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Call us at 1-833-252-2737 (TTY 711)

8AM-8PM Monday-Friday
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Frequently Used Words and Acronyms in PACE

making sense of healthcare terminology

In the 2nd installment of our Explainer Series on the CenterLight Teamcare blog, we are listing a number of the most often used words and acronyms in a Program of All-Inclusive Care for the Elderly (PACE). We hope that this will help minimize confusion and facilitate better understanding of the services and programs available to participants.

Words or Phrases Acronym Meaning
Alternative Care Setting art group ACS An option for PACE participants who prefer a smaller, more intimate setting to receive on-site socialization, social services, personal care services, therapeutic recreation and meals. Other center-based services, such as primary care physician services, nursing and rehabilitation are offered at PACE Centers.*
Appeal N/A The action a participant can take if they disagree with a coverage or payment decision made by the plan or health care provider.1
Benefit Package N/A The health care items, services and/or programs covered under a health insurance plan.
Capitation N/A A payment arrangement between the government and health care service providers to pay a set amount for each enrolled person, per period of time, whether or not that person seeks care.2
Care Coordination N/A The organization of participant services, programs and treatment within one program and across other network providers, with the goal of ensuring the participant receives what they need when they need it.
Centers for Medicare and Medicaid Services CMS A federal agency in charge of the administration of healthcare programs, such as Medicare and Medicaid. CMS works to ensure there is no fraud, waste and abuse in these government programs.
Community Based Long-Term Care home care CBLTC These services are defined as:
  • Nursing services in the home
  • Home health care including therapies or home health aide services in the home
  • Personal care services in the home
  • Adult day health care
  • Private duty nursing
  • Consumer Directed Personal Assistance Services.
Conflict-Free Evaluation and Enrollment Center CFEEC A program that determines if you need Medicaid community-based long term care for at least 120 days. If you do, you may qualify for managed long term care and get home care and other long term care services.3
Consumer Directed Personal Assistance Services CDPAS With CDPAS, eligible PACE participants can choose a family member or friend to be their paid caregiver. The family member cannot be the participant's spouse or designated representative. Learn more about CDPAS by clicking here.
Day Health Center DHC The area inside a PACE Center where participants receive therapeutic recreation services, meals, on-site socializationand some rehabilitation programs designed for all such as falls prevention and exercises.
Department of Financial Services DFS For the purposes of PACE, the DFS oversees all of the insurance companies operating in New York and investigates and prosecutes insurance and financial fraud.4
Diagnostic and Treatment Center doctor and patient DTC Located in PACE Centers and adjacent to the DHC. This is where participants can see the DTC nurse as well as the medical director as part of their regular check up, or if they suddenly feel unwell. Because medical staff is always at the centers, they are able to provide immediate treatment such as IV therapy and wound care, thereby minimizing the need for emergency room and/or hospital visits.
Durable Medical Equipment DME Any medical equipment needed by the participant to continue living safely in their home, and provided to them according to their care plan.
Fee for Service N/A A method in which doctors and other health care providers are paid for each service performed.
Grievance N/A An expression of dissatisfaction by a participant about care or service.
United States Department of Health and Human Services HHS A government agency that protects the health and well-being of all Americans. For more information, visit the HHS website by clicking here.
Health Insurance Portability and Accountability Act of 1996 HIPAA The purpose of HIPAA is to regulate how healthcare information is shared across different channels and to ensure that personally identifiable health information is protected from fraud and theft. Click here to view CenterLight's HIPAA Notice of Privacy Practices.
Interdisciplinary Team team IDT The Interdisciplinary Team (IDT) includes, but is not limited to, doctors, nurses, social workers, therapeutic recreation specialists, rehabilitation professionals such as Physical and Occupational Therapists, and dietitians. The IDT works together to ensure participants receive the care and services they need, and that all aspects of the person's care is addressed. Members of the IDT meet regularly to communicate any changes to the participant's condition and together with the participant and/or their caregiver, come up with an individualized plan of care.
Licensed Home Health Care Services Agency LHCSA A company that offers long-term home health care services. If a participant is enrolled in a PACE program and needs home health care, the IDT works seamlessly to ensure LHCSA services are provided to the participant, as specified in their plan of care.
Local Department of Social Services LDSS Provides or administers the full range of publicly funded social services and cash assistance programs to those whose income meets State guidelines or other criteria.5
Managed Care N/A A type of private health insurance company paid a fixed amount per capita to authorize and pay for all covered services.
Managed Long-Term Care MLTC Insurance plans that are paid a capitated rate to provide Medicaid home care and other long term care services to people who need long term care due to a long lasting health condition or disability. To view the differences among MLTCs, Medicaid Advantage Plus and PACE, click here.
Medicaid N/A The public health insurance program for people with low income operated by New York State.
Medicare N/A The national health insurance program operated by the U.S. federal government for people aged 65 and older who have paid into the system, younger people with disabilities, as well as people with end stage renal disease.1
Medicare Part A N/A Covers hospital care, skilled nursing facility care, nursing home care, hospice, and home health services. It is free if one has worked and paid Social Security taxes for at least 10 years.6
Medicare Part B N/A Covers physician services, durable medical equipment, ambulance services, emergency services, diagnostic tests and procedures, routine physical examinations. One pays a monthly premium for this coverage.
Medicare Part C N/A Referred to as a Medicare Advantage Plan. All Medicare Advantage plans are run by private companies, and they all provide all the benefits of Medicare Part A (except hospice care) and all the benefits of Medicare Part B coverage.
Medicare Part D N/A Provides outpatient prescription drug coverage. Part D is provided only through private insurance companies that have contracts with the government—it is never provided directly by the government.7
New York State Department of Health NYSDOH Ensures that high quality appropriate health services are available to all New York State residents at a reasonable cost.8 Along with CMS, the NYSDOH regulates MLTC plans to protect consumers and ensure adherence to regulations.
Over the Counter otc picture OTC Over-the-counter (OTC) are medicines or other items sold directly to individuals without the need for a prescription from their doctor or other health professional.

For information on CenterLight Teamcare's Enhanced OTC Program, click here.
Program of All-Inclusive Care for the Elderly PACE Provides complete care and services to seniors 55 and older, are eligible for more than 120 days of community-based home care services, in need of nursing home level of care, and are mostly Medicare and Medicaid eligible. For more information, visit the Teamcare PACE page by clicking here.
Prior Authorization N/A Approval that is required before a participant receives specialty visits, certain durable medical equipment and elective procedures.
Provider Network N/A A list of health care providers that a plan has contracted with to provide medical care and services to the plan’s participants.
Quantity Limits N/A A drug coverage rule which limits how much medication the participant can get at a time.
Service Area N/A A geographic area where a health insurance plan accepts participants.
Step Therapy N/A A drug coverage rule where a participant must try one or more similar, lower cost drugs before the plan will cover the prescribed drug.
Utilization Review/Management N/A Managing inpatient admission and length of stay.
 

*For a list of CenterLight Teamcare locations, click here.

1 Medicare Website: www.medicare.gov
2 Wikipedia: www.wikipedia.com
3 New York Medicaid Choice www.nymedicaidchoice.com
4 Department of Financial Services
5 Local Department of Social Services
1 Medicare Website: www.medicare.gov
7 Healthfinder: www.healthfinder.gov
8 Medicare Information, Sheldon's Express Pharmacy

H3329 2020_BLOG_Glossary Approved 02052020
Last updated January 28, 2020

If you have questions, please call us at 1-877-212-8877, Monday-Friday, 9:00 a.m. - 5:00 p.m. TTY users should call 711. You may also request a callback from one of our representatives by completing the form below:
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We welcome your inquiries. Please call our Participant Services Department at 1-833-CL-CARES (1-833-252-2737) Monday-Friday from 8:00 AM through 8:00 PM. TTY users should call 711. You may also write to us at 136-65 37th Ave., Flushing, NY 11354.

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2017_WEB_002 Approved 09252018
Last updated on April 30, 2024
CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2017_WEB_002 Approved MMDDYYYY
Pending DOH and CMS Approval
Last updated on December 27, 2017
CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_ElectronicFundsTransfer Approved 01192022
Last updated on December 28, 2021

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_SDR_Training Approved 01192022
Last updated on December 21, 2021

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2017_WEB_002PressRoom Approved 02062018

Last updated on May 8, 2018
CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2017_WEB_Caregivers Approved MMDDYYYY
Pending DOH and CMS Approval
Last updated on December 7, 2017
CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2018_WEB_LANDING PAGE_003r1_M Approved 01072019
Last updated on January 4, 2019

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2018_WEB_LANDING PAGE_004r1_M Approved 01072019
Last updated on January 4, 2019

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2019_JanuaryBLOG Approved 02132019
Last updated January 30, 2018

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2023HomePage Approved 01102023
Last updated on December 27, 2022


CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2018_WEB_Activities Approved 11262018
Last updated on December 31, 2018

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2018_WEB_LANDING PAGE_005r1_M Approved 01072019
Last updated on January 4, 2019
CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2018_WEB_LANDING PAGE_006r1_M Approved 01072019
Last updated on January 4, 2019
CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2018_WEB_LANDING PAGE_007r1_M Approved 01072019
Last updated on January 4, 2019
CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2019_WEB_Activities_Approved 03122019
Last updated on March 2, 2020
CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2019_WEB_May Approved 05152019
Last updated on May 13, 2019
CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2019_Caregiver_r001 Approved 03132019
Last updated on February 25, 2019
CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2019_CDPAS Approved 03132019
Last updated on February 25, 2019

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_ProviderHomeV3 Approved 01192022
Last updated on March 29, 2022

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2019_CDPAS_caregiver Approved 03132019
Last updated on February 25, 2019
CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2019_CDPAS_caregiver_var1 Approved 05032019
Last updated on April 18, 2019
CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_July2019_BLOG_home Approved 07232019
Last updated July 5, 2019
Participants are enrolled in CenterLight Teamcare at the time of filming.

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2019_LifeAtTeamcare_r001 Approved 05152019
Last updated on May 29, 2019
Participants are enrolled in CenterLight Teamcare at the time of filming.

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_LifeAtCenterLight Approved 06022023
Last updated on May 22, 2023

Participants are enrolled in CenterLight Teamcare at the time of filming.

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_Betty_landingpage Approved 07232019
Last updated on July 3, 2019
CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2019_caregiverbettyvid Approved MMDDYYYY
Pending CMS and DOH approval Last updated on August 19, 2019
CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2021_TeamcareHome_JUN Approved 07022021
Last updated on June 11, 2021
CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2020_Provider_February Approved MMDDYYYY
Pending CMS and DOH approval
Last updated on September 28, 2020

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2020_WEBWhereWeAre Approved 01132020
Last updated on January 3, 2020

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2020_WEB_covid19updates Approved 04072020
Last updated on March 17, 2020

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2020_WEB_FBevents Approved 04172020
Last updated on April 14, 2020

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2021ParticipantCorner Approved 03192021
Last updated on March 4, 2021

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_providernews1 Approved 01262021
Last updated on December 30, 2020

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_2021ParticipantInfo Approved 01192022
Last updated on April 30, 2024

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_OTC Approved 04142021
Last updated on April 2, 2021

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_ProviderNewsMar2022 Approved 04202022
Last updated on March 29, 2022

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_myneedscard_web_v3 Approved 09062022
Last updated on September 14, 2022

CenterLight Healthcare has an approved PACE contract with the Centers for Medicare and Medicaid Services (CMS) and NY State (NYS). Enrollment in CenterLight Healthcare PACE depends on renewal of its contract with CMS and NYS. Members may be fully and personally liable for the cost of unauthorized or out-of-PACE program agreement services.

H3329_ProviderLookUp Approved 01192022
Last updated on December 28, 2021

Photo credit: Linda Farwell Photography