Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 20 - Division of County Operations › Rule 016.20.06-002 - MS 26500 - 26700 - Program of All-Inclusive Care for the Elderly (PACE)

Current through Register Vol. 49, No. 6, June, 2024
26500
PACE - Program of All Inclusive Care for the
			 Elderly
PACE, or Program of All Inclusive Care for the Elderly, is a
				comprehensive health and social services delivery system that provides and
				coordinates primary, preventive, acute and long term care services for
				individuals 55 years of age or older who need nursing facility care to live as
				independently as possible. PACE combines primarily Medicare and Medicaid
				financing to provide a wide array of services that focus on helping
				participants continue to live in the community. However, private pay
				participation in PACE is also an option. PACE services are provided in PACE
				Centers, in the home and in inpatient facilities.
Section 1934 of the Social Security Act, enacted in section
				4802 of the Balanced Budget Act of 1997 established the Program of All
				Inclusive Care for the Elderly (PACE) as a Medicaid State plan option. The
				Division of Aging and Adult Services received a John Hartford Foundation grant,
				administered through the National PACE Association in March of 2002 to
				accelerate the implementation of PACE in Arkansas.
26510
Individuals Eligible
			 for PACE
Persons who are eligible for PACE must meet all of the
				following requirements:
Be fifty-five (55) years of age or older.
Be certified to meet nursing home eligibility criteria.
Be living in an area served by a PACE program.
Be able to live in a community setting without jeopardizing
				his or her health or safety.
Meet the eligibility requirements described in 26520 -
				26561.
26520
Basic Eligibility Requirements
Age
- Must be aged 55 or over.
				Individuals under age 65 must establish disability through SSI/SSA or through
				the Medical Review Team (Re: MS 3323.3).
Citizenship
- Must be a citizen of
				the U.S. or a qualified alien. (Re. MS 6711).
Residency
- Must be a resident of the
				State of Arkansas (Re. MS 2200) and reside in the PACE program service delivery
				area.
Social Security Enumeration
-
				Enumeration is required (Re. MS 1390).
Facility Care Need
- The participant
				must require one of the four levels of nursing facility care: Skilled - S,
				Intermediate I - A, Intermediate II - B, Intermediate III - C.
Cost Effectiveness
- It must be
				demonstrated that the monthly capitation amount is less than the amount that
				would otherwise be paid if the individual was not enrolled in the PACE program.
				The Division of Aging and Adult Services will make this determination.
Safety of the Participant
- The
				health and safety of the participant will not be jeopardized by living in the
				community.
26530
Medical Criteria
PACE participants must meet one of the three following
				criteria:
1. The individual is unable
			 to perform either of the following:
A. At
			 least one of the three activities of daily living (ADL) of
			 transferring/locomotion, eating or toileting without extensive assistance from
			 or total dependence upon another person.
B. At least two of the three activities of
			 daily living (ADL) of transferring/locomotion, eating or toileting without
			 limited assistance from another person.