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B. Processing PACE Referrals

When an individual requests enrollment with the PACE organization and indicates a need for financial/medical assistance, the PACE organization will complete page 2 of the DHB -5106, PACE/Medicaid Referral, and submit it to the local agency in the county the individual resides in. PACE may also assist individuals by completing a Medicaid mail-in application. The date of the application is the date a complete application is received by the local agency.

III. ELIGIBILITY DOCUMENTATION FOR PACE

The local agency must maintain a copy of the PACE enrollment notification, the DHB- 5002, Important Notice About Your Medicaid or Special Assistance Approval, including automated notices, and the current FL-2 to document eligibility for PACE participation. Refer to MA-2420, Notice and Hearings Process.

IV. POLICY PRINCIPLES

A. General Policy Rules

To be authorized for Medicaid coverage of PACE services, the a/b must

1. Be enrolled in the PACE program.

2. Be eligible for Medicaid in the Aged, Blind, and Disabled (MAABD) aid program.

3. Be certified by the Division of Health Benefits (DHB) as meeting nursing home level of care (FL-2). Preadmission Screening and Annual Resident Review (PASAAR) requirements are not applicable to PACE. When the a/b is admitted to a SNF, temporarily or long-term, PASAAR is required.

4. Be at least 55 years old or older.

5. Be living in the approved geographic area of the PACE organization.

B. Budget Unit

Effective the month the PACE Enrollment Agreement is signed, the budget unit is one. This applies even if a couple is enrolled in PACE.

C. Living Arrangement

1. The appropriate PACE living arrangement evidence must be added to dashboard in NCF, to reflect the individual’s living arrangement while enrolled in PACE. See NC FAST Job Aid: PACE

2. The following living arrangements are used for PACE. Benefit History should display one of these codes.