Hawaii Administrative Rules
Title 17 - DEPARTMENT OF HUMAN SERVICES
Department of Human Services
Chapter 1746 - PACE HAWAII PROGRAM
Subchapter 3 - PACE PROGRAM SERVICES
Section 17-1746-15 - Covered services
Universal Citation: HI Admin Rules 17-1746-15
Current through February, 2024
(a) Services available to PACE enrollees shall be negotiated by the department and the PACE provider. The cost of providing PACE services and the administrative costs for the PACE provider shall be included in the capitation payment.
(b) The covered services may be provided by the PACE provider either directly or indirectly through subcontractual arrangements in accordance with the provisions set forth in this chapter.
(c) At the minimum, PACE services shall include:
(1) Multidisciplinary
team to assess, develop, implement and evaluate the treatment plan of each
participant enrolled in PACE;
(2)
Adult day health services of which the core services include health related
services, nursing services, maintenance therapies, social work services,
recreational therapy, and dietary services;
(3) Primary medical care including
consultation, routine care, preventive health care, and physical
examinations;
(4) Occupational
therapy or physical therapy or both when prescribed by the multidisciplinary
team;
(5) Audiology services when
referred by the multidisciplinary team;
(6) Optometry services when referred by the
multidisciplinary team;
(7) Dental
care as determined by the PACE provider dentist and approved by the
multidisciplinary team;
(8)
Podiatry services;
(9) Speech
therapy;
(10) Home care
services;
(11) Prescription drug
services;
(12) Durable medical
equipment;
(13) Non-emergency
medical and non-medical transportation; and
(14) Acuity level A and acuity level C
nursing facility care.
(d) Prior authorization requirements applicable to fee for service providers shall be waived for PACE when such services are furnished by PACE to the PACE enrollees.
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