Attention: All Providers
Alabama Medicaid Agency has initiated a new program called the Program of All-Inclusive Care for the Elderly (PACE). The PACE program operates as a capitated managed care benefit that features a comprehensive medical and social service delivery system using an interdisciplinary team approach in an adult day health center that is supplemented by in-home and referral services in accordance with the needs of the participant.
Enrolled participants must receive all of their services through the PACE Organization. PACE services include but are not limited to the following: Primary Care (including doctor and nursing services); Hospital Care; Medical Specialty Services; Prescription Drugs; Dentistry; Nursing Home Care; Personal Care; Physical Therapy; Adult Day Care; Nutritional Counseling; Laboratory/X-ray Services; Social Services; and Transportation.
The program is currently limited to participants in Mobile and Baldwin counties although programs in other locations are expected later this year.
Providers serving Medicaid recipients in these counties need to be aware that PACE participants must receive all services from PACE program-contracted providers. Claims submitted by non-contract providers will not be paid.
PACE participants’ Medicaid cards have a sticker identifying their affiliation with the program as well as a unique PACE program identification card. PACE participation is also reported through the Agency’s AVRS eligibility verification system.
Individuals enrolling in the PACE program must meet each of the following criteria:
• meet the nursing home level of care
• are able to live safely in the community at the time of enrollment
• be 55 years of age and older
• live in a designated PACE service area, currently Mobile and Baldwin counties
PACE participants may be Medicaid-only, Medicare-only, Medicaid and Medicare (dually eligible), or private pay.
For questions or concerns regarding the PACE program, please contact Linda Lackey at (334) 242-5644, or Jan Sticka at (334) 353-4151 or go to the Agency’s website at www.medicaid.alabama.gov under Programs/Long Term Care.