Programs of All-Inclusive Care for the Elderly (PACE) Services for Regional Center Consumers

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Programs of All-Inclusive Care for the Elderly (PACE) Services for Regional Center Consumers

Programs of All-Inclusive Care for the Elderly (PACE) give medical and social services to older people. They must need nursing home care but can live at home with help. This pub tells you how to join PACE and what happens if a regional center client joins PACE. It tells you how to get more information about PACE.

The purpose of this fact sheet is to explain Programs of All-Inclusive Care for the Elderly (PACE) services and eligibility requirements, as well as how regional center consumers can join a PACE plan without losing regional center eligibility. Some of your regional center services might have to be provided by PACE after you enroll. The PACE plan and your regional center must coordinate with each other to make sure they are not giving you the same services.

What Are Programs of All-Inclusive Care for the Elderly?

Programs of All-Inclusive Care for the Elderly provide medical and social services for older individuals who qualify for nursing home care but can live at home with support. PACE is a Medicare and Medi-Cal program. It is operated throughout California by local PACE organizations.

Who Can Join PACE?

You are eligible for PACE if you:

  • Are 55 years of age or older;
  • Are eligible for nursing home care;
  • Can live safely in the community; and
  • Live in a zip code that is served by a local PACE plan. A list of California PACE plans and the zip codes they serve is available at http://www.dhcs.ca.gov/individuals/Pages/PACEPlans.aspx.

What if I am Denied Enrollment in PACE?

If you are denied enrollment in PACE, the plan must give you written notice of the reasons for the denial. The notice should explain your right to appeal the decision and the appeal process.

What Services Can I Get Through PACE?

PACE plans provide any services available through Medi-Cal and Medicare, as well as other services that are needed to keep you safe and healthy. Examples of PACE benefits are:

  • primary medical care,
  • specialty medical care,
  • emergency medical services,
  • prescription drugs,
  • dental and vision care,
  • physical and recreational therapy,
  • adult daycare,
  • social work services,
  • personal care,
  • medical equipment and supplies,
  • nutritional counseling,
  • meals,
  • caregiver support, and
  • transportation.

PACE plans have day health centers. The day health centers have a primary care clinic and offer social activities. PACE members attend the day health center an average of two to three days per week.

The goal of PACE is to keep people at home and out of a nursing home as long as possible. But if at some point it is necessary for you to receive care in a nursing home, PACE will pay for the care. Or if you move into assisted living, PACE will provide and pay for care beyond that provided by the facility.

How Does PACE Work?

After you join PACE, you get an “interdisciplinary team.” The team includes at least the following people:

  • primary care physician,
  • dietician,
  • nurse,
  • personal care attendants,
  • recreational therapist or activity coordinator,
  • driver,
  • occupational therapist,
  • physical therapist,
  • social worker,
  • home care liaison, and
  • the PACE center supervisor.

The team works with you to develop a written care plan that lists the services you need. The care plan can include both medical and social services.

How Much Does PACE Cost?

How much you pay for PACE depends on your financial situation. If you have Medi-Cal, you will not have to pay a monthly premium for PACE. If you have Medi-Cal with a monthly share of cost, you will continue to pay your share of cost. If you have Medicare, but not Medi-Cal, you will be charged a monthly premium. If you do not have Medicare or Medi-Cal, you can pay for PACE privately.

You do not have to pay deductibles or copayments for any drug, service, or care approved by your interdisciplinary team.

Can I Keep My Regional Center Eligibility if I Join PACE?

Yes, you can keep your regional center eligibility if you join PACE. However, if you enroll in PACE the law says that you must get all your Medicare and Medi-Cal benefits solely through PACE. This means that if your regional center was providing you with any services that are available through Medicare or Medi-Cal, you will have to get them from your PACE plan after you enroll. Your regional center service coordinator will have to work with your local PACE plan to make sure there is no overlap in the services the two agencies provide to you. Your regional center and your PACE plan should work together to create a written agreement that says who is responsible for providing each of your services.

If you are on a Medi-Cal waiver, such as the Home and Community-Based Services Waiver for the Developmentally Disabled (the DD Waiver), you will have to dis-enroll from the waiver before joining PACE. Less than half of regional center consumers are on the DD Waiver. If you are on the DD Waiver and decide you would like to dis-enroll from the waiver so you can join PACE, you can still get services from the regional center that PACE does not provide, but the funding source for your services will change.

Should I Join PACE if I am Already Getting Services From my Regional Center?

Whether to join PACE is an individual decision that will vary from person to person.

While some of the services that PACE and regional centers provide are similar, there are areas where the two service systems differ. The regional centers offer expertise, providers and services tailored for people with developmental disabilities. The PACE programs are tailored for people over the age of 55. You may find it is worthwhile to get services from both programs if you have a developmental disability, are over 55 years of age, are eligible for nursing home care, and think that you would benefit from the complementary specialties of the two systems.

On the other hand, if you like your regional center services and current medical providers, you might not want to join PACE. Joining PACE would require that you receive services from PACE’s employed and contracted providers. It is likely that some and perhaps most of these will be different from your current providers.

How Can I Learn More About PACE?

If you want to learn more about PACE, check the list of California PACE plans available at http://www.dhcs.ca.gov/individuals/Pages/PACEPlans.aspx to see if PACE is available in your area.

You can contact the PACE plan serving your zip code to schedule a home visit or ask to tour their day health center.

Additional information is available at www.calpace.org

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