Program of All-Inclusive Care for the Elderly (PACE) Participants
The Program of All-Inclusive Care for the Elderly (PACE) is administered by MO HealthNet and Medicare to provide comprehensive health care, social, recreational, and wellness services to their participants. One of the main goals of PACE is to allow older adults to live safely in their homes instead of nursing facilities.
A PACE Organization is responsible for providing care that meets the needs of the participants in all aspects of life, 24 hours a day, every day of the year. All PACE centers include a primary care clinic and areas for participants to receive needed therapies, socialization, personal care, and dining services. With the help of an interdisciplinary team, the PACE center also serves as the focal point for the coordination and administration of most PACE services.
Benefits and Services
The PACE benefits package for all participants must include the following:
- All Medicare covered services
- All Medicaid covered services as specified by the Missouri Medicaid State Plan
- Other services determined necessary by the PACE organization’s interdisciplinary team to improve and maintain the participant’s health
Services include, but are not limited to:
- Long-term care facility
- Meals
- Medical specialty services
- Mental health services
- Nutritional counseling
- Occupational therapy
- Optometry
- Physical therapy
- Adult day services
- Dental
- Durable medical equipment
- Emergency services
- Home care services
- Hospital care
- Laboratory/X-ray services
- Prescription drugs
- Preventative care
- Primary care (including doctor and nursing services)
- Recreational therapy
- Respite
- Social services
- Transportation
*NOTE: Once enrolled in PACE, all the care a participant receives must be approved by the interdisciplinary team (with the exception of emergency care).
Eligibility
To be eligible for PACE, you must meet the following criteria:
- Be 55 years of age or older;
- Meet Missouri’s criteria for nursing home level of care;
- Live in the service area for the PACE organization; and
- Be able to live safely in the community.
You do not need to be on MO HealthNet or Medicare to participate in PACE. However, if you are on MO HealthNet and/or Medicare, the cost of PACE may be reduced or there may be no cost to you.
Service Areas
PACE service areas are identified by county and zip code. PACE is available in the following service areas:
- New Horizons PACE St. Louis
St. Louis County (partial county):
63031
63033
63042
63043
63044
63045
63074
63105
63112
63114
63117
63119
63120
63121
63122
63123
63124
63125
63126
63127
63128
63129
63130
63131
63132
63133
63134
63135
63136
63137
63138
63140
63141
63143
63144
63146
63147St. Louis City (partial county):
63101
63102
63103
63104
63105
63106
63107
63108
63109
63110
63111
63112
63113
63115
63116
63117
63118
63119
63120
63123
63125
63130
63133
63136
63137
63139
63143
63147
63155
63180
63182- PACE KC Adult Wellness Center
Jackson County (full county)
- Jordan Valley Senior Care
Greene (full county)
Christian (full county)
Webster (full county)
Polk (partial county):
65601
65613
65617
65622
65640
65648
65649
65663
65685
65710
65725Lawrence (partial county):
64848
65604
65605
65610
65612
65646
65654
65664
65705
65707
65712
65738
65756
65769Dallas (partial county):
65536
65590
65622
65632
65644
65648
65685
65722Dade (partial county):
65601
65604
65635
65646
65770Stone (partial county):
65605
65610
65624
65631
65633
65656
65669
65705
65714
65728
65737
65754Barry (partial county):
65605
65624
65633
65656
65769Taney (partial county):
65616
65653
65737
65740
65771Laclede (partial county):
65536
65632
65722
Cost
You do not need to be on MO HealthNet or Medicare to participate in PACE. However, if you are on MO HealthNet and/or Medicare, the cost of PACE may be reduced or there may be no cost to you.
The amount the PACE organization can charge a participant as a monthly premium depends on the participant’s eligibility under Medicare and MO HealthNet. The PACE organization will detail your monthly premium, if any, and procedures for payment during the enrollment process.
Individuals have the option to pay privately for PACE if they are not eligible for Medicare and/or MO HealthNet.
Enrollment and Disenrollment
To enroll in PACE, you must contact a PACE organization that serves the area where you live. The PACE organization will guide you through the assessment and enrollment process. Enrollment in PACE is voluntary. If an individual meets the eligibility requirements and chooses PACE, the individual enters into an Enrollment Agreement with the PACE organization. Enrollment begins the first day of the month after your approval.
You may disenroll from PACE at any time for any reason. To disenroll from PACE, you must contact the PACE organization where you are enrolled.
Missouri PACE Providers
New Horizons PACE St. Louis
5035 Manchester Ave.
St. Louis, MO 63110
833-654-7223
TTY: 711
PACE KC Adult Wellness Center
4141 Martin Luther King, Jr. Blvd.
Kansas City, MO 64130
816.321.330
Toll Free: 833-672-2352
TTY: 711
Jordan Valley Senior Care
1720 W Grand St.
Springfield, MO 65802
417.851.1550
Toll Free: 833-278-1070
TTY:711
Frequently Asked Questions
- What is an Interdisciplinary Team?
Each PACE Organization has an Interdisciplinary Team (IDT), which is a group of health care and social service professionals who are responsible for a participant’s initial assessment, periodic reassessments, care plan development, and coordination of services. Each IDT is made up of professionals specific to meeting your individual needs. Your IDT meets regularly to ensure that your needs are met.
The IDT may include, but not limited to, a primary care physician, nurse(s), social worker, therapists, dietitian, transportation staff, and personal care attendants.
- What does “nursing home level of care” mean?
In general, it means you meet the criteria to be eligible for admittance to a nursing home. There must be the presence of a mental or physical impairment, which limits your ability to perform essential everyday activities, such a eating, bathing, personal hygiene, dressing, or moving around your home affecting your ability to live independently.
The PACE organization and MO HealthNet work together to complete an assessment with you and your representative, if applicable, to determine if you meet the level of care requirement for enrollment. MO HealthNet will review the determination made by the PACE Organization for completeness and final scoring. This process will determine if you meet the level of care requirement for enrollment.
- Can I keep seeing my current doctor or use my current pharmacy?
Only if they are one of the PACE organization’s providers. All healthcare services must be provided by, or coordinated by, the PACE organization. Each PACE organization will have a whole team dedicated to providing you with high-quality healthcare, including a primary care physician. Any specialists you see may already work with the PACE organization and they may be included in your care plan. This will have to be discussed with your care team.
Each PACE organization contracts with a pharmacy to provide all prescribed medications.- Does PACE cover my prescriptions?
Yes. PACE has Medicare Part D prescription drug coverage. If you enroll in PACE, you will get your Part D covered drugs and all necessary medications from the PACE organization.
- How do I get to and from the PACE center?
PACE includes transportation services. If you require transportation, the PACE transportation staff will pick you up at your home on the days you attend the PACE center and bring you back home at the end of the day. The PACE transportation staff can also assist you with getting in and out of your home if needed.
- What if I disagree with a decision made regarding my services?
Each participant has the right to a fair and efficient process for resolving differences with the PACE organization and its providers. You have the right to:
- File a grievance if you are unhappy with PACE staff or the services you receive
- File an appeal if you disagree with the PACE organization’s denial to provide a care-related service or its decision not to pay for a service you received
You may have additional appeal rights if you participate in MO HealthNet and/or Medicare. The PACE organization will provide you with specific details about grievance and appeal rights and procedures during enrollment.
- What do they do at the PACE center? Do I have to attend regularly?
The PACE center has clinicians and rehabilitation staff onsite. You will receive most of your healthcare at the center. The PACE center also offers recreational and social activities, and provides meals and snacks.
You do not have to attend the PACE center every day. Collaboration between you, your family/representatives, and the interdisciplinary team determine the ideal number of days per week you should come to the PACE center. Some participants may come to the PACE center for appointments only.- Can the PACE organization help me apply for MO HealthNet?
Yes. PACE center staff can help you apply for any services you may benefit from.