As used in this Rule, the following definitions apply:

1. (1) PACE – Programs of All-Inclusive Care for the Elderly.
2. (2) PACE Organization (PO) – entity that has an agreement with Medicaid and CMS to operate a PACE program.
3. (3) PACE Center – facility operated by a PO where primary care is furnished to participants.
4. (4) State Administering Agency (SAA) – state agency responsible for administering the PACE Program Agreement.
5. (5) PACE Program Agreement – agreement between the State Administering Agency, CMS and PO for the operation of a PACE program.
6. (6) Participant – individual who is enrolled in a PACE program.
7. (7) Medicaid Participant – individual determined eligible for Medicaid who is enrolled in a PACE program.
8. (8) Medicare Beneficiary – individual who is entitled to Medicare Part A benefits, or is enrolled under Medicare Part B, or both.
9. (9) Medicare Participant – Medicare beneficiary who is enrolled in a PACE program.
10. (10) Services – includes items and services.
11. (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. (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. (13) AMA – Alabama Medicaid Agency.
14. (14) CMS – Center for Medicare and Medicaid Services.

Author: Linda Lackey, Medicaid Administrator, LTC Project Development Unit.

Statutory Authority: State Plan, Attachment 2.2-A, Attachment 3.1-A and Supplement 3; 42 CFR 460.6.

History: 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 Repealed: Filed April 5, 1999; effective May 10, 1999.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.