Programs of All-Inclusive Care for the Elderly

​​​​​​​​​Programs of All-Inclusive Care for the Elderly (PACE) organizations are Kentucky Medicaid provider type 19. To enroll and bill Kentucky Medicaid, a PACE organization must: 

• Submit a letter of intent to Kentucky Medicaid. 
• Meet the requirements outlined in Section 6 of 907 KAR 3:250.
• Have a signed, three-way agreement with the Centers for Medicare and Medicaid Services (CMS) and Kentucky Medicaid. 
  

Covered Services

When an individual enrolls in PACE, the PACE organization becomes their sole source of services. PACE organizations develop a team that coordinates and/or delivers an individual's preventive, acute, and long-term care needs. 

PACE organizations must meet the coverage provisions of 907 KAR 3:250 to provide covered services. Any services performed must fall within the scope of practice for the provider. Listing of a service in an administrative regulation is not a guarantee of payment. Providers must follow Kentucky Medicaid regulations. 

Verifying Eligibility

To be eligible for PACE, an individual must: 

• ​Be age 55 or older. 
  
• Live in an area served by a PACE organization​. 
  
• Meet nursing facility level of care defined in Kentucky Administrative Regulation 907 KAR 1:022​. 
  
• ​Be able to live safely in the community at the time of enrollment. 
  

Verify Medicaid eligibility by calling the automated voice response system at (800) 807-1301 or visit the web-based KYHealth-Net System. 

Reimbursement

PACE organizations are reimbursed per 907 KAR 3:250​.

Duplication of Service

The department will not reimburse for a service provided to a beneficiary by more than one provider of any program in which the same service is covered during the same time period.