US · guidance
CMS Pub. 100-11, ch. 1, § 20.3
Interaction with Medicare Advantage
Although the PACE program has certain fundamental similarities to Medicare Advantage
and managed care organizations, PACE is not a Medicare Advantage plan. The Balanced
Budget Act (BBA) established distinct requirements for the PACE program. PACE is
similar to some Medicare Advantage options in these ways: it is capitated; it is risk-based; it provides managed care; and it is an elective option. However, PACE differs
significantly from a Medicare Advantage plan in other ways such as: it is not available
nationwide (only in a limited number of states); it includes statutory waivers that expand
the scope of Medicare covered services; it is not available to all beneficiaries (only to a
defined subset of frail elderly); and it is a joint Medicare/Medicaid program. The BBA in
sections 1894(f)(3)(A) and 1934(f)(3)(A) of the Act directed CMS to consider some of
the requirements established for Medicare Advantage programs while developing
regulations for the PACE program relating beneficiary protections and program integrity.
History
(Rev. 2, Issued: 06-09-11; Effective: 06-03-11; Implementation: 06-03-11)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
2c98061b01084ff3f924f8133ebfa2d976ccb7fe31cb3965bffe61fe181a5f4d
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