Alabama Administrative Code
Title 560 - ALABAMA MEDICAID AGENCY
Chapter 560-X-53 - PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)
Section 560-X-53-.02 - Definitions
Current through Register Vol. 43, No. 02, November 27, 2024
As used in this Rule, the following definitions apply:
(1) PACE - Programs of All-inclusive Care for the Elderly.
(2) PACE Organization (PO) - entity that has an agreement with Medicaid and CMS to operate a PACE program.
(3) PACE Center - facility operated by a PO where primary care is furnished to participants.
(4) State Administering Agency (SAA) - state agency responsible for administering the PACE Program Agreement.
(5) PACE Program Agreement - agreement between the State Administering Agency, CMS and PO for the operation of a PACE program.
(6) Participant - individual who is enrolled in a PACE program.
(7) Medicaid Participant - individual determined eligible for Medicaid who is enrolled in a PACE program.
(8) Medicare Beneficiary - individual who is entitled to Medicare Part A benefits, or is enrolled under Medicare Part B, or both.
(9) Medicare Participant - Medicare beneficiary who is enrolled in a PACE program.
(10) Services - includes items and services.
(11) Contract Year - the term of a PACE program agreement, which is a calendar year, except that the initial contract year may be from 12 to 23 months, as determined by CMS.
(12) Trial Period - the first three contract years in which a PO operates under a PACE program agreement, including any contract year during which the entity operated under a PACE demonstration period.
(13) AMA - Alabama Medicaid Agency.
(14) CMS - Center for Medicare and Medicaid Services.
Author: Linda Lackey, Medicaid Administrator, LTC Project Development Unit.
Statutory Authority: State Plan, Attachment 2.2-A, Attachment 3.1-A and Supplement 3; 4 2 CFR 460.6.