WAC 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.