WAC 182-513-1230 Program of all-inclusive care for the elderly (PACE)

WAC 182-513-1230 Program of all-inclusive care for the elderly (PACE).

Effective February 20, 2017

  1. The program of all-inclusive care for the elderly (PACE) provides long-term services and supports (LTSS), medical, mental health, and chemical dependency treatment through a department-contracted managed care plan using a personalized plan of care for each enrollee.
  2. Program rules governing functional eligibility for PACE are listed under WAC 388-106-0700, 388-106-0705, 388-106-0710, and 388-106-0715.
  3. A person is financially eligible for PACE if the person:
    1. Is age:
      1. Fifty-five or older and disabled under WAC 182-512-0050; or
      2. Sixty-five or older;
    2. Meets nursing facility level of care under WAC 388-106-0355;
    3. Lives in a designated PACE service area;
    4. Meets financial eligibility requirements under this section; and
    5. Agrees to receive services exclusively through the PACE provider and the PACE provider's network of contracted providers.
  4. Although PACE is not a home and community based (HCB) waiver program, financial eligibility is determined using the HCB waiver rules under WAC 182-515-1505 when a person is living at home or in an alternate living facility (ALF), with the following exceptions:
    1. PACE enrollees are not subject to the transfer of asset rules under WAC 182-513-1363; and
    2. PACE enrollees may reside in a medical institution thirty days or longer and still remain eligible for PACE services. The eligibility rules for institutional coverage are under WAC 182-513-1315 and 182-513-1380.
  5. A person may have to pay third-party resources as defined under WAC 182-513-1100 in addition to the room and board and participation.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.