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Revision 18-1; Effective March 1, 2018
O-2100 Program of All-Inclusive Care for the Elderly (PACE)
Revision 18-1; Effective March 1, 2018
The Program of All-Inclusive Care for the Elderly (PACE) is a Medicaid state option. The PACE program serves the frail elderly and features a comprehensive service delivery system and integrated Medicare and Medicaid financing. Those who may be eligible for PACE services are persons, age 55 and older, with chronic medical problems and functional impairments who meet criteria for medical necessity (MN) (only required for program entry).
Those who may be eligible for PACE services meet:
- Supplemental Security Income (SSI) criteria; and/or
- Medicaid eligibility using the institutional income/resource limits.
Persons must meet criteria for MN (only required for program entry). Persons must live in the specific catchment area. This program provides community-based services for frail and elderly people who would qualify for nursing facility placement. A comprehensive care approach is used to provide an array of medical, functional and day activity services for a capitated monthly fee that is below the cost of comparable institutional care. Currently, there are three PACE sites in Texas – Bienvivir Senior Health Services in El Paso, The Basics at Jan Werner in Amarillo and La Paloma in Lubbock. (Section 1905(a)(26) of the Social Security Act (enacted in Section 4802 of the Balanced Budget Act of 1997).)
There is no co-payment for the PACE program unless the recipient is admitted to a nursing facility.
For more information about this program, see the HHS website at hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/program-all-inclusive-care-elderly-pace.