Note: An applicant seeking to obtain a contract must enroll in Texas Medicaid. Please visit the Texas Medicaid LTSS Provider Enrollment/Re-Enrollment website to view the enrollment requirements.
Help to start your Program of All-Inclusive Care for the Edlerly is available from the National PACE Association (NPA). According to NPA, developing a program requires a sophisticated level of knowledge about capitated financing and service delivery, integrated and comprehensive care for the frail elderly, and program operations. Support and guidance is available through technical assistance centers. For more information about setting up a PACE site, visit NPA's website.
Contracting to Provide Services
To be eligible to provide services and receive reimbursement for these services, a provider agency must meet certain eligibility criteria. Rules regarding minimum eligibility requirements for contracting can be found in Title 40 of the Texas Administrative Code (TAC) as follows:
- Texas Administrative Code, Title 40, Part 1, Chapter 60: Contracting to Provide Programs of All-Inclusive Care for the Elderly (PACE)
- Texas Administrative Code, Title 40, Part 1, Chapter 49: Contracting For Community Care Services
If you are interested in establishing a PACE site, contact the Community Services Policy Unit at 512-438-2013.
PACE programs provide comprehensive health care that is responsive to the needs of the individual rather than to the constraints of the funding agency. It emphasizes helping older people remain at home as long as medically, socially, and economically feasible. The key elements of the service delivery strategy are preventive care, maximum rehabilitation, and substitution of low-cost services for high-cost services.
Exclusively Serves People who are Frail and Elderly
The PACE model serves only adults age 55 and older who are certified as needing nursing home care and who reside in a defined geographic area.
Consolidates Service Delivery
A multidisciplinary team assesses needs, then plans and directly delivers all services via program staff or under fixed-rate contracts with hospitals, skilled nursing facilities, and medical specialists. The risk-based PACE differs from the brokerage model, which depends on others to provide services.
Provides Comprehensive and All-inclusive Services
PACE provides all health or health-related services needed including, but not limited to,
- inpatient and outpatient medical care,
- specialty services including dentistry and podiatry,
- social services,
- in-home care,
- meals, and
Combines Payments from Medicare, Medicaid and Program Participants
Each PACE site bears 100-percent financial risk for the complete care of its locked-in census. Medicare, Medicaid, and the individual each pay a monthly "premium" based on the individual's entitlement. The average per capita rate is lower than traditional long-term care costs. PACE integrates the long-term care financial responsibilities of Medicare, Medicaid, and the individual into a single unrestricted pool of funds. The model places cost control responsibility in the hands of the service providers without externally imposed cost constraints, such as limits on eligibility or benefit packages. It is designed to give positive incentives to these providers to use resources appropriately and efficiently.