Traditional MedicareCoverageMedium impact
Program of All-Inclusive Care for the Elderly (PACE) Lock-In
Missouri Medicaid (MO HealthNet)·MO·Provider Notice
Effective date
Dec 9, 2025
We identified it
Jun 20, 2026
Summary
Program of All-Inclusive Care for the Elderly (PACE) participants are locked into their PACE provider network and must receive all Medicare and Medicaid benefits solely through their PACE organization. Any services not authorized by the PACE interdisciplinary team as part of the participant's care plan are not covered unless they are emergency services.
Action Required
Immediately: Billing team must verify PACE enrollment status in eMOMED before providing services to elderly patients. Contact PACE organization for authorization before treating PACE participants for non-emergency services. Claims for unauthorized services will be denied unless emergency care.