What PACE is, in one paragraph
PACE stands for the Program of All-Inclusive Care for the Elderly. It's a Medicare and Medicaid program for people 55 and older who are frail enough that a state would otherwise place them in a nursing home — but who want to keep living at home. A PACE organization is paid one flat monthly rate per participant to deliver every service that person needs: primary care, specialists, prescriptions, hospital stays, therapy, a day center, transportation, meals, in-home aides, dentistry, vision, hearing, and long-term services.
Who qualifies
To enroll, a person must:
- Be 55 or older.
- Live in a PACE organization's service area.
- Meet the state's nursing-home level-of-care standard (they need help with activities of daily living, have significant chronic disease, or need skilled care).
- Be able to live safely in the community with PACE support.
Most participants are dually eligible for Medicare and Medicaid, but PACE also accepts Medicare-only and private-pay participants.
How PACE is paid
Payment is capitated. Medicare and Medicaid each pay the PACE organization a fixed monthly amount per participant. That single rate has to cover 100% of the participant's care — no matter how many specialists they see, how many prescriptions they need, or how many hospital days they use. If the PACE program spends less than the capitated rate, it keeps the difference. If it spends more, it eats the loss. That's why every outside referral has to earn its way in.
The interdisciplinary team (IDT)
Every participant is managed by an interdisciplinary team that meets regularly to review the person's status and set the care plan. The federal rule (42 CFR 460.102) requires the IDT to include:
- Primary care provider
- Registered nurse
- Social worker
- Physical therapist
- Occupational therapist
- Recreational therapist or activity coordinator
- Dietitian
- PACE center manager
- Home care coordinator
- Personal care attendant (or representative)
- Driver (or representative)
Specialty input comes into the IDT through the primary care provider — which is where curbside and eConsult access matters.
What PACE covers
PACE covers everything Medicare and Medicaid cover — plus anything else the IDT authorizes. In practice that means:
- Primary care and specialty care
- Prescription drugs
- Hospital and nursing-facility care when needed
- Adult day center services (nursing, meals, activities, therapy)
- Transportation to and from the center and appointments
- In-home care and personal-care aide support
- Physical, occupational, speech, and recreational therapy
- Dentistry, vision, hearing, podiatry
- Durable medical equipment
- Meals and nutritional counseling
- End-of-life and palliative care
Why this matters for specialist access
Every outside specialty visit is an operational and financial cost the PACE program absorbs. A frail older adult who has to travel to a cardiology clinic for a five-minute question loses a full day, may fall or decompensate in transit, and generates transport and staff cost that the capitated rate is supposed to cover. Same-day specialist input at the day center — through a curbside or documented eConsult — protects the participant and the program at the same time.
Frequently asked
Who qualifies for PACE?
A person must be 55 or older, live in a PACE service area, need a nursing-home level of care as determined by the state, and be able to live safely in the community with PACE services. Most participants are dually eligible for Medicare and Medicaid, but private-pay is also allowed.
How is PACE paid?
PACE organizations receive a single monthly capitated payment per participant from Medicare and, for Medicaid-eligible participants, from Medicaid. That one rate has to cover 100% of the participant's care — including specialists, hospital stays, prescriptions, and long-term services.
What is an interdisciplinary team (IDT)?
The IDT is the group of clinicians and staff who plan and manage every participant's care together: primary care provider, nurse, social worker, physical/occupational therapist, dietitian, PACE center manager, home care coordinator, personal-care aide representative, and driver.
What services does PACE cover?
Everything Medicare and Medicaid cover, plus anything the IDT decides the participant needs — day center attendance, transportation, meals, in-home care, dentistry, vision, hearing aids, durable medical equipment, and any specialist care the team authorizes.
References
- 1.Centers for Medicare & Medicaid Services. Programs of All-Inclusive Care for the Elderly (PACE) — program overview. CMS. https://www.cms.gov/medicare/medicaid-coordination/about/pace
- 2.National PACE Association. What is PACE? Model overview and participant eligibility. NPA. https://www.npaonline.org/what-is-pace-care
- 3.42 CFR Part 460 — Programs of All-Inclusive Care for the Elderly (PACE). Electronic Code of Federal Regulations. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-E/part-460
This article is for general educational purposes only and is not medical, legal, billing, or coding advice. Reimbursement rules and amounts vary by payer, state, and year — confirm with a qualified billing professional and your payer's current policy before acting on anything here.
See how Beam approaches this in practice
Beam runs same-day specialist consults documented in the chart. The fit depends on your setting and payer mix — happy to walk through it.