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-.03 - Eligibility Criteria
Current through Register Vol. 43, No. 02, November 27, 2024
(A) General Rule. The PACE program provides for medically necessary services. To enroll in a PACE program, an individual must meet eligibility requirements specified in this section. To continue to be eligible for PACE, an individual must meet the annual recertification requirements specified in Rule No. 560-X-53-.04.
(B) Basic eligibility requirements. To be eligible to enroll in a PACE program, an individual must meet the following eligibility requirements:
(C) Eligibility to enroll in a PACE program is not restricted to an individual who is either a Medicare or Medicaid beneficiary. A potential PACE enrollee may be, but is not required to be, any or all of the following:
(D) Reasons for Denial.(
(E) The Alabama Medicaid Agency will initiate recoupment of payment for services when it determines that state and federal medical necessity and eligibility requirements are not met.
Author: Linda Lackey, Medicaid Administrator, LTC Project Development Unit.
Statutory Authority: State Plan, Attachment 2.2-A, Attachment 3.1-A and Supplement 3; 42 CFR 460.150.