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