Section 182-513-1230 - Program of all-inclusive care for the elderly (PACE)(1) The program of all-inclusive care for the elderly (PACE) provides long-term services and supports (LTSS), medical, mental health, and substance use disorder (SUD) 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:(a) Is age: (i) Fifty-five or older and disabled under WAC 182-512-0050; or(ii) Sixty-five or older;(b) Meets nursing facility level of care under WAC 388-106-0355;(c) Lives in a designated PACE service area;(d) Meets financial eligibility requirements under this section; and(e) 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:(a) PACE enrollees are not subject to the transfer of asset rules under WAC 182-513-1363; and(b) 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.Wash. Admin. Code § 182-513-1230
Adopted by WSR 17-03-116, Filed 1/17/2017, effective 2/17/2017Amended by WSR 21-18-045, Filed 8/25/2021, effective 9/25/2021