Joel Mekler | Medicare Moments: Medicare’s PACE Program: What is it and how can it help | Lifestyles

Andara Puchino

If you’re looking for ways to stay out of an institutional setting like a nursing home — and who wouldn’t — you might want to learn more about PACE.

PACE is shorthand for Programs for All-Inclusive Care for the Elderly, not to be confused with the Pennsylvania State Pharmaceutical Assistance Program, which also happens to be called PACE (Pharmaceutical Assistance Contract for the Elderly).

•What are the Programs of All-Inclusive Care for the Elderly (PACE)? Programs of All-inclusive Care for the Elderly, or PACE, offer an innovative model of care with coordinated medical and rehabilitative services in an integrated system that allows aging seniors to remain in their own homes, maintain independence, lead healthier, and more fulfilling lives. PACE organizations provide the majority of healthcare to participants through an integrated network of professionals including physicians, nurses, therapists, social workers, health care aides, and more. PACE is focused on treating the whole person, not just their combination of medical conditions. That’s why PACE programs have social workers who are experts in listening and helping seniors and their families better understand the aging process.

Important: In the Commonwealth of Pennsylvania PACE is known as LIFE (Living Independence for the Elderly). In Lawrence County, the LIFE program is administered by Lutheran SeniorLife and can be reached at (724) 657-8800.

•Who is eligible for PACE? You can join PACE if you are 55 years old or older, live in the service area of a PACE organization, are certified by the state in which you live as meeting the need for the nursing home level of care, and are able to live safely in the community when you join with the help of PACE services. You and your family participate as the team develops and updates your plan of care and your goals in the program. Note: A person can leave PACE at any time.

•How does PACE work? PACE provides comprehensive care using Medicare and Medicaid funds to cover all of your medically necessary care and services. You can have either Medicare or Medicaid or both to join PACE. Most enrollees in PACE are qualified for both Medicare and Medicaid and have all of their acute and long-term care needs to be provided for by the PACE program. PACE centers meet state and federal safety requirements and include adult day programs, medical clinics, activities, and occupational and physical therapy facilities. PACE provides all the care and services covered by Medicare and Medicaid, as authorized by the interdisciplinary team, as well as additional medically necessary care and services not covered by Medicare and Medicaid.

PACE services include but aren’t limited to:

•Adult day health care that offers nursing; physical, occupational and speech/language therapies; recreational therapies; meals; nutritional counseling; social work and personal care;

•Medical care provided by a PACE physician familiar with the history, needs and preferences of each participant;

•Home health care and personal care;

•All necessary prescription and over-the-counter medications;

•Medical specialties, such as audiology, dentistry, optometry, podiatry, and speech therapy;

•Respite care;

•Hospital and nursing home care when necessary; and

•Transportation services.

Note{/em}: When a person enrolls in PACE, they don’t need to enroll in a separate Medicare Part D prescription drug plan.

•How much does PACE cost? What you pay for PACE depends on your personal financial situation. If you qualify for Medicare, all Medicare-covered services are paid for by Medicare. If you also qualify for your state’s Medicaid program, you will either have a small monthly payment or pay nothing for the long-term care portion of the PACE benefit. If you don’t qualify for Medicaid, you will be charged a monthly premium to cover the long-term care portion of the PACE benefit and a premium for Medicare Part D drugs. However, when enrolled in PACE you will never pay a deductible or copayment for any drug, service, or care approved by the PACE team. An important point to remember is that with PACE, a person’s ability to pay will never keep them from getting the care they need.

•What are the demonstrated benefits to the PACE Model? PACE was developed over 30 years ago and each PACE program is consistently reevaluating its services offered and the integration of delivery in an effort to keep its participants healthy. The PACE model has a proven track record in preserving wellness, supporting healthy outcomes, and promoting quality care. PACE participants utilize, on average, fewer than three days of hospital care annually. In addition to providing care that offers excellent outcomes for seniors, PACE’s financing mechanism reduces the cost of care compared to that of a nursing home by 10 to 20 percent. Note: PACE programs are healthcare providers, not insurers. While the programs utilize a combination of Medicare and Medicaid funds to pay for services, the heart of a PACE program is a unique care delivery model that requires patient assessment, care management, and input integrated with a team of doctors, nurses, therapists, and other providers.

FUTURE OF THE PACE PROGRAM

As Medicare beneficiaries age, PACE becomes more critical than ever. Recently, Sens. Bob Casey and Tim Scott introduced the PACE Expanded Act of 2022 to accelerate the capacity and reach of the existing 144 PACE organizations and spur the establishment of new ones.

According to Sen. Casey, “Millions of Americans are eligible for both Medicare and Medicaid, but the systems are so fragmented and complex, it often leads to gaps in care. My bill with Sen. Scott, the PACE Expanded Act, would streamline services and enable people with a high level of need to stay in the community rather than receive care in a nursing home. Older Americans and people with disabilities should not face obstacles to get the care they need, when they need it, in the setting they prefer.”

The PACE Expanded Act would facilitate increasing the scale and spread of current PACE organizations and developing new ones by doing the following:

•Alleviating bureaucratic burdens experienced by PACE programs applying to CMS to increase their capacities or expand their geographic service areas,

•Enabling eligible older adults to enroll in PACE at any time in the month,

•Testing the PACE model of care with new populations currently ineligible to participate, and

•Increasing the affordability of PACE for eligible Medicare-only beneficiaries.

For more information about PACE, please visit www.npaonline.org. This website is sponsored by the National PACE Association where you can find a PACE program in your community. You can also call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877 486-2048.

Joel Mekler is a certified senior adviser. Send him your Medicare questions at [email protected]

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