The Program of All-Inclusive Care for the Elderly (PACE) is coming to the District of Columbia. This page will be updated with more information as it becomes available, and you may subscribe to email updates by contacting Jacqueline Gould at [email protected].
If you are a dual eligible, you may have received a letter from DHCF about your eligibility for Dual Choice and PACE. These programs are designed specifically for people enrolled in both Medicare and Medicaid, and you can read more about PACE below (and more about Dual Choice here.
What is PACE, and who will be eligible?
The Program of All-Inclusive Care for the Elderly is a nationally recognized model of care that integrates Medicare and Medicaid benefits for eligible beneficiaries. Under this model, beneficiaries are eligible for a broader array of benefits than is typically available under either Medicaid or Medicare programs and their care is managed by a comprehensive, inter-disciplinary team of clinical professionals working to deliver high-quality and highly coordinated care. The blended PACE payment model includes both Medicare and Medicaid financing, and all regularly covered Medicare and Medicaid services are integrated at a community-based site. To be eligible for PACE, individuals must be 55 or older, meet the nursing facility level of care criteria, and reside in the proposed PACE service area, which will be limited to three ZIP codes in District Wards 7 and 8 (20019, 20020, and 20032).
Who is a good candidate to enroll in PACE? Individuals who meet all of the enrollment criteria – who live in the service area of Wards 7 or 8, who are 55 or older and meet the level of care criteria – may be a good candidate for PACE. To learn more about what PACE can offer, check out these resources:
Stages of PACE implementation
The District has been planning the PACE program for some time, and the process requires several major steps:
Secure legal authority to operate a PACE program. First, the District must have legislative authority for the program. Legislation authorizing PACE has been passed by the DC Council and signed by the Mayor. The District has also received federal approval on its PACE amendment to the Medicaid State Plan and published draft regulations for the program, which are under revision based on public comments received. Revised regulations will be republished in 2021. In addition to the development of these policies, DHCF has worked with an actuary to analyze historic data and develop a Medicaid payment rate for PACE that meets federal Medicaid standards for actuarially sound payment rates.
Identify and endorse a provider to operate the program in Wards 7 and 8. After obtaining the legal authority to operate a program, DHCF will tentatively select a PACE provider through a competitive process. DHCF is currently completing the procurement process.
Obtain federal and local approval for the provider’s participation. After final selection by DHCF, the provider must proceed through the PACE provider application process for the Centers for Medicare and Medicaid Services (CMS). DHCF will also complete a readiness review. Once CMS approval is obtained, the approved provider, DHCF, and CMS will sign a three-way PACE program agreement and prepare to launch the program.
Launch program and enroll beneficiaries. Beneficiaries will begin to enroll in the program and access their care via PACE.
Monitor and oversee program operations. Following launch of the program, DHCF will conduct enhanced monitoring and oversight of the program for the first three years of operation, including more frequent reporting and analyses of program metrics. This will ensure that in its earliest stages, the PACE program is serving beneficiaries as intended, delivering high-quality, person-centered care, and operating as dictated by federal and local policy.