The Program of All-Inclusive Care to the Elderly (PACE) was 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 services
- 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 alloweable under the program as provided to IHCP members enrolled with the MCE. The MCE assumes financial risk for services rendered to its members.
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 and obtained from specified doctors, hospitals, pharmacies, and other healthcare providers that contract with the PACE organization. Before rendering services, IHCP providers should always verify member eligibility as described in the Member Eligibility and Benefit Coverage provider reference module. The eligibility verification system (IHCP Provider Healthcare Portal, Interactive Voice Response system and 270/271 electronic transaction) will indicate if the member has current coverage under the PACE program. Providers can also check the member's Medicare and Medicaid (IHCP) cards 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 Indiana Family and Social Services (FSSA) Division of Aging website.