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Glossary

PACE

The Program of All-Inclusive Care for the Elderly: a Medicare and Medicaid benefit under 42 CFR Part 460 in which one organization takes clinical and financial responsibility for a participant aged 55 or over who meets the state's nursing facility level of care and can live safely in the community.

Also Program of All-Inclusive Care for the Elderly, PACE organization, PACE program

PACE is a model before it is a program: one organization, paid a fixed amount per month by Medicare and Medicaid, responsible for everything a frail older adult needs to stay out of a nursing home. Primary care, specialists, the hospital, medications, transportation, the day center, home care, meals. The interdisciplinary team decides what the participant receives, and the organization pays for it whatever it costs.

Eligibility is set at 42 CFR 460.150. A person must be 55 or older, be “determined by the State administering agency to need the level of care required under the State Medicaid plan for coverage of nursing facility services”, live in the organization’s service area, and at enrollment “be able to live in a community setting without jeopardizing his or her health or safety”. The first three are facts; the fourth is the PACE organization’s own judgement, made during intake, and the one on which it may deny enrollment.

Three things distinguish PACE from the waiver programs it is often listed beside:

  • It is not a waiver. PACE is a permanent benefit under sections 1894 and 1934 of the Social Security Act, with its own regulation. An HCBS waiver is a state program with a cap; PACE is an organization with a contract.
  • The organization is the sole provider. The enrollment agreement includes the participant’s acknowledgement “that he or she understands the requirement that the PACE organization must be the applicant’s sole service provider”. Every outside clinician the participant has been seeing becomes someone whose records the organization now needs.
  • The clock runs from enrollment. Enrollment takes effect on the first day of the month after the signed agreement, and the plan of care is due within 30 days of that date. The initial comprehensive assessment that the plan rests on is done by eight disciplines, each in person.

The records question in PACE is therefore larger than in most settings. The team is taking over the whole of a person’s care, and the history of that care sits in the systems of every provider the person saw before. PACE intake records is the page about that.

Where it is defined

Vivlio for paceThe intake checklist, from twelve months of progress notes to the medication list, assembled before the team meets.

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Send your details and the calendar opens right here. Book thirty minutes and we will walk a record through the view you would actually use, or skip the call and we will come back in writing.

  1. Send your detailsTwo minutes. Your organization, name, email and phone, and the time records cost you; the rest is optional and helps us reply with something specific.
  2. Pick a timeThirty minutes, live, over synthetic records in the shape your team works in. No slides, and no discovery call before the demo.

Who this is for, and who it is not

  • Coverage comes firstVivlio retrieves from providers, hospitals and health systems it can reach through national exchange networks and direct connections. Name the facilities your patients come from on the form and we check coverage before anyone spends thirty minutes on a demo.
  • You can say what the chasing costsThe form asks how many hours a week your team loses to chasing records. If nobody can put a number near it, the case for Vivlio is not there yet, and we would rather say so than sell you a demo.
  • Patients and files at volumeThis is built for intake that runs every day. For one record, once, your patient can request it from the provider directly, and that will be faster than going through us.
  • Treatment, with the paperwork doneProduction access needs an NPI, a declared purpose of use and a signed BAA. Nobody swipes a card onto live PHI.

If none of those describe you, say so in the last field and we will come back in writing instead of booking a call.

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