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182-513-1225  <<  182-513-1230 >>   182-513-1235

PDFWAC 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.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 21-18-045, § 182-513-1230, filed 8/25/21, effective 9/25/21. Statutory Authority: RCW 41.05.021, 41.05.160, P.L. 111-148, 42 C.F.R. §§ 431, 435, and 457, and 45 C.F.R. § 155. WSR 17-03-116, § 182-513-1230, filed 1/17/17, effective 2/17/17.]
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