Integrated

The purpose of this task is to produce two papers that will be used to provide information and foster discussion of the possibilities and obstacles to expanding the PACE to rural areas. The overall goal of the project is to assist key stakeholders to evaluate the options for expanding the PACE to rural areas. Two working papers will be produced under this task and provided to attendees at a two day invitational conference organized by the National PACE Association and National Rural Health Association. The first paper will concentrate on the PACE experience with rural populations and providers types. This paper will address PACE experience to date in serving rural populations, the options used by rural and urban sites in using different sponsors, such as community health centers, and the lessons to be learned from groups that have undertaken planning or actual development of PACE. The paper will summarize the findings from a review of literature and reports, and interviews with key stakeholders. It will focus on (1) identifying challenges inherent in expanding PACE to rural areas, (2) discussing methods used to address these challenges or barriers (or planned approaches), and (3) identifying any regulatory or legislative barriers to PACE expansion. The second paper "Integrated, comprehensive, and case managed programs serving the elderly in rural areas: Are there lesson for PACE? " will identify and describe other programs that have key elements of PACE and their experience in caring for the frail elderly in rural areas. It will compare these programs to the current structure of the PACE model to identify ways in which the PACE model might be modified or adapted to enhance the likelihood of exporting it from a primarily urban to a rural setting. It will also explore the possibilities for using the current supply of rural health providers involved in these programs and various ways of organizing them to meet the key requirements of the PACE program. Finally, it will examine reasons that these programs have not been converted to PACE sites and seek to determine whether such conversion is feasible and, from the perspective of the existing program and funder (e.g. the state Medicaid program), desirable..