The Program of All-Inclusive Care to the Elderly (PACE) was designed and implemented by the state of Indiana to provide quality community-based care for Indiana Health Coverage Programs (IHCP) members who:
- Are 55 years old or older
- Are certified by the State to qualify for nursing home level of care
- Are able to live safely in the community at the time of enrollment
- Live in a PACE service area
PACE benefits include:
- Primary care (doctor and nursing services)
- Hospital care
- Medical specialty services
- Prescription drugs
- Nursing home care
- Emergency services
- Home care
- Physical, occupational, and recreational therapy
- Adult day care
- Nutritional counseling
- Social services
- Laboratory/X-ray services
- Social work counseling
Risk-Based Managed Care Delivery System
The PACE program is operated within the risk-based managed care (RBMC) delivery system, and PACE organizations are considered managed care entities (MCEs). In this delivery system, contracted MCEs are paid a capitated monthly premium for each IHCP member enrolled with the MCEs. The capitated premium covers the cost of the services covered under the program and incurred by IHCP members enrolled with the MCE. The MCE assumes financial risk for services rendered to its members. The Indiana Family and Social Services Administration (FSSA) currently partners with Franciscan Alliance in Indianapolis and Dyer, Indiana, and Trinity Health in Mishawaka, Indiana, to serve Indiana's PACE participants.
PACE participants are required to sign an enrollment agreement indicating they understand the PACE organization must be their sole service provider. Services must be preapproved or obtained from specified doctors, hospitals, pharmacies, and other healthcare providers that contract with the PACE organization. Before providing services to a member, IHCP providers should always check the member's Medicare and IHCP card for a sticker indicating that the member is a PACE participant. The IHCP will deny payment of fee-for-service claims submitted by non-PACE providers for PACE members.
Additional information about PACE is available on the Program of All-Inclusive Care for the Elderly page on the FSSA website.