CMS Pub. 100-11, ch. 1, § 30.3

Participants must be age 55 or older; reside in the PACE organization’s service area; be

certified as eligible for nursing home care by their state and be able to live safely in a

community setting at the time of enrollment. Eligible beneficiaries who choose to enroll

in PACE agree to forgo their usual sources of care and receive all their services through

the PACE organization. (Additional information on Eligibility and Enrollment can be

found in Chapter 4 of the PACE Manual).

PACE provides participants all the care and services covered by Medicare and Medicaid,

as authorized by the interdisciplinary team (IDT), as well as additional medically-necessary care and services not covered by Medicare and Medicaid. There are no

limitations or condition as to amount, duration or scope of services and there are no

deductibles, copayments, coinsurance, or other cost sharing that would otherwise apply

under Medicare or Medicaid. The IDT assesses the participant’s needs and develops a

comprehensive care plan that meets the needs of its participants across all care settings on

a 24 hour basis, each day of the year. Social and medical services are provided primarily

in an adult day health care center, but are supplemented by in-home and referral services

as needed.

The benefit package for all PACE participants includes: Primary Care, Hospital Care,

Medical Specialty Services, Prescription Drugs (including Medicare Part D drugs),

Nursing Home Services, Nursing Services, Personal Care Services, Emergency Services,

Home Care, Physical Therapy, Occupational Therapy, Adult Day Health Care,

Recreational Therapy, Meals, Dental Care, Nutritional Counseling, Social Services,

Laboratory/X-Ray, Social Work Counseling, End of Life Care and Transportation.

Hospital, Nursing Home, Home Health, and other specialized services are generally

furnished under contract. In most cases, the comprehensive service package permits

participants to continue living at home rather than be institutionalized.