Human Services Department

Medical Assistance Division

Program for the All-Inclusive Care of the Elderly (PACE)

Fact Sheet

What is PACE?

  • PACE comprehensively serves individuals with long-term care needs who are over 55 years of age and live in an eligible zip code including Bernalillo, Sandoval, and Valencia Counties.
  • PACE is amanaged care program authorized by the Balanced Budget Act of 1997, developed to address the needs of individuals with long-term care needs.
  • Care is provided by an interdisciplinary team that includes the enrollee, family members, and all professional and paraprofessional staff who interact with the participant.
  • HSD contracts with only one NM PACE Provider: Total Community Care, d.b.a. Innovage of Greater NM, located in ABQ using capitated financing with a total contract value of $11,858,226/24.

Cost of Program:

If an Individual Is… / Then… / Capitated Rate per Month under HSD Contract
Eligible for Medicaid / Medicaid pays for the program (Participant pays nothing) / $2,918.01
Eligible for Medicare but not Medicaid / Participant pays the Medicaid portion of the program / $0
Medicare and Medicaid eligible / Participant pays nothing / $2,588.61
Neither Medicaid nor Medicare eligible / Participant pays for the cost of the program / $0
Total Contract Allocation FY14 / $11,858,226.24

Current Enrollment:

Current Census / Medicare/Medicaid / Medicaid Only / Private Pay
384 / 368 / 10 / 6

Waiting List:

Current # Waiting: 197

Average Monthly Disenrollment (July – Jan 1): 6.7

Average Monthly Enrollment (July – Jan 1): 7.8

Average Monthly Enrollment (July – Jan 1): 384

Issues of Concern:

  • PACE Provider wishes to increase census to reduce numbers waiting for services; however, those individuals could easily be served through Centennial Care.
  • PACE Provider has interest in expanding zip codes, stating all of the following areas are currently served: Albuquerque, Corrales, Rio Rancho – limited, Bernalillo – limited, Los Lunas – limited, Placitas – very limited. PACE seeks to serve all the above areas in their entirety. Provider argues that any removal of current zip code boundaries would not add additional “cities” to their service area.
  • PACE Provider has interest in opening a new facility to serve individuals in a larger territory to include the West side.
  • Provider arguments supporting this measure include long travel times to the PACE Center for some individuals who live further west. Such frail individuals may have incontinence and/or musculoskeletal frailty issues that make long rides of 45 minutes or more intolerable.
  • Why are PACE members exempt from Centennial Care?
  • TCC documented successes include: Controlling hospital and emergency room utilization; Medication management; Achieving positive health outcomes for the frail elderly
  • Desire to maintain separate MCO status
  • Strong lobbying by PACE org; Key lobbyist: Scott Baugh
  • General Services include
  • Access to all appropriate Medicaid/Medicare services
  • Rehab and Equipment
  • Prescriptions and Over the Counter Medicines
  • Transportation
  • Primary Physicians
  • Specialty Physicians
  • Inpatient Hospitalization
  • Outpatient Services, including Lab, X-ray, Surgery, etc.
  • Assisted Living
  • Nursing Home Care
  • Home Care Services: Chores, Personal Care, Homemaker, Skilled Nursing; Portable Meals
  • Professional Services: Dentistry, Dentures, Optometry, Glasses, Audiology, Devices; Podiatry
  • On-site meals and meals at home
  • Adult Day Health Services include
  • Physicians On-Site/Medical Supervision
  • Nursing Care
  • Rehabilitative Therapies and Equipment
  • Meals & Nutritional Counseling
  • Dentistry & Podiatry
  • Social Services
  • Personal Care
  • Recreational Activities/Exercise
  • Relief for Caregivers
  • Transportation
  • Education for Participant & Families
  • Unique Features of the PACE Model:
  • Allows PACE programs to offer a seamless service environment and to avoid the fragmentation of the usual system of care (Mukamel, DB, et al. Program characteristics and enrollees’ outcomes in the Program of All-Inclusive Care for the Elderly (PACE)The Milbank Quarterly 85(3), 2007 (attached).
  • Covers the spectrum of health care needs, from primary to acute to long-term care
  • Physicians are employed by each program to provide primary care
  • Interdisciplinary teamwork among professionals and paraprofessionals
  • Care provided in a day center, which the enrollees attend several days per week for therapy, personal and medical services, meals, and supportive care.
  • Allows persons to remain in community living as independently as possible for as long as possible with the highest possible quality of life.

PACE Fact Sheet updated 01.14.14 Page 1