PACE provides home and community-based services to eligible individuals who meet the medical requirements for nursing facility care and can be served safely and appropriately in the community.

• The individual must be eligible for the ADvantage program to be eligible for PACE.
• The individual must be 55 years of age or older.
• The individual must live in a PACE service area.

There is an interdisciplinary team at the PACE facility who will determine if the individual meets the requirements for the PACE program.

The PACE coordinator will notify the appropriate DHS worker when individuals have been approved for PACE.

1. If the individual is already approved for ADvantage waiver services, the worker will update the appropriate information.
2. If the individual is not already approved for ADvantage waiver services, the worker and PACE nurse will have to determine eligibility. The PACE certification would not include any ADvantage coding.

To be in the PACE program the participant must agree to accept the PACE providers for their medical CARE. If the participant chooses a non-PACE provider without prior authorization, s/he may be responsible for the bill (except for emergency medical care).

There are a few reasons that an individual’s PACE eligibility must be ended:

• client moves out of the PACE area
• client decides to go back to the ADvantage program instead of PACE
• client is disenrolled by PACE provider.

The PACE provider, nurse, or client will notify the worker if any of these circumstances occur.