This section sets forth guidelines for persons who receive services from approved PACE entities. PACE provides services for the frail elderly in the home and community through a comprehensive delivery system which includes acute and long term care services. PACE services may be provided in an institutional or non-institutional arrangement. PACE providers are required to have an interdisciplinary team of medical staff that will assess a persons needs, develop a plan of care and deliver services. These services are provided primarily in an adult day health center supplemented by in-home and referral services in accordance with the participants needs.
Both Medicaid and Medicare reimburse for services through a monthly capitated payment structure, much like managed care. No fee for service claims are paid, other than payment of the Medicare premium through buy-in, regardless of the particular living arrangement at the time of service or the provider billing the service. Persons choosing PACE are restricted to coverage through the PACE entity's provider network. Services received outside of the PACE entity are the responsibility of the client. Persons not entitled to Medicare or not eligible for Medicaid may be private pay for PACE.