General Information
Program of All - Inclusive Care for the Elderly (PACE) Organizations are unique managed care programs that provide virtually all medical and social services for participating frail elderly. PACE Organizations are typically not-for-profit or public entities. PACE Organizations use a multidisciplinary team approach in an adult day health center supplemented by in-home and referral services in accordance with the participant's needs.
PACE Organizations provide more comprehensive coverage than traditional Medicare or Medicare managed care. Select "Laws and Regulations" to find helpful links to laws and policies relevant to PACE Organizations.
To learn more about PACE Organizations select "PACE Organization Page" to be linked directly to the CMS website to obtain useful industry and PACE program information.
Appeal Information
A PACE Organization participant may choose to pursue an appeal either through the Medicaid Fair Hearing Process or the Medicare managed care appeals process. If a PACE Organization participant chooses to pursue an appeal using the Medicare managed care appeals process, the PACE Organization should carefully review and follow the instructions in the "Maximus Reconsideration Process Manual for PACE Organizations."
The "Maximus Reconsideration Process Manual for PACE Organizations" contains required forms for creating and submitting a case to Maximus. Select "PACE Forms" to download these forms and the relevant instructions.
Maximus Reconsideration Process Manual for PACE Organizations
For more information, please contact the Medicare Part C Plan Liaison via email at medicareappeal@maximus.com