Understanding PACE: Integrated Care for Seniors 55+

2. What Is PACE? • PACE is an integrated system of care for individuals ages 55+ who meet the following criteria: • Reside within a PACE service area, • Are certified as meeting the need for nursing facility level of care, and; • Are able to reside safely in the community with the help of PACE services.

3. PACE Services Include: • Primary Care • Hospital Care • Medical Specialty Services • Prescription Medications • Nursing Facility Care • Emergency Services • Home Care • Physical Therapy • Occupational Therapy • Adult Day Care • Dentistry • Social Services • Transportation • Lab/X-ray Services • Respite Care • And More!

4. PACE also includes all other services determined necessary by an interdisciplinary team of healthcare professionals to improve and maintain the overall health for individuals enrolled.

5. In PACE, the focus is on the individual • PACE provides the individual with a team of healthcare professionals who work together to provide coordinated, person-centered care. • The team is focused on getting to know participants as an individual, gearing care toward their personal goals and preferences. • Individuals and families are encouraged to participate with the team in the development and updating of care goals and plan of care.

6. How PACE differs • PACE has almost daily contact with each participant. • Who • Personal care giver • Transportation • Social Workers • Therapists • Physician • Where • In their home • At the PACE site • During transportation • Physician Visits

7. The PACE Team Includes: Each of these team members work together to ensure individuals receive comprehensive healthcare services that meet their individual needs and preferences. Although most services are provided by the staff at the PACE center, PACE contracts with many specialists and community providers. These community partnerships ensure access to all the care they require that the individual has..

8. PACE Covers Prescription Medications • PACE will provide Medicare Part D covered medications, as well as all other necessary medications. • If an individual is a PACE participant they, do not need to join a separate Medicare Part D plan. • This includes over the counter medication.

9. PACE Provides Care in the Community • One of the goals of PACE is to provide individuals with the assistance they need to remain residing within the community, in their own home. • This is accomplished by: • Family support through respite care, support groups, and caregiver training • Home health care assistance, as necessary • Adult Day Center services available throughout the week at the PACE center

10. Nursing Facility Care • Sometimes a higher level of care is necessary, either on a temporarily or long term basis. In such cases, PACE will cover the cost of nursing facility care. • However, note that, at any given time, only 7% of PACE participants reside within a nursing facility – the focus is on providing individuals preventive services to assist in remaining safely in the community as long as possible

11. PACE Transportation • PACE provides all medically necessary transportation. • to the PACE center for activities or medical appointments. • within the community.

12. How Much Does PACE Cost? • If the individual qualifies for Medicare, all Medicare-covered services are paid for by Medicare. • If the individual qualifies qualify for Medicaid, they will either have a small monthly payment (patient liability), or no payment at all for the long-term care portion of the PACE benefit. (Most participants have no patient liability) • If the individual doesn’t qualify for Medicaid, they will be charged a monthly premium to cover the long-term care portion of the PACE benefit and a premium for Medicare Part D Medications. • In PACE there is never a deductible or copayment for any medication, service, or medical care approved by the PACE team.

13. Excluded Services • PACE services do not include: • Services not authorized by the care team • Private hospital rooms, private duty nursing in a facility, telephone charges, and/or television rentals • Cosmetic surgery, unless for reconstruction or improved functioning of a body part due to accident or cancer • Experimental medical, surgical, or other health procedures • Services furnished outside of the United States

14. In Virginia… …PACE programs have been in operation since 2007. …there are currently 5 PACE organizations, with a total of 11 individual PACE sites, serving over 1,400 participants. …PACE programs are monitored by the Centers for Medicare & Medicaid Services (CMS) and the Virginia Department of Medical Assistance Services (DMAS).

15. PACE in Virginia: Coverage Area There are 11 PACE sites across the Commonwealth located in: • Big Stone Gap • Cedar Bluff • Charlottesville • Farmville • Gretna • Lynchburg • Newport News • Norfolk • Portsmouth • Richmond • Roanoke

16. PACE in Virginia: Coverage Area

17. Factors to consider to recommend PACE • Is the individuals service needs reaching Nursing facility level? • Is remaining in the community strongly desired by the individual? • Does the individual require closer monitoring due to unstable medical condition? • Does the family want more involvement in care decisions? • Is the individual socially isolated?

18. Action Plan

19. Key Points to Remember • PACE is extremely supportive of each individual so they can remain in the community • PACE only enrolls individuals on the 1st of the month • PACE is life long care unless the individual voluntarily disenrolls or fails to comply with agreed upon service plans.

20. For more information on PACE… • Visit the DMAS PACE webpage at http://www.dmas.virginia.gov/#/longtermprograms • Visit the Virginia PACE Alliance webpage at www.vapacealliance.org • Visit the National PACE Association at www.npaonline.org

21. Locations to apply for Medicaid • Your Local Department of Social Services • Cover Virginia Web page • On this website you can learn about Virginia’s Medicaid and FAMIS programs for children, pregnant women and adults. You can also get information about health insurance options available through the Federal Marketplace. You can apply online or search for someone who can assist you with your application https://www.coverva.org