Understanding Medicaid Home and Community Services: A Primer, 2010 Edition. Section 1934


Section 1934 was also enacted as part of the BBA, making PACE a Medicaid State Plan optional benefit. In combination with Medicare statutory authority in Title XVIII, this authority makes PACE a non-waiver option for fully capitated Medicare and Medicaid managed care for dually eligible persons. Enrollment is voluntary. The major limitation is that the authority applies specifically to the PACE model and may not be used to authorize an MLTC program that does not adhere to the model. See Table 8-6 for a description of PACE.

TABLE 8-6. Program of All-inclusive Care for the Elderly (PACE)
Start Date 1983 at On Lok in California; 1990 in replication sites.
Target Group Persons 55 or older who ae clinically certified to need a nursing facility level of care.
Service Area 72 PACE providers operate programs in 30 states, as of September 2009.
Scope of Medicaid Capitation All Medicaid services, including primary and acute health care, long-term care services (HCBS and institutional), and behavioral services. (Medicare services are also fully capitated in a separate payment that the PACE program receives from the Medicare program.)
Authorities Section 1934 State Plan amendment. After several years operating under a §1115 waiver, the Balanced Budget Act of 1997 made PACE a State Plan option. The authority may only be used to establish a PACE program, which is a specific model of care that features an Interdisciplinary Team, adult day health centers where members receive primary health care, and staff model care networks that include physicians who work for the PACE provider organization. Parallel Medicare authority is contained in Title XVIII of the Act at §1894.
For more information: http://www.npaonline.org/website/article.asp?id=4/.

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