Ala. Admin. Code r. 560-X-53-.02

Current through Register Vol. 42, No. 10, July 31, 2024

Section 560-X-53-.02 - Definitions

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.

Ala. Admin. Code r. 560-X-53-.02

Emergency rule effective May 1, 1991. Permanent rule effective August 14, 1991. Repealed: Filed April 5, 1999; effective May 10, 1999. New Rule: Filed November 10, 2011; effective December 15, 2011.

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.