Page 1

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued September 23, 2024 Page 1 of H-3600 Replacing October 17, 2022 Revised/added text indicated by underscore Deleted text indicated by “**” H-3600 PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY

H-3610 GENERAL INFORMATION

The Program of All-inclusive Care for the Elderly (PACE) organization must provide preventative, primary health, acute and long-term care services to people age 55 or older who are certified to require nursing home care. The program enables frail, older adults to live in their homes while enhancing their quality of life.

The PACE organization must provide all Medicaid and Medicare services. The PACE organization provides primary care, adult day health care and therapy services. They must have a provider network for all other services (physicians, therapists of all kinds, pharmacies, hospitals, hospice, nursing homes, home health agencies, medical supplies, and personal care services, etc.).

Emergency services may be provided outside the PACE network, but non-emergency services must be authorized and paid by the PACE provider. Medicare and Medicaid will not reimburse any other provider for covered services when the beneficiary is linked to a PACE organization.

A participant’s enrollment in PACE is effective on the first day of the calendar month following the date the PACE organization receives the signed enrollment agreement.

To be eligible to enroll in PACE, an individual must:

• Be 55 years of age or older;

• Reside in the PACE organization’s service area;

• Meet nursing home level of care requirements; and

• Be able to live safely in the community at the time of enrollment.

Note: PACE organizations are located in the Greater New Orleans, East and West Baton Rouge, and Lafayette areas.