Program of All-Inclusive Care for the Elderly Sample Clauses

Program of All-Inclusive Care for the Elderly. (PACE) — A comprehensive service delivery and financing model that integrates medical and LTSS under dual capitation agreements with Medicare and Medicaid. The PACE program is limited to individuals age fifty-five (55) and over who meet the skilled-nursing- facility level of care criteria and reside in a PACE service area.
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Program of All-Inclusive Care for the Elderly. (PACE) — As defined in 42 C.F.R. § 460.6, and authorized under California law at Welfare and Institutions Code section 14591 et seq., PACE is a capitated program for individuals over the age of 55 certified by DHCS for nursing home level of care. PACE organizations cover all Medicare and Medicaid benefits, including medical services and long-term services and support, organizes a comprehensive service delivery system governed by federal regulations, and integrate Medicare and Medicaid financing. PACE is a three-way partnership between the federal Government, California, and the PACE Organizations.
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Program of All-Inclusive Care for the Elderly. (PACE) For the adult family home providers serving Medicaid enrollees through a contract with MCO PACE, all of the provisions of this Agreement shall apply, except as expressly provided herein.
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Program of All-Inclusive Care for the Elderly. (PACE) - A comprehensive service delivery and financing model that integrates medical and LTSS under dual capitation agreements with Medicare and Medicaid. The PACE program is limited to individuals aged fifty-five (55) and over who meet the nursing-facility level of care (LOC) criteria and reside in a PACE service area. Provider – An individual, group, facility, agency, Institution, organization, or business that furnishes or has furnished medical services to Enrollees. Provider Contract – An agreement between the Contractor and a Provider for the provision of services. Provider Network - The collective group of health care and social support Providers, including but not limited to PCPs, nurses, nurse practitioners, physician assistants, GSSCs, specialty Providers, mental health/substance use disorder Providers, community and institutional long-term care Providers, pharmacy Providers, and acute hospital and other Providers employed by or under subcontract with the Contractor. Provider Preventable Conditions (PPC) — As identified by EOHHS through bulletins or other written statements of policy, which may be amended from time to time, a condition that meets the definition of a “Health Care Acquired Condition” or an “Other Provider Preventable Condition” as defined by CMS in federal regulations at 42 C.F.R. § 447.26(b). Rating Categories - An identifier used by EOHHS to identify a specific grouping of Enrollees for which a discrete Base Capitation Rate applies pursuant to the Contract. Readiness Review – Prior to being eligible to accept SCO enrollments, each prospective Contractor selected to operate a SCO plan must undergo a Readiness Review. The Readiness Review evaluates each prospective Contractor’s ability to comply with the requirements specified in this Contract, including but not limited to, the ability to quickly and accurately process claims and enrollment information, accept and transition new Enrollees, and provide adequate access to all Medicare and Medicaid-covered Medically Necessary Services. EOHHS will use the results to inform its decision of whether the prospective Contractor is ready to operate a SCO plan. At a minimum, each Readiness Review includes a desk review and potentially a site visit to the prospective Contractor’s headquarters. Recovery Learning Community (RLC) – Consumer-run networks of self-help/peer support, information and referral, advocacy and training activities. Training in recovery concepts and tools, advocacy forums a...
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Program of All-Inclusive Care for the Elderly. (PACE) — A program that is operated by an approved PACE organization and that provides comprehensive services to PACE enrollees in accordance with a PACE program agreement. PACE provides a capitated benefit for individuals age 55 and older who meet nursing home level of care as determined by CARES. It features a comprehensive service delivery system and integrated Medicare and Medicaid financing. (See ss. 1894 and 1934 of the Social Security Act and 42 CFR Part 460.)
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Program of All-Inclusive Care for the Elderly. (PACE) For the adult family home providers serving Medicaid enrollees through a contract with a PACE organization, all of the provisions of this Agreement shall apply, except as expressly provided herein. If the State enters into a contract with a new PACE organization and the terms of the contract with that organization are different from the terms of a contract already in place with a PACE organization, the State will fulfill its bargaining obligations in accordance with Article 9, Duty to Bargain. If the state contracts with a new PACE Organization, the AFHC will be notified.
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Program of All-Inclusive Care for the Elderly. (PACE) (Xxxxxx County ALTC, ALTCEW and Snohomish County LTCA AAAs only) The AAA will provide assessment services for PACE to determine either initial eligibility or ongoing eligibility for participants choosing PACE in accordance with Chapter 22 of the Long-Term Care Manual. PACE staff will not be part of the TXIX clinical ratio and will track time completing assessment services for PACE separately from other work duties. The PACE is an innovative program providing frail individuals age 55 and older comprehensive medical and social services coordinated and provided by an interdisciplinary team of professionals in a community-based center and in their homes, helping program participants delay or avoid long-term nursing home care. Case management services for PACE are provided by the PACE provider.
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Program of All-Inclusive Care for the Elderly 
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