PACE Programs

A capitated benefit authorized by the Balanced Budget Act of 1997 (BBA) that features a comprehensive service delivery system and integrated Medicare and Medicaid financing. For most participants, the comprehensive service package permits them to continue living at home while receiving services rather than being institutionalized. Capitated financing allows providers to deliver all services participants need rather than being limited to those reimbursable under the Medicare and Medicaid fee-for-service systems. The BBA established the PACE model of care as a permanent entity within the Medicare program and enables States to provide PACE services to Medicaid beneficiaries as a State option. The State plan must include PACE as an optional Medicaid benefit before it can enter into program agreements with PACE providers. Participants must be at least 55 years of age, live in the PACE service area, and be certified as eligible for nursing home care by the appropriate State agency. The PACE program becomes the sole source of services for Medicare and Medicaid eligible enrollees. PACE programs provide social and medical services primarily in an adult day health center, supplemented by in-home and referral services in accordance with the participant's needs. The care is overseen by an interdisciplinary team, consisting of professional and paraprofessional staff.