Program of All-inclusive Care for the Elderly (PACE)

What is PACE?

PACE stands for Program of All-inclusive Care for the Elderly. It is an innovative Medicare program that provides frail individuals age 55 and older comprehensive medical and social services coordinated and provided by an interdisciplinary team of professionals in a community-based center and in their homes, helping program participants delay or avoid long-term nursing home care. Each PACE participant receives customized care that is planned and delivered by a coordinated, interdisciplinary team of professionals working at the center. The team meets regularly with each participant and his or her representative in order to assess the participant's needs. A participant's care plan usually integrates some home care services from the team with several visits each week to the PACE center, which serves as the hub for medical care, rehabilitation, social activities and dining.

The PACE model was developed in San Francisco in the 1970s as ON LOK, the Chinese-American community’s alternative to nursing home placement. It was formally established by CMS as a permanent Medicare Advantage option in 1997.

Who is eligible to participate in PACE?

To participate in PACE, an individual must be 55 years of age or older, require nursing home level of care but be able to live safely in the community at time of enrollment with the services of PACE, and reside in the service area of a PACE organization. PACE participants may disenroll from the program at any time and for any reason and those with Medicare or Medicaid who disenroll will be assisted in returning to their former health care coverage.

What services are provided through PACE?

PACE provides its participants with all services covered by Medicare and Medicaid, without the limitations normally imposed by these programs. It also provides any other services deemed necessary by the interdisciplinary team that would allow program participants to remain in the community. Services provided by PACE include, but are not limited to, primary care (including doctor, dental and nursing services), prescription drugs, adult day health care, home and personal care services, nutrition services, and hospital and nursing home care if and when needed. Transportation to and from the center and all off-site medical appointments is also provided.

Who pays for PACE?

PACE agencies receive a set amount of Medicare and Medicaid funds each month to ensure participant care, whether services are provided in the home, community or in a nursing home setting. This capitated funding arrangement rewards providers who are flexible and creative in providing high quality care and gives them the ability to coordinate care across settings and medical disciplines. The program also accepts participants who pay privately.

Is PACE available in my community?

There are currently four PACE sites in King County, operated by Providence and you must live in their coverage area (see zip codes) to participate.

Providence ElderPlace

4515 Martin Luther King Jr Way S, Suite 100
Seattle, WA 98108

Providence ElderPlace West

4831 35th Ave. SW
Seattle, WA 98126

Providence ElderPlace Kent

7829 S. 180th Street
Kent, WA 98032

Providence ElderPlace Redmond (PACE)

8632 160th Ave. NE
Redmond, WA 98052
 

You must reside in the following zip codes to be eligible for PACE

98001, 98002, 98003, 98004, 98005, 98006, 98007, 98008, 98009, 98011, 98015, 98027, 98028, 98033, 98034, 98052, 98053, 98074, 98075, 98077, 98023, 98029, 98030, 98031, 98032, 98038, 98040, 98042, 98055, 98056, 98057, 98058, 98059, 98072, 98101, 98102, 98103, 98104, 98105, 98106, 98107, 98108, 98109, 98111, 98112, 98115, 98116, 98117, 98118, 98119, 98121, 98122, 98125, 98126, 98131, 98133, 98134, 98136, 98144, 98146, 98148, 98155, 98166, 98168, 98177, 98178, 98188, 98198, 98199

How do I get more information on PACE?

For information on the program and enrollment, contact Providence PACE intake at (206) 320-5325 or https://washington.providence.org/services-directory/services/e/elderplace.

For policy and contract information please contact Washington Aging and Long-Term Support Administration, managed care Policy, Kelli Emans at (360) 725-3213 or kelli.emans@dshs.wa.gov.

Additional information can also be found on the National PACE Association website or the CMS website.

How to become a PACE contractor in Washington?

Prospective PACE organizations may be a for-profit or not-for-profit private or public entity that is primarily engaged in providing PACE services. Prospective PACE organizations must complete a feasibility study which includes providing evidence the PACE organization will either be cost neutral or save money for long term care services provided by the State in the service area.

The PACE organization enters into a three-party agreement with the Centers for Medicare and Medicaid Services and the Washington Aging and Long Term Support Administration contract is also signed between the PACE organization and ALTSA.

It may take up to two years to complete the process to become a PACE organization.  Organizations should understand and complete the following general steps:

  • Potential organization researches Federal regulations and information available from the National PACE Association to assess the feasibility of becoming a PACE organization.
  • Potential organization completes a feasibility study.
  • Potential organization submits a letter of intent and the feasibility study to ALTSA (address listed below).
  • Potential organization prepares and submits a PACE application to ALTSA.
  • ALTSA contacts CMS Central Office to notify them of the possible addition of PACE sites.
  • ALTSA evaluates the organization and approves the application as appropriate.
  • ALTSA submits the formal application to CMS along with the ALTSA assurance that the entity is considered to be qualified as a PACE organization and is willing to enter into a PACE organization agreement with the entity.
  • Readiness Review occurs with an ALTSA site visit.
  • Within 90 days of formal application, CMS approves, denies, or requests additional information.
  • Once CMS approves, ALTSA and CMS enter into a PACE organization agreement with the organization.
  • The PACE organization contracts with ALTSA.
  • The PACE organization proceeds to enroll beneficiaries.

Any entity seeking to become a PACE organization in Washington may contact ALTSA regarding state-specific requirements.

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