⁶As background, the Program of All-Inclusive Care for the Elderly (PACE) is an outgrowth of the On Lok program, a CMS-funded program begun in 1979 that is based in San Francisco. PACE was originally authorized in the Omnibus Budget Reconciliation Act of 1986 as a demonstration program with ten sites nationwide. As of November 1998, fifteen program sites in ten states had been implemented, with an additional thirteen sites and six states under development through Medicaid-only capitation contracts (Rudolph and Lubitz 1999). Under the Balanced Budget Act (BBA) of 1997, PACE became a regular part of the Medicare program, with a limited number of site expansions available each year. PACE is for individuals fifty-five years of age or older (sixty-five in some states) who meet Medicaid’s nursing home eligibility criteria. It is a voluntary program that integrates social and medical services in a combination of adult day health care and home care. Through the use of a multidisciplinary team approach and a staff-model delivery system, PACE covers all primary, acute, and long-term care services, including physicians’ services, hospitalizations, nursing home care, therapies, pharmaceuticals, and equipment. Minnesota Senior Health Options (MSHO) is a voluntary demonstration program that integrates acute care and long-term care for individuals dually eligible for Medicaid and Medicare. The program began in seven counties in the Minneapolis/St. Paul area and recently expanded statewide. A number of approaches, including geriatric evaluation and management, disease management, outpatient group care, and a more extensive use of geriatric nurse practitioners, can be found in some elements of the MSHO, but the extent of their implementation varies across plans and enrollees (Kane et al. 2003). [Return to Text]