational therapist, recreational therapist or activity coordinator, dietitian, PACE center supervisor, home care liaison, health workers/aids, or their reprsentatives, and drivers or their representatives.

Under the Medicare program, the monthly capitation rate paid by HCFA to the PACE provider equals the Adjusted Per Capita Cost (AAPCC) as calculated by HCFA for HMO reimbursement with adjustment for frailty factors. Under the Medicaid program, the monthly capitation rate is negotiated between the PACE provider and the State Medicaid Agency and is specified in the contract between them. The capitation rate is fixed during the contract year regardless of changes in the participant's health status. The rates are considered payment in full.

The PACE regulation is currently in the formal clearance process and is anticipated to be published in the Federal Register within the next few months.

Yes. Section 710 of the Omnibus Appropriations Act of 1998 permits States to cover PACE enrollees under institutional groups and rules similar to those that apply under home and community based services waivers. This means that States can elect to cover PACE enrollees under the special income level group (also known as the 300 percent group). States can also apply other institutional rules to PACE enrollees, such as spousal impoverishment and post-eligibility treatment of income.