1. A. The PACE benefit package for all participants, regardless of the source of payment, must include:

   1. 1. all Medicaid-covered services, as specified in the state’s approved Medicaid plan;
   2. 2. interdisciplinary assessment and treatment planning;
   3. 3. primary care, including physician and nursing services;
   4. 4. social services;
   5. 5. behavioral health services;

   6. 6. restorative therapies, including:

      1. a. physical therapy;
      2. b. occupational therapy; and
      3. c. speech-language pathology services;
   7. 7. personal care and supportive services;
   8. 8. nutrition counseling;
   9. 9. recreational therapy;
   10. 10. transportation;
   11. 11. meals;

   12. 12. medical specialty services including, but not limited to:

       1. a. anesthesiology;
       2. b. audiology;
       3. c. cardiology;
       4. d. dentistry;
       5. e. dermatology;
       6. f. gastroenterology;
       7. g. gynecology;
       8. h. internal medicine;
       9. i. nephrology;
       10. j. neurosurgery;
       11. k. oncology;
       12. l. ophthalmology;
       13. m. oral surgery;
       14. n. orthopedic surgery;
       15. o. otorhinolaryngology;
       16. p. plastic surgery;
       17. q. pharmacy consulting services;
       18. r. podiatry;
       19. s. psychiatry;
       20. t. pulmonary disease;
       21. u. radiology;
       22. v. rheumatology;
       23. w. general surgery;
       24. x. thoracic and vascular surgery; and
       25. y. urology;
   13. 13. laboratory tests, x-rays, and other diagnostic procedures;
   14. 14. drugs and biologicals;

   15. 15. prosthetics, orthotics, durable medical equipment, corrective vision devices, such as:

       1. a. eyeglasses and lenses;
       2. b. hearing aids;
       3. c. dentures;
       4. d. repair and maintenance of these items; and
       5. e. wheelchairs, including custom wheelchairs that are medically necessary;

   16. 16. acute inpatient care, including:

       1. a. ambulance;
       2. b. emergency room care and treatment room services;
       3. c. semi-private room and board;
       4. d. general medical and nursing services;
       5. e. medical surgical/intensive care/coronary care unit;
       6. f. laboratory tests, x-rays, and other diagnostic procedures;
       7. g. drugs and biological;
       8. h. blood and blood derivatives;
       9. i. surgical care, including the use of anesthesia;
       10. j. use of oxygen;
       11. k. physical, occupational, recreational therapies, and speech-language pathology services;
       12. l. social services; and
       13. m. psychiatric treatment;

   17. 17. nursing facility care, including:

       1. a. semi-private room and board;
       2. b. physician and skilled nursing services;
       3. c. custodial care;
       4. d. personal care and assistance;
       5. e. drugs and biologicals;
       6. f. physical, occupational, recreational therapies, and speech-language pathology, if necessary;
       7. g. social services; and
       8. h. medical supplies and appliances;
   18. 18. other services determined necessary by the interdisciplinary team to improve and maintain the participant’s overall health status.

Authority Note

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254, Title XIX of the Social Security Act, and 42 CFR 460 et seq.

Historical Note

HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 30:245 (February 2004), amended by the Department of Health, Bureau of Health Services Financing and the Office of Aging and Adult Services, LR 50:388 (March 2024).