8300 Program of All-Inclusive Care for the Elderly (PACE)

This section sets forth guidelines for persons who receive services from approved PACE entities. PACE provides services for the frail elderly in the home and community through a comprehensive delivery system which includes acute and long term care services. PACE services may be provided in an institutional or non-institutional arrangement. PACE providers are required to have an interdisciplinary team of medical staff that will assess a persons needs, develop a plan of care and deliver services. These services are provided primarily in an adult day health center supplemented by in-home and referral services in accordance with the participants needs.

Both Medicaid and Medicare reimburse for services through a monthly capitated payment structure, much like managed care. No fee for service claims are paid, other than payment of the Medicare premium through buy-in, regardless of the particular living arrangement at the time of service or the provider billing the service. Persons choosing PACE are restricted to coverage through the PACE entity's provider network. Services received outside of the PACE entity are the responsibility of the client. Persons not entitled to Medicare or not eligible for Medicaid may be private pay for PACE.

8310 General Eligibility - Persons enrolled in PACE must be age 55 or older and residents of the PACE service area. Currently, there are three approved PACE providers within the state: Via Christi HOPE (Wichita), Midland Care (Topeka) and Bluestem PACE (McPherson). Each provider covers several counties within their own catchment area. Residential, categorical, general, financial and nonfinancial requirements must be met. Categories are limited to MA CM, SI and MS (except for Working Healthy and the Breast and Cervical Cancer group). Persons age 55-64 must be determined disabled by Social Security standards. Persons must meet the long term care threshold for nursing facility reimbursement (see 8114 ) Referrals for potential PACE enrollees will be made on ES-3166 and sent directly to the PACE provider. The PACE provider will contact KDOA to determine if LOC requirements are met.

8315 PACE Communication - The eligibility worker must coordinate with the PACE entity in order to determine eligibility. A special communication form, the ES-3166, Notification of PACE Information, is used as official notification of changes and other action that will impact the PACE case.