Frequently Asked Questions (Updated August 2019)
What is PACE?
PACE, the Program of All-inclusive Care for the Elderly, offers a benefit that combines medical care, long-term care and prescription drugs to help frail and disabled individuals age 55 and older live independently within the community.
Can anyone sign up for PACE?
To be eligible for PACE, individuals must be:
- Age 55 or over
- Live in the counties served by a PACE center
- Meet Iowa's criteria for nursing facility level of care
- Be able to live safely in the community with help from the PACE center
What is "nursing facility level of care"?
"Nursing facility level of care" means that the following conditions are met:
- The presence of a physical or mental impairment which restricts the participant's daily ability to perform the essential activities of daily living, bathing, dressing, and personal hygiene, and impedes the member's capacity to live independently.
- The participant's physical or mental impairment is such that self-execution of required nursing care is improbable or impossible.
Following a functional assessment, level of care eligibility is determined by an Iowa Medicaid Enterprise medical team member. Eligibility is determined at the time of application and annually thereafter.
Must I have Medicaid or Medicare to participate with PACE?
Individuals may have to pay the PACE centers monthly rate using private funds. The monthly rate will be consistent with the PACE rates paid by Medicaid or Medicare. You can have either Medicare or Medicaid, or both, to join PACE. Medicare eligible participants must apply for Medicare and get Medicare. PACE participants are not required to enroll in Medicaid.
How do Medicare and Medicaid coordinate with the PACE program?
Medicare and Medicaid pay the PACE program to take care of your medical needs. Your Medicare and/or Medicaid card are replaced with a PACE card. The PACE center becomes your primary care provider's office. All your care has to be coordinated by the PACE team.
What is a PACE card?
A PACE card takes the place of the Medicaid and Medicare cards. You will be provided with a card once you are approved for PACE.
What services are covered by PACE?
PACE services include, but are not limited to, all Medicare and Medicaid services. A PACE center is facility where the PACE organization is housed and provides medical services to support and assist you. The PACE center has a medical clinic that includes physician and nursing services. Some of the other services and supports available with prior approval are physical therapy, occupational therapy, speech therapy, personal care, nutritional counseling, recreational therapy, social activities and meals.
Other medically necessary services that cannot be provided at the PACE center or in your home, will be coordinated for you. PACE staff will schedule appointments for you and schedule transportation to your appointments, if needed. Any services not available at the PACE center must be authorized by the PACE team of professionals.
Appointments for medical care outside of the PACE center are required to have prior authorization by the PACE team. You will need to pay for unauthorized appointments and services.
If approved, the services listed below can be provided, but are not limited to the following:
| Services Available at the PACE Center | Other PACE Benefits |
|---|---|
|
|
You must call your PACE center if you have an urgent care situation.
Some example of urgent care are:
- Fever
- Stomach pain
- Ear aches
EMERGENCY SERVICES ARE THE EXCEPTION AND DO NOT NEED PRIOR APPROVAL.
Emergency Care
An emergency is any condition that places your life in danger or causes permanent disability if not treated immediately. If you have an emergency, call 911 or go directly to the nearest hospital emergency room. Take your PACE card with you. You do not need to call your PACE center first. However, call, or ask someone to call your PACE center as soon as possible to let the PACE staff know that you needed emergency care. PACE staff will assist you with any follow-up care that you need. The following are examples of emergencies:
- A serious accident
- Poisoning
- Heart attack
- Stroke
- Severe bleeding
- Severe burns
- Severe shortness of breath
Follow-Up Care After an Emergency
You must contact your PACE center for all follow-up care. Do not return to the emergency room for follow-up care. The PACE center will either provide or authorize this care for you. Please remember that you will need to pay for services that are not authorized by the PACE organization.
What Counties Are Covered by PACE?
At this time, PACE is not available in all Iowa counties. To learn more about the PACE program or for assistance with an application, contact the PACE center in the county where you reside.
| Immanuel Pathways Southwest Iowa | Immanuel Pathways Central Iowa | Siouxland PACE |
|---|---|---|
| Counties in service area: Harrison Mills Pottawattamie | Counties in service area: Boone Dallas Jasper Marshall Madison Marion Polk Story Warren | Counties in service area: Cherokee Monona Plymouth Woodbury |
| PACE Center Address: 1702 N 16th Street Council Bluffs, IA 51501 | PACE Center Address: 7700 Hickman Road Windsor Heights, IA 50324 | PACE Center Address: 1200 Tri View Avenue Sioux City, IA 51103 |
| Telephone: 712-256-7284 TTY: 1-800-537-7697 | Telephone: 515-270-5000 TTY: 1-800-537-7697 | Telephone: 712-224-7223 Toll Free: 1-888-722-3713 TTY: 712-224-7253 |
Website: | Website: | Website: |
Can I keep seeing my current doctor or use my current pharmacy?
No. PACE employs their own medical staff to serve participants. If you are in need of a specialist outside of what is available at the PACE center, PACE will schedule your appointment and provide transportation to and from the appointment. PACE contracts with a pharmacy to provide prescribed medication to participants.
Appointments for medical care outside of the PACE center are required to have prior authorization by the PACE team. You will need to pay for unauthorized appointments and services.
What is an Interdisciplinary Team?
This team will help you plan and coordinate your care across any number of support settings that may include home, hospital, nursing facility, or hospice care.
The team must include the following professionals:
- Primary Care Physician (PCP)
- Registered Nurse
- Master's Level Social Worker
- Physical Therapist
- Occupational Therapist
- Recreational Therapist
- PACE Center Manager
- Home Care Coordinator
- Personal Care Attendant
- Transportation Driver
- Dietician
What is the cost of PACE?
You may have a monthly cost share or spend down to remain eligible for Medicaid. If you live in an assisted living facility you have to pay for your room and board each month. If you are enrolled in Medicaid, you may have a monthly financial responsibility for your care. It is possible that you may have to pay for both.
However, the absence of Medicare or Medicaid copays and deductibles are a major benefit to the PACE program.
How are decisions about my care made?
Decisions about your health care, long-term care and medications are made by you and your PACE team. The PACE team of healthcare professionals are committed to providing quality care to keep you as healthy as possible. Your PACE team will identify the best way to meet your needs and authorize additional supports and services as needed.
What if I disagree with a decision made regarding my services?
A grievance or complaint can be submitted to PACE staff verbally or in writing. A grievance could be something that most likely can be corrected easily, such as "It is too cold in here" or could be something that is more serious or complicated such as "The PACE staff did not come to my home to help me today."
Any grievance or complaint that you submit must be documented and resolved by the PACE team.
If you feel that the PACE team is not trying to work with you to resolve your complaint, you may contact Iowa Medicaid Member Services at 1-800-338-8366.
What does the PACE program expect from me?
As a PACE participant, you will work with your PACE team to help them develop a care plan to meet your medical and social needs. Your participation in developing and following your care plan is essential to achieving your health goals. As a PACE participant, you'll need to keep your care team up-to-date on changes in your condition or if you change your residence. Participants must also use PACE providers or receive approval from the care team prior to receiving services.
What are my rights and responsibilities for the PACE program?
Your PACE center will give you a copy of your rights and responsibilities, and discuss them with you.
My Rights
- To be treated with respect.
- To be protected against discrimination.
- To information and assistance.
- To choice of providers.
- To emergency services.
- To confidentiality.
- To make treatment decisions.
- To file grievances and appeals.
- To disenroll from the PACE program at any time.
My Responsibilities
- To communicate with my PACE center regarding my needs, any changes in my care, and my choices.
- To understand that all medically necessary services are provided through my PACE centers.
- To understand that any unauthorized services (except emergency care) will be my financial responsibility.
- To contact my PACE center if I received emergency care.
- To contact my PACE center if I am going to move out of the PACE service area.
How do I start the application process?
Contact the PACE program for the county in which you live. A representative will explain the comprehensive benefits package available through PACE and assist with the application process. The PACE representative can also provide guidance related to the Medicaid application process.
When you received Medicaid benefits, which includes capitation fees paid to a managed care organization, even if the plan did not pay for any services, the State of Iowa has the right to ask for money back from your estate after your death. Members affected by the estate recovery policy are those who:
- Are 55 years of age or older, regardless of where they are living; or
- Are under age 55 and:
- Reside in a nursing facility, an intermediate care facility for persons with intellectual disability, or a mental health institute, and
- Cannot reasonably be expected to be discharged and return home.
You Have The Right To Appeal: