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.