The Program of All-Inclusive Care for the Elderly (PACE)

The Program of All-inclusive Care for the Elderly (PACE) is a managed care model of acute and long-term care that integrates the provision and financing of medical and long-term care services. The PACE model is centered on the belief that it is better for the well-being of seniors with chronic care needs and their families to be served in the community whenever possible. The goal is to maximize the participant’s autonomy and ability to reside in their community while receiving quality care at a lower cost relative to the Medicare, Medicaid and private-pay traditional payment systems.

PACE Organization Information

PACE organizations receive referrals from providers in the community who believe a person meets Medicaid eligibility both financially and medically.

A PACE organization will assist a person in applying for Medicaid and with initial asset and income evaluation. The PACE organization will also help the applicant obtain required information and verification.

The PACE organization is responsible for performing the medical/functional assessment that determines if a person meets the nursing home level of care criteria as required by the Oklahoma Health Care Authority (OHCA). OHCA will monitor this process.

An interdisciplinary team (IDT), consisting of professional and paraprofessional staff, assesses the participants' needs, develops care plans, and delivers all services, including acute care services, hospital services and if necessary, nursing facility services. PACE programs provide social and medical services primarily in an adult day health center, supplemented by in-home and referral contracted services in accordance with the participant's needs.

The PACE service package must include all Medicare and Medicaid covered services, and other services as determined necessary by the interdisciplinary team.

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 organizations must complete a PACE Program Development Assessment 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 (CMS) and OHCA. A contractual agreement is also signed between the PACE organization and OHCA.

Becoming a PACE Organization

• Potential organization will research federal regulations and information available from the National PACE Association to assess the feasibility of becoming a PACE organization.
• Potential organization completes a PACE Program Development Assessment.
• Potential organization submits a letter of intent and the PACE Program Development Assessment to OHCA at PACEInquiry@okhca.org.
• OHCA contacts CMS Central Office to notify them of the possible addition of PACE sites.
• OHCA evaluates the organization and approves the application as appropriate.
• The potential organization submits the formal application to CMS along with the OHCA assurances/attestations that the entity is considered to be qualified as a PACE organization and is willing to enter into a PACE organization agreement.
• State readiness review occurs with an OHCA site visit and approval.
• Within 90 days of formal application submitted to CMS, CMS approves, denies or requests additional information.
• Once CMS approves, OHCA and CMS enter into a three-way agreement with the PACE organization.
• The PACE organization contracts with OHCA in a two-way agreement.
• The PACE organization proceeds to enroll beneficiaries.

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

Further Information

Information regarding PACE can be obtained by contacting:

The OHCA PACE Unit
4345 N. Lincoln Blvd.
Oklahoma City, OK 73105

405-522-7044 or PACEInquiry@okhca.org

Additional information regarding The Program of All-Inclusive Care for the Elderly (PACE) can be found on the National PACE Association website.