Frequently Asked Questions (Updated August 2019)
What is PACE?
PACE, the Program of All-inclusive Care for the Elderly, offers a benefit that combines medical care, long-term care and prescription drugs to help frail and disabled individuals age 55 and older live independently within the community.
Can anyone sign up for PACE?
To be eligible for PACE, individuals must be:
- Age 55 or over
- Live in the counties served by a PACE center
- Meet Iowa's criteria for nursing facility level of care
- Be able to live safely in the community with help from the PACE center
What is "nursing facility level of care"?
"Nursing facility level of care" means that the following conditions are met:
- The presence of a physical or mental impairment which restricts the participant's daily ability to perform the essential activities of daily living, bathing, dressing, and personal hygiene, and impedes the member's capacity to live independently.
- The participant's physical or mental impairment is such that self-execution of required nursing care is improbable or impossible.
Following a functional assessment, level of care eligibility is determined by an Iowa Medicaid Enterprise medical team member. Eligibility is determined at the time of application and annually thereafter.
Must I have Medicaid or Medicare to participate with PACE?
Individuals may have to pay the PACE centers monthly rate using private funds. The monthly rate will be consistent with the PACE rates paid by Medicaid or Medicare. You can have either Medicare or Medicaid, or both, to join PACE. Medicare eligible participants must apply for Medicare and get Medicare. PACE participants are not required to enroll in Medicaid.
How do Medicare and Medicaid coordinate with the PACE program?
Medicare and Medicaid pay the PACE program to take care of your medical needs. Your Medicare and/or Medicaid card are replaced with a PACE card. The PACE center becomes your primary care provider's office. All your care has to be coordinated by the PACE team.
What is a PACE card?
A PACE card takes the place of the Medicaid and Medicare cards. You will be provided with a card once you are approved for PACE. Below are images of sample PACE cards:
What services are covered by PACE?
PACE services include, but are not limited to, all Medicare and Medicaid services. A PACE center is facility where the PACE organization is housed and provides medical services to support and assist you. The PACE center has a medical clinic that includes physician and nursing services. Some of the other services and supports available with prior approval are physical therapy, occupational therapy, speech therapy, personal care, nutritional counseling, recreational therapy, social activities and meals.
Other medically necessary services that cannot be provided at the PACE center or in your home, will be coordinated for you. PACE staff will schedule appointments for you and schedule transportation to your appointments, if needed. Any services not available at the PACE center must be authorized by the PACE team of professionals.
Appointments for medical care outside of the PACE center are required to have prior authorization by the PACE team. You will need to pay for unauthorized appointments and services.
If approved, the services listed below can be provided, but are not limited to the following:
| Services Available at the PACE Center | Other PACE Benefits |
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You must call your PACE center if you have an urgent care situation.
Some example of urgent care are:
- Fever
- Stomach pain
- Ear aches
EMERGENCY SERVICES ARE THE EXCEPTION AND DO NOT NEED PRIOR APPROVAL.
Emergency Care
An emergency is any condition that places your life in danger or causes permanent disability if not treated immediately. If you have an emergency, call 911 or go directly to the nearest hospital emergency room. Take your PACE card with you. You do not need to call your PACE center first.However, call, or ask someone to call your PACE center as soon as possible to let the PACE staff know that you needed emergency care. PACE staff will assist you with any follow-up care that you need. The following are examples of emergencies:
- A serious accident
- Poisoning
- Heart attack
- Stroke
- Severe bleeding
- Severe burns
- Severe shortness of breath
Follow-Up Care After an Emergency
You must contact your PACE center for all follow-up care. Do not return to the emergency room for follow-up care. The PACE center will either provide or authorize this care for you. Please remember that you will need to pay for services that are not authorized by the PACE organization.
What Counties Are Covered by PACE?
At this time, PACE is not available in all Iowa counties. To learn more about the PACE program or for assistance with an application, contact the PACE center in the county where you reside.
| Immanuel Pathways Southwest Iowa | Immanuel Pathways Central Iowa | Siouxland PACE |
Counties in service area: | Counties in service area: | Counties in service area: |
| PACE Center Address: 1702 N 16th Street Council Bluffs, IA 51501 | PACE Center Address: 7700 Hickman Road Windsor Heights, IA 50324 | PACE Center Address: |
| Telephone: 712-256-7284 TTY: 1-800-537-7697 | Telephone: | Telephone: 712-224-7223 Toll Free: 1-888-722-3713 TTY: 712-224-7253 |
Website: | Website: | Website: |
Can I keep seeing my current doctor or use my current pharmacy?
No. PACE employs their own medical staff to serve participants. If you are in need of a specialist outside of what is available at the PACE center, PACE will schedule your appointment and provide transportation to and from the appointment. PACE contracts with a pharmacy to provide prescribed medication to participants.
Appointments for medical care outside of the PACE center are required to have prior authorization by the PACE team. You will need to pay for unauthorized appointments and services.
What is an Interdisciplinary Team?
This team will help you plan and coordinate your care across any number of support settings that may include home, hospital, nursing facility, or hospice care.
The team must include the following professionals:
- Primary Care Physician (PCP)
- Registered Nurse
- Master's Level Social Worker
- Physical Therapist
- Occupational Therapist
- Recreational Therapist
- PACE Center Manager
- Home Care Coordinator
- Personal Care Attendant
- Transportation Driver
- Dietician
What is the cost of PACE?
You may have a monthly cost share or spend down to remain eligible for Medicaid. If you live in an assisted living facility you have to pay for your room and board each month. If you are enrolled in Medicaid, you may have a monthly financial responsibility for your care. It is possible that you may have to pay for both.
However, the absence of Medicare or Medicaid copays and deductibles are a major benefit to the PACE program.
How are decisions about my care made?
Decisions about your health care, long-term care and medications are made by you and your PACE team. The PACE team of healthcare professionals are committed to providing quality care to keep you as healthy as possible. Your PACE team will identify the best way to meet your needs and authorize additional supports and services as needed.
What if I disagree with a decision made regarding my services?
A grievance or complaint can be submitted to PACE staff verbally or in writing. A grievance could be something that most likely can be corrected easily, such as "It is too cold in here" or could be something that is more serious or complicated such as "The PACE staff did not come to my home to help me today."
Any grievance or complaint that you submit must be documented and resolved by the PACE team.
If you feel that the PACE team is not trying to work with you to resolve your complaint, you may contactIowa Medicaid Member Services at 1-800-338-8366.
What does the PACE program expect from me?
As a PACE participant, you will work with your PACE team to help them develop a care plan to meet your medical and social needs. Your participation in developing and following your care plan is essential to achieving your health goals. As a PACE participant, you'll need to keep your care team up-to-date on changes in your condition or if you change your residence. Participants must also use PACE providers or receive approval from the care team prior to receiving services.
What are my rights and responsibilities for the PACE program?
Your PACE center will give you a copy of your rights and responsibilities, and discuss them with you.
My Rights
- To be treated with respect.
- To be protected against discrimination.
- To information and assistance.
- To choice of providers.
- To emergency services.
- To confidentiality.
- To make treatment decisions.
- To file grievances and appeals.
- To disenroll from the PACE program at any time.
My Responsibilities
- To communicate with my PACE center regarding my needs, any changes in my care, and my choices.
- To understand that all medically necessary services are provided through my PACE centers.
- To understand that any unauthorized services (except emergency care) will be my financial responsibility.
- To contact my PACE center if I received emergency care.
- To contact my PACE center if I am going to move out of the PACE service area.
How do I start the application process?
Contact the PACE program for the county in which you live. A representative will explain the comprehensive benefits package available through PACE and assist with the application process. The PACE representative can also provide guidance related to the Medicaid application process.
Estate Recovery Program
When you received Medicaid benefits, which includes capitation fees paid to a managed care organization, even if the plan did not pay for any services, the State of Iowa has the right to ask for money back from your estate after your death. Members affected by the estate recovery policy are those who:
- Are 55 years of age or older, regardless of where they are living; or
- Are under age 55 and:
- Reside in a nursing facility, an intermediate care facility for persons with intellectual disability, or a mental health institute, and
- Cannot reasonably be expected to be discharged and return home.
You Have The Right To Appeal
https://dhs.iowa.gov/appeals/appeal-a-dhs-decision
FAQs
What is true about the Program of All-Inclusive Care for the Elderly pace )? ›
What is the Program of All-Inclusive Care for the Elderly (PACE)? PACE provides comprehensive medical and social services to certain frail, elderly people (participants) still living in the community. Most of the participants who are in PACE are dually eligible for both Medicare and Medicaid.
What is Program of All-Inclusive Care for the Elderly Pace Expanded Act of 2022? ›PACE provides comprehensive care for low-income seniors and people with disabilities ages 55 and up by integrating Medicare coverage and Medicaid long-term care.
What is the main goal of the PACE program? ›The goal of PACE is to keep participants out of a nursing home as long as possible. If at some point it is in the best interest of the participant to receive care in a nursing home, PACE will pay for the care and the supervision of the interdisciplinary team will continue.
What is the pace model in healthcare? ›Program of All-Inclusive Care for the Elderly (PACE) is a type of HCBS that provides medical services and supports everyday living needs for certain elderly individuals, most of whom are eligible for benefits under both Medicare and Medicaid. These services are provided by an interdisciplinary team of professionals.
How does California PACE program work? ›PACE programs allow a property owner to finance the up-front cost of energy or other eligible improvements on a property and then pay the costs back over time through a voluntary assessment. The unique characteristic of PACE assessments is that the assessment is attached to the property rather than an individual.
Is Pace a good program? ›PACE programs are a very good option for families that are able to provide some level of care. Unfortunately, as of July 2022, PACE programs were not available nationwide. Currently, there are PACE / LIFE Programs at 273 locations spread through 30 states.
Which of the following is a program that provides healthcare benefits to the aged and the disabled regardless of income? ›Medicare is a Federal health insurance program for people 65 years or older, certain people with disabilities, and people with end-stage renal disease (ESRD).
What program is specifically designed to provide health care for citizens over 65 regardless of income? ›Medicare is federal health insurance for people 65 or older, and some people under 65 with certain disabilities or conditions. A federal agency called the Centers for Medicare & Medicaid Services runs Medicare. Because it's a federal program, Medicare has set standards for costs and coverage.
What is the program that extends health coverage to almost all Americans age 65 and over? ›In 1965, the passage of the Social Security Amendments, popularly known as Medicare and Medicaid, resulted in one basic program of health insurance for persons aged 65 and older, and another program providing health insurance for people with limited income funded by state and federal sources, respectively.
What are the outcomes of PACE program? ›Results: Outcomes of PACE programs have been positive. There has been steady census growth, good consumer satisfaction, reduction in use of institutional care, controlled utilization of medical services, and cost savings to public and private payers of care, including Medicare and Medicaid.
What are the benefits of pace? ›
- Adult day care.
- Dentistry.
- Emergency services.
- Home care.
- Hospital care.
- Laboratory/x-ray services.
- Meals.
- Medical specialty services.
PACE is an approach developed by Dr Dan Hughes, an American psychologist who works with traumatised children. PACE stands for Playfulness, Acceptance, Curiosity and Empathy. These principles help to promote the experience of safety in your interactions with young people.
What is the pace process? ›PACE is an acronym for Primary, Alternate, Contingency, and Emergency. The method requires the author to determine the different parties that need to communicate and then determine, if possible, the best four forms of communication between each of those parties.
Is pace a free government program? ›If you have Medicaid, you won't have to pay a monthly premium for the long‑term care portion of the PACE benefit. If you have Medicare but not Medicaid, you'll be charged a monthly premium to cover the long‑term care portion of the PACE benefit and a premium for Medicare drug coverage (Part D).
What criteria must an elderly person meet in order to participate in the PACE program? ›In order to be eligible for PACE, the applicant must be at least 55 years old and able to live in the community safely, meeting the level of care requirements determined by the California Department of Health Care Services. The level of care requirements are identical to those needed for skilled nursing care.
Why was the PACE program created? ›PACE was created as a way to provide clients, family, caregivers and professional health care providers the flexibility to meet a person's health care needs while continuing to live safely in the community.
What is PACE program in PA? ›PACE and PACENET offer comprehensive prescription coverage to older Pennsylvanians and cover most medications that require prescriptions, including insulin, syringes and insulin needles. These programs are administered by the Pennsylvania Department of Aging and funded by the Pennsylvania Lottery.
What does PACE stand for seniors? ›PACE stands for Program of All-inclusive Care for the Elderly.
Is the PACE program real? ›The PACE program began in Berkeley in 2007 and has been shaped and expanded over the years by new state laws and federal guidance from the IRS and Department of Housing and Urban Development (HUD).