Long-term services and supports (LTSS) manual

Program of all-inclusive care for the elderly (PACE)

Revised Date: 
November 30, 2018

Purpose: 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.

WAC 182-513-1200 and WAC 182-513-1230 describes the eligibility for PACE.

WAC 182-513-1200 Long-term services and supports authorized under Washington Apple Health programs

Effective February 20, 2017

  1. Long-term services and supports (LTSS) programs available to people eligible for noninstitutional Washington apple health coverage who meet the functional requirements.
    1. Noninstitutional apple health coverage in an alternate living facility (ALF) under WAC 182-513-1205.
    2. Community first choice (CFC) under WAC 182-513-1210.
    3. Medicaid personal care (MPC) under WAC 182-513-1225.
    4. For people who do not meet institutional status under WAC 182-513-1320, skilled nursing or rehabilitation is available under the CN, medically needy (MN) or alternative benefits plan (ABP) scope of care if enrolled into a managed care plan.
  2. Non-HCB waiver LTSS programs that use institutional rules under WAC 182-513-1315 and 182-513-1380 or HCB waiver rules under chapter 182-515 WAC, depending on the person's living arrangement:
    1. Program of all-inclusive care for the elderly (PACE) under WAC 182-513-1230.
    2. Roads to community living (RCL) under WAC 182-513-1235.
    3. Hospice under WAC 182-513-1240.

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.

Clarifying Information

Eligibility for PACE is based on institutional or home and community-based (HCB) waiver rules; the rules depends on the setting a person resides. If in a medical facility, institutional rules are used for financial eligibility. If in the home or community, waiver rules are used for financial eligibility.

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.

Clarifying Information

PACE is a voluntary program that provides long-term care and acute medical services to older and disabled clients. The client can be enrolled in PACE in their own home, a residential setting, or in a medical institution. Enrollment is effective the first day of the month and disenrollment is effective the last day of the month. Clients are eligible for PACE services on the first of the month following the date the client is financially and functionally eligible.

There are a few exceptions to regular institutional rules. A person must be 55 years of age or older for PACE and there are no transfer of asset penalties. Modified Adjusted Gross Income (MAGI) clients are also eligible to be enrolled in PACE.

Clients receiving PACE in a medical institution are required to pay towards their PACE services under institutional post-eligibility rules (WAC 182-513-1380). A client in the community pays for their PACE services using the rules for Home and Community Services (HCS) HCB waiver post-eligibility rules (WAC 182-515-1509).  If the client receives PACE under a MAGI Medicaid program, they do not pay participation.

PACE is “all inclusive;” a person should not have out-of-pocket medical expenses (e.g., health insurance, copayments, etc.). When a PACE enrollee reports medical expenses, they cannot be allowed as deductions. The client is not required to pay the expense, the expenses are covered by PACE.

Worker Responsibilities

ACES requires a PACE Provider ID and the Provider ID can be located in ACES Provider Search. The financial worker will enter the Provider ID along with the HCBS indicator (A) for PACE. The indicator will drive eligibility for L31 and L32 programs. Since the PACE Provider has its ID entered, the PACE provider receives all LTC-related letters.

Financial will be notified by the end of the month prior to PACE enrollment date.  ACES does not allow future start dates, so financial will process the program change or approval on the first business day of the month that PACE services are authorized.

Note: The L31 & L32 coverage groups are used for both hospice as a program and PACE. This is because both hospice as a program and PACE both use the same HCB waiver rules for eligibility. ACES determines which program (hospice or PACE) a client is on based on the service indicator and facility coded on the ACES institutional services screen. A PACE recipient cannot receive hospice as a service because they receive all care through the PACE provider.

HCS Financial staff are not responsible for ongoing maintenance of a MAGI PACE client unless client is no longer eligible for their MAGI Medicaid program.  HCS Financial will redetermine the appropriate Medicaid program for ongoing coverage if the client is financially eligible. 

When a PACE client disenrolls from PACE, the HCS Financial staff will receive a Financial / Social Services Communication form (DSHS 14-443) indicating the client’s disenrollment. Disenrollment from PACE is effective the last day of the month. The client should be redetermined for other Medicaid programs and the financial staff should coordinate with social services to determine if other HCS services will be authorized in the ongoing months.

Related Links

Social Service WACs:

388-106-0700 What services may I receive under PACE?

388-106-0705 Am I eligible for PACE services?

388-106-0710 How do I pay for PACE services?

388-106-0715 How do I end my enrollment in the PACE program?